The Development and Characteristics of Maladaptive Behavior in School-Based Group Therapy for Adolescent AOD Problems

Background and Purpose: Group therapy is the most popular modality used in the treatment of alcohol and other drug (AOD) problems and most studies report beneficial effects. However, a few studies have reported that aggregating youth with conduct problems created environments in which youths exhibited negative behavior that was positively reinforced by other group members (i.e., "deviancy training"), producing iatrogenic effects. Within closed-membership groups consisting of adolescents with AOD problems, there might be particular concerns about members developing relationships based on deviance and exhibiting disruptive behavior patterns reinforced by others within the group. This presentation reports on a study funded by NIAAA, which examined group composition (i.e., proportion of conduct problems among group members), maladaptive behavior in group (MGB, i.e., antisocial behavior and deviancy training), and group leader behaviors on AOD outcomes. In this new report from all groups involved in the study, we present data on the patterns, characteristics, and development of MGB within and across 20 groups, and discuss how group composition relates to MGB across these groups.

Methods: Data derive from a completed clinical trial involving 120 youths randomly assigned to 20 closed-ended groups using the Westchester Model Student Assistance Program protocol. In this study, two evaluator teams reviewed audio tapes and verbatim transcripts of every group session to rate MGB. Descriptive analyses explored the amount and type of MGB and its development over group sessions, along with repeated measures analysis of variance to examine its development over time. Correlational analyses were used to examine the relationship between the proportion of adolescents with conduct disorder in a group and the amount of MGB in the group.

Results: There were 3702 incidents of disruptive group behavior over 180 group sessions (mean = 21 incidents/session). Most of the incidents were coded as “distracting behaviors” (23.2%, 859) which were behaviors that interfered with, interrupted, or stopped the session, followed by glorification or encouragement of AOD use (20.5%, n = 758), pejorative verbalizations to other group members (9.5%, n = 350), and victimizing or disparaging others (7.3%, n = 272). MGB showed a clear pattern of development across the groups, peaking around the middle group sessions. There was a strong linear trend in that MGB in early sessions predicted later MGB (F 12.04, p < .01, η² = .55). There was a moderately strong association between the proportion of conduct disorder in groups and the exhibition of MGB in groups, r = .53, p < .01.

Conclusions and Implications: This study revealed a considerable amount of MGB. Across the twenty groups, MGB presented a pattern of development over group sessions pointing to the need for leader actions early. In addition, the proportion of youths with conduct problems in a particular group significantly related to the amount of MGB exhibited in those groups. These findings help in the planning of AOD treatment groups and in what group workers may expect in groups consisting of students with AOD problems.