Addiction Therapy

Alcoholism and drug addiction have serious physical, mental, and emotional consequences. For each individual, there are different underlying issues that play a part in substance abuse. If you or your loved one is struggling with addiction, addiction therapy is an important step when entering a life of recovery.

Addiction therapy generally takes place in an inpatient treatment program, where patients live at the facility and have access to 24-hour care, or an outpatient treatment program, where clients attend scheduled therapy sessions while maintaining their daily lives. In both types of programs, clients will participate in a combination of individual, group, behavior, and cognitive therapy sessions. Without addiction therapy, an addict or alcoholic may not resolve the issues underlying their substance abuse, which can lead to relapse.

What Does Addiction Therapy Treat?

Addiction therapy addresses those physical, mental, and emotional problems associated with addiction, in order to best prepare a person for living a sober life. These therapy sessions can help people struggling with substance abuse—including alcohol, prescription drugs, and illicit drugs—as well as behavioral addictions, like gambling or sex addictions.

In general, addiction therapy helps people to focus on the reasons behind their addiction. There can be many factors contributing to a person’s addiction, such as difficulty coping with life’s stresses, low self-esteem, family dysfunction, past traumas, or co-occurring mental disorders. An addict may not be aware of these issues, which often affect people at a subconscious level and require professional help to work through.

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By addressing these factors, addiction therapists help better prepare clients to handle their lives sober. The goals of addiction therapy are to help an individual:

• Recognize the problems caused by substance abuse
• Find the motivation to change
• Change his or her behavior
• Repair relationships with both family and friends
• Build new relationships with people who don’t use drugs and/or alcohol
• Create a lifestyle based on recovery

The Addiction Therapy Process

Physical Stabilization

Therapy sessions usually begin after detox, or at a point when drugs and alcohol are no longer in the person’s system. When physically stable, the addict or alcoholic can then confront any mental or emotional issues in addiction therapy.

Mental Stabilization

Many clients, in both inpatient and outpatient treatment, meet with a psychiatrist to assess their mental condition and whether or not there’s a need for medication. Early in recovery, an addict’s brain is also recovering its chemical balance, so some people benefit from the stabilization that different medications can offer.

There are also many people with co-occurring mental disorders or behavioral disorders that contribute to their substance abuse, which is called a dual diagnosis. Most commonly, dual diagnosed addicts and alcoholics suffer from depression, anxiety, or post-traumatic stress disorder (PTSD). Many addicts and alcoholics self-medicate to repress traumatic experiences, so some facilities offer specific trauma-oriented therapies.

Addiction treatment programs understand these issues. Treatment professionals can provide the proper psychiatric help, medication, and addiction therapy that an addict or alcoholic needs.

Emotional Stabilization

Addicts and alcoholics also develop an emotional dependency on mind-altering substances. Especially when drugs or alcohol are used to cope with life’s stresses or numb out unwanted feelings, this emotional reliance runs deep and can jeopardize a person’s recovery if it’s not addressed.

One of the most important things addiction therapy will offer is healthier coping skills. In individual therapy sessions, clients talk with a licensed clinical professional one-on-one about the thought patterns and feelings that lead them to abuse substances. They can process difficult emotions or past traumas in a safe environment, where therapists will offer new insights and teach healthy coping mechanisms. Each client is assigned a primary therapist, with whom they meet individually once or twice a week.

In group therapy, clients get the chance to connect with one another on an emotional level. These emotional bonds are usually non-existent when a person is living a life of addiction. Experiencing human connection again allows an addict or alcoholic to realize they’re not alone. Clients share experiences with one another and, maybe for the first time in a long time, feel understood.

Being immersed in a group that shares similar struggles and pains will lessen any feelings of shame or inferiority that an addict might feel. This empathy and understanding is not only therapeutic, but it also teaches the value of peer support. When clients leave treatment, it's important that they have the motivation and social skills to build a recovery support group around themselves.

Different Types of Addiction Therapy

Within group and individual counseling sessions, treatment programs use several different types of addiction therapies:

• Cognitive-Behavioral Therapy (CBT)—Examines the relationship between thoughts, feelings, and behaviors. Therapists help clients explore the situations, stressors, feelings, thoughts or underlying beliefs that lead to substance abuse and other self-destructive behaviors, in order to change those patterns and improve coping skills.
• Family Therapy—With clients’ permission, they meet with family members and loved ones for therapy sessions guided by a therapist. These sessions aim to involve the family so they can help their loved one live a sober life, while also processing any family conflicts that may exist as a result of addiction.
• Motivational Interviewing—Helps to build the client’s motivation for change and commit to a specific plan of recovery. This therapy style avoids argument and confrontation, centering on empathy, understanding, and support from the therapist to help a client in their process of change.
• Contingency Management—Gives positive reinforcement, in the form of tangible rewards, to help move individuals away from self-destructive behaviors and attitudes.
• Expressive Therapy—Provides clients with opportunities to express and process their emotions creatively, such as music or art therapy. Generally, this type of therapy is offered at select facilities.
• Educational and Didactic Sessions—Helps clients better understand the mechanisms behind substance abuse, using lessons, lectures and activities. Some lessons may focus on the facility’s treatment philosophy, 12-step or otherwise. These sessions offers clients an array of knowledge and tools:
  • Understanding effects of substances on the brain and body
  • Cross addictions
  • Relapse prevention
  • Social skills and social pressures
  • Anger management
  • Family roles and codependency
  • Establishing boundaries
  • Nutrition and wellness
  • Life skills

Finding the Right Treatment Option

Every treatment facility centers around a philosophy of addiction recovery, which shapes their approach to addiction therapy. The most common of these is based on the 12 Steps of Alcoholics Anonymous. The 12 Steps are considered a guide to getting and staying sober, focusing on self-awareness, righting past wrongs, community support, and spiritual connection. In 12-step oriented facilities, clients attend 12-step recovery meetings, as well as educational group sessions exploring the 12-step philosophy, program, and principles.

