Addiction Therapy Options

Before Therapy, Understand Addiction

Addiction is a chronic disease in which an individual suffers from compulsive and uncontrollable substance-seeking behaviors despite the physical and psychological harm they may inflict on themselves and others. As the person’s mind and body become used to or dependent on the substance, it’s common for substance use to be entirely out of control.

It’s also important to remember that, while there is a behavioral component to addiction, the substance often affects the addict’s brain function. In addition, the long-term damage of drugs or alcohol can make it harder for the individual to think clearly and make good choices.

Overall, addiction is a disease that affects behavior and brain function.

Addiction Treatment Overview

Addiction treatment exists at both an inpatient and an outpatient level, with varying intensity levels depending on the patient’s individual needs. Inpatient and outpatient treatment facilities provide different therapy options—most commonly a combination of individual and group therapy sessions—as part of their addiction treatment program.

Medical Detox

In many cases, detoxification is one of the first steps of the addiction recovery process. When the body detoxes, it rids itself of the substance it had gotten used to, whether alcohol, prescription drugs, or illicit drugs. Individuals should seek medical guidance when quitting any substance, as some withdrawal symptoms can be life-threatening.

Some rehab centers offer in-house medical detox services, while others will provide patients with a referral to a detox center. In many cases, patients can undergo medical detox safely at home but with the guidance of a doctor or addiction counselor.

Rehab Programs

Generally speaking, there are two main types of addiction rehab programs:

1. Inpatient Treatment
2. Outpatient Treatment

However, various types of therapy can support the recovery process.

Types of Therapy for Addiction Treatment

Many see addiction recovery as mainly focusing on quitting alcohol or drug use. While that’s true, receiving therapy or counseling is vital to success. The National Institute on Drug Abuse recommends that addiction treatment providers include behavioral therapy in every recovering addict’s treatment plan.

Common categories of addiction therapy include:

• Individual Therapy
• Group Therapy
• Family Therapy
• Couples Therapy

Therapy helps recovering addicts identify triggers and work through emotional issues that may have led to addictive behavior. It also supports relapse prevention by providing patients with healthier coping skills and better self-esteem.

Terms like “talk therapy,” “psychotherapy,” and “counseling” are often used interchangeably, but there are notable differences between them. In this section, we’ll detail the different types of therapy used for substance abuse treatment and what each entails.

Individual Therapy

Individual therapy or individual counseling is what most people think of when discussing therapy. Generally, it involves the patient and a licensed therapist in a private, comfortable room where the patient can speak freely and without judgment.

When patients undergo individual drug or alcohol addiction therapy, the licensed therapist will typically spend the first session learning the patient’s general history. During session one, the therapist will usually ask about diagnosed mental health issues, family medical history, past traumas, co-occurring health conditions, and/or history of addiction.

Then, the therapist will use this history to help the patient determine the sources and/or causes of the addictive behavior.

The ultimate goal is to develop a short-term and long-term strategy to avoid addictive behaviors in the future, often finding replacement activities to engage in when cravings or temptations occur.

Group Therapy

As the name suggests, group therapy occurs in a group setting with other patients struggling with addiction. A licensed counselor usually conducts the session, and attendees are encouraged to share their stories and support one another.

Group therapy can be especially powerful for those who feel intimidated by a one-on-one session or want to meet other people with similar struggles. Counselors will ask each patient to introduce themselves to the group and engage in activities to break the ice, share their experiences, and ultimately feel a sense of unity with others in a safe, supportive environment.

Family Therapy

Addiction often negatively impacts family members, leading to resentment and uncertainty. When a family is at odds with one another, unproductive arguments can break out. But when a counselor participates in the conversation, they can provide an objective perspective and ensure each person has a chance to express themselves.

Calm, compassionate discussion can help the addict, and their family members better understand each other’s pain so they can find a path forward. Family therapy aims to create a comfortable setting for all parties, allowing their concerns to be heard and developing a strategy to help the addict feel supported and held accountable.

Couples Therapy

When someone struggles with addiction, their partner often gets caught in the crossfire. Just as family therapy can create an environment where all parties can be acknowledged and heard, couples therapy can provide the same benefits.

Working with a licensed counselor can ensure that discussions with your partner are productive and help both parties find an achievable and sustainable treatment strategy. Couples therapy can also help strengthen your relationship and/or marriage.

