Intervention Study of Group Counseling for Meaning in Life on Relapse Tendency of Drug Addicts

In order to understand the intervention effect of the meaning in life group psychological counseling on the relapse tendency of drug addicts, "Chinese Meaning in Life Questionnaire", "Source of Meaning in Life Scale", "Scale of Perceived Social Support", "Relapse Tendency Questionnaire" and "Therapeutic Factor Questionnaire for Group Psychotherapy" were used as measurement tools. A group psychological counseling intervention study was carried out on 24 drug addicts (12 in the experimental group and 12 in the control group)The results showed that: (1) Group counseling integrated with the meaning in life content can significantly improve the sense of life meaning and social support of drug addicts, and reduce their relapse tendency, but the long-term effect is insufficient.(2) The key therapeutic factors in this group psychotherapy are, in order of importance, emotional catharsis, family situation reproduction, existence awareness factor, interpersonal learning, interpersonal learning acquisition, hope reconstruction, group cohesion and self-understanding.


Introduction
Relapse is considered to be the behavior of drug addicts (drug dependents) who re-use the drugs or other drugs they were dependent on before detoxification for various reasons after successful detoxification treatment [1]. In recent years, with the increasing attention paid to the drug problem and the increase in related research from all walks of life, scholars have realized that it is not difficult to detoxify physiologically and overcome withdrawal reactions, but it has not been able to solve the problem of relapse well. Studies have shown that the six-month relapse rate of drug addicts leaving the center is 93.31% [2]. Therefore, preventing relapse and reducing the high relapse rate are the keys to detoxification work. Finding the main reasons that lead to relapse and exploring effective preventive measures are the fundamental ways to improve the success rate of drug rehabilitation, and it is also an important task for drug rehabilitation. Relapse behavior is thought to be the result of a combination of psychological, social, and biological effects. It found that the psychological factor played the most prominent role, and 46.8% of drug abstainers relapsed because of strong addiction, anxiety and emptiness [3].
Meaning-in-life is an individual's perception of the purpose and value of their existence, which refers to "the degree to which people comprehend, understand, or see the meaning of their lives, along with the degree to which they become aware of their purpose, mission, and primary purpose in life", including having a sense of meaning and seeking meaning [4]. Among them, having a sense of meaning refers to the degree to which an individual feels whether his life is meaningful (emphasis on the outcome), while the sense of meaningseeking refers to the degree of an individual's active search for meaning (emphasis on the process). The meaning-in-life originates from the life events in which the individual acquires meaning in the life experience, the experience of the individual's past learning and the way of life now, and it varies from culture to culture.
Research has confirmed that the feeling of meaning in life is closely related to the positivity of psychological functions; the lack of meaning in life is highly related to some mental diseases, such as meaninglessness is an important symptom of chronic alcoholism, low self-esteem, depression, selfidentity crisis and other diseases, and when the individual feels that life is meaningful, it will enhance the individual's positive emotions, happiness, life satisfaction and hope [5]. Compared with people without suicidal thoughts, people with suicidal thoughts often cannot find the meaning of their "existence". In short, the lack of meaning in life is an important cause of psychopathological problems. Frankel believes that people fill this void with drugs, and that substance addiction is a direct consequence of a sense of meaninglessness in one's life. Many drug addicts in Thompson's (2012) study have families, social circles, good jobs and material conditions, but their subjective feelings are still emptiness, anger, depression and loneliness [6], which is exactly symptoms of existential emptiness that Frankel mentioned. Studies have supported that drug addiction is related to the lack of reason for existence or meaning-in-life [7]. It can be seen that only achieving temporary withdrawal success is not the end of drug treatment and real recovery.
Helping drug abstainers to find the direction and meaning in life in the future is the real value of drug treatment, and it is also the key to lasting efficacy. The purpose of this study was to investigate the intervention effect of group psychological counseling for the meaning in life on the relapse tendency of drug addicts, and to make efforts to reduce the relapse tendency of compulsory isolation drug addicts.

