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Addiction Therapy

Millions of people in the U.S. alone abuse drugs, alcohol, and other addictive substances. With the U.S. in the midst of battling opioid overdose deaths and what appears to be an emerging epidemic of stimulant abuse, it’s clear that addiction is here to stay. A 2016 federal report from the Surgeon General found that only 10 percent of people with an addiction will receive the treatment they need to address it.

Fortunately, it is treatable. Most people who receive treatment for substance abuse will need addiction therapy in some form so that they can make a successful recovery. Some people think detox alone will help someone get back on the path to sobriety, but the process involves a great deal more. Changing the thoughts and behaviors that accompany substance abuse is just as important as physically recovering from it.

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Many medical and mental health professionals use addiction therapy to treat chronic substance abuse disorders. This method has proven effective in helping people with addictions to stop using drugs and alcohol and harming their physical and mental health.

This kind of therapy is also focused on treating the underlying core issues that lead to substance abuse. This is important because it helps people learn what causes them to use and what they can do to make better life choices.

If you or a loved one are considering addiction therapy, read on to learn how it helps people reach their goal of sobriety and live a life free from addiction.

What Is Addiction?

Addiction is widely recognized among medical professionals and addiction care specialists as a complex disease of the brain. As VeryWell mind explains, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes “substance-related disorders resulting from the use of 10 separate classes of drugs.” Those classes are as follows:

  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens (PHP, LSD)
  • Inhalants
  • Opioids
  • Sedatives
  • Hypnotics (anxiolytics)
  • Stimulants (cocaine, amphetamine-type substances)
  • Tobacco; and
  • Other or unknown substances

Medical and mental health professionals consult the DSM-5 to review criteria that can help them properly diagnose substance use disorders (SUDs). The physical and psychological symptoms help them to identify which SUD the patient is struggling with and choose the appropriate therapy for it.

The DSM-5 criteria recognize the various behaviors and emotional symptoms that show in people who battle addiction. Those criteria for substance use disorder include the following:

  • Taking the drug in larger amounts and for a longer time than intended
  • Wanting to cut down or quit but finding it challenging to do so
  • Spending a great deal of time trying to obtain the substance
  • Experiencing drug cravings
  • Not being able to carry out obligations at work, school, or home because of drug use
  • Continuing to use the substance despite the issues caused by or made worse by drug use
  • Giving up social, occupational, or recreational activities because of drug use
  • Using the substance regularly in risky situations
  • Still using the drug after recognizing continual physical and psychological difficulties stemming from drug use
  • Being able to use large amounts of the drug, which indicates tolerance
  • Experiencing withdrawal symptoms when drug use is stopped or reduced

Two or three of the above criteria indicate a mild substance use disorder. A person who meets four or five of the requirements has a moderate SUD. People who have six or more of these criteria have severe SUD.

Health care professionals assess where a person falls among these criteria and determine the addiction treatment techniques that best meet the needs of the person. They may choose one or more than one kind of therapy to address the SUD (or alcohol use disorder, AUD, if that’s the case).

Below, we cover the most commonly used therapies used to guide people who are in recovery and enrolled in an addiction treatment program. These programs can be used in residential treatment programs as well as intensive outpatient programs (nine hours or more a week) or outpatient programs (fewer than nine hours a week).

Substance Abuse Therapies

Drug and alcohol rehabilitation centers use various therapies to treat people with SUDs. The therapy chosen is typically based on the specific needs of the person who is being treated. In some cases, behavioral therapy is administered alongside medications that help people abstain from using substances in harmful ways. This is known as medication-assisted treatment or MAT.

As the Substance Abuse and Mental Health Services Administration explains, the U.S. Food and Drug Administration (FDA) has approved MAT programs, which are clinically based and customized to meet a person’s needs. The medications used are also FDA-approved and include Suboxone (a combination of buprenorphine and naloxone) and methadone.

The combination of medications with counseling and therapies is known as a whole-patient approach to treating SUDs. It is primarily used in treating people who have opioid use disorder that can involve heroin use and the misuse or abuse of opiate prescription pain relievers. The goal is to keep people from relapsing as they work to recover toward full-time sobriety.

