Substance Abuse Counseling Techniques

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The underlying causes of addiction are mostly genetic and environmental. A person’s genetic makeup can make him or her more prone to sensation-seeking behavior, more compulsive mand more vulnerable to addiction. Life events such as trauma, stress and early exposure to substances of abuse can also affect a person’s vulnerability.

Addiction causes physical and mental side effects. Physical side effects include cravings and withdrawal symptoms, and mental side effects include increased stress and feelings of depression, anxiety or loneliness.

Effective treatment focuses on the genetic and environmental causes of addiction. It also treats the physical and mental side effects.

Detox keeps patients physically safe and as comfortable as possible during withdrawal. Therapy treats the mental aspects. Depending on the severity of the disease, detox can remove cravings and withdrawal symptoms in one to three weeks. However, most people require months or years of continuous counseling to recover from the mental side effects.

The main purpose of counseling and therapy for addiction is to address the underlying causes of the disease to prevent them from causing relapse. Although detox is a vital component of treatment because it helps patients handle withdrawal and ease cravings, it does nothing to address the factors that led to drug abuse in the first place.

Research during the last 30 years has led to advances in evidence-based behavioral therapy for alcohol and drug addiction. The therapies have proved effective in treating substance use disorders in addition to co-occurring mental health issues such as depression, anxiety and obsessive-compulsive disorder.

Marta Nelson of Advanced Recovery Systems defines evidence-based treatment and explains that these treatments are researched and proven effective.

Today, therapy for substance use disorders is available in a variety of settings, including inpatient residential rehab programs, outpatient rehab programs, sober living communities, private practices and a variety of support groups.

The goal of therapy during a 30-, 60- or 90-day rehab program is to prepare individuals in recovery for life after intensive treatment, but many patients require continued therapy for many months or years after rehab.

Therapy often decreases in frequency and duration as a person learns to cope with the causes of his or her addiction and to handle life’s stressors. However, many experts believe a person never fully recovers from addiction. People who experience a traumatic event or increased stress should turn to therapy to decrease the chances of relapse.

Therapy isn’t a one-size-fits-all process. Different approaches are more appropriate and effective for different people, depending on their age, type of addiction and the factors that contributed to their addiction.

Nanci Stockwell of Advanced Recovery Systems talks about the types of therapy used during addiction treatment.

Behavioral Therapies

Addiction treatment centers use behavioral therapies more than any other therapeutic technique, according to the 2014 National Survey of Substance Abuse Treatment Services. Behavioral therapies help patients understand the causes of high-risk behavior and develop tools for avoiding or coping with high-risk situations.

Cognitive Behavioral Therapy

Cognitive behavioral therapy focuses on learning to reduce problematic behavior associated with substance abuse. A key theme in CBT is anticipating risky situations and applying coping strategies, such as avoidance or self-control, to prevent relapse.

CBT is one of the most popular therapies in addiction medicine, and counselors use it to treat a variety of addictions.

During CBT, patients learn to recognize and modify risky behavior by using a variety of skills. They learn the underlying causes of problematic behavior so they can fix the problems at their source. They’re able to recognize cravings or triggers and develop strategies for handling those situations. Research shows that patients who learn skills during CBT are able to apply them during real situations later in life.

Dialectical Behavior Therapy

Dialectical behavior therapy is effective for patients who struggle to regulate emotions and have thoughts of self-harm or suicide. The therapy emphasizes an acceptance of uncomfortable thoughts, feelings or behaviors to allow patients to overcome them.

DBT involves relaxation techniques, such as yoga, that help the patient become more aware of thoughts and emotions. They learn skills such as controlled breathing and muscle relaxation to tolerate self-destructive thoughts or urges. The goal is to decrease the frequency and severity of self-harming behavior and encourage healthy change.

The Matrix Model

The Matrix model gives individuals in recovery from stimulant addiction a framework for maintaining abstinence. It’s primarily used in patients recovering from methamphetamine or cocaine addiction.

Therapy using the Matrix model involves a variety of evidence-based therapies that promote relapse prevention and encourage family therapy, education and support-group participation. Therapy sessions usually include detailed worksheets or manuals for the patient to reference.

The therapist is a teacher and coach, developing a positive relationship with the patient and promoting behavioral change. The therapist promotes dignity and self-worth in the patient who avoids confrontational communication. However, the Matrix model does involve drug testing.

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing therapy alleviates distress associated with traumatic memories and symptoms of post-traumatic stress disorder, which commonly cause or worsen substance use disorders.