Object
In this study, 150 drug addicts from the second brigade of Shaoguan Compulsory Isolation Drug Rehabilitation Center were selected for questionnaire survey, illiterate persons were excluded, and 144 valid questionnaires were obtained. According to the score of sense of meaning in life(Individuals with a meaning of life score below 51 are considered to have no clear meaning in life).At the same time, combined with the voluntary principle, 40 subjects were selected to enter the second round of the questionnaire survey as the pre-test of the group intervention study. Afterwards, subjects who were unable to participate in the group intervention and post-test investigation due to objective reasons were excluded. According to the scores of each scale, 12 subjects in each of the experimental group and the control group with no significant difference in the scores of each scale were formed.

Pre-test Tool
Chinese The scale contains 30 items and 5 dimensions, namely concern for society, self-growth, relationship harmony, life enjoyment, and physical and mental health. The a-coefficient of the total scale is 0.94, the split-half reliability coefficient is 0.89, and the test-retest reliability coefficient is 0.84. Testretest reliability coefficients ranged from 0.78 to 0.86 [10].
Perceived Social Support Scale (PSSS). The Perceived Social Support Scale (PSSS) developed by Zimet et al. separately measures the perceived level of support from various sources of social support such as family, friends and others. At the same time, the total score reflects the overall degree of social support felt by individuals. The PSSS contains 12 items, and each item adopts a seven-level scoring method, namely, strongly disagree, strongly disagree, slightly disagree, neutral, slightly agree, strongly agree, and strongly agree. The a coefficient of the full scale was 0.88, and the testretest reliability was 0.85 [11].
Relapse Tendency Questionnaire. In the "Relapse Tendency Questionnaire" compiled by Geng Wenxiu, the subscale of drug addiction willingness measures the subjective relapse tendency of drug abstainers. The total score ranges from 0 to 55. The lower the total score, the lower the relapse tendency, and the higher the total score, the higher the relapse tendency. The a coefficient is 0.86 [12].

Post-test Tool
The post-test tool was the same as the pre-test tool, and the "Group Psychotherapy Curative Factor Questionnaire" was added to the experimental group. The therapeutic efficacy factor questionnaire for group psychotherapy was compiled and revised by Yalom et al. It contains 60 items and 12 subscales, corresponding to 12 therapeutic efficacy factors. The results of factor analysis of the questionnaire are stable and have good reliability and validity. The α coefficient of the Chinese version is between 0.65 and 0.81, and the test-retest reliability after one week is between 0.87 and 0.98, with good convergent and discriminant validity [13].

Research Process
The experimental group participated in group psychological counseling, while the control group did not participate in group psychological counseling, and maintained the routine educational activities in the drug rehabilitation center.
After the group psychological counseling, a postquestionnaire test was conducted on the experimental group and the control group to test the effect of group psychological counseling.

Group Counseling Program
The group activity plan revolves around improving the meaning of life of drug addicts, consisting of 8 units: knowing you and me and the meaning of life, lack and filling, suffering and understanding, significant others, value and recognition, career and growth, death and regret, future and commitment.1-2 times a week, 2.5 hours each time, a total of 9 activities. The suffering and understanding unit consists of two activities. Based on the literature review in this paper, substance addiction is a direct result of personal sense of meaninglessness in life. Frankel believes that people can gain a sense of meaning in life in three ways, namely the creation of value, the experience of love, and the meaning of suffering. Creating value is considered to be the contribution of individuals to the normal functioning of society through their daily work and creation, thus embodying their value creation. The value of experience means that individuals can feel the meaning and value of life by experiencing the beautiful things in life, someone, experiencing love, etc. The meaning of suffering means that people can find the meaning of life from misfortune, because people have the potential to obtain the meaning of life in suffering [14].
The study found that the dimension of social concern and the level of meaning in life are important factors affecting the relapse tendency of drug addicts. Therefore, the group activity plan will focus on improving the level of meaning in life. Because the social concern about this dimension involves a wide range of content, it may not be conducive to the focus of the group's sense of meaning in life, so it will not be included in this group activity for the time being. In addition, through the hierarchical regression analysis on the meaning of life of drug addicts, this paper found that the source dimension of self-growth is an important factor that positively affects the sense of meaning of life of drug addicts, so the content of selfgrowth is integrated into the group activity plan. This research will use the above basic theories of meaning in life, value creation, experience of love, meaning of suffering, and the source of meaning of life to self-growth to improve addicts' sense of meaning in life, thereby improving their relapse tendency.