“The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug,” SAMHSA writes.

Many options are available in addiction therapy. Finding the right one is essential as it can help one advance in treatment. Depending on the individual’s situation, any of the following may be used in the treatment program to help them overcome substance abuse:

Cognitive Behavior Therapy (CBT)

Cognitive behavioral therapy or CBT is evidence-based psychotherapy helps people explore the connection between their thoughts, emotions, and behaviors. This popular therapy helps treat a wide variety of mental health disorders, including anxiety, depression, post-traumatic stress disorder (PTSD), and phobias.

CBT requires patients to pair up with a psychotherapist or therapist for a preset number of sessions. Here, they learn how to recognize and increase their awareness of unhealthy, dysfunctional, inaccurate, or distorted thought patterns that often pave the way to destructive or self-defeating behavior. It includes those behaviors that lead people to use.

Negative thought patterns often aid people in their use of addictive substances, which is why recovering users must change how they think. A change in thinking and feeling likely will result in changing how one behaves. Awareness develops, and a desire to correct adverse thoughts follows.

CBT gives people the tools to manage their inner and outer worlds. This kind of therapy encourages focusing on a specific problem using a goal-oriented approach, as the Mayo Clinic highlights in its guidance on the topic. The mental health professional may also show patients techniques they can use to relax so that they better cope with life’s stresses healthily and effectively.

“A central element of CBT is anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies,” NIDA writes in its guide on principles of drug addiction treatment. It also reports that, according to research, the skills learned through CBT approaches last after treatment ends.

Dialectical Therapy (DBT)

Dialectical behavior therapy (DBT) is a modified kind of cognitive behavioral psychotherapy that also is aimed at helping people to identify and change negative thought patterns as well as work on making positive changes to their behavior. An outpatient setting is ideal for DBT.

People who engage in harmful or self-destructive behaviors participate in this kind of therapy and attend weekly group meetings where they learn skills in a safe and secure environment. They are taught to practice accepting themselves fully as they are.

That includes accepting any uncomfortable or unsettling thoughts or feelings they have. Doing this while also working to change can help DBT clients to resolve internal conflicts they have as they work to bring polar opposites together and see how they create the whole picture.

DBT, an evidence-based treatment, has four standard parts that make up a comprehensive treatment program. They are:

Individual therapy. This is where clients apply the skills and strategies they need to achieve their treatment goals.

Group skills training. Here, they learn about the four skill modules that standard DBT therapy covers. Those are mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. People in recovery from substance abuse also acquire a set of skills that help them address their specific addiction(s).

Guidance of a therapist consultation team. This team is focused on ensuring people get the most out of a treatment designed to meet their needs.

Phone coaching. A one-on-one telephone consultation with a therapist helps ensure that people in recovery can connect with a professional should they have a crisis that happens between sessions. Phone coaching can also take place to ensure the skills taught in DBT are being utilized when they are needed.

Eye Movement Desensitization and Reprocessing Therapy

Eye Movement Desensitization and Reprocessing Therapy (EMDR) helps patients work through trauma and disturbing memories alongside the substance addictions they wish to overcome. 

The psychotherapy was developed in the 1980s to treat people who had post-traumatic stress disorder (PTSD), an anxiety disorder characterized by distressing memories, flashbacks, or stimuli that makes people relive the trauma they wish to forget.

As the American Psychological Association writes, EMDR is different from other trauma-focused psychotherapies in that it focuses on the memory and changes how the brain stores that particular memory. Other treatments focus on changing the emotions, thoughts, and responses resulting from traumatic experiences. EMDR also does not require clients to have extended exposure to the upsetting memory or detailed descriptions of the trauma experienced.

The goal of EMDR therapy is to help desensitize a person to any memories that can cause anxiety, panic, or stress.

The New York Times explains what EMDR’s goal is, which is “… to let the brain’s information processing system make new internal connections as the client focuses on the thoughts, emotions, memories, and other associations that are freely made during the sets of bilateral stimulation.”