Psychotherapy

Psychotherapy focuses on more long-term treatment, and psychotherapists generally require more training. Psychotherapy aims to address the root cause of the patient’s issues, diving deeper than a general counseling session.

A key difference between psychotherapists and counselors is that psychotherapists can provide counseling, but not all counselors have the training to provide psychotherapy.

Psychotherapy can be highly effective in treating addiction because, generally speaking, addiction is often rooted deeply in the addict’s behavior and requires intensive strategies to address. Addiction is a disease and, therefore, can require a more targeted approach to treatment and long-term success.

The types of psychotherapy can be varied, but the most common types include:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Rational Emotive Behavior Therapy (REBT)
• Motivational Interviewing

Cognitive Behavioral Therapy (CBT)

When people think of therapy in general, they often picture Cognitive Behavioral Therapy (CBT). CBT is the more common treatment prescribed to those suffering from mental illnesses and addiction. CBT is conducted one-on-one with a licensed mental health care provider and can occur weekly, biweekly, or monthly.

The ultimate aim of CBT is for the patient to become more aware of negative thought patterns. Patients then learn how to view and respond more effectively to challenging situations to avoid self-destructive behavior in the future.

CBT can assist with:

• Managing and redirecting cravings
• Preventing relapse
• Learning coping techniques for stressful life situations
• Identifying ways to manage intense emotions
• Resolving relationship conflicts
• Learning better ways to communicate

Dialectical Behavioral Therapy (DBT)

While CBT focuses on being aware of your thought patterns and behavior, Dialectical Behavioral Therapy (DBT) is a cognitive therapy more targeted at balancing intense emotions and avoiding conflict in relationships.

Originally developed to treat Borderline Personality Disorder, DBT has also proven effective for addiction and substance use disorder. However, DBT shines in its ability to help patients find balance and avoid black-and-white or all-or-nothing thinking.

DBT can assist with:

• Improving the ability to regulate emotions
• Tolerating distress and negative emotions
• Finding balance in opposite perspectives instead of black-and-white thinking
• Communicating effectively with others
• Feeling more present and less lost in emotions

Rational Emotive Behavior Therapy (REBT)

Rational Emotive Behavior Therapy (REBT) is a method that focuses on self-defeating thoughts and feelings by challenging the rationality of those feelings. REBT can be very effective for patients more responsive to rational or analytical processes.

The strategy with REBT is to identify these self-defeating thoughts and feelings, challenge their validity, and replace them with healthier, more productive beliefs.

Where CBT focuses on how thought patterns affect behavior and DBT focuses on balancing intense, oppositional emotions, REBT challenges patients’ beliefs about themselves.

REBT can assist with:

• Identifying and replacing self-defeating, negative beliefs and feelings
• Avoiding self-destructive and irrational behaviors
• Improving self-esteem and self-regard
• Letting go of negative thoughts
• Learning to accept yourself and others

Motivational Interviewing

Some recovering addicts find themselves struggling with motivation and may need some guidance to prepare for this significant lifestyle change. Motivational Interviewing is a type of short-term therapy that usually lasts 1-2 sessions.

The therapist will interview the patient about their current state of mind and then help the patient work through their resistance toward the changes they ultimately want to make in their life.

Motivational Interviewing can assist with:

• Moving past feelings of resistance toward sobriety
• Identifying one’s inherent motivations
• Working through feelings of resentment or anger
• Instilling self-confidence
• Discovering discrepancies between goals and current behavior

Other Types of Therapy for Treating Addiction

Aside from the three psychotherapy approaches previously discussed, a few other techniques have proved effective for addiction. These methods can be combined with many different options as a supplement or used on their own to treat substance and alcohol use disorder.

Contingency Management

Contingency Management (CM) uses the power of tangible rewards to encourage and reinforce positive behaviors, making these methods a great supplement to psychotherapy. This methodology features two leading practices: Voucher-Based Reinforcement (VBR) and Prize Incentives Contingency Management.

Voucher-Based Reinforcement (VBR)

Voucher-Based Reinforcement (VBR) often works well for addicts that struggle with opioid or stimulant abuse (such as cocaine or methamphetamine). VBR works by awarding the patient a voucher for every drug-free sample provided. Patients can exchange vouchers for food, movie tickets, or other goods and services consistent with a substance-free lifestyle.