EMDR therapy helps the patient reprocess the memory of a traumatic event so it is less painful. The patient performs external eye movements while thinking of the traumatic event. The process teaches the brain to associate the memory with less upsetting feelings so it can heal.

Studies indicate EMDR can relieve symptoms of PTSD after three 90-minute sessions. Patients with severe PTSD symptoms, such as combat veterans, usually require more sessions than individuals with less severe symptoms.

Motivational Therapies

Motivational therapies are the second-most-common therapies used by drug rehab facilities. The therapies help patients find internal motivation to begin or continue treatment. They often provide incentives for maintaining sobriety and are used in combination with behavioral therapies.

Motivational Enhancement Therapy

Motivational enhancement therapy is a specific type of motivational interviewing for substance abuse. It reduces patients’ doubts or uncertainties about engaging in treatment or stopping drug use. The goal is to encourage change as opposed to teaching patients how to change.

MET begins with an assessment and is followed by two to four individual counseling sessions. The therapist begins by eliciting motivational statements. He or she supports the patient’s self-motivation, and the pair discusses ways to cope with risky situations. The remaining sessions involve monitoring change, reviewing strategies and continuing support of internal motivation.

Other forms for therapy, such as CBT, commonly follow MET. It’s effective at getting people into treatment but should not be the sole therapeutic approach.

Contingency Management and Motivational Incentives

Contingency management and motivational incentive approaches to therapy reinforce positive behavior with tangible rewards. The therapies augment other forms of therapy to increase abstinence during counseling.

The therapies incorporate vouchers or chances to win prizes to promote abstinence. Voucher-based therapy involves rewarding clean drug screens with vouchers that can be exchanged for food, movies and retail goods.

Prize-based incentives reward drug-free screens with a chance to win a prize by drawing from a bowl. Some experts worry that prize-based incentives might promote gambling behavior, but studies do not show an association between the therapy and gambling.

Community Reinforcement

The community reinforcement approach plus vouchers is commonly used on an outpatient basis. The therapy involves motivational incentives in the form of familial, social and recreational rewards in addition to vouchers to motivate abstinence from substance abuse.

The goal is to help patients maintain sobriety so they can develop skills for long-term recovery.

CRA usually lasts 24 weeks, and patients attend individual counseling once or twice per week. During counseling sessions, they learn skills to minimize substance abuse, improve relationships, develop hobbies, build social support and receive vocational counseling. Patients also undergo urine tests two or three times per week and are awarded vouchers for retail goods for drug-free tests.

Family Counseling and Therapies

Counseling and therapy for addiction often involve counseling for family members in addition to the person in recovery. Therapy teaches families the underlying causes of addiction, how to reduce risk factors for relapse and how to properly support their loved one in recovery.

Family counseling is beneficial for family members negatively affected by another person’s addiction. It helps each family member learn about the impact his or her actions have on others, and it teaches families how to effectively communicate and function.

Family Behavior Therapy

Family behavior therapy addresses problems that affect the entire family. The goal is to reduce risk factors for addiction, such as unemployment, family conflict, abuse and conduct issues. It uses techniques such as contingency management and behavioral contracting, in which a patient agrees to a written contract with a therapist.

Therapy sessions involve multiple family members, such as spouses or parents and their children. Therapists teach strategies and skills for improving communication and the living environment. Each patient sets behavioral goals that are reviewed during each session by other family members.

Multisystemic Family Therapy

Multisystemic family therapy is primarily used to correct severe antisocial behavior in children and adolescents affected by addiction.

Treatment occurs in natural environments such as the home, school or neighborhood, and it has been proved to reduce rates of incarceration and substance abuse.

Multidimensional Family Therapy

Multidimensional family therapy is an outpatient treatment for teens who abuse drugs. It focuses on individual, family, peer and community networks to reduce problematic behavior and encourage healthy behavior.

MDT occurs in clinics, family court, school or homes. It usually involves individual sessions and family sessions in which the adolescent learns decision-making and problem-solving skills. During family sessions, parents examine their parenting style and learn to positively and effectively influence healthy behavior.

Brief Strategic Family Therapy

Therapists use brief strategic family therapy to reduce family interactions that support or exacerbate teen drug abuse or problematic behavior. Such behavior includes problems at school, delinquency, association with anti-social peers, aggressive tendencies and high-risk sexual behavior.

BSFT is founded on the concept that each family member’s behavior affects the entire family. The therapist identifies and corrects family interactions that provoke problematic behavior. The approach can be used in mental health facilities, rehab clinics, homes and a variety of other settings.

