EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 1

Effectiveness of Psychotherapy on Relapse Prevention: Scholarly Project Part 2, Final

Submission

Kaitlin Kelley

School of Nursing, MCPHS University

NURS 820b: Translation Research Practicum

Dr. Kimberly Shea, DNP, MSN, RN

November 7, 2021

Author Note

Author assistance for this Scholarly Project Part 2, Final Submission was received from

the MCPHS University Writing Center on November 5, 2021.

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Abstract

The use of alcohol and illicit drugs remains a significant healthcare issue across the United

States. Patients with substance use disorders face various physical and psychosocial concerns

directly related to their substance use, and the number of patients presenting for treatment with

these diagnoses continues to rise and place a burden on our healthcare system. Through the

examination of current, reliable research, this Scholarly Project explores the use of individual

and group psychotherapy as a non-pharmacological treatment intervention for patients with

substance use disorders. Group and individual therapy provided in these studies were shown to

reduce rates of relapse within participants through the use of subjective and objective outcomes

and measures. The results of these studies prove the effectiveness of group and individual

therapy on relapse prevention, and can be helpful for psychiatric providers in providing effective

treatment to patients with substance use disorders.

Keywords: substance abuse, relapse, group therapy, individual therapy, psychotherapy,

mental health, dual diagnosis

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Effectiveness of Psychotherapy on Relapse Prevention

The prevalence of substance abuse throughout the United States continues to rise, not

only impacting patients’ physical and psychosocial health but also placing a significant burden

on our healthcare system (Dugosh et al., 2016). The National Institute on Drug Abuse (NIDA,

2020) reported that nearly $740 billion is spent in the United States every year related to the use

of alcohol, illicit drugs, and tobacco. Opiate use and related overdoses and deaths have become

an epidemic throughout the country, requiring increased federal support and education to prevent

worsening outcomes (Centers for Disease Control and Prevention [CDC], 2021). The CDC

(2021) reported that 70% of drug overdoses in 2019 involved an opioid, resulting in the death of

nearly 50,000 people. The National Institute on Alcohol Abuse and Alcoholism (NIAAA, 2021)

reported that the 2019 National Survey on Drug Use and Health found 14.5 million people ages

12 and older were diagnosed with an alcohol use disorder. An estimated 95,000 people die from

alcohol related causes annually, making it one of the top preventable causes of death in the

United States (NIAAA, 2021).

The National Institute on Drug Abuse (NIDA, 2021) reported the rate of relapse for

substance use disorders ranges from 40-60%. Psychotherapy is an important nonpharmacological

treatment option for relapse prevention that allows for treatment of underlying psychiatric

conditions, including post-traumatic stress disorder (PTSD), anxiety, and depression, as well as

providing behavioral modification specific to substance use and addictive behaviors (Dugosh et

al., 2016). Several variations of psychotherapy are utilized for patients with substance use

disorders, including individual psychotherapy such as cognitive behavioral therapy (CBT),

educational forums, group therapy, and family therapy (Dugosh et al., 2016).

While both individual and group therapy are frequently utilized in the treatment of
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 4

patients with substance use disorders, this Scholarly Project will examine the differences and

effectiveness between the two forms of psychotherapy on relapse prevention. The PICO question

identified for this Scholarly Project is: In patients with substance use disorders (P), what is the

effect of group therapy (I), in comparison to individual therapy (C), on relapse prevention (O)?

Methodology

This Scholarly Project utilized a thorough review of literature to address the identified

PICO(T) question. The databases used for searching for available research were the Cumulative

Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, and PubMed. The

keywords utilized in the search included group therapy, individual therapy, and relapse

prevention. The initial inclusion criteria for studies included primary, peer reviewed, scholarly

research studies in the English language that were published within the past 5 years. Additional

inclusion criteria included that the studies had to directly incorporate the use of group therapy or

individual therapy as an intervention for relapse prevention for substance users. Exclusion

criteria included a lack of peer review, small sample size, and not using group or individual

therapy as the main intervention of the study. Initial database results yielded over 30 research

studies; however, many were not utilized in final literature matrix after the inclusion and

exclusion criteria was applied.

Once studies were obtained through the database searches, their abstracts were reviewed

to gain an overview of the study. If the abstract met criteria for the study, the introduction,

methodology, and further sections were reviewed for appropriateness and rigor. Once

appropriate studies were chosen, additional research studies relevant to this scholarly project

were found through their reference sections and further analyzed. Following all inclusion and

exclusion criteria, 11 appropriate, quality studies relevant to the PICO(T) question remained.
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Quantitative and qualitative primary research studies were obtained and included in this

Scholarly Project.

Theoretical Framework

The American psychologist Carl Rogers developed the foundation of client centered

therapy in the 1940s as a humanistic approach to psychotherapy (Rogers, 1951). Lago et al.

