Psychotherapy

Psychotherapy, also known as talk therapy, helps people process their thoughts and emotions so they can work through their addiction and find their way to a healthy state of well-being. In addiction recovery, psychotherapy helps people identify and work through those things that led them on the path to abusing substances and engaging in behaviors that promote that behavior.

Addiction is not just about the act of abusing substances in and of itself. It’s also the actions, situations, environments, triggers, emotions, and behaviors that led to the addiction. To address all of these things while battling addiction on a physical, mental, and spiritual level can be taxing and difficult.

Having a professional to help guide clients through what is a difficult journey can help them overcome their fears and doubts. Such a guide can also help them learn how to manage their lives in healthy, meaningful, and effective ways. 

Psychotherapy in Addiction Treatment

Therapy is essential for recovering from and overcoming substance abuse and addiction. The goal is to enable clients to have the strategies and tools they need so they can remain sober and avoid having a relapse that takes them back to the dangerous and dark places they are trying to escape from. The kind of therapy one receives is based on a variety of factors that are unique to that person. In psychotherapy, talking about things is important to the goal of bringing clarity and perspective to any situation.

The American Psychiatric Association says psychotherapy can help with:

• Coping with everyday life
• The effects of trauma
• Medical illness
• Loss, such as the death of a loved one
• Specific mental disorders, such as depression and anxiety.

For recovering substance users, talk therapy helps them:

• Understand their use of addictive substances, such as drugs and alcohol, and why
• Highlight and reinforce those behaviors that support the goals of sobriety and abstinence
• Address fears and concerns about receiving substance rehabilitation treatment
• Learn how to care for themselves mentally and emotionally

How Does Psychotherapy in Addiction Treatment Work?

Psychotherapy is beneficial in many ways. An immediate benefit of this collaborative treatment is that you don’t have to face your challenges and struggles on your own as you do the work to change your actions and improve your life. You also have the benefit of using evidence-based strategies that have helped countless people.

As the American Psychological Association explains, in psychotherapy, or talk therapy, psychologists apply scientifically validated procedures that are used to help clients develop and practice habits that are more beneficial for them.

An important part of it is the relationship between a person and the psychologist (or therapist) that is built upon trust and respect as the two talk in an objective, neutral, and judgment-free setting. It’s important that trust is there from the beginning. It sets the tone for the therapy’s duration.

The association writes, “You and your psychologist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best. By the time you’re done, you will not only have solved the problem that brought you in, but you also will have learned new skills so you can better cope with whatever challenges arise in the future.”

What to Expect

It is understandable that you might be nervous about your first meeting with your therapist or psychologist. But keep in mind that this is your time for healing. Get to know the medical professional you will be working with to ensure your addiction and specific needs are addressed. Remember, this is a collaborative relationship. This is the time to be honest about your substance abuse. The more you share about yourself with your therapist, counselor, or psychologist, the greater the chance you will get what you need from your therapy sessions.

Either before or during your initial meeting, clients typically fill out a screening questionnaire to assess their substance use as well as their thoughts, feelings, and behaviors concerning that use. You also might be asked to detail certain situations surrounding your use. The information is then evaluated to help the mental health professional determine the best therapies as well as how those are laid out for your situation.

You should expect to be treated with respect at all times and have your concerns listened to. Therapy is an open dialogue that you need to have with a trusted, knowledgeable guide. If you have questions or aren’t comfortable with the direction your therapy is going in, express those to the mental health professional or someone who can address your concerns and help you focus on your healing and moving forward.

Therapy is not a quick fix or a cure. Keep your expectations realistic and give yourself time to figure out how to change your behavior. No one changes overnight. Also, be realistic in your progress, which is something your therapist can help you gauge. Change needs to come from the inside and needs time to develop. There will be ups and downs on this journey, but that is why a person who has been skilled to handle these situations will be with you as you figure things out.

As the American Psychiatric Association notes, confidentiality is a basic requirement of psychotherapy.  It also reminds that while the person undergoing therapy shares personal feelings and thoughts, “intimate physical contact with a therapist is never appropriate, acceptable, or useful.”

In addiction recovery, clients typically choose a treatment program that offers therapy. These therapies can be offered in various treatment settings, such as long-term residential or outpatient treatment. Making the decision about which treatment center to enter is up to you or your loved one. Some factors to take into consideration include the addiction that must be addressed, whether the client’s health insurance plan will cover some, most or all of the costs, where the person would like to attend, and if the facility has what is required to treat that addiction.

On the Fence About Therapy? 

