In order to help a variety of clients recover from the psychological and emotional effects of addiction, substance abuse treatment professionals must draw from a range of therapies that have been verified by clinical research.
These modalities address different aspects of the recovery process, from behavioral modification and relapse prevention to family counseling and recovery from trauma.
By utilizing one or more of these tools, counselors and therapists can help clients gain confidence in themselves and their ability to cope with life in sobriety.
Since its development by Dr. Aaron Beck of the Beck Institute in the 1960s, Cognitive Behavioral Therapy, or CBT, has become one of the most popular forms of treatment for depression, anxiety, substance abuse, and many other disorders that affect an individual’s daily functioning. Dr. Beck’s original focus was patients with severe depression who did not respond to traditional forms of therapy, such as psychoanalysis. Beck found that many depressed patients showed improvement in their symptoms when they worked on changing their attitudes and beliefs about themselves and the world around them. The goals of CBT include:
- Recognizing destructive, distorted thoughts, such as “I’ll never be able quit drinking,” or “Everyone in my life hates me now.”
- Replacing those thoughts with healthy, positive ones, such as “I can get sober with the help of others,” or “There are a lot of people in my life who care about me.”
- Relating to other people and the world in general in more constructive ways
- Changing the way the patient responds to life stressors and triggers
In substance abuse treatment, CBT can be very useful at helping the client identify the factors that trigger cravings for drugs or alcohol, and responding to those triggers in healthy ways. For instance, a client who drinks in response to conflicts with a partner and children might be taught how to communicate more effectively with family members, so that these conflicts can be resolved before they cause anger or anxiety. In CBT, clients and therapists work together to solve problems and create healthy alternative solutions to the behaviors that lead to substance abuse.
Instead of delving deeply into the issues of the client’s past, CBT concentrates on solving current problems in the present. CBT is a versatile, goal-oriented modality that can be applied in individual therapy sessions, in which the client works directly with a psychologist, counselor, or therapist, or in group therapy, where clients share their coping strategies with their peers.
According to Psychiatric Clinics of North America, reviews of clinical literature show that CBT has been highly effective at treating substance use disorders, both as a standalone treatment modality and in combination with other therapies. The problem-solving techniques of CBT can be applied by any professional in the fields of substance abuse treatment or mental health who has studied this therapy and practiced CBT in a clinical setting.
Rational Emotive Behavior Therapy, or REBT, was developed by Dr. Albert Ellis of the Ellis Institute in the 1950s. REBT is similar to CBT in that it focuses on helping clients solve problems and reach goals in the present, rather than looking back into the past.
REBT helps patients identify destructive behaviors, such as drinking, overeating, or abusing drugs, and to replace those behaviors with healthy actions that lead to greater satisfaction with life.
In addition to teaching the client practical ways to resolve problems and cope with stressors, REBT helps the client learn how to regulate emotions in order to achieve a more balanced, realistic outlook.
In substance abuse treatment, emotional regulation is an important part of helping clients handle cravings, manage stress, and avoid relapse. REBT can be an effective approach for clients who have trouble controlling their moods and feelings, or who tend to react emotionally to stressors in their lives.
Anger, fear, resentment, grief, or even joy can be triggers for drug and alcohol abuse in an individual struggling with addiction. Teaching clients how to cope with intense or painful emotions is one of the primary goals of substance abuse treatment. This is the focus of Dialectical Behavior Therapy, or DBT, a therapy developed by Dr. Marsha Linehan of the Linehan Institute. Similar to CBT in its problem-solving approach, DBT was originally developed by Dr. Linehan to help patients with borderline personality disorder cope with strong emotions, reach a state of inner balance, and remain in treatment long enough to see results. DBT has since been applied successfully to the treatment of addiction, anxiety, depression, eating disorders, and many other serious psychiatric conditions. The objectives of this modality in substance abuse treatment include:
- Encouraging the client to reach a state of self-acceptance, no matter where the person is in the recovery process
- Helping the client learn the practice of mindfulness, or remaining focused on the present, as a way to deal with strong emotions
- Teaching the client practical methods for tolerating distress, a state of inner anxiety and pain that often leads to drinking or using drugs
- Helping the client learn to regulate strong emotions, so that the person is less vulnerable to intense and sudden changes in mood
- Counseling the client on how to relate to other people more effectively in order to reduce conflict and build stronger relationships
According to Addiction Science & Clinical Practice, DBT is most effective at helping clients who come to rehab with complex emotional issues, co-occurring mood disorders, a history of self-harm, or a history of chronic relapse. This form of therapy is practiced most successfully by psychologists, therapists, and other mental health practitioners who have studied this approach to treatment on a professional level.
Motivational Interviewing, or MI, is both a treatment modality and a philosophical approach to counseling. Two of the primary founders of MI were psychologists Dr. William R. Miller and Dr. Stephen Rollnick, both clinical psychologists. MI was first applied to the treatment of alcoholism as a way to encourage problem drinkers to find reasons to change their addictive behaviors. As a motivational, nonjudgmental approach to substance abuse treatment, MI represents a departure from more traditional, confrontational styles used in rehab. MI is based on the following principles:
- The therapist’s attitude is encouraging, collaborative, and non-confrontational.
- The therapist and client work together to help the client identify internal motives for change.
- The therapist helps the client envision a better future and develop strategies for achieving it.
- Although the therapist facilitates and encourages change, it is the client’s role to accept the need for recovery.
