Experiential Addiction Treatment: Creating Positive Connection through Sociometry and Therapeutic Spiral Model Safety Structures

By Scott Giacomucci, MSS, LCSW, CTTS, CET III, TSI AL

Many argue that addiction is preceded by a sense of psychosocial dislocation, experiences of relational trauma, attachment ruptures, or neglect. The lived experience of drug addiction is incredibly isolat- ing and likely to disrupt relationships with one’s closest attachmentgures. Most agree that one’s social experiences-relationships, fam-ily, groups, and community-signi cantly impact the chances of recov- ery after addiction. Sociometry, the study of groups and interperson- al dynamics within groups, is uniquely effective in providing clients with corrective relational experiences in addiction treatment groups. This article outlines multiple experiential sociometry tools that hold the potential to cultivate safety, explore similarities between group members, establish group cohesion, and assess the group based on chosen criteria. These action-based sociometric processes, in addition to two safety structures from the Therapeutic Spiral Mod- el (TSM) of psychodrama, are outlined with facilitation guidelines and clinical vignettes depicting their utilization at Mirmont Treatment Center. These strength-based group structures can be adapted with different criteria, different populations, and used in any type of group setting.

Keywords: Addiction; Group therapy; Isolation; Sociometry; Thera- peutic spiral model; Trauma


Addiction is a complex mental health issue in uenced by multiplefactors, including (epi) genetics, trauma, loss, alienation, consumer- ism, and multiple societal forces [1-3]. An addiction treatment centeris uniquely positioned to target the factors of clients’ experiences, re- lational trauma, loss, and isolation. The social nature of a treatmentcenter’s community provides a response to the isolation that so often characterizes substance use disorder and other co-occurring mental health issues such as depression and anxiety.

Many have highlighted isolation is one of the primary causes or underlying factors of drug addiction [1,2,4]. Alexander [1], arguesthat addiction is an adaptation to social dislocation-“It is a functionalway of responding to and dealing with dislocation. It is even a creativeresponse that, for a while, can reduce the pain of dislocation”. Alex-ander [1], describes dislocation as the loss of, or failure to achieve psychosocial integration-or a healthy interdependence between self, family, groups, and society. Recent neuroscience research has shown that physical and social pain look identical in the brain [5], which sup-ports what drug users already know-opiates (and other drugs) work to reduce both types of pain [6]. From an evolutionary perspective, sep-aration from the social group (family, tribe, community, etc.,) meant certain death-“this is why forced dislocation, in the form of ostracism, excommunication, exile, and solitary con nement, has been a dread-ed punishment from ancient times until the present” [1]. From birth, human beings are dependent on relationships with their caregivers longer than any other living creature [7]. As an individual progress through the stages of psychosocial development, one is sorting out their place in society and develops interdependence within multiple subgroups of society (family, neighborhood, classroom, sports team, workplace, etc.,) [1,8]. This interdependence between individual, sub-groups, and society has been called psychosocial integration [1]. In healthy development, psychosocial integration lends itself to a sense of belonging, community, and individual identity or ego strength.

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