(2017) described how this new perspective on psychotherapy differed from traditional therapies

in which the therapist provided psychoanalysis and was in control of therapeutic process. Within

this client centered model of therapy, the patient is the expert of their own care and their

experiences are responsible for personal change and development. The theoretical framework

behind client centered therapy is based on the belief that people can fulfill their full potential

through resilience and growth as the therapist creates conditions to assist the client in change,

which include unconditional positive regard, acceptance without moral judgment, and empathy

(Lago et al., 2017). Allowing the patient with the ability to control their own care works to

promote client autonomy and personal growth. Client centered therapy has continued to grow

and develop over the years as Rogers later expanded his theory into family relationships,

education, and group work (Lago et al., 2017).

Carl Roger’s theory of client centered therapy will be utilized as the theoretical

framework for this Scholarly Project. This framework is applicable to the desired population and

goal of this Scholarly Project, which is to compare the effectiveness of individual therapy and

group therapy on relapse prevention for patients with substance use disorders. A well-known

form of client centered therapy is motivational interviewing, which is often utilized successfully

to treat patients with substance use disorders and prevent relapse (Polcin et al., 2017). In

addition, client centered therapy is a framework that is commonly applied to both individual and
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group therapies due to its versatility and ability to be used with the majority of patients and

situations (Marchand et al., 2018). This therapeutic process can be applied directly to substance

users for relapse prevention, as it is able to directly assists patients in addressing areas that lead

to relapse such as denial, lack of motivation, and personal growth (Marchand et al., 2018). With

a focus on empathy and lack of judgement from the provider, the treatment provided is

autonomous and empowering, which is beneficial for encouraging change in substance users.

With the patient in control of their treatment, client centered therapy is able to meet the patient’s

unique needs, goals, and preferences for relapse prevention (Marchand et al., 2018).

Critique of the Literature

Through the use of database searches including CINAHL, Google Scholar, and PubMed

as well as adherence to the inclusion and exclusion criteria, nine quantitative articles (Kim et al.,

2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore et al., 2016; Parthasarathy et al., 2020;

Polak et al., 2020; Sugarman et al., 2016; Zemestani & Ottaviani, 2016; Zemore et al., 2018) and

one qualitative article (Chilton et al., 2019) were chosen for the literature matrix to address the

PICO(T) question for this Scholarly Project. It is critical that nurses are able to determine the

strengths and weaknesses of research studies in order to further apply them to practice (Ryan et

al., 2007). The 10 research studies utilized in the literature matrix of this Scholarly Project were

examined to determine credibility related to elements influencing believability and robustness of

the research in order to apply to clinical practice. The critique of these research studies utilized

the step-by-step guides to critiquing qualitative and quantitative literature created by Coughlan et

al. (2007) and Ryan et al. (2007).

Qualitative Articles
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Elements Influencing Believability of the Research

Writing Style. The one qualitative article included in this literature matrix is overall well

written (Chilton et al., 2019). The study is clear and concise throughout and is absent of

grammatical errors and use of jargon. The structure and layout are organized, allowing the reader

to follow the steps of the study efficiently. The study is broken down into clear, identified

sections and utilizes tables to allow the reader to easily examine important information (Chilton

et al., 2019).

Authors. The authors of the qualitative study have credentials that indicate a degree of

knowledge related to the PICO(T) question and substance use disorders including PhDs in health

sciences and psychology (Chilton et al., 2019).

Report Title. The title of the qualitative study is clear, accurate, and unambiguous. The

title presents key information, including the population and intervention, as well as identifies the

use of a qualitative approach. The use of a participant’s quotation in the title makes the title

lengthy; however, potentially draws attention to the study in a database search (Chilton et al.,

2019).

Abstract. The abstract of a qualitative study should offer a clear overview of the study

and provide an outline of the key points that will be examined (Ryan et al., 2007). Within the

abstract of the qualitative study for this Scholarly Project, an outline of the study is provided

through brief identification of the aim of the study, phenomenon of interest, study sample,

research design, methodology, and a clear overview of the results and conclusion of the study

(Chilton et al., 2019). By providing key information in the abstract, this article was identified

from the database search as appropriate for the PICO(T) question and found applicable for this
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Scholarly Project.

Elements Influencing Robustness of the Research

Statement of the Phenomenon of Interest. The phenomenon of interest must be clearly

identified and consistent with the research question (Coughlan et al., 2007). The phenomenon of

interest is clearly stated within the qualitative study and is consistent in the research question as

it relates to relapse prevention for substance users (Chilton et al., 2019).

Purpose/Significance of the Study. The researcher should state within the study the

significance of the study and how it will add to the general body of knowledge related to the

phenomenon (Ryan et al., 2007). The qualitative study clearly identifies the purpose and

significance of the study on dual diagnoses and how its findings could enhance outcomes for

people with substance use disorders (Chilton et al., 2019).

