In the treatment of alcohol and drug abuse disorders and addiction, therapy is one of the most important elements. Therapy helps provide the tools and understanding that a person needs in order to control cravings, manage the mental and emotional issues that may underlie substance abuse, and move forward into long-term recovery from addiction.
Still, people may be concerned about therapy and its effectiveness for addiction treatment. The various types of therapy may be confusing or misunderstood. Some people may not even be sure how to find the therapist who will be most likely to help them reach and maintain recovery.
It is helpful to understand the role of therapy in substance abuse treatment and what to look for in a therapy program or therapist that can best help people manage the symptoms and challenges of addiction. Having this knowledge can make it easier to make the decision to get the treatment needed to recover from addiction.
Overview of Therapy
Therapy is just one factor in substance abuse treatment programs; however, it is the most common treatment element, whether through individual counseling or group therapy.
Therapy provides a number of different tools and support for the person who is struggling with substance abuse: Among its many benefits, therapy helps individuals with:
- Understanding the triggers that cause cravings and result in use of the substance
- Development of tools and strategies to interrupt triggers for use and implement different behaviors
- Exploration of underlying issues, emotions, and behaviors that lead to substance abuse
- Development, practice, and reinforcement of behaviors that can replace drug-seeking behaviors
- Establishment and reinforcement of supportive social and interpersonal structures
- Ongoing evaluation and readjustment of treatment successes to maintain recovery over time
These are just some of the ways that therapy can help people understand and manage their specific addiction issues and move forward into long-term recovery.
Types of Therapy
There are various therapy types that can be implemented to help people learn to manage their addictive disorders. These include individual and group therapies for a variety of needs, as summarized below:
Cognitive Behavioral Therapy
When a person is struggling with addiction, it can help for the person to explore and understand the causes of the behavior. This is the method and approach of Cognitive Behavioral Therapy (CBT). In CBT, an individual might begin to understand that a trigger for cravings is seeing a particular person or dealing with a particular stressor. In CBT, the person learns to recognize triggers and their accompanying thoughts, and interrupt them, inserting a different behavior. This can help the person learn to manage the craving and drug-seeking behavior before they start.
CBT has high levels of success in helping people maintain recovery after treatment. For example, in one study, people in a group who were recovering from benzodiazepine addiction were prescribed a slow tapered dosage of the drug. CBT was also provided during treatment. As a result of CBT, individuals were more likely to complete the taper as directed and avoid relapsing to use of the substance for three months after treatment was over. Interestingly, research has shown that CBT is not only effective during the therapy, but also becomes more effective after treatment has ended.
Based on CBT, trauma-focused CBT includes a person’s history with trauma as part of the therapy. In this case, it focuses on the effects that trauma may have on the person’s decision to use drugs or alcohol.
The person learns to understand how memories of or feelings about the traumatic event may affect triggers and cravings. Along with helping to develop interruptive behaviors, this therapy also helps process the trauma and deal with the issues that the person may have been trying to cover up or dissociate from through drug or alcohol use.
Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) is a method through which people learn to balance the ideas of change and acceptance in their lives. This is a particularly effective therapy for people who have co-occurring disorders – that is, one or more additional mental health disorders alongside the substance abuse disorder.
As an example, people who are struggling with borderline personality disorder often drop out of treatment based on wildly fluctuating moods and self-harm intention. The premise is that through using DBT, a person learns to visualize and work toward particular life goals through changing behavior, rather than having behavior change be the goal in and of itself.
This type of therapy has proven to be particularly successful for people with borderline personality disorder, but it also has an application for other types of co-occurring disorders, like post-traumatic stress disorder and antisocial personality disorder.
For many people with substance abuse disorders or addictions, it can be a challenge to maintain a positive social network. For some, the people they spend time with serve as enablers or triggers to substance abuse. Others may not even have a social support system, and in their despondence or frustration with this, they may use alcohol or drugs as an outlet.
Interpersonal therapy helps these people to build social connections that can assist them in overcoming the depression, loneliness, and other emotional drivers of addictive behaviors that can contribute to their desire to drink or use drugs. Through establishing social networks and activities, these people then have a distraction from their addiction or substance of abuse.
Work with women who are experiencing both alcoholism and major depression demonstrates that interpersonal therapy can help reduce both drinking behaviors and depression symptoms.
Contingency Management Therapy
For some people, the promise of a reward is a great motivator for behavioral change. That is the theory behind Contingency Management Therapy, which gives people vouchers for prizes, gifts, or services for maintaining desirable behaviors such as abstinence.
In some cases, this is shown to be one of the more effective therapies for addiction treatment, because it creates a subconscious connection in the person’s mind that equates the desired behaviors with the joy of rewards. This can form chemical connections in the brain that reinforce these behaviors.
Motivational Interviewing or Motivational Enhancement Therapy
This type of program keeps in contact with the individual at regular intervals for a period of time post-treatment to help support resolve and to remind the person of the goals developed while in treatment. It serves to keep motivation and accountability high.
Community Reinforcement Approach
A combination of interpersonal therapy and Contingency Management Therapy, this modality helps people to find both social support and reward systems to help change their behavior. This kind of therapy works best as a way to help abstain from substance use long enough for the person to learn the new skills needed to maintain sobriety in the long run.