There often is hesitation among people in addiction treatment who now must choose between addressing their addiction or doing nothing and falling back into the addiction trap, which ends in overdose and death for many people. Therapy is important to help prepare clients to live a life without drugs and avoid relapse. It is important to recognize stimuli that could lead one back to using.

Some of these triggers are:

• Stress
• Remembering negative situations, such as loss of a job, relationship
• Environments where one used to use, such as a residence or neighborhood, or even a city or state
• Social networks of friends, associates, even loved ones who continue to use

Any of these can set off cravings for drugs and urges to use. Psychotherapy helps one navigate those potential pitfalls and help them focus on the second chance they have been working so hard for.

Addictions are not all the same, and not everyone who has them is affected in the same exact ways. If you or someone you know isn’t sure about whether to enter a treatment center that incorporates psychotherapy into its recovery program, these questions can help bring some clarity.

• Do you feel sad, angry, depressed?
• Are you becoming more isolated and withdrawn? Do you avoid social situations?
• Do you feel like you need more support?
• Are you unable to control your drinking of alcohol or using drugs?
• Are you using addictive substances used despite their negative effects on your everyday routine, health, or relationships?
• Are you unable to stop using substances despite wanting to?
• Are you drinking or using drugs more than initially intended?
• Are you experiencing mood swings or becoming aggressive or engaging in harmful behavior as a result of your substance use?

These are all signs that psychotherapy is needed. Consider entering a substance abuse treatment program and finding a mental health professional who can help you find the right therapy for you. 

Common Addiction Psychotherapies

There are many different kinds of therapies out there. There are specific ones used often in addiction treatment and recovery. Some are:

Cognitive Behavioral Therapy (CBT) 

This psychotherapy focuses on the present and targets unhealthy, self-defeating thoughts and beliefs that accompany dysfunctional behaviors that can lead to substance abuse and addiction. CBT is conducted for a set period, typically lasting several months. Therapists who work in CBT teach their clients the skills that are needed to solve specific problems and correct distorted thinking that can trigger a return to substance use.

Upon completion of CBT, clients should:

• Have more awareness of what they think and how they feel
• Feel able to recognize the factors, such as thoughts and behaviors, affect or influence their emotions
• Feel enabled to improve how and what they feel by changing thoughts and behaviors that don’t work for them and

Dialectical Behavior Therapy (DBT) 

This is a version of Cognitive-Behavioral Therapy that teaches people how to change negative thinking patterns and work toward regulating their emotions and change behaviors that are harmful or self-destructive. It differs from CBT, however, in that it requires clients to attend a weekly group therapy meeting where life skills training is taught. Individual therapy is also required. People who have a substance use disorder along with a mental health disorder can enroll in a Dialectical Behavior Therapy for Substance Use Disorders program. It’s known as DBT-SUD and has been modified to help people who have both disorders, a condition considered co-occurring disorders or dual diagnosis. Standard DBT is usually offered for one year as part of an outpatient treatment program.

There are four stages of DBT, and when it is completed, clients should:

• Be able to reduce behaviors conducive to substance abuse
• Manage urges, cravings or temptations to use addictive substances
• Increase health behaviors that support sobriety goals

Motivational Interviewing

Clients who want to understand what motivates them to change and rebuild their lives after a battle with substance addiction may benefit from Motivational Interviewing (MI) or motivational enhancement therapy. MI is client-centered counseling that helps clients resolve insecurities and feelings that are contradictory, ambivalent, or mixed, according to MotivationalInterview.net (MI.net). Such feelings are common among people in addiction recovery, but this therapy can help them sort those out. If they are not addressed, they can derail efforts to achieve sobriety and abstain from drugs and alcohol. MI is a brief intervention that also was first created for people who want to overcome substance abuse.

Motivational Enhancement Therapy is more commonly used along with other therapies clients are taking. It can serve as pretreatment for those who are taking Cognitive-Behavioral Therapy or with a different therapy that supports the desire to start anew. When clients have finished motivational therapy, they should be able to:

• Process and think how they have been affected by substance use/substance abuse
• Identify why they want to change and keep those goals at the forefront of their recovery
• Find ways to increase their motivation so they can stay focused and commit to change.