Literature Review. The function of the literature review in qualitative research is to

provide an objective account on what has been written on the subject (Ryan et al., 2007). A

literature review of the current research on the topic of interest was completed for the qualitative

study (Chilton et al., 2019). The literature review fulfills its objective of providing context and

knowledge to the background of the study as well as comparing the study findings to current

literature. The literature review meets the philosophical underpinning of phenomenology by

taking results directly from the point of view of the participants and comparing it to the current

literature (Chilton et al., 2019).

Theoretical Framework. The theoretical framework of the qualitative study is identified

and adequately described. The theoretical framework is appropriate and applicable to PICO(T) in

that it works to modify the behavior and enhance treatment outcomes of dual diagnoses patients
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 9

suffering from substance use disorders (Chilton et al., 2019).

Method and Philosophical Underpinnings. The philosophical underpinning of

phenomenology was identified for the qualitative study and is appropriate because it is based on

the lived experiences of humans, as the authors explained (Chilton et al., 2019). This

philosophical underpinning is applicable to the PICO(T) question and aim of this Scholarly

Project to assess the efficiency of therapy in relapse prevention through direct experience from

participants of the study.

Methodology: Research Design. The research design of the qualitative study is

identified and is further explored throughout the study’s methods of data collection, sampling,

and analysis. The qualitative study’s use of an inductive qualitative methodology based in

phenomenology is appropriate for this Scholarly Project’s PICO(T) question in that it inducts

conclusions regarding outcomes for substance users based on their lived experiences (Chilton et

al., 2019).

Sample. The sampling method, sample size, and inclusion and exclusion criteria for

selecting participants is clearly identified within the qualitative study (Chilton et al., 2019). The

sampling method and purposeful choice of participants is appropriate for gaining accurate

findings for the phenomenon of interest and the patients are suitable for this Scholarly Project in

that they all have current substance use disorders (Chilton et al., 2019).

Ethical Considerations. Participants should always have the right to informed consent

regarding participation in a research study, which follows the ethical principle of autonomy

(Ryan et al., 2007). Participants in the qualitative study were informed of the nature of the

research and participants were protected from harm through informed consent and confidentiality
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(Chilton et al., 2019). Although direct quotations of patient’s experiences were utilized in the

study, confidentiality of their names and personal information was maintained through use of

pseudonyms. Ethical permission was granted for the study and the ethical committee is clearly

stated (Chilton et al., 2019).

Data Collection. When using interview format for data collection in qualitative research

studies, it should be evident how research questions and themes were derived (Ryan et al., 2007).

In this qualitative study, data collection strategies are described, and researchers followed the

identified steps of data collection throughout the study (Chilton et al., 2019). The use of semi

structured interviews as the method of data collection in the study was suitable for the PICO(T)

question of this Scholarly Project (Chilton et al., 2019).

Data Analysis. The specific strategies used to analyze data were identified and the exact

steps of the data analyses method were described. Data saturation was not specifically mentioned

in the qualitative study (Chilton et al., 2019).

Rigour (Trustworthiness). Research studies must be examined for rigor in order to

ensure credibility and integrity of the qualitative research to be utilized (Ryan et al., 2007). This

section will also look into the elements of credibility, dependability, transferability, and

goodness that were maintained throughout the study. In the qualitative study, the authors

accurately described how rigor was ensured (Chilton et al., 2019).

Rigour in Documentation. Rigor in documentation was maintained throughout the

overall organization of the study and the use of well documented, clear, and descriptive sections.

The authors clearly labeled themes of data and utilized direct quotes to add to the rigor of

documentation (Chilton et al., 2019).

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Procedural Rigour. Procedural rigor was maintained in the qualitative study through

precise data collection techniques and consistent standards across all procedures (Chilton et al.,

2019). Procedural rigor should have a critical component to reduce biases and misinterpretations

(Ryan et al., 2007).

Ethical Rigour. In the qualitative study, the confidentiality of participants is maintained,

and the rights of participants are upheld with the use of informed consent (Chilton et al., 2019).

Credibility. Credibility is maintained through the faithfulness to the phenomenon of

interest and may be enhanced by the researcher’s knowledge and experiences (Ryan et al., 2007).

In the qualitative study, credibility is maintained through the described knowledge base of the

authors and the appropriateness of the sample of participants with dual diagnoses to the

phenomenon if interest (Chilton et al., 2019).

Dependability. The qualitative study provides dependability as it is auditable and allows

the reader to clearly follow the methodology and steps used by the researcher and come to the

same conclusions. The study offers insight into its decision trail throughout the steps of the

research process and each step is traceable and clearly documented (Chilton et al., 2019).

