Therapy in Addiction Treatment
Various techniques are used to treat substance use disorders (SUDs), but behavioral therapy is the most common.1 Behavioral therapies are provided in individual, family, and group counseling sessions and may be used in more than one type of setting to confer the maximum benefit to participants.1
Types of Therapy in Addiction Treatment
Each person responds differently to addiction treatment. Since people may experience better results with certain settings or techniques than others, some treatment facilities offer combinations of treatment approaches, while others specialize in certain techniques.1 Using a combination of individual and group counseling sessions that are provided in residential, inpatient, or outpatient treatment settings allows care to be tailored to the needs of each individual.1 Some of the most commonly used behavioral therapy techniques are discussed below.
Dual Diagnosis & Co-Occurring Disorder Treatment
Dual diagnosis, or co-occurring disorders, is when a person with an SUD also has a mental illness.2 Since each disorder can influence the course and treatment of the other, treatment is most effective when it addresses both issues simultaneously, a course known as integrated treatment.2, 3 Integrated treatment involves behavioral therapy, which can be paired with medications to increase effectiveness and manage symptoms.2, 3 Behavioral therapy techniques that are effective for dual diagnosis treatment include cognitive-behavioral therapy (CBT), contingency management (CM), motivational interviewing (MI), and dialectical behavioral therapy (DBT).2, 3
You can find more information about dual diagnosis and co-occurring disorder treatment here.
Cognitive Behavioral Therapy (CBT)
CBT is a behavioral therapy technique that is used to treat addiction to alcohol, cocaine, marijuana, and stimulants.1 This type of therapy examines the relationship between your thought patterns and emotions and how they influence behaviors.1, 4 By learning to monitor your thoughts and identify harmful patterns that lead to negative behaviors, such as substance use, you can create new patterns that support recovery.1, 3, 4
CBT incorporates a variety of skill techniques, all of which help one weigh the pros and cons when making a choice, learning about cravings and how to manage them, identifying and planning to manage situations that pose a high risk for relapse, and developing effective problem-solving skills.1 , 4 CBT is effective at treating SUDs and results persist even after treatment has ended.1, 3
Contingency Management (CM)
CM is used to treat addiction to alcohol, benzodiazepines, marijuana, opioids, and stimulants, and numerous studies have shown this technique to be effective, even after the completion of treatment.1, 5 CM encourages desirable behaviors by providing rewards for reaching small benchmarks, such as clean test results, remaining abstinent, or attending treatment consistently.1, 3, 5 Providing incentives for positive behavior can increase motivation to stay sober and attend treatment sessions consistently.1 Some programs may increase the value of the rewards as greater periods of compliance are attained.1
MI is a short-term therapy that addresses ambivalence about sobriety and treatment, rather than providing formal treatment for substance use.1, 6 Rather than focusing on addressing factors that contribute to addiction, MI works to build up your motivation to change from the inside, removing the barriers that stand in the way of recovery.1 , 6 MI is accomplished through individual sessions, although significant others are welcome to participate as well.1 This technique works through active listening to decrease feelings of defensiveness, understanding discrepancies between your current state and your goal, accepting and exploring resistance rather than actively trying to combat it, and helping you become more confident in your ability to overcome barriers and create change in your life.1, 6 MI is commonly paired with other techniques in the course of treatment.6 It is effective for alcohol and marijuana use disorder, although results are mixed for other substances.1
Dialectical Behavioral Therapy
DBT was originally developed to treat self-harming behaviors, such as those found in people with borderline personality disorder, but it has been found to work in treating SUDs as well.3, 7 The basis of DBT is to create a balance between change and acceptance, much like the principles promoted in 12-step programs.7 While goals include smaller steps such as attaining and maintaining sobriety, the overall goal is to develop a satisfying life that feels worth living and life goals that are broader than simply staying sober.7 Therapy is provided in intensive group and individual sessions and occurs over a longer period than some other types of therapy.8 Successful DBT can lead to abstinence, increase treatment compliance, help manage mental health conditions, improve relapse prevention skills, increase social supports, improve problem-solving skills, and increase your ability to manage emotions.7, 8 This type of treatment has been proven effective, with progress remaining after completion of treatment.8
Rational Emotive Behavioral Therapy
