A central element of substance abuse treatment is therapy.
Along with medical treatments for detox and withdrawal, education about substance abuse, and practical physical care treatments like nutrition and personal training, therapy provides one of the most important parts of rehab: the ability to directly effect change of substance abuse behaviors.
Because there’s no one type of treatment that is helpful for all people in treatment, as explained by the National Institute on Drug Abuse, there is a range of therapy types that may be used in various combinations to help individuals maximize their ability to achieve recovery and avoid relapse to substance abuse.
Overall Goal of Treatment Therapies
Substance use disorders are primarily considered to be psychological disorders. Therefore, when a person is struggling with a substance use disorder, psychological treatments are indicated to help the person recover from and manage the issue. A major mechanism for this treatment is therapy.
The overall goal of treatment therapies is to support the person in the ability to avoid relapse to substance abuse after treatment. According to the American Psychological Association, therapy is undertaken to help people learn to manage mental or emotional problems, change behaviors, and lead happier, more productive lives. This work to change thought and behavior patterns is sometimes referred to as cognitive restructuring.
For substance abuse, therapy can help the person learn to manage the substance use disorder, including being able to change the behavioral response to the thoughts and situations that trigger the desire to abuse drugs or alcohol. This ability to recognize one’s own thought-behavior patterns and change the response to them, or otherwise manage the mental issues that lead to substance abuse, specifically helps in preventing relapse.
Overview of Substance Abuse Therapy Options
The full range of therapy types is designed to meet the person at the level of need and provide specific tools for managing the substance use disorder. This includes:
- Fostering an understanding of the triggers and cravings that lead to drug abuse
- Developing strategies to manage and change response to the situations that trigger cravings
- Exploring the feelings that underpin those situations and how to manage them
- Practicing helpful responses and behaviors
- Establishing a level of social support and motivation for change
- Evaluating progress and adjusting therapy types and levels if necessary
Various broad types of the therapies used to accomplish these goals are described below. Within each of these categories, there are additional options to customize the treatment to the individual’s needs.
- Cognitive Behavioral Therapies
This therapy approach is designed to help a person understand how thought processes or exposure to certain situations triggers the desire to abuse drugs or contributes to cravings. For example, the person in Cognitive Behavioral Therapy (CBT) might explore situations during which cravings develop, what feelings are occurring at the time, and how those feelings contribute to cravings. The person can then learn to interrupt this cycle and insert new behaviors in response to the situation to curb substance use.
Different types of CBT or similar types of therapy can be provided for this reason. For example, there is a type of CBT that is specifically focused on approaching issues of trauma with people for whom it is a factor.
According to a study review from the American Journal of Psychiatry, Cognitive Behavioral Therapy has been shown not only to help people learn to apply different behaviors and thought processes to situations that trigger substance use, but to also help establish continual improvement in the ability to avoid relapse in the long-term after treatment.
- Interpersonal Therapy
According to a study in the International Journal of Medical Toxicology and Forensic Medicine, there is a substantial connection between a person’s loneliness and the emotional challenges that tend toward substance abuse behaviors. Interpersonal therapy endeavors to intervene in that connection by helping the person learn to build and sustain a meaningful social network and activities that distract from the triggers and cravings for substance use.
This type of therapy prevents relapse by helping the person decrease loneliness, social difficulties, and lack of involvement in activities that can lead to substance abuse. One study from the journal Substance Abuse shows that women who were treated through this type of therapy were able to curb drinking behaviors, decrease depression symptoms, and improve their interpersonal relationships not only during treatment, but also up to 32 weeks after treatment.
Occupational therapy is a practical therapy that helps people get a handle on the day-to-day activities of life that may have gotten out of control or been neglected during the time that the person was abusing drugs or alcohol. According to the American Occupational Therapy Association, occupational therapy can help people learn to reestablish their roles outside of treatment in order to give more meaning and purpose to daily life without use of drugs or alcohol.
In some cases, the struggle and stresses of daily living can contribute to the emotional state that leads to substance abuse. Using occupational therapy to help people manage these elements of life can reduce triggers to abuse substances, making it easier to avoid relapse after treatment is over.
As described in an article from the Journal of Clinical Psychology, traumatic situations or self-consciousness about the feelings or behaviors around substance use disorders can make it difficult to recognize and approach the source of the feelings or behaviors, or put those internal processes into words. The person may have also buried many feelings deeply or lost connection with them because of substance abuse or addiction. Experiential therapy helps in these situations by enabling people to approach their issues in a nonverbal manner.
Working with horses, music, art, or other pastimes while processing the feelings around substance abuse and triggers can bring up suppressed or painful issues in a safe space, making it easier to confront and manage those issues. There is a wide range of experiential therapies that can be drawn from based on the particular interests and comfort zone of the individual.
Another way of building a supportive social network is to participate in self-help groups or other types of peer support, both during and after treatment. This includes 12-Step groups or similar organizations that surround the person with others who are dealing with the same addiction or substance abuse issues, creating a feeling of solidarity and greater confidence in the ability to avoid relapse.
A study from the journal Addiction shows that people who participate in 12-Step groups as well as traditional rehab are more likely to be able to maintain sobriety in the long run as compared with those who complete only traditional treatment.
Family and marital counseling during rehab are important not only for the person being treated, but for the family as well. According to the Substance Abuse and Mental Health Services Administration, family therapy helps to build the support structure that can give the person in treatment the confidence to persevere in avoiding relapse after treatment is over. In addition, this type of therapy helps make sure that the family members understand how their interpersonal relationships contribute to the potential for continued recovery or relapse into substance abuse. By helping the whole family build tools to support recovery, the person has a higher chance of maintaining abstinence from the substance.
Because each person is different, certain therapies may or may not be warranted in an individual situation. These therapies can be mixed and matched and combined with other treatment modalities to meet the specific needs warranted by the degree of substance abuse, history of relapse, home and work situations, and other elements that affect recovery.