Ben is a social worker in a Veterans Administration Community-based Outpatient Clinic (CBOC) where he is in an alcohol/drug treatment program. For the past 13 weeks, he has conducted a group with nine veterans focused on helping them to remain sober after attendance at an inpatient or outpatient patient rehabilitation program. In an effort to promote group cohesion, the membership of the group is closed for a four month cycle so that no new members are added during this period. The focus of the program is to identify triggers to substance abuse, explore and deal with the issues that lead to substance abuse, and to develop the social supports needed to help them sustain abstinence. The group is very mixed in terms of ages and ethnicity. Two of the men are African American, one is Asian, and three are Latino. Three of the men are gulf war veterans and one is a veteran who was deployed in Afghanistan. The others are Vietnam veterans except for one who had not been deployed overseas. Despite their common veteran status the start of the group was difficult because most were resistant or reluctant to discuss their feelings. Many of the men had learned in their lives, and in the service, that "real men" did not discuss their feelings in front of others, and that to do so was a sign of weakness. In addition, ethnicity played a part. The Asian American, for example, learned from his family of origin and culture that to discuss one's problems was to bring shame onto the family. Similarly, "machismo" affected the Latino members' willingness to disclose. During the early sessions of the group, Ben did a good job of addressing these issues. He acknowledged members' reluctance to share because of family of origin issues and the "manlymen" culture of military service. He recognized that some of the men would prefer to be action oriented. He focused on behavioral change, and validated discussion of affect when members of the group brought them up. Over time, the men became comfortable with each other and began to discuss their feelings as well as their thoughts and behaviors in more intimate detail. During week 13, three weeks before the group was to end, Ben brought up the topic of termination. He mentioned that veterans often experience abrupt terminations, such as leaving a combat unit abruptly after months of working closely together. Realizing that the men may be reluctant to explore these feelings about ending the group as it was currently constituted, he asked them to spend a few minutes writing about how they typically leave situations. He told the group that it was his pattern to minimize endings, stating that he would casually tell others that he would "see them later." He let them know that he had to work hard to not minimize endings, because this was his natural pattern. After the group members wrote for about ten minutes, he asked them to share what they wrote in dyads. After the men talked in dyads, he asked them to share with the group as a whole what they discussed, if they were comfortable doing so. During this discussion he helped the men to identify ways that they could continue to support each other and get support for themselves from resources in the community.

Discussion the following questions:

1)What skills did the group leader exhibit?

2)What was the most effective intervention?

3)What would you have done differently?

4)What would be some intervention options during the remaining two meetings?

5)What special considerations are there for veterans?

6)What special considerations are there for members who have a history of alcohol and substance abuse and how would you address these issues during the ending stage of the group?

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