MI can be used either in individual therapy sessions or in group therapy to create a positive environment that promotes change and encourages self-efficacy. The focus of MI is on building the client’s self-esteem, not judging or criticizing past behavior. The Center for Substance Abuse Treatment emphasizes that the therapist practicing MI works with the client to identify strengths and competencies, and uses those strengths to help the client achieve recovery goals.
MI is a very optimistic, present-focused counseling style that has been adopted by many therapists, social workers, and other professionals in the field of substance abuse treatment.
This counseling style is especially effective for individuals who are ambivalent about committing to a rehab program or who have a history of relapsing in the past.
It can also be highly effective as part of a treatment plan for clients with co-occurring mental illness, who may need encouragement to overcome the effects of depression or anxiety.
Addiction is not an individual disease, but a condition that involves everyone who touches the addict’s life. The Family Systems Model is based on the concept of the family as an emotional unit rather than a set of separate individuals. Just as the entire family participates in the addictive process in some way, the group must be treated as a whole in order to recover from this disease. Even though one member of the household may be the focus of treatment, all members of the group must be engaged in treatment in order for them to recover.
Family Systems Therapy is practiced by licensed marriage and family counselors, as well as social workers and substance abuse treatment professionals. As part of a program that includes a Family Systems approach, the client and the spouse or partner, as well as children, siblings, and other significant persons, might participate in activities like the following:
- Individual counseling sessions for each of the members of the household
- Educational sessions that teach the client and loved ones about the nature of addiction and its underlying causes within the family system
- Support groups for the client’s loved ones
- Workshops and intensive programs that involve the entire family
- Counseling by telephone or online chat for family members who cannot take part in activities at the rehab facility
The emphasis in Family Systems Therapy is on healing the family unit by teaching family members how to improve their communication, reestablish trust, and address issues of trauma or abuse.
For many people who are challenged by drug or alcohol addiction, suppressed memories of emotional pain or physical trauma can trigger the urge to drink or use. However, it is often difficult for the individual to access these memories or to bring the associated feelings to a satisfactory resolution.
Eye Movement Desensitization and Reprocessing, or EMDR, is a unique therapy that aims to resolve traumatic memories through rapid movements of the eyes.
In a series of sessions, therapists trained in EMDR guide clients through disturbing memories while having clients move their eyes rapidly back and forth under closed eyelids. Sounds and pulsations may be added to the session to reinforce the effects of rapid eye movement.
Since its development by Dr. Francine Shapiro of the Shapiro Institute, EMDR has provided relief from the symptoms of anxiety, depression, and other psychiatric conditions associated with trauma. After a series of sessions, many clients report that these memories are no longer as powerful or vivid, and that they find it easier to relax, to sleep, and to avoid abusing drugs or alcohol.
EMDR has been applied effectively in the treatment of post-traumatic stress disorder, or PTSD. A review of clinical studies published in the Indian Journal of Psychological Medicine found the results of EMDR to be effective enough at relieving the distress of PTSD and other anxiety disorders to warrant using this treatment as a standard trauma therapy. This modality has also earned the endorsement of organizations like the U.S. Department of Veterans Affairs and the American Psychiatric Association as a therapy for PTSD.
EMDR has proven to be especially beneficial for survivors of child abuse, combat trauma, sexual assault, and other acts of violence. However, this therapy can be valuable for any rehab client who has difficulty overcoming disturbing memories or coping with fear and anxiety.
Because trauma lies at the root of addiction for many individuals, trauma-focused therapies have become a cornerstone of alcohol and drug rehab programs. Seeking Safety is a counseling model developed by Dr. Lisa Navajits, a research psychologist, to help people find relief from the effects of trauma, domestic violence, and substance abuse. Although the Seeking Safety Model does confront the issues of addiction and trauma, it does not demand that the client dwell on painful or disturbing memories. The primary goal of this approach is to help the client find a sense of security in all aspects of life, including personal relationships, thoughts, behaviors, and emotions. To achieve this sense of safety, the therapist works with the client in four key content areas:
- Cognition: working with the client to address the thought processes surrounding trauma and substance abuse
- Behavior: empowering the client with healthy coping strategies to deal with the surrounding environment
- Interpersonal relations: helping the client overcome problems with trust resulting from abuse inflicted by others
- Case management: providing resources the client needs to deal with everyday concerns like housing, employment, healthcare, and childcare
Seeking Safety integrates treatment for substance abuse with therapy for PTSD, so both issues are addressed at the same time, giving the client a sense of continuity and establishing a sense of trust. In individual or group sessions, clients learn coping strategies that can be applied to both substance abuse and PTSD.
Victims of trauma often suffer from feelings of helplessness, powerlessness, and suppressed anger. The therapist’s role in Seeking Safety and other trauma-focused modalities is to guide the client to a place of stability, where the person feels in control. This compassionate approach can help the client overcome the need to use drugs or alcohol as a way to feel safe or comfortable. Trauma-focused therapies can be used in individual counseling sessions, in group therapy, or in didactic contexts by counselors, social workers, or therapists who are trained in this specialty.
The therapies used in treatment vary from one client to another, depending on the individual’s needs, preferences, personal history, and the modalities available at the facility.
As part of the assessment and admission process, the client is evaluated to determine which therapies will produce the best outcomes.
Together, these therapies should reflect the client’s goals and provide the support needed to move through the stages of the recovery process.