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Abstract
This paper dives into the marked differences and similarities between addiction support groups
and treatment groups. While there are many support groups, the consensus is that they are self-
governed entities, run by long-term members, and are free for anyone struggling with the effects
of addiction to join. On the other hand, treatment groups are clinically run entities, by licensed
clinicians. Here, services are provided by a trained professional to execute theoretical treatment,
interpret individual and group interactions, use specified assessments, and therapeutically change
treatment goals as needed. Similarities were found in therapeutic outcomes, as they both provide
a marked improvement in emotional, behavioral, and symptomatic areas of addiction. However,
the groups differ in that treatment groups require payment for a clinical service being rendered,
and most therapeutic groups for addiction are involuntary and have a marked attendance.
Spirituality is also discussed, as support groups generally are spiritually based, while treatment
groups are not. Overall, the author finds that one group is not better than the other. Rather, the
client is the central focus on which one would be better, as it applies to the client’s specified
needs. Future implications conclude that therapists need to have information and resources
readily available for clients, at all times, for both groups and not inhibit the client’s desire to
accept or deny them—despite the clinician’s understanding and training in therapeutic treatment.
Keywords: support groups, treatment groups, addiction, Alcoholics Anonymous,
Narcotics Anonymous, Al-Anon, clinical treatment
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
Support Groups and Treatment Groups
Support groups and treatment groups can be used interchangeably. However, they are
different in their approach, overall goal, and requirements. Support groups focus on, what is in
its own name—support. Here, members can find support for whatever struggle or crisis they are
going through. In the treatment group, however, each member of the group has come for a
selected amount of time to improve a set of thoughts, emotions, and/or behaviors.
This paper will describe and compare three famous support groups—Alcohols
Anonymous (AA), Narcotics Anonymous (N.A.), and Al-Anon—against therapeutic groups (i.e.,
anxiety groups, residential treatment groups, etc.). Here, commonalities and differences will be
demonstrated via their histories, structure, and function.
Alcoholics Anonymous (AA)
Brief History of AA
One of the United States' first support groups, solely for addiction, is Alcoholics
Anonymous (Alcoholics Anonymous, 2023). Its inception starts with the story of Bill W., In
Akron OH. Bill was a New York stockbroker and was an alcoholic (Alcoholics Anonymous,
2023). He attended Dr. Samuel Shoemaker’s (an episcopal priest) support group titled “The
Oxford Group” (Burning Tree Ranch, 2023). Here, Dr. Shoemaker talked about moral
rearrangement, and how it was needed to overcome life obstacles (Burning Tree Ranch, 2023).
In this group, Dr. Shoemaker taught the four absolutes; they are honesty, unselfishness, purity,
and love (Burning Tree Ranch, 2023). These absolutes, along with the camaraderie of being with
other people struggling with something in their life, helped Bill find sobriety (Burning Tree
Ranch, 2023). However, it was not until Bill met Dr. Bob S., an Akron City Hospital surgeon,
that the group truly began (Alcoholics Anonymous, 2023). Dr. Bob was also a member of The
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
Oxford Group but did not find success until meeting a sober and transformed Bill (Alcoholics
Anonymous, 2023). Bill (being the first “sponsor) helped Bob through his struggles with
alcoholism, which helped Bob greatly as Bill not only saw alcoholism as a disease but also had
been through the same battle himself (Alcoholics Anonymous, 2023). Thus, after finding success
as a pair, they began helping others addicted to alcohol, forming the first AA group at Akron
City Hospital (Alcoholics Anonymous, 2023). It was in these first meetings with other alcoholics
did Bill form the infamous twelve steps and traditions of alcohol addiction (Alcoholics
Anonymous, 2023). In 1939, Bill published these, along with personal stories of success, his
personal story, and passages of hope, in “The Big Book” (Alcoholics Anonymous, 2023). This
literary work is still used today in the, now, millions of AA groups there are across the globe, to
help guide alcoholics to support other alcoholics and find sobriety (Alcoholics Anonymous,
2023).
Meeting Structure and Function
The meeting structure is usually led by the “chair” (a.k.a. the group leader) welcoming
the group, having everyone say the basic rules of AA, recite the AA Preamble and/or the serenity
prayer as a group, making/asking for announcements, and passing around an offering basket
(Alcoholics Anonymous, 2023). While AA has no fees, a basket is passed around for anyone
who wants to donate to dues (Alcoholics Anonymous, 2023). From here, the chair then discusses
what is to be discussed—whether it’s a chapter in “The Big Book”, one of the twelve steps, or a
combination of them (Alcoholics Anonymous, 2023). Here, chosen speakers (especially
“sponsors” who have made improvement in their recovery) and unchosen speakers are allowed
to share their story and current struggles—as it relates to the chosen topic (Alcoholics
Anonymous, 2023). After the discussion is over, and all who wanted to speak have spoken, a
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
closing to a meeting can be done however the group sees fit (Alcoholics Anonymous, 2023).