Transferability. The information within the qualitative study was detailed clearly and

appropriately to allow the reader to follow and evaluate if it could be transferable to their own

research (Chilton et al., 2019).

Confirmability. Confirmability is maintained in the qualitative study by the explanation

of how conclusions and interpretations were reached. Direct quotes from participants were

provided and the methodology, data analysis, conclusions provided further explanation to the

findings (Chilton et al., 2019).

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Goodness. The principle of goodness is followed throughout all aspects of the qualitative

study (Chilton et al., 2019). Information regarding the data collection and form of data analysis,

description of philosophical underpinning, and the interpretation and presentation of data ensures

the goodness of the research study (Ryan et al., 2007).

Findings/Discussion. The findings of the qualitative study are presented appropriately, as

well as the original purpose of the study and report on what was already known of phenomenon.

Findings were broken down by the themes which worked to organize the findings for the reader

and the use of direct quotes from participant interviews supported the identified (Chilton et al.,

2019). The discussion of findings for the study directly addressed elements of the PICO(T)

question of this Scholarly Project.

Conclusions/Implications and Recommendations. Conclusion of research studies

should indicate how the gained information is of interest and should reflect the study’s findings

(Ryan et al., 2007). The importance and implications of the findings of the qualitative study were

addressed, as well as recommendations on further research and development of the findings

(Chilton et al., 2019).

References. All references including books, journals, and other media utilized within the

qualitative research study were accurately referenced (Chilton et al., 2019).

Quantitative Articles

Elements Influencing Believability of the Research

Writing Style. The quantitative articles included in this literature matrix were overall

well written. The research was clear and concise throughout each study and absent of

grammatical errors and use of jargon. The structure and layout were organized allowing the
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reader to follow the steps of the study efficiently. The studies were broken down into clear,

identified sections and subsections. All studies utilized tables and figures to further assist the

reader in examining important information (Kim et al., 2016; Komasi et al., 2016; Mokhtari et

al., 2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016;

Zemestani & Ottaviani, 2016; Zemore et al., 2018).

Authors. The number of authors within the quantitative studies varied from two to eight

with titles including RN, MSW, PhD, MSc, MD, BA, ScD, and DrPH. All authors were

associated with accredited institutions and practicing in fields related to the PICO(T) question,

including division of alcohol and drug abuse, health services, and psychiatry (Kim et al., 2016;

Komasi et al., 2016; Mokhtari et al., 2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et

al., 2020; Sugarman et al., 2016; Zemestani & Ottaviani, 2016; Zemore et al., 2018). Authors

qualifications and job titles can provide indication into a degree of knowledge on the subject

(Coughlan et al., 2007).

Report Title. The titles of the studies were clear, accurate, and unambiguous. The

reports titles presented key information and the purpose of the study, as well as remained

between approximately 10-15 words long (Kim et al., 2016; Komasi et al., 2016; Mokhtari et al.,

2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016;

Zemestani & Ottaviani, 2016; Zemore et al., 2018).

Abstract. The quantitative studies contained abstracts that provided a clear overview of

their study including the research problem, sample, methodology, findings, and

recommendations (Kim et al., 2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore et al.,

2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016; Zemestani &

Ottaviani, 2016; Zemore et al., 2018). Several studies utilized headings within their abstract for
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further organization (Kim et al., 2016; Komasi et al., 2016; Parthasarathy et al., 2020; Polak et

al., 2020; Sugarman et al., 2016; Zemore et al., 2018). By providing key information in the

abstract, these studies were chosen from the database search as appropriate for the PICO(T)

question and found applicable for this Scholarly Project.

Elements Influencing Robustness of the Research

Purpose/Research Problem. Both the purpose of the study and research problem were

clearly identified within all of the quantitative studies (Kim et al., 2016; Komasi et al., 2016;

Mokhtari et al., 2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman

et al., 2016; Zemestani & Ottaviani, 2016; Zemore et al., 2018). The purpose and research

problems found within the studies are all applicable to the PICO(T) question of this Scholarly

Project.

Logical Consistency. A research study must logically follow the steps of the research

process, as well as provide a clear link between steps beginning with the purpose of the study

and following with the literature review, theoretical framework, research question, methodology,

data analysis, and findings (Coughlan et al., 2007). The quantitative studies all follow the steps

of the research study in a logical manner. The steps naturally flow and the links between

sections are clear (Kim et al., 2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore et al.,

2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016; Zemestani &

Ottaviani, 2016; Zemore et al., 2018).

Literature Review. The primary purpose of the literature review is to define the research

question of the study and demonstrate appropriate depth surrounding the topic, as well as

identify gaps in current literature (Coughlan et al., 2007). The literature review of the studies
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 15

were logically organized and provided a balanced critique of the literature. The majority of the

literature within the literature reviews were of recent origin and primary, peer reviewed studies

(Kim et al., 2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore et al., 2016; Parthasarathy et

al., 2020; Polak et al., 2020; Sugarman et al., 2016; Zemestani & Ottaviani, 2016; Zemore et al.,

2018).