People in this type of program get vouchers but also incorporate other recreation, social activities, and family relationship improvements to help distract from the desire for drugs or alcohol. It seems particularly effective for people who are struggling with alcoholism.
Family or Marital Counseling
Part of building or rebuilding social structures involves the relationships closest to the person. Family and couples therapy for people struggling with addiction can help provide several levels of assistance in addiction recovery. Research has shown that family therapy is one of the most helpful therapy types for addiction recovery.
Providing counseling to the family along with the individual can serve several purposes. These include:
- Educating participants about relationship behaviors or issues that may contribute to addiction behaviors, such as enabling or codependence, and how to change those behaviors
- Helping the family restructure relationships in a way that contributes to recovery and abstinence
- Helping the person see the support structure that the family can provide throughout recovery, adding another source of motivation
Through this type of therapy, people can learn to recognize the ways in which relationships affect and are affected by the addiction or substance abuse. They can then work on building a healthier way of relating with each other and the individual in treatment to prevent the thoughts or situations that may lead to relapse.
Recovery Without Therapy: Can It Be Done?
The most important element of substance abuse treatment is the individual’s willingness to recover. Ultimately, motivation is considered to be the key to changes that enable a person to take control of addiction. For this reason, an extremely motivated person may be able to recover from a substance abuse disorder without therapy.
However, most people struggle with this level of motivation in the face of temptation. This is where therapy can come in – it can help the individual develop and maintain motivation. In addition, therapy helps to discover tools and build strategies to overcome temptation.
There are many psychological factors that can lead to relapse, including
- New or unexpected life stresses
- Association with people who enable the addictive behavior or continue to use the substance
- Subconscious or environmental cues, like smells or locations
- Lack of supportive social structure
Even those who quit using on their own can be subject to these and other stimuli that can cause them to start using again. Because of this, therapy is important during treatment to develop contingency planning tools that help manage these situations. Therapy is also important after treatment to maintain motivation and to develop new tools and strategies as new situations arise.
The Importance of Therapy in Sobriety
It has been demonstrated that therapy can provide a positive reinforcement that helps people maintain sobriety. For example, in one study people in alcohol recovery were provided with a post-treatment program for self-monitoring that allowed them to report their progress through an automated phone call. If part of their reports included relapse or risk of relapse, they were given additional questions to answer. Participants then received personalized therapy feedback.
Not only did abstinence rates rise significantly based on this program, but program participants also stated that the best part of the program for them was the therapist feedback. Their ability to cope and manage their recovery was increased by this treatment.
This emphasizes the importance of therapy in maintaining abstinence. Having motivational support and advice to handle situations as they arise is beneficial in helping to change behaviors and continue using the cognitive tools that have been learned.
Determining the Best Therapy Modality for the Client
Finding the best therapy for a given situation depends on the individual’s specific needs. As demonstrated above under the various therapy types, certain therapies may apply better to certain individuals. For example:
- People struggling with alcoholism and depression may benefit most from interpersonal therapy.
- Someone with a borderline personality disorder and a drug addiction may do better with DBT.
- A military veteran of war with a heroin addiction may benefit from trauma-focused CBT.
The challenge can be to find a therapist who understands the specific needs of the individual who is dealing with addiction and how to meet them. Because no single treatment program is helpful for everyone, it is important to have a therapist and treatment program that is customized to the individual. Therapists who understand the special needs of people who are dealing with addiction are more likely to be able to create these types of treatment programs.
In addition, therapists who work with addiction treatment centers are more likely to have the range of experience that can help them create the right therapy program for each individual. This is enhanced further if the program specializes in co-occurring disorders.
The most recommended drug addiction treatment program is an inpatient, residential treatment program with a full spectrum of treatments, including comprehensive therapy. This often results in the most helpful climate to motivate and support a person trying to recover from addiction.
How to Find a Therapist
One of the most important elements of drug treatment is the rapport that the individual has with the therapist. A good professional treatment relationship with a therapist is a predictor of positive outcomes in treatment.
In order to find a therapist with whom a person has the best rapport and who can also help the person achieve long-term recovery, it’s important to seek someone who has a great deal of experience in providing addiction treatment therapies.
Some ways to approach this may be to call the local or state department of mental health and ask for information on local drug abuse counselors or programs, or to get recommendations from friends who have been through treatment and able to maintain recovery.
Individuals can benefit from seeking help through a research-based, reputable addiction treatment program or rehab center. These organizations provide the most frequently recommended type of initial treatment – comprehensive residential treatment. This type of program sets the right patterns in place during therapy sessions, with experienced professionals on hand 24 hours per day.
Professional addiction treatment programs understand how to customize treatment for specific types of addiction, as well as for co-occurring disorders. The most helpful programs can also recommend therapists outside the program who have the experience to support the person through post-treatment therapy. Sometimes this service is part of the program, and in some instances, aftercare and alumni programs are included as well. With a strong therapy program based on the specific modalities deemed most likely to help the individual reach recovery, these programs can be the best approach to a full-spectrum treatment plan that is most likely to result in long-term positive outcomes.