SUPPORT GROUPS AND TREATMENT GROUPS 1
Benchmark Support Groups and Treatment Groups Compare and Contrast
Samantha Deenihan
School of Clinical Mental Health Counseling, Liberty University
Abstract
This paper is going to explore and analyze the similarities and differences between addition
support groups. Specifically, Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Al-
Anon, and professionally facilitated addictions therapy groups. By exploring the historical
development, the structure, and the guiding philosophies of each group type, this paper is going
to highlight how these models contribute to addiction recovery through different mechanisms.
Support groups are peer-led, spiritually influenced communities that highlight shared
experience, personal accountability, and long-term support. In contrast, therapy groups are
facilitated by trained clinicians, and they often focus on evidence-based practices, treatment
goals, and measurable outcomes. This paper is also going to examine how both approaches
SUPPORT GROUPS AND TREATMENT GROUPS 2
handle relapse, celebrate progress, and also incorporate multicultural and spiritual elements
into their approach. Based on firsthand observations of AA, NA, and Al-Anon meetings, the
discussion includes practical reflections on how support groups and therapy groups can
complement one another in the clinical practice period the conclusion is going to emphasize the
importance of integrating both of these models into a comprehensive treatment plan to better
serve individuals and families affected by addiction. There is no one way to solve addiction,
that's why it's important to integrate many models.
Support Groups and Treatment Groups Compare and Contrast
Addiction remains a complex public health issue that impacts not only individuals but
families, communities across different cultures, socioeconomic statuses, and spiritual lines.
Recovery from addiction often requires more than just an individual's willpower. It also calls for
consistent support, professional intervention, and a community that helps you with your
healing. Two important approaches to supporting individuals through this recovery process are
peer- led support groups and professionally facilitated therapy groups. While both aim to assist
individuals in overcoming addiction, they differ significantly in structure, leadership, theoretical
foundation, and methods of engagement (Flores, 2010; Moos, 2008).
Support groups such as AA, NA, and Al-Anon have proved a foundation of hope, love,
and connection for millions of individuals around the world. These foundations are built on
shared experiences and the well-known 12 step model, these groups also prioritize anonymity,
spiritual growth, and mutual accountability (Kelly, 2017; White, 2014). Addiction therapy groups
are rooted in clinical theories and often led by licensed professionals. These addiction therapy
groups highlight structured treatment, psychological insight, and measurable progress (Yalom &
Leszcz, 2020).
SUPPORT GROUPS AND TREATMENT GROUPS 3
This paper explores the historical development, the structures of meetings, and the
therapeutic goals of both addiction support groups and therapy groups. This paper will also
compare and contrast these two approaches and their strengths, limitations, and their
dimensions regarding cultural and spiritual. I will be drawing from direct observations of these
meetings; this paper will deepen the understanding of how these models operate and how they
can be effective in future clinical practice.
Support Group Brief History
Alcoholics Anonymous (AA)
AA was founded in 1935 in Akron, Ohio but Bill Wilson who was a stockbroker in New
York and Dr. Bob Smith who was a surgeon. Both of them were recovering alcoholics. The group
was founded from the desire to stay sober but also help other individuals do the same by
sharing each of their experiences with each other. Its core philosophy centers on the 12-step
program, which emphasizes spiritual awakening, accountability, and community support
(Alcoholics Anonymous World Services, 2001; White, 2014).
A major milestone in AA’s history was the publication of Alcohols Anonymous, commonly
referred to as The Big Book in 1939. This text outlines the 12 steps and also includes some
personal stories of recovery and the process. This text also became the blueprint for many
recovery programs around the world (Alcoholics Anonymous World Services, 2001).
AA continues to grow and evolve with the times. Online meetings have grown
significantly since the COVID-19 pandemic and also has made more efforts to be more inclusive
of the younger and more diverse populations (Kelly, 2017). AA Has its roots based in spirituality
but they welcome individuals from all backgrounds who desire sobriety.
SUPPORT GROUPS AND TREATMENT GROUPS 4
Narcotics Anonymous (NA)
Narcotics Anonymous (NA) was founded in 1953 and Los Angeles. This was a response to
the growing need for a 12-step recovery program that's specifically focused on drug addiction.
While initially being based on the AA model, NA adapted its language to be more inclusive of all
substances not just alcohol (Narcotics Anonymous World Services, 2008). One of its key
publications the Basic Text, further solidified its identity and also provided guidance for
members and groups around the world.