Theoretical Framework. The theoretical framework for nine of quantitative studies

were identified and adequately described. All of the theoretical frameworks described in these

studies were appropriate and applicable to PICO(T) in that they could be utilized in improving

outcomes through psychotherapy for substance users (Kim et al., 2016; Komasi et al., 2016;

Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016;

Zemestani & Ottaviani, 2016; Zemore et al., 2018). One study did not have a theoretical

framework clearly mentioned; however, the broad concept of quality of life and perception of

one's life in the context of local culture and value systems was discussed (Mokhtari et al., 2019).

Aims/Objectives/Research Question/Hypotheses. All of the studies identified and

clearly reported their aims, objectives, and research question within the introduction sections of

the study. The aim and research question for all of the studies were congruent with the

information obtained from the literature review (Kim et al., 2016; Komasi et al., 2016; Mokhtari

et al., 2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al.,

2016; Zemestani & Ottaviani, 2016; Zemore et al., 2018). One study provided clearly labeled and

bolded hypotheses to ensure clarity for the reader (Kim et al., 2016).

Sample. The target population for all of the studies were all clearly identified and of

appropriate size. The inclusion and exclusion criteria were explained for all of the studies. (Kim

et al., 2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore et al., 2016; Parthasarathy et al.,
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2020; Polak et al., 2020; Sugarman et al., 2016; Zemestani & Ottaviani, 2016; Zemore et al.,

2018). Probability sampling was utilized for the majority of the studies due to the nature of

randomized controlled trials (Kim et al., 2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore

et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016; Zemestani &

Ottaviani, 2016).

Ethical Considerations. Participants should always have the right to informed consent

regarding participation in a research study, which follows the ethical principle of autonomy

(Ryan et al., 2007). Within all of the studies, the authors described that all participants were

informed of the nature of the research and participants were protected from harm through

informed consent and confidentiality (Kim et al., 2016; Komasi et al., 2016; Mokhtari et al.,

2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016;

Zemestani & Ottaviani, 2016; Zemore et al., 2018). Ethical permission was granted for the

studies and clearly stated for all studies.

Operational Definitions. The majority of terms, theories, and concepts mentioned within

all of the studies were clearly defined (Kim et al., 2016; Komasi et al., 2016; Mokhtari et al.,

2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016;

Zemestani & Ottaviani, 2016; Zemore et al., 2018).

Methodology. The majority of the studies had an identified experimental research design

in which two groups received different treatment (Kim et al., 2016; Komasi et al., 2016; Moore et

al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016; Zemestani &

Ottaviani, 2016). One study identified a quasi-experimental research design (Mokhtari et al.,

2019) and one study identified a longitudinal design (Zemore et al., 2018).
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 17

Data Collection. Nine of the studies utilized questionnaires and written data as their

primary form of data collection (Kim et al., 2016; Komasi et al., 2016; Mokhtari et al., 2019;

Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Zemestani & Ottaviani, 2016;

Zemore et al., 2018). One study utilized audio and videotaped therapy sessions to collect data

(Sugarman et al., 2016).

Instrument Design. The majority of the studies utilized preexisting, self-reporting rating

scales as their data collection instrument (Kim et al., 2016; Mokhtari et al., 2019; Moore et al.,

2016; Parthasarathy et al., 2020; Polak et al., 2020; Zemestani & Ottaviani, 2016; Zemore et al.,

2018). One study reported their pre and post intervention questionnaire as their sole data

collection instrument (Komasi et al., 2016) and one study described audio and videotaped

therapy sessions as their instrument (Sugarman et al., 2016).

Validity and Reliability. Validity is the ability for the research instrument to measure

what it is intended to and reliability is the instruments ability to consistently and accurately

measure data within the study (Coughlan et al., 2007). Reliability and validity testing was taken

and discussed for all of the quantitative studies (Kim et al., 2016; Komasi et al., 2016; Mokhtari

et al., 2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al.,

2016; Zemestani & Ottaviani, 2016; Zemore et al., 2018). While the majority of the studies

referenced previous studies on the research topic, only one studied described a specific pilot

study that was undertaken (Sugarman et al., 2016).

Data Analysis and Results. Quasi-experimental and experimental studies use inferential

statistical tests to identify relationship or differences between variables (Coughlin et al., 2007).

All of the studies clearly described the type of statistical analysis that were undertaken including

specific software when applicable. Over 50% of the sample participated in the research study for
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 18

all of the studies. Significance of the research findings were accurately presented for all of the

studies (Kim et al., 2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore et al., 2016;

Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016; Zemestani & Ottaviani,

2016; Zemore et al., 2018).