Results
In this study, spss23.0 was used for data analysis, and the statistical method of t-test was mainly used.

Differences in the Scores of Each Scale Between the Experimental Group and the Control Group Before and After the Intervention
As shown in Table 2, there was no significant difference between the experimental group and the control group in the scores of sense of meaning in life, social support, source of meaning in life and relapse tendency before intervention. After the intervention, the scores of life meaning and social support in the experimental group were significantly higher than those in the control group, and the scores of relapse tendency in the experimental group were significantly lower than those in the control group. The meaning of life score in the experimental group improved, but failed to reach a significant level.

Differences in the Scores of Each Scale Between the Experimental Group and the Control Group After One Month of Intervention
One month after the group psychological counseling, a follow-up test was conducted on the experimental group and the control group. The results are shown in Table 2. The meaning of life and social support in the experimental group were significantly higher than those in the control group. The relapse tendency of the experimental group was still significantly lower than that of the control group, and the score of the source of meaning of life in the experimental group was higher than that of the control group, but all failed to reach a significant level.

The Effect of Group Psychological Counseling in the Experimental Group
After 5 weeks of group treatment, the scores of each treatment factor were obtained from the group treatment efficacy factor questionnaire filled out by members of the experimental group. The specific statistical descriptions are shown in Table3.

Design of Group Counseling Programs
The group assistance program in this study involves the basic theory of life meaning, the creation of value, the experience of love, the meaning of suffering and self-growth to improve the meaning of life of drug addicts, thereby reducing their relapse tendency. One of the three ways Frankl proposes to gain a sense of meaning in life is to understand the meaning of suffering. The meaning of suffering means that people can find meaning in life from misfortune, because people have the potential to obtain meaning in suffering.
Frankel came to the insight through his own personal experience. Since the external environment cannot be changed, we can still choose our own attitude. By changing ourselves, we can use spiritual power to discover the meaning of life in pain and face up to the difficulties. and painful ways to experience and give meaning to life [13]. Therefore, in the unit of suffering and understanding, group members are asked to think about the pain they have experienced in their past lives and the growth brought about by these pain experiences, in order to stop being immersed in the pain of the past and understand the pain brought by the pain. Your own meaning grows from it.
Frankel learned from his own experience that the external environment is something we cannot change, but we can still choose our own attitude, by changing ourselves and using spiritual power to discover the meaning of life in the pain, so as to experience and give the meaning of life in a way that faces difficulties and pain [13]. Therefore, in the unit of suffering and understanding, group members are asked to think about the pain they have experienced in the past, and to understand the meaning of the pain, so that they can no longer be immersed in it and grow from it.

Discussion on the Efficacy of the Group Counseling Program
Group counseling that incorporates meaning of life content can significantly improve the meaning of life and social support of drug addicts, and reduce their tendency to relapse. However, the long-term effect was insufficient. After one month, the relapse tendency of the experimental group was still lower than that of the control group, but it failed to reach a significant level. Members said that the time of this group activity was too short, and the handling of many issues was not in-depth enough. At the same time, the reasons for drug addiction and relapse are very complicated. This group support is mainly to enhance the sense of meaning in life, which may not have a long-term impact. In addition, there are also individual differences, which makes it difficult for individuals to be violent. These are the reasons for the initial success of this group support but the lack of after-effects.

Therapeutic Factors of Group Psychotherapy and Its Mechanism of Action
The key therapeutic factors in this group psychotherapy are, in order of importance, emotional catharsis, family situation reproduction, existence awareness, interpersonal learning, interpersonal learning acquisition, hope remodeling, group cohesion and self-understanding.

Emotional Catharsis and Group Cohesion
The group provides members with a safe space to vent their emotions, with members saying "participating in group activities has taught me to pour my heart out". By expressing empathy and concern, counselors and group members gave members a sense of acceptance and support. Members said that they "learn to share with others, learn to talk, and communicate authenticall". On the other hand, the catharsis process itself can relieve the anxiety of the group members, and the members said, "It has greatly relaxed my body and mind". In addition, emotional catharsis can further promote the development of group cohesion, and members are willing to invest, accept, and support the entire group and other members."I began to accept others, and I can listen carefully to other people's opinions". Therefore, emotional catharsis and group cohesion, as important therapeutic factors, played a key role in this group, and also promoted the smooth development of the group program.