NA grew slowly at first, mainly because the societal stigma and legal challenges
surrounding drug use at this time, but by the 1980s it began to expand globally and as of today
hosts over 70,000 weekly meetings in more than 140 countries (NAWS, 2024)
Milestones in the development of NA include services like the inclusion of youth- specific
and LGBTQ+ meetings and using digital formats for meetings as well. NA feels strongly about
anonymity, mutual support and spiritual growth, although it avoids promoting any religious
ideology (Humphreys, 2004)
Al-Anon
Al-Anon was founded in 1951 by Lois Wilson, the wife of AA co-founder Bill, Wilson. This
was to support the loved ones of alcoholics. This organization was formed to provides a safe
space for families, loved ones, and friends can share their struggles, hard times, and gain insight
into strategies to cope, particularly related to codependency and enabling behaviors (AlAnon
Family Groups, 2021)
Al-Anon also uses the 12 steps and the 12 traditions of AA but have changed then to fit
the experience of those that are affected by another person’s drinking. Their meetings are
highlighting emotional healing, detachment with love, and finding strength through fellowship
SUPPORT GROUPS AND TREATMENT GROUPS 5
(Laudet, 2008).
Al-Anon has groups in over 130 countries, and a related group called Alateen was
developed in 1957 to meet the needs of adolescents affected by alcoholism in the family
(AlAnon Family Groups, 2021).
Support Group Meeting Structure and Function
Alcoholics Anonymous (AA)
AA meetings typically follow a structured but also in formal format. Some of these
meetings may be open which allow anyone to attend, or they may be closed which means they
are restricted to individuals who identify as having a drinking problem. These meetings begin
with readings from The Big Book and also the recitation of the 12 steps and 12 traditions. Often
followed by a moment of silence or a prayer (Alcoholics Anonymous World Services, 2001).
There are also different types of meetings, there are discussion meetings, speaker meetings, in
step study meetings period each with a different format, but all continue to emphasize mutual
support through personal sharing (Kelly & White, 2012).
AA meetings are usually facilitated by peers, not professionals. The group leader ensures
that the meetings run smoothly, opens and closes with readings, and invites members to share.
During these meetings there is no interpretation, therapy or even diagnosing (Humphreys,
2004).
Success in a is acknowledged through sobriety “chips” or “tokens”, that are given at
various milestones such as 30 days, 90 days, in yearly anniversaries. These are some of the
symbols of progress that are celebrated as signs of hope and community encouragement (Kelly
SUPPORT GROUPS AND TREATMENT GROUPS 6
& White, 2012). When individual relapses, it is treated with compassion. Individuals are always
welcomed back and encouraged to begin again with a renewed commitment to the program
(Moos, 2008).
Narcotics Anonymous (NA)
NA meetings tend to mirror AA meetings in the structure sense but with unique
adaptations specified for drug addiction. NA is inclusive of all substances and refers to addiction
broadly. Meetings typically open with a moment of silence, readings from the Basic Text, the 12
steps and traditions of NA and then they cover announcements (Narcotics Anonymous World
Services, 2008).
NA meeting are peer- led, with an individual that is responsible for organizing the format
and keeping the meeting a safe space. Leadership rotated among members, and when the need
to make decisions, they are made democratically within the group (Humphreys, 2004)
Meetings may be topic based, step focused, or even speaker led. This is depended on the
day and sometimes group preference. Sharing during these meetings is a key element.
Members are discussing their experiences, feelings, and insights without giving advice.
The celebration of recovery is essential to NA. They often use “clean time” chips were
key tags for various lengths of sobriety. NA Encourages members to recognize these milestones
and meetings to build community support (Kelly & White, 2012).
NA also uses sponsor- sponsee relationships. Sponsors are there to help new members
apply the 12 steps in their daily life. Relapse is acknowledged as part of their recovery journey
and is addressed without shame, emphasizing returning to meetings and continuing giving this
process effort (Moos, 2008)
SUPPORT GROUPS AND TREATMENT GROUPS 7
Spirituality is prominent in NA, but the group does explicitly state that it is not affiliated
with any religion. Members are most of the time encouraged to define our power in a way that
makes sense to them individually (Kelly, 2017).
Al-Anon
Al-Anon Meetings are designed for family members, friends, and loved ones of individual
struggling with alcoholism, not for the individual with the substance use disorder. These
meetings are here to help individuals regain their emotional stability, detach from the alcoholics
behavior, and most importantly to focus on their own well-being (Al-Anon Family
Groups, 2021).
These meetings follow a similar structure to AA. They begin with reading such as the
serenity prayer, the 12 steps and 12 traditions of Al-Anon, and How Al-Anon works. These
meetings also may have a theme, step, or topic that is going to be up for discussion period the
focus of these meetings is on experience, strength, and a hope, with member sharing how they
cope are struggling with living in close proximity of alcoholism (Laudet, 2008)
Like AA and NA, Al-Anon is peer led. In these meetings there are no therapist or
counselors, but there are facilitators and there to rotate leadership responsibilities that are
fellow members. The job of the facilitator is to ensure the meeting adheres to guidelines and
are promoting respectful listening.
