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Guide to Therapy in Addiction

therapy in addiction

If addiction is a complicated issue – with a plethora of cause-and-effect dynamics that cover everything from genetics to mental health to socioeconomic risk factors – the same can certainly be said for therapy in addiction.

In general, a successful strategy for therapy is one that covers every possible cause or condition contributingto the issue at hand. A one-size-fits-all approach is doomed to fail in most cases. There are many popular types of therapy offered today, as we shall see.

The Importance of Therapy in Addiction

drug userThere is a lot more to therapy than merely serving as a follow-up step to detoxification. It is an integral part of a well-conceived program for treating the whole person. The National Institute on Drug Abuse puts it quite bluntly: treatment without therapy is not treatment.

Likewise, addiction involves much more than the obvious physical symptoms and issues. There is a psychological aspect – possibly even multiple mental factors –at play. What is gleaned by a quality therapist helps to explain why the patient started abusing drugs or alcohol in the first place.

Far beyond the initial detox phase is a journey that brings healing and recovery. Addressing existing perceptions and thought patterns is a necessary part of all that.New positive constructs must be formed and practiced if true and lasting success is to be achieved with addiction, as well as any other self-destructive behaviors.1

What Does It Mean to Have an Addiction?

To better understand how various therapeutic approaches work, it’s important to clearly state what is meant by this complex condition called “addiction.” Addiction describes a condition in which users lack the ability to stop using a habit-forming substance on their own.

Those who abuse drugs or alcohol may still be able to walk away from those substances if circumstances require it. Getting a DUI might necessitate it. The spouse may give an ultimatum. Maybe the boss at work demands it. Whatever it is, a life change must occur in order for something highly valued to be kept. This can spur users into desperate action.

Then the real work begins. The body and mind must be weaned from the powerful effects of that substance. While the detox phase of treatment takes care of the physical drug craving, therapy is also vital. It helps users face and overcome the mental element of addiction and other underlying issues.2

Let’s take a look at a few of the most commonly used forms of therapy available today.

Cognitive Behavioral Therapy

problematic_behaviorCBT therapy helps addicts understand the system of thoughts and behaviors that leads them to abuse dangerous substances. Overwhelming problems are broken down into smaller parts. This makes it easier to see how they are connected and how they affect the user. Once a therapist helps the person see existing negative patterns, it is then possible to use that knowledge to start practicing healthier and more productive ways of thinking and acting.It’s a life “reset.”

This type of therapy outlines for patient’s how five distinct parts can create a cycle:

  • The situation
  • Thoughts
  • Emotions
  • Physical feelings
  • Actions

The “situation” is the specific circumstance that brings about a negative response. And the cycle begins. Examining the process in terms of the thoughts, emotions, physical feelings and actions is a way the therapist can help the person see how and why the chain reaction works against him.3

CBT is designed to anticipate the problems an addict will face when trying to function in the everyday world without the use of substances to cope. This includes handling those times when it is most tempting for the person to use or drink. Simply telling a patient to exercise more self-control doesn’t help. Instead, specific coping strategies and skills are practiced in an effort to conquer the cravings that will come. Learning that the power exists to say no to bad urges is key.

CBT is widely endorsed by many experts in the medical community. In one study involving cocaine users, 60 percent of patients receiving CBT as part of their program stayed drug-free for a full year after completion of formal treatment.1

Dialectical Behavioral Therapy

one on one therapy sessionDBT is about the psychosocial aspects (the relationship between social factors and individual behavior and thought) of the patient’s life, especially as they pertain to substance abuse and how the abuse has affected the world around them.4

Addicts often react impulsively and harmfully to other people or situations. This tendency may come from any number of risk factors. These factors contribute to the likelihood of an addiction. The Mayo Clinic includes this list of suspects to promoting addiction:

  • Family history
  • Gender
  • Age
  • Lifestyle
  • Mental health status
  • Socioeconomic disadvantages
  • Access to drugs or alcohol5

The DBT approach suggests that addicts have a higher level of emotional arousal than most people. They tend to get very worked up, become very intense, and take much longer to collect themselves emotionally.

DBT is very useful in treating patients who have psychosocial disorders. Schizophrenia, anxiety disorders and eating disorders are examples of such mental illnesses. They are caused by difficult life experiences.People who have these conditions often attempt to self-medicate by abusing drugs or alcohol. Such co-occurring disorders (that is, co-existing with addiction) make therapy for the patient all the more crucial. Both physical and psychological cleansing is needed for healing the whole person.

In DBT, patients are asked to focus on two things that may seem foreign to their mental state and their inclination to abuse substances: change and acceptance. The “change” comes from the therapist pushing for the drug abuse to cease. It’s a sudden breaking off of connections to the patient’s former lifestyle. The “acceptance” involves getting the patient to understand that sobriety is difficult, mistakes will be made, and a relapse does not mean hopeless failure. It is, in effect, an attempt to get the patient to accept his limitations without losing focus on the bigger picture of abstinence.