Discussion/Conclusion/Recommendations. All of the articles featured distinct sections

for conclusions, discussion, and recommendations/implications. The findings of the studies all

linked back to the original literature review and addressed the initial research problem and

phenomenon. The strengths and limitations for all of the studies were discussed and

recommendations for further research was made (Kim et al., 2016; Komasi et al., 2016; Mokhtari

et al., 2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al.,

2016; Zemestani & Ottaviani, 2016; Zemore et al., 2018).

References. All references including books, journals, and other media utilized within the
qualitative research study were accurately referenced (Kim et al., 2016; Komasi et al., 2016;
Mokhtari et al., 2019; Moore et al., 2016; Parthasarathy et al., 2020; Polak et al., 2020; Sugarman
et al., 2016; Zemestani & Ottaviani, 2016; Zemore et al., 2018).
Synthesis of Literature

Each research study utilized for this Scholarly Project focused on the use of

psychotherapy on relapse prevention for substance users. Within the studies, data was collected

using either semi-structured interviews or screening tools. Semi-structured interviews collected

direct subjective data from the participants to formulate results on group therapy interventions

related to the substance use and relapse prevention of participants (Chilton et al., 2019;

Sugarman et al., 2016). Screening tools measured pre and post psychotherapy outcomes of

participants and included specialized addiction surveys, the Addiction Severity Index (ASI),

Trauma Symptom Checklist-40 (TSC-40), Jones Irrational Beliefs Questionnaire, Health Survey

Questionnaire, Teen Well-Check Questionnaire, Quality of Life Inventory (QOLI), Beck

EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 19

Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and the Penn Alcohol Craving

Scale (PACS) (Kim et al., 2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore et al., 2016;

Parthasarathy et al., 2020; Polak et al., 2020; Zemestani & Ottaviani, 2016; Zemore et al., 2018).

Through a thorough synthesis of the literature, several different common themes emerged from

results of the studies including group therapy improving relapse prevention, individual therapy

improving relapse prevention, and longitudinal improvement on relapse prevention (Chilton et

al., 2019; Kim et al., 2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore et al., 2016;

Parthasarathy et al., 2020; Polak et al., 2020; Sugarman et al., 2016; Zemestani & Ottaviani,

2016; Zemore et al., 2018).

Group Therapy Improved Relapse Prevention

Within the research studies utilized in this Scholarly Project, the common theme of

utilizing group therapy as a psychotherapy intervention for relapse prevention was prominent in

several studies (Chilton et al., 2019; Mokhtari et al., 2019; Sugarman et al., 2016; Polak et al.,

2020; Zemore et al., 2018). Interventions provided to the group within these studies included

psychoeducational therapy, 12-step programming, LifeRing, specialized women’s recovery

therapy, and group integrated cognitive behavioral therapy. The studies which utilized group

therapy interventions focused their outcomes and gained results through subjective and objective

measures including readiness to change, quality of life, affiliative statements, addressing

cravings, and increasing the amount of negative urine toxicology screenings.

Intervention Improved Subjective Outcomes

The results of several of the studies that utilized group therapy as an intervention to treat

substance use disorders showed improved subjective measures and outcomes in their participants
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 20

(Chilton et al., 2019; Sugarman et al., 2016). Subjective findings and results showed that

participants reported the group therapy intervention improved their sense of humility and

empathy, feelings of support and belonging, readiness to change, and therapeutic relationship

skills which all assisted them in relapse prevention (Chilton et al., 2019). Participants reported an

increased number of affiliative statements within the group setting following psychotherapy

intervention, which led to increased support, shared experiences, and development of strategies

as a group to prevent relapse (Sugarman et al., 2016).

Intervention Improved Objective Outcomes

The results of several of the studies that utilized group therapy as an intervention to treat

substance use disorders showed improved objective measures and outcomes in their participants

(Mokhtari et al., 2019; Polak et al., 2020; Zemore et al., 2018). Participants who received group

12 step therapy reported improvements on all quality-of-life indicators through standardized

screening tools in compared to the control group who did not receive specialized psychotherapy.

The improvements in these quality-of-life objective findings directly correlated with improved

rates of relapse prevention (Mokhtari et al., 2019). Participants engaged in group therapy

interventions were found to have decreased positive urine toxicology results during treatment

compared to control group, as well as increased QOLI scores, which participants reported led to

aspirations and healthy expectations related to sobriety and worked to prevent relapse (Polak et

al., 2020).