This can be done with another prayer, opening the floor to new topics, and/or having a
refreshment time afterward (Alcoholics Anonymous, 2023).
It’s important to note that an AA meeting typically meets once a week for one hour, but a
group can be as frequent or infrequent as desired (Alcoholics Anonymous, 2023). The function
of the group is contingent on if the AA meetings are either open or closed (Alcoholics
Anonymous, 2023). Open meetings are for addicts and their friends or family; closed meetings
are for addicts only (Alcoholics Anonymous, 2023). Open meetings are meant to involve loved
ones and help all parties helping the alcoholic understand the group and be able to understand
what they are going through (Alcoholics Anonymous, 2023). However, closed meetings allow
members to open up about their own personal struggles—that they might not feel comfortable
sharing with loved ones—and be able to receive one on one feedback from someone who has
been in their shoes (Alcoholics Anonymous, 2023). While it does support one’s treatment
journey and encourages sobriety, AA’s function is to find community, commonality, and social
support for alcoholism as a part of one’s full treatment plan (Sussman, 2010, p. 27).
Narcotics Anonymous (NA)
Brief History of NA
Although AA was a large success for alcoholics, there was still a great need for addiction
help for those addicted to drugs (Lewis, 2010, p. 2). Narcotics Anonymous began as “Addicts
Anonymous” in 1947, in Lexington, Kentucky. Houston S., a member of AA who saw the need
for his friends who has multiple addictions (not just alcohol), started the group with patients at
the The United States Public Health Service Hospital, going through the twelve steps of AA
(Lewis, 2010, p. 2). One of the early group members, Danny C., formed an Addicts Anonymous
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
Group in New York City; however, since there was already an “AA” group, he changed the
name to “Narcotics Anonymous” to create a distinction between the two groups (Lewis, 2010, p.
2). NA eventually spread to Los Angeles, California, where Jimmy K.—a drug addict and early
NA group member—in 1953, officially established the organization (Lewis, 2010, p. 2). From
here, although they struggled to launch as well as AA, NA eventually grew in popularity—
especially with their own titled works, “The Basic Text”—to spread to a global scale (Snyder,
2014, p. 422). Their 12 steps are identical to that of AA, with the exception that any mention of
alcohol is essentially swapped with “addiction” (Snyder, 2014, p. 422). In addition, in the white
booklet, there are sets of questions for the addict to answer about their drug use, as well as stories
relating to the use of drugs alone (Snyder, 2014, p. 422).
Meeting Structure and Function
The meeting structure for NA meetings resembles that of AA meetings, and also differs
in “flow”, per se, as AA meetings do. However, the marked difference is the materials used, the
time length, and the discussion topics (Narcotics Anonymous, 2014, p. 4). To preface, the same
rules apply that there are open and closed meeting options (Narcotics Anonymous, 2014, p. 7).
That being said, the materials used in NA include The Basic Text (a.k.a. “The White Booklet”),
and other pamphlets related to an array of different drug addictions—i.e., methamphetamine,
opioids, marijuana, etc (Narcotics Anonymous, 2014, p. 7). Secondly, meetings usually run
about 90 minutes long, with refreshments or a break offered in the middle, as there is not a
universal addiction topic to focus on (Narcotics Anonymous, 2014, p. 4). Lastly, as mentioned,
since there are many forms of drug addiction, conversations may sway depending on what drug
is being discussed by the speaker or member (Narcotics Anonymous, 2014, p. 4). This being the
case, NA strongly advises that not only do members only share once per meeting, but also that
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
they avoid crosstalk or whispering—allowing people to feel like they have fully shared, have
been understood, and heard (Narcotics Anonymous, 2014, p. 8). Thereby, just as AA,
Al-Anon
Brief History of NA
Al-Anon’s beginnings can be seen in the foundation of AA itself. First, chapter 2 of “The
Big Book”, is dedicated to wives of AA members (Timko, Young, & Moos, 2012, p. 280). While
families were acknowledged as being a part of the addict’s progress in AA, there was not yet a
formal group for family members to find interpersonal support (Timko, Young, & Moos, 2012,
p. 281). However, while members of AA had their meetings, it became customary for the wives
and family of the addict to meet/socialize until the meeting was over (Timko, Young, & Moos,
2012, p. 281). In these simple hangouts between family members, they realized that the twelve
steps were helping them as well, as it related to their relationships, thoughts, and behaviors with
their alcoholic loved one—including codependency and enabling (Timko, Young, & Moos,
2012, p. 281). Thus, in 1951, Lois W. (wife of founder Bill W.) and Anne B. (wife whose
husband was in AA) formed Al-Anon (Timko, Young, & Moos, 2012, p. 281). After its
inception, “The Al-Anon Family Groups” book was published, including a modified version of
the twelve steps, and material (being focused on stories that helped families of addicts and
showed their perspectives) (Timko, Young, & Moos, 2012, p. 282). For example, instead of step
twelve saying that the message of a spiritual awakening should be carried to other alcoholics, it
was changed to say “others” (Timko, Young, & Moos, 2012, p. 282).