These meetings do not track sobriety time but instead they do measure the progress in
emotional and spiritual terms. Such as the ability to set boundaries, detach with love, and or to
find serenity regardless of the loved one’s behavior. So, the progress is measured in the
boundaries that the individual can set. There is no shaming of those who struggle, these
SUPPORT GROUPS AND TREATMENT GROUPS 8
meetings are to promote compassion, honesty, and personal responsibility (Al-Anon Family
Groups,
2021).
Addiction Therapy Groups Brief History
Addiction therapy groups emerge from clinical and psychological traditions with a more
formal, evidence-based foundation. These groups are facilitated by trained professionals and
tend to focus on sociological treatment with the nurse group format.
Early pioneers such as Jacob Moreno and Kurt Lewin emphasized therapeutic power of
group interaction and cohesion (Yalom & Leszcz, 2020). Group therapy was increasingly being
put in psychiatric hospitals, especially with returning veterans suffering from trauma and
addiction.
During the 1950s and 1960s, addiction therapy groups gained more traction in inpatient
and residential treatment programs. These groups were primarily influenced by Carl Rogers
person centered approach, which emphasized empathy, unconditional positive regard, and
selfactualization within a group of contexts (Rogers, 1961). Irvin Yalom, articulated that creative
factors of group therapy, such as catharsis and interpersonal learning continue to inform
addiction therapy groups today (Yalom & Leszcz, 2020).
By the 1970s and 1980s addiction therapy groups had expanded in clinical settings, this
was because of the rise of therapeutic communities and intensive outpatient programs. George
De Loan Was particularly influential in institutionalizing addiction specific group therapy and
structured environments, where peer accountability and confrontational techniques were
integrated with counseling (DeLeon, 2000).
There was a rise of evidence based practices in the 1990s and 2000s, many of
SUPPORT GROUPS AND TREATMENT GROUPS 9
these addiction therapy groups began incorporating cognitive behavioral therapy, motivational
interviewing, relapse prevention, and trauma and forced care (Carroll & Onken, 2005). These
are approaches allow therapist to address the psychological, behavioral, and emotional
components of addiction within the group setting.
Some of these therapy groups now include psycho educational groups, cognitive
behavioral groups, relapse prevention groups, and trauma and forced or dual diagnosis groups.
These groups reflect a shift from insight oriented approaches toward skills based and client
centered strategies, designed to foster resilience, insight, and behavioral change (Substance
Abuse and Mental Health Services Administration [SAMHSA], 2005).
The goals of addiction therapy groups are multidimensional. Some of these goals are to
reduce substance use, improve psychological functioning, prevent relapse, promote
interpersonal support, and to foster accountability. Unlike support groups, therapy groups are
time limited, goal directed and documented for treatment plans (Toseland & Rivas, 2017).
Addiction therapy groups today are a very important part about patient treatment
comma residential care comma and integrated behavioral health systems period they are also
increasingly adapting to diverse populations, like LGBTQ+, veterans, and adolescents. They are
also offering these addiction therapy groups in both in person and telehealth formats.
Research continues to explore how group interventions can be tailored for clients with
co-occurring disorders, trauma histories, and diverse cultural identities (Magill & Ray, 2009).
Having the option to do virtual group therapy has also opened doors to greater access especially
for under deserved populations and or individuals living in rural areas.
SUPPORT GROUPS AND TREATMENT GROUPS 10
Addiction Therapy Groups Meeting Structure and Function
Addiction therapy groups are a foundation of modern substance use treatment, often
embedded with inpatient programs, intensive outpatient programs, partial hospitalization
programs, and your community mental health centers. These groups are structured and often
clinician lead and evidence based, with defiant objectives and measurable outcomes. Therapy
groups are part of a formal treatment plan and often complement individual counseling or case
management services.
Addiction therapy groups vary in their formatting and function because it's very
dependent on therapeutic goal, the client population, and the stage of recovery. But SAMHSA
(2005) categorizes addiction therapy groups into five broad types. They are psychoeducational
groups, skills development groups, cognitive behavioral groups, support groups, interpersonal
process groups.
The group facilitator who is often a licensed counselor, clinical social worker or
psychologist please a center role in the success of the therapy groups. The facilitator is providing
A clinical structure, maintaining safety, and also enforces group rules and guides through this
therapeutic process. These facilitators are also using evidence-based techniques such as
motivational interviewing, cognitive reconstruction, and behavioral rehearsal to promote
change in the clients (SAMHSA, 2005).