These vouchers are initially low in value, only increasing when the number of drug-free samples increases. If a sample returns positive for substances, the voucher value is reset to the lowest value, thus encouraging the patient to continue abstaining from higher value vouchers.

Prize Incentives Contingency Management

Prize Incentives Contingency Management operates similarly, using cash prizes instead of vouchers. During Prize Incentives Contingency Management, patients with drug-free samples can draw from a bowl to win prizes worth between $1 and $100.

Patients can also earn drawings by completing other tasks like attending therapy sessions and meeting specific goals. The number of times a patient can draw begins at one and will increase with each consecutive negative drug test. Should a patient test positive, the number of draws will reset to one.

12-Step Programs

Due to its popularity, many people have heard of 12-step programs before. Standard 12-step programs include Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

These programs can be very effective, especially for those who lean more religious or spiritual, as many 12-step programs mention God or reference a higher power. However, some agnostic or atheist addicts may avoid 12-step programs despite them technically being secular programs.

While some programs may be explicitly religious (usually Christian), many other programs are more secular and do not require the addict to be religious or spiritual to participate.

12-step programs operate off three key ideas:

• Acceptance: understanding and accepting that addiction is a chronic disease one cannot control, that willpower alone cannot stop it, and that abstinence is the only solution.
• Surrender: giving oneself to a higher power, joining the fellowship and support structure, and following the 12 steps to recovery.
• Active Involvement: regularly participating in 12-step meetings and activities

Alcoholics Anonymous is the first program to use the 12-step method, but many mutual aid programs have adopted the 12-step structure for other addictions. These 12-step programs often include a sponsorship option, where a successful group member who has reached long-term recovery mentors someone just starting the program.

Eye Movement Desensitization and Reprocessing (EMDR)

Developed to address trauma in those with Post-Traumatic Stress Disorder (PTSD), Eye Movement Desensitization and Reprocessing (EMDR) has been very effective for substance use disorder. EMDR is a psychotherapy that enables the patient to heal from the emotional distress and symptoms experienced due to a disturbing life experience or trauma.

The medical community has established a link between addiction and trauma, as many often self-medicate to cope with trauma or experience trauma resulting from substance abuse. According to the National Institutes of Mental Health, up to 59% of young people with PTSD develop substance abuse problems.

EMDR works by desensitizing the patient to triggers and allowing the mind to heal from unprocessed trauma memories. There are eight phases in the treatment process, and a licensed therapist guides the patient through the process.

The eight phases include:

• Phase 1: History and planning. The therapist gathers current symptoms and triggers, past triggers, and unwanted behaviors.
• Phase 2: Preparation. The therapist focuses on building trust between patient and therapist, discussing EMDR fundamentals, and explaining the course of treatment.
• Phase 3: Assessment. The therapist establishes targets based on Phase 1 and develops positive statements to counter the negative beliefs caused by trauma.
• Phase 4: Desensitization. The therapist instructs the patient to shift their eye movement to follow the therapist’s hand while the patient recalls disturbing images, feelings, thoughts, and/or physical sensations. The therapist repeats this process until the patient reports less severe reactions to the upsetting content.
• Phase 5: Installation. With strong emotional reactions tempered, the patient focuses on the positive statement from Phase 3 while following the therapist’s hand and applying instructions like in Phase 4.
• Phase 6: Body scan. The patient reports if any adverse reactions remain from Phases 4 and 5; if so, the therapist repeats the process.
• Phase 7: Closure. The therapist leads the patient through relaxing and calming exercises and informs the patient of what to expect between sessions while processing the trauma.
• Phase 8: Reevaluation. At the beginning of the next session, the therapist will ensure the positive results from Phase 6 have continued. Once all issues have been addressed, treatment will end.

EMDR can help those struggling with addiction heal from trauma and avoid relapse in the future. In addition, as EMDR desensitizes patients to triggers, many people find they can more easily combat temptation should they encounter a trigger.

Find Addiction Therapy Options Near You

If you or someone you love is ready to get help with addiction, the good news is there are many great resources and treatment centers available to help. While searching online can be a great place to start, it’s easy to get overwhelmed with the sheer amount of search results.

Luckily there are great tools like the Substance Abuse and Mental Health Services Administration (SAMHSA) online treatment locator at https://findtreatment.gov.

You can also reach out to your general physician or your local health department to see what treatment facilities and support groups are available in your area. If transportation is an issue, many community-based programs can assist with the logistics of attending meetings and counseling sessions.