Treatment Therapies

According to a 2015 study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about one in 20 Americans today have a substance use disorder (SUD). Of the estimated 23 million Americans with a substance use disorder, only a quarter has likely received any treatment. Out of those that have been treated, the majority are likely not receiving the best possible combinations of therapy and medication for their specific condition.
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SUDs are extremely complex illnesses that aren’t so easily treated with a single approach. In the vast majority of SUD cases, an individualized set of treatments is necessary to address both the immediate health issues brought by the disease and the causes of compulsive drug-taking behavior.

Effective treatment is not just a matter of weaning patients off their drugs of choice either. Rehabilitation also needs to take into account the individual social, psychological, professional, and legal contexts facing the patient.

Fortunately, there are a multitude of options available for patients suffering from a substance use disorder. This article will briefly discuss key treatment therapy concepts in modern rehab settings as well as the most commonly used psychiatric approaches.

What Is a Therapist, Exactly?

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Knowing what therapy is and what therapists are can be key to understanding what meaningful addiction recovery and rehabilitation are. Contrary to popular belief, getting advice from family and friends, no matter how helpful, does not count as therapy. Recreational activities that make one feel better do not count as therapy either unless they are done in a specific context.

A therapist, by definition, is a duly-licensed and certified person with formal training in therapeutic techniques. Therapists can be any professional trained in the appropriate techniques to aid patient recovery, including psychiatrists, psychologists, counselors, or clergy and similar religious figures with the appropriate training.

Strictly speaking, therapy is a type of professional service for aiding recovery. Activities that aid in recovery can only be considered therapeutic if they are done on the advice of a qualified therapist.

Given that substance use disorders often bring changes in behavior, behavioral therapies are the predominant form of treatment for these illnesses. However, medication is also a crucial part of the recovery process, especially for easing a SUD patient’s withdrawal.

What Is Individual Therapy?

“Individual therapy” involves one patient or client who is being treated by at least one therapist. There can be multiple therapists handling different parts of the process, but the key idea is that there is only one patient involved. The key advantage of individual therapy is that the patient can receive the full attention of the attending therapists.

What Is Group Therapy?

In contrast to individual therapy, group therapy involves multiple patients being treated at the same time. This has the major benefit of allowing patients to meet with other patients with similar problems. Given that addiction has been stigmatized for centuries, group therapy can help patients cope with feelings of isolation by giving them a ready source of emotional support in each other.

Group vs. Individual Therapy

Most therapeutic approaches can be done on an individual or group basis. Neither individual therapy nor group therapy is necessarily better than the other, but each has its advantages and disadvantages. In many cases, the ideal program for patients with a substance use disorder will involve both group and individual therapy sessions. 

Benefits of Individual Therapy 

  • The therapist can focus their full attention on the patient
  • Analysis and treatment can be much more comprehensive
  • The patient’s schedule can be more easily accommodated in outpatient sessions
  • Can be better for individuals who have difficulty communicating
  • Patient confidentiality is easier to maintain
  • The patient-therapist relationship tends to be much stronger, thus patients are more likely to be honest in their interactions
  • The pacing of the sessions can be tailored to a patient’s needs
  • The confidentiality of the client’s issues is most easily maintained in individual therapy
  • Better suited for helping a patient develop a self-awareness of their condition

Downsides of Individual Therapy 

  • Some patients may not do well when they are at the center of attention
  • Costs cannot be shared with other patients, typically making the sessions more expensive
  • Some patients find it necessary to have other people they can directly relate to  

Benefits of Group Therapy 

  • Generally more affordable than individual therapy
  • Much better at helping patients feel understood, as they are in contact with others who have undergone similar experiences
  • Patients can feel empowered when they give support to others
  • Hearing other people’s stories helps put one’s own experiences in context
  • Patients can hear different, sometimes opposing, perspectives on issues similar to theirs, which can be an opportunity for growth and understanding
  • Can help the patient feel accountable to more people when it comes to their own recovery
  • Some patients find it easier to share experiences honestly in a group setting
  • Other patients’ experiences can serve as a model for one’s future growth and recovery 