Individual Therapy Improved Relapse Prevention

Within the research studies utilized for this Scholarly Project, the common theme of

individual psychotherapy improving relapse prevention for substance users was prominent in
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 21

several studies (Kim et al., 2016; Komasi et al., 2016; Moore et al., 2016; Parthasarathy et al.,

2020; Zemestani & Ottaviani, 2016). Psychotherapy was provided to individual participants and

included interventions such as solution focused brief therapy, metaphor therapy, cognitive

behavioral therapy, situation, brief intervention, and referral to treatment (SBIRT), and

mindfulness-based relapse prevention (Kim et al., 2016; Komasi et al., 2016; Moore et al., 2016;

Parthasarathy et al., 2020; Zemestani & Ottaviani, 2016). These studies examined subjective and

objective patient outcomes and results to formulate themes including realistic solutions, problem

solving, irrational beliefs related to substance use, and negative urine toxicology screens (Kim et

al., 2016; Komasi et al., 2016; Moore et al., 2016; Parthasarathy et al., 2020; Zemestani &

Ottaviani, 2016).

Intervention Improved Objective Outcomes

The results of the studies that utilized individual therapy as an intervention to treat

substance use disorders showed improved objective measures and outcomes for their participants

(Kim et al., 2016; Komasi et al., 2016; Moore et al., 2016; Parthasarathy et al., 2020; Zemestani

& Ottaviani, 2016). Once individual psychotherapy was completed, participants were found to

have improved ASI and TSC-40 scores in comparison to the control group who did not receive

the intervention. Decreasing the factors that contribute to the severity of their addiction worked

to prevent relapse and to assist in maintaining sobriety (Kim et al., 2016). Participants showed

decreased scores on the Jones Irrational Beliefs Questionnaire following the individual therapy

intervention compared to the control group. A decrease in irrational beliefs related to recovery

including the need of demand for approval, high self-expectation, frustration and reactivity, and

perfectionism worked to decrease rates of relapse in the participants (Komasi et al., 2016).

Participants were found to have decreased weekly negative urines and improved ASI scores
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 22

compared to control group, which proved the success of the individual therapy provided on

relapse prevention (Moore et al., 2016). Participants were found to have decreased BDI, BAI,

and PACS scores after the completed individual therapy compared to the control group. This

decrease in reported cravings, depression, and anxiety was found to be directly related to a

reduction in relapse at the follow up assessment (Zemestani & Ottaviani, 2016).

Intervention Improved Subjective Outcomes

The results of several of the studies that utilized individual therapy as an intervention to

treat substance use disorders showed improved subjective measures and outcomes for their

participants (Kim et al., 2016; Moore et al., 2016). Participants reported that with SFBT as a

form of individual psychotherapy, they were able to form small, concrete goals related to

sobriety which directly decreased their rate of relapse (Kim et al., 2016). Participants reported

that the CBT skills they learned in the individual psychotherapy provided guidance in improving

their mental health and preventing relapse (Moore et al., 2016).

Longitudinal Relapse Prevention

Two of the research studies utilized within this Scholarly Project examined the results of

psychotherapy interventions on relapse prevention over an extended period of time

(Parthasarathy et al., 2020; Zemore et al., 2018). These studies utilized group and individual

psychotherapy interventions focused on preventing relapse for substance users and measured

results directly after the intervention and then over set periods including 6 months, 1 year, and 3

years. These studies showed lower rates of depression and substance use disorders, as well as

improved relapse prevention after the interventions were provided and participants fully

participated in their treatment (Parthasarathy et al., 2020; Zemore et al., 2018).

EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 23

Improved Effect on Mental Health

After SBIRT therapy was provided to adolescent participants, there was found to be

lower rates of depression and mental health diagnoses compared to the control group during the

1-year post intervention screening. This lower rate of depression and mental illness was found to

have a direct correlation to lower rates of substance use disorders within the participants

(Parthasarathy et al., 2020).

Improved Effect on Substance Use

After SBIRT therapy was provided, the 3-year post intervention screening showed a

significant decline in substance use compared to the control group, as well as access to decreased

relapse for participants who did have a substance use disorder (Parthasarathy et al., 2020). When

assessing participants a year after receiving either woman’s focused psychotherapy, LifeRing, or

12 step therapy programming, the rates of relapse declined for all participants who remained

active within the psychotherapy program of their choice (Zemore et al., 2018).

Gaps in the Literature

While researching the current literature related to psychotherapy interventions for relapse

prevention, there were several gaps that presented. One area that lacked sufficient research was

psychotherapy and relapse prevention within specialized populations including adolescents,

geriatrics, and veterans. The majority of the current literature focused their studies on a mix of

races and genders within the adult population. This was useful in providing overall

generalizability on the research topic, however it left a gap in understand the effects of

psychotherapy on relapse prevention for specific groups and populations. Another important gap

within the literature that presented was that there were few studies that directly compared the
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 24

effectiveness of group therapy to individual therapy on relapse prevention. While there were

many studies regarding each form of therapy, there were little that compared effectiveness of the

two. Another gap within the literature that presented was that there were minimal studies that

assessed the longevity of the psychotherapy provided for relapse preventions. Most studies were

conducted over a span of a few weeks to months with no long term follow up on the overall

effect of the therapy on the patient over time. An additional gap within the literature that

presented was that all of the participants in the studies had either healthcare, transportation, or

internet access in order to participate in the studies. Homeless populations without access to care

or technology are at increased risk for substance use and they are a population that should be

studied further for this research topic.