Meeting Structure and Function
The meetings (again, depending on location and people) can happen during their loved
one’s AA meeting or separately. In addition, meetings are open and closed as well, usually
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
happening once a week (Timko, Young, & Moos, 2012, p. 282). The meeting structure almost
mirrors that of AA, where the chair leads the group in reciting the twelve steps and traditions,
making announcements, stating the rules and values of AA, and opening up an opportunity to
donate to the group funds (Timko, Young, & Moos, 2012, p. 282). Discussions can vary as well,
as they can talk about various topics, or have a central focus on one of the twelve steps. There
are also still sponsors and sponsees, where more seasoned members help those who first join
(Timko, Young, & Moos, 2012, p. 282).
The function of the group differs, of course, as the focus is on the service to others, the
self (as an individual, apart from the addict), and how to best help one’s alcoholic loved one
(Timko, Young, & Moos, 2012, p. 282). First and foremost, the group is meant to help members
share in the pain and suffering that comes from having an alcoholic loved one (Timko, Young, &
Moos, 2012, p. 282). The group is not to be treatment, or include treatment; rather, it is to find
healing in the community and receive social support. Secondly, the use of twelve steps is used to
help each member self-identify ways in which they obstruct their loved ones' treatment or ignite
it (Timko, Young, & Moos, 2012, p. 282). As mentioned, most addict families struggle with
some form of codependency and/or enablement (Timko, Young, & Moos, 2012, p. 282). The
twelve steps and social support help members to shift focus to what they can change—why the
“The Serenity Prayer” message of “…what I can change.” is repeated in all meetings (Timko,
Young, & Moos, 2012, p. 282). In service to others, it is the primary goal for each member to
serve others in the group, and community (Timko, Young, & Moos, 2012, p. 282). This way, the
focus also shifts from feeling isolated to understanding the problem is bigger than an individual’s
four walls.
Addiction Therapy Groups
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
Addiction Therapy Groups are in a class of their own, as they are geared toward clinically
addressing specific issues within a specific population (Ezhumalai, Muralidhar,
Dhanasekarapandian, & Nikketha, 2018, p. 1). Here, clinicians choose the appropriate theoretical
treatment, and carefully choose participants, for the most appropriate ethical and therapeutic
outcome (Ezhumalai, et al., 2018, p. 1).
Brief History of Therapy Groups
Psychotherapy Groups (a.k.a. Therapy Groups) began in the 1800s, as Dr. Joseph Pratt
realized tuberculosis patients—that met for discharging instructions—had a positive mood
change after meeting together (Ezhumalai, et al., 2018, p. 1; Barlow, 2008, p. 240). After this
finding, early group therapy in the 1900’s began to blossom across all treatment modalities—
WWII veterans, patients with neurosis, disrupted children, etc. (Ezhumalai, et al., 2018, p. 1).
However, in 1936, Dr. Kurt Lewin developed Group Dynamics Theory, which launched using
group therapy as a means of clinical treatment (Ezhumalai, et al., 2018, p. 1). Lewin, and other
pioneers in the group counseling field, contributed to research geared toward the benefits of
using a group to implement therapeutic counseling. Before group therapy for addiction was
available, those with addiction had limited clinical options—pricy (yet ineffective) treatments,
hospitalizations, homes for addicts to live away from society, and asylums (Ezhumalai, et al.,
2018, p. 2). Thankfully, as the field of counseling grew, as with the view of mental health and
substance abuse, research pointed toward the many benefits of group counseling for those with
addiction—including a lessened lapse and relapse rate (Substance Abuse and Mental Health
Administration, 2015, p. 3-5).
Therapy Groups Meeting Structure and Function
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
Addiction Therapy Groups differ in leader roles, formation, location, purpose, and length
from previously described groups (Ezhumalai, et al., 2018, p.1-2). First and foremost, it should
be stated that the functionality of an addiction therapy group is clinical; meaning, the sessions are
heavily planned (based on theoretical orientation), licensed clinicians must lead sessions, and
there is a specific amount of time in which group members should see individual improvement in
psychological functioning, reduction of symptoms, social functioning, and interpersonal skills
(Ezhumalai, et al., 2018, p. 2). That being stated, the therapist leading the group therapy sessions
acts as the professional clinician, who is the source of all the information needed to start,
maintain, and complete treatment (Ezhumalai, et al., 2018, p. 5). They not only are trained in
how to treat psychological impairments of addiction, but they are also trained in how to measure
success among group members, model appropriate behaviors, maintain the milieu of the group,
enable participation, and interpret psychological functioning and exchange of each group
member (Ezhumalai, et al., 2018, p. 5).