The facilitators are also assessing clients progress, managing group dynamics, and
ensuring confidentiality. In some trauma informed settings, these facilitators are trained to
recognize signs of distress and how to respond to the appropriate techniques when needed
(Najavits, 2002).
SUPPORT GROUPS AND TREATMENT GROUPS 11
Documentation is another important responsibility within the facilitator. Therapy groups
are most of the time reimbursable through insurance, meaning that they are requiring clear
treatment goals, objectives, and progress notes as part of their clinical record (Toseland & Rivas,
2017).
Group members are expected to participate actively but still remain in their level of
comfort. Members often set personal goals for themselves, provide feedback to peers, and also
practice new behaviors in a supportive environment just in case they need help. These groups
are also providing a little bit of social interaction, while allowing members to explore trust,
boundaries, communication patterns, and emotional regulation (Yalom & Leszcz, 2020).
Most of these groups are time limited, and they range from six-twelve weeks for
outpatient programs. These sessions can also last between 60-90 minutes, with agendas,
checkins, topic introductions and most of the time closing reflections. The group sizes is usually
limited to 6 to 12 members to promote cohesion and effective facilitation (Toseland & Rivas,
2017).
Compare and Contrast
The topic of addiction recovery is a multidimensional process that can be supported
through both peer- led support groups and professionally facilitated therapy groups. Both
groups share a common goal of helping with recovery comma healing comma and personal
growth.
They differ in structure, leadership, therapeutic approach, and accountability mechanisms.
Both support groups and therapy groups offer group based healing environments. These
environments reduce isolation, and provide a sense of belonging. Members of each type of
SUPPORT GROUPS AND TREATMENT GROUPS 12
group benefit from sharing their experiences, receiving feedback, and building relationships that
foster that mutual encouragement ( Yalom & Leszcz, 2020) both groups encourage self-
reflection and personal responsibility, can be ongoing or time limited, they both incorporate
recovery principles such as honesty, accountability, and the development of coping skills, and
they also provide structure, confidentiality, and consistency which are vital for clients with
histories of trauma or chaos and addiction (Moos, 2008; Kelly & White, 2012). Both of these
models also integrates spiritual themes which can promote A deeper sense of meaning and
hope (Kelly, 2017).
One of the most fundamental differences is who leads the group. Support groups are
peer facilitated the leaders are volunteers who lived experience of addiction or are affected by it
( Humphreys, 2004). Therapy groups are led by licensed mental health professionals, such as
counselors, psychologist, or social workers, who use evidence based techniques to guide the
groups ( SAMHSA, 2005).
Support groups also tend to be open-ended, voluntary, and non-clinical. They are also
emphasizing fellowship, shared experiences, and spiritual growth. Therapy groups are structural
clinical interventions, with defined goals, treatment plans, and therapeutic techniques. The
groups are also time limited, and outcome focused, aiming to really measure progress in areas
such as emotional regulation, and relapse prevention (Carroll & Onken, 2005; Toseland & Rivas,
2017). Therapy groups also involve clinical documentation common goal tracking, and
treatment evaluation for insurance period support groups do not maintain records and operate
independently (Yalom & Leszcz, 2020).
Support groups offer several strengths. One being because they are free of charge,
community based, and peer-led support groups are widely available across geographic and
SUPPORT GROUPS AND TREATMENT GROUPS 13
socioeconomic context (Humphreys, 2004). Also, their informal structure, and mainly their
participation is voluntary makes it less intimidating for individuals to share especially in the
beginning of their recovery journey. We've had support groups are not led by trained
professionals and are not equipped to manage complex co-occurring disorders such as trauma,
bipolar disorder or even severe depression. The lack of having the clinical oversight can lead to
inconsistent experiences.
Therapy groups offer structured clinically guided interventions that target specific
aspects of substance use and mental health recovery period these groups also utilize evidence-
based approaches to deliver measurable therapeutic outcomes. Many of these groups are short
term or time limited due to insurance, funding constraints, which may not provide the long-
term community support that this individual may need. The cost and access can also be barriers
for underserved populations particularly those where clinicians are scarce.
Therapy groups are increasingly being designed with having cultural competence in
mind, this is addressing race, ethnicity, gender identity, and socioeconomic status in the
treatment process (Magill & Ray, 2009). While many support groups make efforts to include
everybody, their structure sometimes limits formal training in having this cultural competence
( Laudet, 2008),
Support groups placed a strong emphasis on spirituality and having the idea of a higher
power, which is flexible and non-denominational (Kelly, 2017). Therapy groups may incorporate
some spiritual exploitation when clinically appropriate but typically do so only when requested
by a client or if it's relevant to the client's treatment goals.