Reappearance of Family Situations
The results show that this group counseling can significantly improve the social support of drug addicts, and the effect is still significant after one month. People's thoughts, emotions, and behaviors are all influenced by their family's growth experience. They can reproduce the individual's performance and feelings in the original family experience in the group, so as to achieve the purpose of treatment. According to the results of this study, relationship harmony is considered to be the most important source of life meaning for drug addicts. Frank believes that individuals can feel the meaning and value of life by experiencing the good things in life, someone, experiencing love and so on. Therefore, set up a unit of important others in the group to guide members to think about the most important person in life. At the same time, through the reenactment of the situation, you can tell your heartfelt words to important others, untangle the knot, and reunderstand the concern of family members and friends for yourself, so as to improve the members' sense of life meaning.

Existential Awareness Factor
The existential factor prompts members to think about the ultimate meaning of existence in the group: death, loneliness, freedom, and nothingness. This is the most important therapeutic factor that acts as a group supplement for the meaning of life theme. It helps individuals realize the finitude and infinity of their own lives, face up to the destination of their lives, learn to take their own responsibilities, and live creatively and meaningfully. Therefore, the unit of knowing you, me, him and the meaning of life is set up in the group support to guide members to think about the meaning of their own existence, and to discuss whether they have thought about the meaning of their own life before, and do they know why they live? The members said, "I started to seriously think about the meaning of my life and how to face the future life.", "I am no longer confused about the future", "I learned to think and have a clear goal for my future life." Consider the reasons for drug use through this unit of missing and filling, and discover the relationship between missing and drug use. Introduce the unit of suffering and understanding, and ask the group members to think about the pain they have experienced in their past lives and the growth brought about by the pain experience. The members said, "The biggest gain is that I found the meaning of my life and shared my pain and growth with other students." In the unit of death and regret, members are guided to face the limitation of life, inspire them to cherish life and make up for regrets. The members said, "I'm no longer depressed and inferior," and "do what I should do and live a meaningful life." The results show that this group counseling can significantly improve the meaning of life of drug addicts, and the effect is still significant after one month, which is the effect of the existence of awareness treatment factors.

Interpersonal Learning and Interpersonal
Learning Acquisition Knowing one's own interpersonal communication mode through interpersonal interaction between groups, and using the group as a social microcosm to practice and improve one's interpersonal communication skills and ability to solve interpersonal problems, is also a therapeutic factor to improve the sense of social support. The members said, "I will do some empathy.", "I feel that my heart is a little open now, and I am willing to communicate with people, no longer autistic and depressed.", "Have a positive and optimistic mood, encourage yourself often, communicate with people more, and repay your family with a grateful heart."

Hope to Reshape
The hope is not only to keep patients able to continue treatment, but also to inspire other therapeutic factors to play a role, and that patients' confidence in treatment itself has a therapeutic effect. Through the unit of Future and Commitment, you will be inspired to pursue your dreams and constantly evolve towards your ideal self. The members said, "I look forward to the future, there are many things I want to do, and I am no longer confused about the future", "I have more confidence in myself and find my life purpose." 4.3.6. Self-understanding Understanding and understanding of oneself is the basis and premise of change. Discover one's own value through the unit of value and recognition, improve self-acceptance, compare the difference in value before and after drug use, enhance self-understanding and insight, and stimulate the desire for change. The members said, "I began to reflect on myself and realized that there were problems in myself, cognitive biases, depression in my personality, and poor communication skills." Through the career and growth unit, think about a career that suits your characteristics and plan your future. The members said, "I found my future life direction".

Conclusion
After research, the following conclusions can be drawn: 5.1 Group counseling incorporating the meaning of life content can significantly enhance the sense of meaning of life and social support for drug addicts, and reduce their tendency to relapse, but the long-term effect is insufficient.

5.2
The key therapeutic factors in this group psychotherapy are, in order of importance, emotional catharsis, family situation reproduction, existence awareness factor, interpersonal learning, interpersonal learning acquisition, hope reshaping, group cohesion and self-understanding.