Those who need treatment for substance use disorders may be unaware of what the whole rehabilitation process entails—including the full range of potential therapeutic offerings.
Some people may equate rehab with some form of medical detox, but detox alone is not a substitute for more comprehensive, longer-term addiction treatment.1 Continued treatment can help prevent relapse and lower relapse-related risks, such as overdose.1,2 Ongoing addiction treatment is likely to consist of several therapeutic approaches combined with the intention of increasing treatment engagement, changing maladaptive behaviors, and ultimately helping people achieve long-term abstinence.1
Cognitive Behavioral Therapy
While originally utilized to treat depression, cognitive-behavioral therapy (CBT) was later adapted to help prevent relapse in people with substance use disorders such as alcoholism and cocaine addiction.3,4 The treatment method, and its application in addiction medicine, is based on the theory that individuals can best modify their substance use behavior by identifying learned patterns linking specific contexts, thoughts, and feelings as they relate to maladaptive behaviors (in this case, drug and/or alcohol use).4
In recognizing these patterns, people may begin to “unlearn” them. They may work toward these ends through the development of better coping skills—such as by avoiding high-risk situations, places, people, or other triggers, as well as by improving their ability to manage cravings and more-positively react to negative thoughts/moods.3,4
Recovering from addiction isn’t just about working on the issues that brought someone to treatment, but about managing ones yet to emerge in the future. Patients need to be prepared for what awaits them post-treatment, and CBT techniques can help with that. While it would be ideal to altogether avoid triggers and other stressors, it’s not always possible. Armed with a set of improved coping skills learned through cognitive-behavioral approaches, individuals leaving treatment may be better prepared, should they encounter a new trigger, to take a step back and think about how to proceed before they act. That’s really what CBT is all about—retraining a potentially maladaptive pattern of thoughts and behaviors to a more healthy, positive one.
Motivational Interviewing (MI) approaches clients in a manner that allows them to come to terms with the reasons they are in treatment and what they need to address on their own to make progress in recovery. This guided process uses specific methods of questioning clients so they can come to terms with what has been stopping them from moving forward with the changes they desire to make.
In many cases, continuing to drink or use drugs and getting help for the underlying substance use disorder(s) represent opposing desires for individuals in treatment. Using motivational interviewing techniques, therapists work with their patients to help resolve this ambivalence in favor of reinforcing the resolve and recovery efforts made to quit.3 There are four core principles of motivational interviewing. They are:5
- Express empathy—Rapport may be better developed with the patient in recovery by demonstrating empathy. Therapists repeat patients’ statements back to them through reflective listening in order to convey that they are present and understand how they feel in terms of ambivalence to treatment.
- Develop discrepancy—Therapists subtly point out how current patient behaviors may interfere with the positive changes they want to see happen in their lives. The perception of this discrepancy can motivate change
- Roll with resistance—Therapists use compassion and empathy in the face of resistance, rather than confrontation or demands.
- Support self-efficacy—Therapists can boost self-esteem and self-confidence of the individual in treatment. Believing in one’s own ability to make healthy changes helps motivate them to realize their goals.
Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR) therapy is a type of psychotherapy for people with post-traumatic stress disorder, or PTSD. Its therapeutic potential comes from its ability to reduce the emotional distress associated with certain traumatic memories.6 Such a therapeutic effect may also be helpful when applied to cases of co-occurring substance use disorder and trauma-related mental health conditions.
Through EMDR, patients in recovery work to replace negative emotional reactions to specific problematic memories with less-charged ones or, even, positive ones.6 The person in treatment will be asked to recall specific traumas while performing a pattern of repetitive eye movements (or, in some cases, sequences of finger tapping or musical tones), and this “dual stimulation” helps that individual to work against the negative feelings that the trauma evokes.6
A positive, replacement thought becomes the focus while the client engages in the repeated behavior for 20-30 seconds or however long the therapist deems necessary. After this process is complete, the client discusses the experience with the therapist. The EMDR process is then repeated as long as negative feelings remain present in an effort to retrain the mind in how to respond to the initial traumatizing thoughts.
Dialectical Behavioral Therapy
Dialectical Behavioral Therapy (DBT) is a cognitive-behavioral treatment approach initially developed to help decrease the self-harming and self-defeating behaviors commonly encountered in individuals with borderline personality disorder. This therapeutic approach has since been adapted to treat people with various other mental health issues, including substance use disorder.3,6 DBT combines the emotional regulation of CBT with the teaching of mindfulness skills, distress tolerance, and improved interpersonal effectiveness with the goal of decreasing continued substance use.3
Expressive, Holistic and Complementary Therapies
Art therapy and music therapy are both forms of expressive therapy used at some treatment centers to complement some of the more standard approaches to substance abuse rehabilitation. Neither require the client to be artistically inclined. Rather, individuals learn different art techniques through classroom sessions that focus on giving participants healthy and positive ways to relieve stress while doing something they enjoy.
These therapies are less about the end product—the musical performance or the finished artwork—and more about the creation process. Oftentimes, various feelings and issues may come up in the creation process that may be further explored in individual therapy.
Other complementary approaches that may be encountered at certain treatment centers:
12-Step Facilitation / Recovery Groups
Active participation in peer support or self-help groups such as Alcoholics Anonymous, Narcotics Anonymous, or other 12-Step program varieties is an important element of many long-term treatment strategies. 12-Step facilitation, as a therapeutic intervention, strives to motivate acceptance of the need for abstinence and foster a willingness to actively engage with 12-Step fellowship programs as a means of lasting recovery.3,7
12-Step meeting attendance provides support for those in recovery from substance abuse and behavioral addictions. These and other mutual support groups (e.g., SMART Recovery) are common components of many individuals’ aftercare routine, following completion of formal, comprehensive rehabilitation.
Individual, Group and Family Therapy
Behavioral therapies—a grouping that may encompass the modalities outlined on this page as well as additional ones not covered here—are the most commonly utilized forms of substance abuse treatment.8 While individual treatment program designs will vary, these types of therapies are likely to be administered in some combination of individual, group, and/or family counseling settings.
Individual therapy provides important one-on-one time with a therapist or counselor. Solo sessions with a therapist or counselor create a safe space to share personal issues, and can further serve as opportunities to more closely evaluate recovery progress and allow adjustments to be made to the treatment plan, when needed. In addition, coping skills that will help the client to avoid relapse beyond the treatment period can be honed during these sessions.
Group settings may constitute much of the total time spent in therapy while completing a rehab program. The group dynamic avails the wisdom gained by others on similar recovery journeys and can facilitate better interpersonal interaction as a recovering individual prepares to enter the “real world” at the completion of the treatment period.
There are many ways family members can give and receive support during their loved one’s treatment experience, and family therapy is one of them. Attending sessions together allows the family unit to begin healing broken relationships and build a solid foundation of trust once again.
Addiction treatment pharmacotherapy—sometimes referred to as medication-assisted treatment (MAT)—constitutes the standard of care for certain types of substance use disorders, including opioid use disorder and alcohol use disorder. MAT combines FDA-approved pharmacotherapies (and, in some cases, off-label uses for other medications) with some combination of behavioral therapeutic interventions (such as the others mentioned throughout this article) to help people with long-term abstinence in recovery.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)—Preface.
- Partnership for Drug-Free Kids. (n.d.). Risks for Relapse, Overdose and What You Can Do.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)—Cognitive-Behavioral Therapy.
- National Institute on Drug Abuse. (2012). Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency.
- National Alliance on Mental Illness. (n.d.). Psychotherapy.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)—Twelve-Step Facilitation Therapy.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)—Principles of Effective Treatment.