Rational emotive behavior therapy (REBT) is a subtype of CBT that sees distorted thoughts, expectations, and ideas surrounding situations as leading to dysfunction.9 This technique uses a model to examine a triggering event, what type of consequences you as a result of this event, and the beliefs you have about the event.9 You may have a range of beliefs about various events, some of which are rational, but others may be irrational.9 These beliefs are what REBT is mainly focused on, and change occurs by challenging unhealthy and unrealistic beliefs.9 REBT can be provided in all types of therapeutic settings, including individual, group, and family counseling, and has been shown to be effective.9
The Matrix Model is a program that is used to treat stimulant use disorders.1, 10 Treatment involves a combination of individual and group counseling and participation in 12-step meetings. Education groups for family members are offered to increase support outside of therapy sessions.1, 10 There is a heavy focus on self-efficacy, relapse prevention, increasing self-worth, learning skills that are vital to the recovery process, and developing sober social supports.1 Studies have shown that the Matrix Model is an effective therapeutic technique for stimulant use disorders and that progress frequently continues after completing this type of therapy.1 , 10
Medication Assisted Treatment (MAT)
Medication-assisted treatment (MAT) involves pairing prescribed medications and therapeutic techniques to increase benefits during SUD treatment.1, 11 Combining medications and therapy is more effective than using either method by itself.1 Incorporating medications into existing treatment can decrease symptoms of withdrawal, reduce substance use and cravings, decrease the likelihood of overdose in some cases, improve the ability to maintain employment, and increase treatment compliance.1, 11 MAT is designed to treat addiction to specific substances, such as opioids or alcohol.1 (p6)
Methadone is a long-acting prescription medication1 used to prevent symptoms of withdrawal in people who are physically dependent on opioids, limit cravings for opioids, and prevent any opioids that are ingested from having an effect.1 , 11 Methadone can be used short-term to help a person get off opioids and stabilize, or it can be used as a long-term recovery support.11
One should exercise caution when considering Methadone for treatment. Addiction to methadone is very common amongst those in recovery from heroin or other opioids. You can learn more about Methadone here.
Naltrexone is a prescription medication that functions by blocking opioids from causing a high, a feeling of euphoria, or any other effects, so that if someone does use opioids while on this medication, they will have no effect.1 , 11 Naltrexone is available in an oral formulation that is taken either once a day or several times a week, or provided in a monthly injection.1 Naltrexone is suited for people who have already gone through detoxification.1
Acamprosate (Campral) is a prescription medication that can help people avoid alcohol relapse.1, 11 It doesn’t treat acute withdrawal symptoms, but can minimize long-term withdrawal symptoms involving anxiety, sleep issues, and low mood.1 , 11 Studies have shown that acamprosate can improve sobriety outcomes in individuals with alcohol use disorder, especially people with severe disorders.1, 11
Disulfiram (Antabuse) is a medication that works as a type of aversion therapy since combining it with alcohol causes uncomfortable symptoms including nausea, vomiting, headache, palpitations, chest pains, shortness of breath, flushing, and a sense of overheating.1, 11 Disulfiram treatment is most effective among people who are extremely focused on treatment, and it can be dispensed by another person to ensure that each dose is ingested.1 This medication can also be used on an as-needed basis, especially if a person plans to be attending a situation where they may encounter a drinking trigger that places them at high risk for relapse.1
Other Complementing Therapies
Some treatment facilities offer additional complementing therapies to help people further benefit from treatment. These offerings vary depending on the facility, and some people may choose to participate in these therapies outside of formal treatment. Some popular therapies include:
- Yoga, which can help people feel more relaxed, mindful, and positive.12 Studies show that participating in yoga while in treatment for addiction can help people feel less angry, depressed, tired, tense, and confused, and increase a sense of relaxation.12 Yoga is especially helpful since it doesn’t require any special equipment, can be done in most settings, and is not strenuous.12
- Equine therapy, which allows participants to work with horses as part of the therapy process.13 This type of care has been shown to increase engagement in treatment, develop a more positive sense of self, gain self-confidence, develop a persona outside of being in treatment, and provide an activity that is enjoyable to look forward to.13
- Exercise, which is well-known to reduce stress and provide a positive way to cope with negative emotions. Exercise has also been shown to decrease cravings and increase feelings of energy and good health.1, 14 Exercise can also be a way to incorporate positive activity into your daily routine and signify a commitment to taking care of your health, which may have been neglected while using substances.