The structure of a therapeutic addiction group varies. The formation of the group can be
voluntary or involuntary. Usually, an addiction treatment group is involuntary, as it is a required
part of an inpatient treatment facility and/or court-mandated treatment (Ezhumalai, et al., 2018,
p. 3). Voluntary groups do exist, especially if therapists believe a certain community could
benefit from it and/or have an overwhelmingly similar issue; however, confidentiality (while not
100% guaranteed) is stricter, and a topic of discussion often (Ezhumalai, et al., 2018, p. 3-4).
Groups typically last on a weekly continuum or a set amount of weeks (typically 6-25)
(Ezhumalai, et al., 2018, p. 3). For example, a Cognitive Behavioral Group Therapy Group could
be once a week, for three hours, for eight weeks, while a Narrative Therapy Group could be once
a week, for 50 minutes, for eight weeks (Carlbring, Jonsson, Josephson, & Forsberg, 2010, p. 95;
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
Park and Kim, 2023, p. 229). Lastly, the ages of the group members are usually separated by age
ranges as well—i.e., adolescents, young adults, etc.—and exclude those who are unfit to
withstand group therapy tasks; this includes those with suicidal thoughts, psychotic symptoms,
severe personality disorders, and with cognitive deficits/decline (Ezhumalai, et al., 2018, p. 3).
Compare and Contrast
Support Groups and Treatment Groups are similar in their strengths—meaning, the ways
in which they benefit attendees. As AA was arguably the first widespread support group for
addiction, it served as a “what can go right” group for researchers (Ezhumalai, et al., 2018, p. 2).
While they have different overall objectives, both groups provide therapeutic improvement, and
improved social skills (Ezhumalai, et al., 2018, p. 2). They also have similar structures, in that
most are weekly meetings, that last about an hour, and focus on a set topic. Lastly, they are
similar in their drive to protect confidentiality, as both groups communicate the overall goal to
keep what is said in the group inside the group (Ezhumalai, et al., 2018, p. 2; Lewis, 2010, p. 2).
However (as mentioned), while confidentiality is never a guarantee, addiction therapy benefits in
being legally and ethically bound under verbal and written confidentiality, and the Health
Insurance Portability and Accountability Act (HIPAA) (Substance Abuse and Mental Health
Administration, 2015).
However, the groups differ in purpose, leadership roles, formation, and spirituality. For
example, while an AA group can be involuntary, AA is only focused on participation and
adherence to rules, while treatment groups are focused on improving therapeutic outcomes
within a set amount of time. Meaning, while AA does set out to have its members achieve and
maintain sobriety, there are not clinical measurements of educational, corrective, developmental,
cognitive, or behavioral changes (Ezhumalai, et al., 2018, p. 3). In addition, the leadership roles
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BENCHMARK SUPPORT AND TREATMENT GROUPS COMPARE AND CONTRAST
are stricter with treatment groups, as the clinician leading it must be a masters counseling student
(under the supervision of a licensed counselor or physician), or be a licensed psychiatric nurse,
psychotherapist, psychologist, or psychiatrist (Ezhumalai, et al., 2018, p. 2). In formation, while
support groups and treatment groups might be located in similar places, the marked difference is
the price of admission. Support groups are typically donation-based only, while treatment groups
require payment—via insurance, pro-bono donation, or out-of-pocket payment (Ezhumalai, et
al., 2018, p. 2). This is because in a treatment group, a clinical service is being provided, with
specialized care (Ezhumalai, et al., 2018, p. 2). This can be a weakness, as it reduces access to
care to many who cannot afford services or who are not insured (Substance Abuse and Mental
Health Administration, 2015). Lastly, while spirituality is always encouraged in psychotherapy
of any kind, in a group setting, religious or spiritual aspects are generally not a part of group
therapy. Support groups have more religious freedoms, in that having a belief in a higher power
is a part of the program (Alcoholics Anonymous, 2023).
Conclusion
In my opinion, both groups are beneficial and show marked improvement. While, yes, I
have been trained to provide therapeutic care as a student therapist, I understand that a group
does not have to be clinical to positively impact the lives of my clients. In fact, I would hope that
if my clients believe a support group would somehow serve them better, they would feel
supported to go for it. However, as I am an intern at an inpatient psychiatric hospital, I can see
where group therapy clinically does wonders, especially when a targeted treatment modality is
used with a group/issue where it will work best. Therefore, in the future, I will make sure that I
not only understand all options myself but also that I can readily be able to give my clients
information and resources for local support groups and treatment groups.
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