Downsides of Group Therapy 

  • Patient confidentiality is non-existent
  • Individual patients cannot expect the full attention of attending therapists
  • Unsuited for antisocial or shy individuals
  • Patients may use the group setting to avoid making meaningful changes
  • More extroverted patients may get more attention
  • Some patients may find the pacing uncomfortable
  • Patients need to adjust to the session schedules

Examples of Therapy Used for Treating SUD

There are a wide variety of mainstream psychiatric therapies for treating substance use disorders. Most of these can be done in an individual or group setting. Some of the most popular approaches include the following:

Cognitive-Behavioral Therapy (CBT) 

CBT is one of the most effective types of therapy for drug use disorders. This involves helping patients identify the root causes of their drug-taking or drug-seeking as well as teaching them techniques for changing their behavior. CBT can be paired with other therapies and can also be used to treat co-occurring psychiatric conditions.

Motivational Interviewing (MI) 

This type of therapy involves helping patients to find their own motivation for recovery so that they accept treatment efforts more readily. This shifts some of the work of treatment and long-term positive outcomes from the therapist to the patient. This method is also intended to empower SUD patients and give them more control over their treatment.

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Contingency Management (CM) 

This type of therapy involves incentivizing positive behavior by rewarding it. It has been proven highly effective for preventing relapses in SUD cases.

12-Step Therapy 

This group therapy approach involves regularly meeting with a peer support group to prevent a relapse. Alcoholics Anonymous is an example of a support group network that employs this approach.

Dialectical Behavioral Therapy (DBT) 

While more often used for behavioral disorders, DBT has also been successfully adapted for substance use disorders. It is a specialized subtype of CBT, and it also attempts to help patients learn coping skills to prevent relapse.

Rational Emotive Behavior Therapy (REBT) 

This type of therapy aims to help patients better understand their own emotions and thoughts. By doing so, they can potentially come up with rational ways to be emotionally and mentally healthy and avoid problematic drug use as well.

Role of Medication in SUD Treatment

While counseling and behavioral therapies are the primary methods by which SUD is treated, medication can also be critical for some cases. Opioid, benzodiazepine, and alcohol withdrawal, for example, can be lethal without the proper medication. Medications may also be prescribed or recommended for assisting withdrawal from other drugs as well as for managing any co-occurring psychiatric or physical health conditions.

Alternative Therapies 

There are also several alternative therapies that, while not sufficient for treating a substance use disorder, can help improve positive outcomes when combined with other scientifically-proven methods. Some of these include:

Exercise 

Moderate exercise can provide an alternative focus to drugs while simultaneously providing a way to relieve stress and normalize the levels of dopamine and other hormones, whose natural production may have been disrupted by drug use. 

Meditation/Mindfulness 

This alternate approach to cognitive behavioral therapy can help patients better understand the context of their illness and treatment, ultimately helping them make better decisions.

Animal-Assisted Therapy 

Pets can help alleviate symptoms of anxiety and depression, both of which are common among those with SUD.

Yoga

As with mindfulness and exercise, yoga can provide additional grounding that can help conventional treatments work better. 

Massage 

Among its touted benefits, massage is claimed to help alleviate withdrawal symptoms, as well as enhance the self-awareness needed for other conventional therapy.  

Art Therapy

Creating art can help patients express themselves, giving therapists insight into their current state. It can also help them feel empowered and give them a sense of purpose.

Combined Approaches to Treatment

It’s rare for treatment and rehab programs to focus on only one approach for substance use disorders. In most cases, clinicians will attempt a combined approach using multiple conventional and alternative therapies in group and individual settings. The attending clinicians may make a selection of therapies that could be tailored to a patient’s needs or use existing multi-pronged approaches such as the Matrix model.

Conclusion

There is no single treatment that works for all cases of substance use disorder. Thankfully, we have a wide array of available therapies and strategies that can be used to improve virtually every patient’s chance of recovery.

If you suspect that you or someone you know has a substance use disorder, contact a qualified treatment specialist immediately.

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