Functional Family Therapy

Functional family therapy is also based on the idea that dysfunctional family interactions create and support problematic behavior. The goal of FFT is to improve communication, problem-solving skills and parenting skills. Each therapy session involves the adolescent and one or more family members.

FFT engages families in the treatment process to encourage motivation for change. It also incorporates contingency management techniques and other types of behavioral therapy.

Adolescent Community Reinforcement Approach

Adolescent community reinforcement approach is similar to the community reinforcement approach used for adults, but it involves standardized procedures for improving communication, solving problems and coping with stress. Role playing and behavioral rehearsal techniques are key aspects of the therapy.

Assertive Continuing Care

Assertive continuing care involves weekly home visits during the three-month period after a teenager is discharged from a drug rehab facility. The therapy teaches teens and their caregivers problem-solving skills, communication techniques and other tools for promoting recovery.

12-Step Facilitation Therapy

Therapists often encourage patients to participate in 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous to support long-term recovery.

Such 12-step programs are founded on a few key principles: Individuals with substance use disorders have no control of the disease, must surrender to a higher power and actively participate in support group meetings. Many therapists refer patients to 12-step groups, and some treatment facilities host support group meetings.

Alternative & Holistic Therapies

Decades of scientific research on addiction treatment have found behavioral, motivational and family-based therapies to effectively treat substance use disorders. Other therapies such as EMDR and 12-step facilitation therapy are also backed by a plethora of research.

There are no other evidence-based replacements for these traditional therapies, but studies do support a variety of complementary treatments for addiction.

Yoga, Meditation and Mindfulness

Yoga is an exercise that emphasizes controlled breathing and body postures to promote physical strength, concentration and serenity. Clinical trials involving yoga and mindfulness found the therapies were effective complements to preventing and treating addiction, according to a study published in Complementary Therapies in Medicine.

A meta-analysis of studies on meditation published in Alcoholism Treatment Quarterly found that the technique can reduce stress, anxiety, tobacco smoking, and alcohol and drug abuse. Additionally, a clinical trial on mindfulness therapy published in the Journal of Consulting and Clinical Psychology found yoga was a feasible and effective treatment for opioid abuse and chronic pain.

Animal Therapy

Several therapies for addiction involve animals. During equine therapy, one of the most popular animal-assisted therapies, patients interact with horses. The horses give feedback through nonverbal cues. The patients learn to understand their own emotions and overcome negative emotions such as frustration and fear.

Other therapies involve people in recovery voluntarily helping animals at shelters or having animals during traditional therapy sessions. Research indicates animal- or pet-assisted therapy can improve a patient’s participation in treatment and willingness to talk about any history of trauma or substance abuse. Animal-assisted therapy can also reduce stress, fear and anxiety.

Acupuncture

Acupuncture therapists insert fine needles into the body to stimulate healing. Acupuncture is a complementary treatment option at several rehab facilities, and people in self-help programs also report benefits from acupuncture.

A study of patients in recovery from cocaine addiction published in the Archives of Internal Medicine found patients assigned to acupuncture therapy were more likely to abstain from cocaine use. Another study published in the American Journal of Public Health found acupuncture significantly improved tobacco smoking cessation rates.

Music Therapy

Music therapy techniques include lyric analysis, songwriting, musical games and ad-libbing music based on emotions. During music therapy, patients engage emotions, motivations and barriers to treatment through lyrics and melody.

Research on music therapy has found songwriting can promote healthy change, drumming can promote relaxation and dancing can reduce stress, anxiety and symptoms of depression. A study published in the Drug and Alcohol Review found music therapy was positively associated with a patient’s willingness to participate in treatment.

Art Therapy

Patients express themselves by drawing, painting, sculpting or creating art journals during art therapy. Art therapy techniques also include stress painting, in which patients paint during periods of high stress, and the creation of incident drawings: illustrations of events that transpired during substance abuse.

Some therapists emphasize interpretation and contemplation as therapeutic techniques during art therapy. Studies on art therapy indicate it can decrease denial, treatment avoidance and shame. It can also be used to facilitate group discussions and motivate change.

Horticultural Therapy

Horticultural therapy involves gardening and other plant-based activities led by a trained therapist. Studies indicate horticultural therapy, also referred to as garden therapy and therapeutic gardening, can enhance critical thinking, improve attention span, decrease stress, reduce anxiety and improve social integration.

Effective substance abuse treatment requires patients to address all underlying causes of addiction. Most patients undergo multiple therapies to address all of the causes. Counseling and therapy are essential tools in the recovery process and have been proved to help individuals in recovery.

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