Other forms of therapy that are commonly used in addiction treatment include:

Group Therapy

In this setting, people join their peers and have opportunities to give and receive help, support, and feedback to other group members who are facing the same or similar challenges. There are many benefits to group therapy. Members learn more from one another about recovering from substances and develop friendships that can be relied on throughout the process and even beyond when group therapy sessions end. This arrangement also gives structure and routine to group members, which are both important in addiction recovery. There are several group therapy models one can choose from. They are:

• Psychoeducational groups. These gatherings teach clients about substance abuse and related behaviors and consequences. This type of group presents structured, group-specific content, often taught by means of materials such as videotapes, audio cassette, or lectures.
• Skill development groups. These groups teach skills that help clients achieve and maintain abstinence, such as social skills, communication skills, anger management skills, and refusal skills among others.
• Cognitive-Behavioral Therapy Groups. The guide explains that CBT groups are appropriate for early recovery and support accommodating a large number of clients at a relatively low cost. Groups can focus on leadership styles and skills and techniques that teach members about self-destructive behaviors and focus on problem-solving as well as setting goals for the short and long term.
• Support Groups. These groups support “members’ efforts to develop and strengthen their ability to manage their own thinking and emotions and to develop better interpersonal skills as they recover from substance abuse,” the guide explains.
• Interpersonal Process Groups.  People in this group model use the knowledge of the way people function psychologically, known as psychodynamics, to promote change and healing, according to the guide.

There are also specialized groups that are not in the five-model categories. One is relapse prevention groups, which focus on helping members maintain abstinence or recover from relapse, the guide explains. It writes, “This kind of group is appropriate for clients who have attained abstinence, but who have not necessarily established a proven track record indicating they have all the skills to maintain a drug-free state.”

Contingency Management (CM)

This psychotherapy treatment uses positive reinforcements, such as vouchers and rewards, to encourage clients to commit to abstaining from addictive substances such as alcohol, opioids, stimulants, marijuana, and nicotine.

The National Institute on Drug Abuse writes, “Research has demonstrated the effectiveness of treatment approaches using contingency management (CM) principles, which involve giving patients tangible rewards to reinforce positive behaviors such as abstinence. “Studies conducted in both methadone programs and psychosocial counseling treatment programs demonstrate that incentive-based interventions are highly effective in increasing treatment retention and promoting abstinence from drugs.”

There are two kinds of incentives. One is VBR, or voucher-based reinforcement, in which the client receives a voucher for every drug-free sample the person provides. The vouchers have monetary value and can be redeemed for food, movie passes, and other items. NIDA reports that this VBR has been successful in promoting abstinence from opioids and cocaine.

The other incentive is called Prize Incentives CM. In these programs, which typically run for three months, clients are eligible to win cash prizes instead of vouchers if they can produce a drug-negative urine test or breath test. They can draw from a bowl for a chance to win a prize one or more times a week. Prizes range from $1 and $100.

The Matrix Model

This therapy is designed to help recovering clients abstain from using stimulants, such as methamphetamine and cocaine. It can be used for people at different stages of addiction treatment. People who need medical detoxification should not start with the Matrix Model. It is more fitting for people who are past that initial step and need an individualized treatment plan that addresses their specific needs.

“Patients learn about issues critical to addiction and relapse, receive direction and support from a trained therapist, and become familiar with self-help programs,” NIDA explains about the therapy on its site. It also incorporates the use of family education groups, relapse prevention groups, 12-step programs, and other essential elements common in addiction recovery. The therapy also draws from other tested ones, such as Cognitive-Behavioral Therapy.

How Long Do Psychotherapy Sessions Last?

The length of psychotherapy depends on the needs of the client who will be attending therapy. The American Psychiatric Association advises that psychotherapy can be a short-term arrangement that consists of a few session that addresses immediate issues or concerns. Or, it can be a long-term arrangement that lasts months or years. In this setting, therapists help clients address longstanding or complex issues, the APA says. The length of therapy is also determined by goals outlined by the therapist and client. Together, they will determine how long and how frequently they should meet.

Are Medications Used in Psychotherapy?

Yes. The American Psychiatric Association writes that medications are used in combination with psychotherapy to treat mental health conditions. But that’s not the case for everyone’s situation. Again, it depends on the individual and what the person’s needs are. “In some circumstances, medication may be clearly useful and in others, psychotherapy may be the best option. For many people, combined medication and psychotherapy treatment is better than either alone. Healthy lifestyle improvements, such as good nutrition, regular exercise, and adequate sleep, can be important in supporting recovery and overall wellness,” it writes. If you or your loved one needs medications, this will be determined by addiction care specialists and medical professionals who review the results of initial assessments.

Sources

APA. (2016). “What Is Psychotherapy?” American Psychiatric Association from https://www.psychiatry.org/patients-families/psychotherapy

American Psychological Association. (n.d.) “Understanding Psychotherapy and How It Works.” American Psychological Association from http://www.apa.org/helpcenter/understanding-psychotherapy.aspx

MotivationalInterview.Net. (2017, December 3). All About Motivational Interview from http://www.motivationalinterview.net/clinical/whatismi.html

NIDA. (2018). National Institute on Drug Abuse. “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-0