There are also many treatment programs that are non-12-step oriented. These facilities are shaped around different recovery philosophies, which shape some of their educational sessions. Though clients won’t go to 12-step meetings, they’ll likely attend any of the many other recovery programs and meetings. There are holistic rehabs, which focus on healing the body, mind, and spirit, and faith-based rehabs for people who want to incorporate their religious beliefs into their recovery.

A Closer Look at the Therapies You Will Hear About

The list above names the main approaches. Treatment programs, intake staff, and insurance paperwork use a wider vocabulary, so this section explains the terms you are likely to meet and what each one looks like in a session. NIDA's overview of treatment names cognitive behavioral therapy, contingency management, motivational enhancement, family therapy, and twelve-step facilitation as behavioral treatments with research behind them; the rest below are common in programs and have their own professional bodies or federal guidance.

Behavioral therapy and psychotherapy

"Psychotherapy" and "talk therapy" mean the same thing: structured conversation with a trained clinician aimed at changing how you think, feel, and act. "Behavioral therapy" is the family of approaches within it that focus on the behavior itself, its triggers, and its consequences. Cognitive behavioral therapy, described above, is the best known. Relapse prevention work, where you map the people, places, feelings, and times of day that lead to use and practice a plan for each, is behavioral therapy applied to recovery.

Dialectical behavior therapy (DBT)

DBT was developed by psychologist Marsha Linehan for people with borderline personality disorder and chronic suicidal thoughts, and it is now used in many addiction programs, particularly where intense emotions drive the drinking or using. The name refers to holding two things at once: accepting yourself as you are, and working to change. DBT combines weekly individual therapy with a skills group that teaches four sets of skills:

• Mindfulness: noticing what you are feeling and thinking in the moment without acting on it
• Distress tolerance: getting through a crisis or a craving without making it worse
• Emotion regulation: understanding and changing intense emotions that keep causing problems
• Interpersonal effectiveness: asking for what you need, saying no, and keeping self-respect in relationships

Skills groups usually assign homework, and a published review describes the findings for people with both borderline personality disorder and substance use disorders as promising.

Motivational interviewing (MI)

MI, developed by William Miller and Stephen Rollnick, starts from the idea that being torn about change is normal and that arguing with someone about it makes them dig in. The counselor listens, reflects back what you say, and draws out your own reasons for change rather than supplying them. SAMHSA's guidance describes four processes: engaging (building trust), focusing (agreeing on what to work on), evoking (drawing out your reasons and confidence), and planning. If a counselor asks open questions, affirms what you are already doing well, reflects your words back, and summarizes, that is MI. It is often used at intake and in the first weeks, when motivation is shakiest.

Contingency management (CM)

CM is the simplest to describe: tangible rewards for verified progress. NIDA describes it as positive reinforcement such as rewards or privileges for staying drug free, attending and participating in counseling, or taking treatment medication as prescribed. In practice that means vouchers, prize draws, or gift cards earned for negative drug tests or attendance, with the reward delivered right away. It is used most in stimulant treatment, where no medication exists, and alongside medication in opioid programs. It works while the rewards are in place; programs pair it with other therapy so the change outlasts the incentive.

Family therapy

Addiction reorganizes a household around the person using, and family therapy treats the household as the client. Sessions include partners, parents, or children with the person's permission and aim to improve communication, set boundaries, and stop patterns that keep the use going. You may hear the names of specific models: structural family therapy (adjusting roles and boundaries within the family), systemic approaches (looking at how each person's behavior affects the whole), cognitive behavioral family therapy (changing the thoughts and habits family members bring to each other), and narrative therapy (separating the person from the problem and building on the family's strengths). NIDA notes family therapy is particularly useful for young people.

Group therapy

Group sessions are the backbone of most programs, and SAMHSA's group therapy guidance describes five kinds you may sit in: psychoeducational groups that teach about addiction, skills development groups, cognitive behavioral groups that work on thinking patterns, support groups where members hold each other accountable, and interpersonal process groups that work on how you relate to other people. A good group is led by a trained clinician, keeps what is said inside the room, and gives you practice being honest in front of others, which most people in early recovery have not done in a long time.

Client-centered therapy and the therapeutic alliance

Client-centered (or person-centered) therapy comes from Carl Rogers, who argued that people change when the therapist is genuine, shows unconditional positive regard, and listens with accurate empathy. You will rarely see it offered as a stand-alone program, but its principles run through MI and most modern counseling. SAMHSA's guidance ties those principles to what clinicians call the therapeutic alliance: the working relationship between you and your therapist, including whether you agree on goals and whether you trust them enough to say the hard things. If after a few sessions you do not feel heard, say so, and if it does not improve, asking for a different therapist is a reasonable request, not a failure.

Art therapy and music therapy

Both are recognized professions with their own credentials, not just activities. The American Art Therapy Association defines art therapy as a mental health profession that uses active art making and the creative process within a psychotherapeutic relationship; the American Music Therapy Association defines music therapy as the clinical use of music interventions toward individual goals by a credentialed professional. In a program that means drawing, painting, collage, or journaling with an art therapist, or listening, playing, improvising, songwriting, or discussing lyrics with a music therapist, usually in a group. They give people a way to work on feelings that are hard to put into words and are typically offered alongside, not instead of, the therapies above. Ask whether the person leading the session holds a credential in that field.