During an EMDR session, the therapist works with the person as the person revisits a memory of a negative encounter. The therapist guides the person as they reprocess the memory for short periods that can last as little as 30 seconds.

During that time, the therapist may wave a finger or two back and forth and ask the client to follow the movement with their eyes. Or, the therapist may use tapping movements, vibrations, or tones in one ear on different sides of the body. The stimuli that occur as the trauma is remembered helps the client reframe their thoughts and emotions about the distressing memory.

People of different ages and backgrounds have found EMDR helpful in reducing stress and anxiety and boosting overall health and well-being.

Family Therapy

Addiction is often called a “family disease” because of how different people in the family unit are affected by a member’s substance use. Family therapy may also be called other names, such as family counseling, family systems therapy, or couples therapy. This psychotherapy works with individuals who want to improve their relationships and develop healthy communication between family members.

A benefit of family therapy is that it acknowledges that no one has to face or battle addiction alone. Often, people draw focus and strength from their loved ones as they take on the task of changing their lives after addiction. It also acknowledges the feelings and issues of non-using family members who are affected by individuals in the family who do use.

In family therapy, individuals and their family members meet to discuss and work through issues to improve family relationships and interactions so that they can heal from the chasm of substance abuse. This kind of therapy can also help people in recovery have better relationships with themselves and stay focused and dedicated to their recovery.

A variety of family therapies and techniques can be used. Mental health professionals can help families figure out the approach that works for them, as each family is different.

Structural therapy, which considers the whole family, examines the social interactions between members and how they respond to one another. The approach can help families grow together as a unit instead of separately. Narrative therapy is also one form of family therapy that could be employed. It differs from structural therapy as it focuses on each person in the family as an individual instead of the family as a unit.

Each person can learn how to use their skills to address their unique issues. This method promotes clarity for each family member and how they can move forward in a way that is most meaningful to them.

Motivational Interviewing

Before one can fully commit to substance abuse recovery, they may need more time to think about it and why they want to do it. Motivational interviewing, also known as MI, can help with that. It is person-centered counseling that helps people sort out mixed, contradictory, or ambivalent feelings about an issue or a decision. The goal is to do some soul-searching and deep digging to find the will to change and identify what needs changing.

According to MotivationalInterview.net (MI.net), MI was initially created to help people who are battling substance use disorders (SUD). Almost anyone can stand to use some motivation for something they would like to achieve or see happen, but the people who can most benefit from MI are those who doubt whether drug or alcohol treatment will work for them as well as people who have SUD and mental health disorders at the same time.

The motivational interview can take place as part of other behavioral therapies, including those listed in this writing, as well as a stand-alone therapy.  It also can be used in other recovery support groups, such as 12-step programs such as Alcoholic Anonymous, cognitive behavioral therapy, and other interventions. 

Sources

(August, 2017). Understanding the Epidemic. Centers for Disease Control and Prevention. from https://www.cdc.gov/drugoverdose/epidemic/index.html

Bebinger, Martha. “Seizures Of Methamphetamine Are Surging In The U.S.” NPR, NPR, 29 July 2019. from www.npr.org/sections/health-shots/2019/07/29/745061185/seizures-of-methamphetamine-are-surging-in-the-u-s

Hartney, E., Ph.D. (2019, June 22). The Symptoms Used to Diagnose Substance Use Disorders. from https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926

SAMHSA. (2019, April 26). Medication-Assisted Treatment (MAT). from https://www.samhsa.gov/medication-assisted-treatment

Cognitive behavioral therapy. (2019, March 16). from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

National Institute on Drug Abuse. (2018, January). Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine). from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral

Chapman, Alexander L., (2006 September). Dialectical Behavioral Therapy. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/#__sec3title

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

Allison.bradbury. “Mental Health and Substance Use Disorders.” SAMHSA, 13 Apr. 2019. from www.samhsa.gov/find-help/disorders.

The New York Times. (2012, March 2). The Evidence on E.M.D.R. from https://consults.blogs.nytimes.com/2012/03/02/the-evidence-on-e-m-d-r/

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