In essence, DBT is designed to teach patients how to deal with “life’s ordinary problems” by visualizing and maintaining goals that are apart from the impulsive behavior that led them to substance abuse. One study showed that DBT patients greatly reduced their rate of substance abuse (over patients not having DBT as part of their treatment), even 16 months after formal treatment. They were more socially adjusted. It is an effective treatment for severely dysfunctional addicts.1

Family Therapy

family therapyIt is understood that an addiction’s effects have a major impact – not only on the addict, but also on those who are near and dear. A substance use disorder is oftentimes wrought with severed family, social and professional relationships. The user’s primary objective is getting the next fix. The need seems all-encompassing. The habit fuels its own continuation.

While many therapies focus on realigning the patient’s mental health, some therapies combine the cognitive and dialectical tacts (both similar in nature) with more work on rebuilding close relationships.

Family-oriented therapy not only tackles substance abuse, but also looks at that issue in the larger context of how that abuse affects those around the user. It addresses communication within the family unit.It may delve into unemployment and family finances – how those issues impact the family. Substance-abusing parents are encouraged to set goals tied to healthy parenting behaviors. This often calls for spending a certain amount of time with the children. It might also mean setting a budget for supporting dependents. Partners are encouraged to play a pivotal role in administering rewards for accomplishing these goals.

When it comes to addiction therapy, the family should not be underestimated or taken for granted. The role of the family in any health issue is central, and the goal of family therapy is addressing needs. Hopefully what results is a more functional, productive and happy family with clear thoughts prevailing. The well-being of the family and the patient’s own health are connected and improved in tandem.1

Aftercare Support

12 step support groupAddiction is a lifelong health concern for those affected. It persists for years (even decades) after a patient is formally discharged from rehab. While treatment models,like CBT and DBT, serve a key purpose,a patient must continue to fight off temptations each and every day back in the “real world.” But who is there for the addict to fall back on when struggles come or battles are lost with substances when the sanctuary of the therapist’s office isn’t available.

That’s where aftercare comes in. These support programs are an essential form of therapy. It is imperative that a connection to the treatment guidelines and social network is maintained, even during the addict’s new sober life. Such resources are what keep the addict grounded and focused on maintaining sobriety. They are there to encourage their friend to stay the course when the addict is invited out to a party, when sad or bored, or even when the novelty of a clean lifestyle starts to wear thin.1

This service is facilitated by 12-Step groups and “Anonymous” programs (Alcoholics Anonymous, Narcotics Anonymous, etc.). While these groups can’t provide the same level of professional therapy that’s offered by a counselor, their role is key. They provide a constant stream of encouragement, support, accountability and understanding. The people in these groups know what it’s like to lose everything to addiction. They know what it’s like to fight their way to a place of health and stability. They also know what it’s like to have a relapse. While it’s a step back, all is not lost. The recovering addict simply must begin anew.

Taking precautions concerning relapse triggers is a major topic in aftercare programs. Addicts who think all the work is done when they step out of a treatment facility is not being realistic. Without ongoing involvement in such meetings and having a sponsor, the addictive behavior will likely resume. In the same way that detox without therapy is not treatment, therapy without aftercare is similarly incomplete.

Aftercare support is not highly structured. Membership is informal. There is rarely any documentation involved. The emphasis is on anonymity. And while that can be a blessing to participants, it invites scrutiny from skeptics who distrust the focus on the spiritual concepts. However, references to a “higher being” are integral in the Alcoholics Anonymous movement.

Research has found that patients who persist with aftercare therapy as part of their treatment for drug or alcohol abuse see more “improved outcomes” (less likely to be readmitted for formal treatment) than patients who receive no engagement following the completion of their residential or outpatient treatment.6

Medication-Assisted Treatment:  An Effective Supplement to Therapy in Some Situations

Medication-assisted treatment (MAT) is the use of medications with counseling and behavioral therapies. It is designed to treat particular types of addiction. In those cases, research shows that a program of medication and therapy can be highly successful.

MAT is primarily used for the treatment of addiction to opioids, such as heroin and prescription pain relievers that contain opiates. The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug.7


1 “Principles of Drug Addiction Treatment”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment, (December 2012).

2 “Drugs, Brains, and Behavior: The Science of Addiction”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction, (July 2014).

3“Cognitive Behavioral Therapy”, Royal College of Psychiatrists, http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx, (2016).

4 “An Overview of Dialectical Behavioral Therapy”, Psych Central, http://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/.

5 “Drug Addiction: Risk Factors”, Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/drug-addiction/basics/risk-factors/con-20020970.

6 “Increasing Adherence to Substance Abuse Aftercare Group Therapy”, Journal of Substance Abuse Treatment, http://www.journalofsubstanceabusetreatment.com/article/S0740-5472%2898%2900015-4/abstract.

7 “Medication and Counseling Treatment”, Substance Abuse and Mental Health Services Administration, http://www.samhsa.gov/medication-assisted-treatment/treatment, (September 28, 2015).

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