SUPPORT GROUPS AND TREATMENT GROUPS 14
Conclusion
A dictionary covery is a multidimensional process both support groups and therapy
groups play a very important role in addressing its biological, psychological, social, and spiritual
dimensions. Support groups such as AA, NA, and Al-Anon provide accessible, peer driven spaces
where most individuals can find understanding, fellowship, and purpose without having those
barriers of cost or being clinically formatted. Addiction therapy groups are guided by licensed
professionals using evidence based approaches to facilitate measurable outcomes. These groups
are especially effective for individuals in early recovery with those complex clinical needs.
As a future clinician I now know and have a better understanding on how to integrate
both group types and practice. I can see myself using support groups as a key referral source for
clients transitioning out of formal treatment or some that are seeking ongoing community
accountability. But I do recognize the need to facilitate or Co lead their peer groups that align
with treatment goals, especially for clients that are also navigating trauma, relapse risk, and
Cooccurring disorders.
By having this knowledge, it equips me to assess client needs more holistically and to
offer more informational group based care period whether that means going through spiritual
discipline of the 12 steps or having that structured interventions of CBT and trauma informed
therapy. Integrating both of them in my future clinical work will not only enhance the outcomes
but will also empower my clients to recover with community, clarity and dignity
SUPPORT GROUPS AND TREATMENT GROUPS 15
References
Al-Anon Family Groups. (2021). Al-Anon/Alateen 2021 annual report. https://al-anon.org
Alcoholics Anonymous World Services. (2001). Alcoholics Anonymous: The story of how many
thousands of men and women have recovered from alcoholism (4th ed.). Alcoholics
Anonymous World Services.
Alcoholics Anonymous World Services. (2024). AA fact file. https://www.aa.org OK
Carroll, K. M., & Onken, L. S. (2005). Behavioral therapies for drug abuse. American Journal of
Psychiatry, 162(8), 1452–1460. https://doi.org/10.1176/appi.ajp.162.8.1452
De Leon, G. (2000). The therapeutic community: Theory, model, and method. Springer.
Flores, P. J. (2010). Group psychotherapy with addicted populations: An integration of
twelvestep and psychodynamic theory. Routledge.
Humphreys, K. (2004). Circles of recovery: Self-help organizations for addictions. Cambridge
University Press.
Kelly, J. F. (2017). Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of
research. Addiction, 112(6), 929–936. https://doi.org/10.1111/add.13590
Kelly, J. F., & White, W. L. (2012). Broadening the base of addiction mutual-help organizations.
Journal of Groups in Addiction & Recovery, 7(2–4), 82–101.
https://doi.org/10.1080/1556035X.2012.705701
Laudet, A. B. (2008). The impact of Alcoholics Anonymous on other substance abuse-related
twelve-step programs. In M. Galanter & L. Kaskutas (Eds.), Research on Alcoholics
Anonymous and spirituality in addiction recovery (pp. 71–89). Springer.
Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug
users: A meta-analysis of randomized controlled trials. Journal of Studies on
SUPPORT GROUPS AND TREATMENT GROUPS 16
Alcohol and Drugs, 70(4), 516–527. https://doi.org/10.15288/jsad.2009.70.516
Moos, R. H. (2008). Active ingredients of substance use-focused self-help groups. Addiction,
103(3), 387–396. https://doi.org/10.1111/j.1360-0443.2007.02111.x
Najavits, L. M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse.
Guilford Press.
Narcotics Anonymous World Services. (2008). Narcotics Anonymous: Sixth edition. NA World
Services.
Narcotics Anonymous World Services. (2024). About NA. https://www.na.org
Rogers, C. R. (1961). On becoming a person: A therapist's view of psychotherapy. Houghton
Mifflin.
Substance Abuse and Mental Health Services Administration. (2005). Substance abuse
treatment: Group therapy (Treatment Improvement Protocol Series No. 41).
https://store.samhsa.gov/product/TIP-41-Substance-Abuse-Treatment-Group-Therapy/
SMA15-3991
Toseland, R. W., & Rivas, R. F. (2017). An introduction to group work practice (8th ed.).
Pearson.
White, W. L. (2014). Slaying the dragon: The history of addiction treatment and recovery in
America (2nd ed.). Chestnut Health Systems.
Yalom, I. D., & Leszcz, M. (2020). The theory and practice of group psychotherapy (6th ed.).
Basic Books.
SUPPORT GROUPS AND TREATMENT GROUPS 18