- Meditation, which can be used to manage emotional stressors and is beneficial for people with SUDs.15 Mindfulness techniques can help reduce cravings and relapse and increase a person’s ability to cope with triggers.15
Wondering What Type of Therapy is Right for You?
American Addiction Centers tailors programs to meet your needs, making sure that the therapy you get is right for you.16 Knowledgeable and compassionate staff members are available through a confidential helpline to assist you or a loved one in figuring out what type of treatment would be best in starting on the path to recovery. With facilities located across the United States, help is closer than you think.17
How American Addiction Centers Can Help
We have helped thousands of people reclaim their lives that are troubled by addiction. Our treatment model focuses on not only recovery from addiction but also helps people understand the triggers and items that stimulate their addiction. We operate facilities across the nation and can be found in the following states:
Still Unsure About Seeking Treatment?
Learning about addiction and treatment options may feel overwhelming. If you are still unsure about how treatment works, how to ask for help, or how to get treatment, consider the following guides:
- National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd edition).
- National Alliance on Mental Illness. (2020). Substance use disorders.
- National Institute on Drug Abuse. (2020). Common comorbidities with substance use disorders.
- U.S. Department of Veterans Affairs. (2019). Cognitive-behavioral therapy for substance use disorders.
- McPherson, S.M., Burduli, E., Smith, C.L., Herron, J., Oluwoye, O., Hirchak, K., … & Roll, J.M. (2018). A review of contingency management for the treatment of substance-use disorders: Adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. Substance Abuse and Rehabilitation, 9, 43-57.
- National Institute of Justice. Motivational interviewing for substance abuse.
- Dimeff, L.A., & Linehan, M.M. (2008). Dialectical behavior therapy for substance abusers. Addiction Science and Clinical Practice, 4(2), 39-47.
- Chapman, A.L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry (Edgmont), 3(9), 62-68.
- MacLaren, C., Doyle, K.A., & DiGuiseppe, R. (2016). Rational emotive behavior therapy (REBT): Theory and practice. Contemporary theory and practice in counseling and psychotherapy, 233-263.
- Obert, J.L., McCann, M.J., Marinelli-Casey, P., Weiner, A., Minsky, S., Brethen, P., & Rawson, R. (2000). The Matrix Model of outpatient stimulant abuse treatment: History and description. Journal of Psychoactive Drugs, 32(2), 157-164.
- Substance Abuse and Mental Health Services Administration. (2020). Medication and counseling treatment.
- Fitzgerald, C., Barley, R., Hunt, J., Klasto, S.P., & West, R. (2020). A mixed-method investigation into therapeutic yoga as an adjunctive treatment for people recovering from substance use disorders. International Journal of Mental Health and Addiction, 1-16.
- Kern-Godal, A., Brenna, I.H., Arnevik, E.A., & Ravndal, E. (2016). More than just a break from treatment: How substance use disorder patients experience the stable environment in horse-assisted therapy. Substance Abuse: Research and Treatment, 10, 99-108.
- Brellenthin, A.G., Crombie, K.M., Hillard, C.J., Brown, R.T., & Koltyn, K.F. (2019). Psychological and endocannabinoid responses to aerobic exercise in substance use disorder patients. Substance Abuse, 1-12.
- Garland, E.L., & Howard, M.O. (2018). Mindfulness-based treatment of addiction: Current state of the field and envisioning the next wave of research. Addiction Science and Clinical Practice, 13(14), 1-14.
- American Addiction Centers. (2020). American Addiction Centers.
- American Addiction Centers. (2020). Treatment centers.