Implications for Further Research

After examining the current research on the topic of this Scholarly Project, it’s apparent

that there is further research that needs to be done to address the gaps present within the

literature. While there was overall sufficient research looking at samples of adult substance users

varying in races and ages, there needs to be further research conducted on specific groups,

including specialized populations and specific ages and ethnicities, to fully understand the effects

of psychotherapy on relapse prevention. Vulnerable populations including adolescent,

transgender, and geriatric populations should be specifically studied to further gain knowledge

on the research topic. Future research must also examine the effects of psychotherapy on larger

populations over longer periods of time to gain accurate and substantial conclusions on the direct

effects of relapse prevention over the course of the illness. While following the participants over

a short period and obtaining promising results on relapse prevention is promising, there needs to

be further long-term assessments conducted to understand the effectiveness of the psychotherapy

EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 25

provided. Another direction for future research on this topic that will be useful in gaining

knowledge is to study the effects on psychotherapy on various types of substance disorders

within the same study. The majority of the studies focused on providing therapy to one specific

type of substance use disorder, such as alcohol use disorder or opiate use disorder. Examining

multiple types of substance addictions within one study and examining the effect of the given

psychotherapy on each will likely provide clear, conclusive results on the therapy’s effectiveness

on relapse prevention.

Implications for Practice

The results of the studies utilized within this Scholarly Project have provided insight and

implications into the practice of a psychiatric provider treating patients with substance use

disorders. Within all of the studies utilizing group therapy as an intervention, participants

showed improved subjective and objective findings related to preventing relapse. Participants of

group therapy reported increased sense of belonging and acceptance to assist in relapse

prevention, an increase in quality-of-life measures leading to hopefulness and sobriety, an

increase in affiliative statements including supportive, positive, and empathetic comments related

to substance use, and shared experience with other group members (Chilton et al., 2019;

Mokhtari et al., 2019; Sugarman et al., 2016; Polak et al., 2020). These findings prove that group

therapy effectively works to provide treatment regarding substance use while also fostering a

social, group therapeutic alliance to prevent relapse. Additional studies using individual therapy

as an intervention found higher adherence to sobriety, decreased depression, anxiety, and

cravings, and decreased substance use diagnoses following psychotherapy interventions

(Parthasarathy et al., 2020; Moore et al., 2016; Zemestani & Ottaviani, 2016). These results

prove that providing individual therapy can decrease rates of depression and anxiety, increase
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 26

motivation, and decrease cravings to prevent relapse. For psychiatric providers, the positive

results of these studies regarding both group and individual therapy decreasing the rates of

relapse can be used to efficiently provide or refer patients to receive group or individual

psychotherapy interventions as a nonpharmacological treatment option to assist in maintaining

sobriety.

Conclusion

Substance use remains a significant issue within the United States, affecting the
physical and mental health of millions of people as well as placing a financial burden on our
healthcare system. Preventing relapse to illicit substances in people facing addiction is crucial in
decreasing this epidemic (Dugosh et al., 2016). Psychotherapy is a nonpharmacological
intervention used to treat substance use disorders and prevent relapse within this population. This
Scholarly Project examined the current literature on psychotherapy as a treatment option for
substance users and compared the effectiveness of both group and individual therapy on relapse
prevention. When examining the studies used for this Scholarly Project, both group and
individual therapy were proven to decrease rates of relapse in a variety of patients. Through the
improvement of subjective findings such as motivation, positivity, and feelings of hopefulness,
as well as improvement of objective findings such as negative urine toxicology results, cravings,
and quality of life measures, patients had an increased ability in maintaining sobriety throughout
the study. Two studies monitored sobriety over an extended period of up to three years, and
psychotherapy showed to improve the rate of preventing relapse and overall mental health for the
participants. Although there were limited studies directly examining the effectiveness of group
therapy in comparison to individual therapy, the current literature proved that both forms of
psychotherapy decreased the rates of relapse within participants (Chilton et al., 2019; Kim et al.,
2016; Komasi et al., 2016; Mokhtari et al., 2019; Moore et al., 2016; Parthasarathy et al., 2020;
Polak et al., 2020; Sugarman et al., 2016; Zemestani & Ottaviani, 2016; Zemore et al., 2018).
EFFECT OF PSYCHOTHERAPY ON RELAPSE PREVENTION 27

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