Therapy in Treatment & Rehab Explained
Therapy lies at the heart of all addiction treatment. While medication, detoxification programmes and other elements of treatment can deal with specific aspects of addiction and substance abuse, only therapy can reveal and address the underlying issues causing and exacerbating addiction. A great variety of models of and settings for therapy have been developed over the past few decades as addiction treatment has matured as a field of medicine. A basic understanding of these models, their benefits and drawbacks, can be very useful for anyone considering addiction treatment themselves or a loved one.
Understanding Therapy in Addiction Treatment/Rehabilitation
In the field of addiction treatment, “therapy” comprises a huge variety of different models and approaches. Some therapies may not seem to have much in common with the stereotype of “talking therapy”. Nevertheless, all of them primarily target the mind rather than the body.
Until recently, therapy was typically viewed with a degree of suspicion by the average person, who may have associated it with mental illness – or, at the other extreme, might have seen it as being somewhat fraudulent and not necessarily a reputable part of modern medicine. There was a stigma associated with therapy. Thankfully, over the past few decades this perspective has changed dramatically, and many people in the UK have now had some kind of experience of therapy and have benefited greatly from it.
Because addiction is an essentially psychological phenomenon, though in many cases also involving physiological drivers, symptoms and challenges. Therapy can and does have a role to play throughout any addiction treatment, from the very beginning of an addict’s first engagement with medical professionals right the way through to long-term recovery. Some recovering addicts find benefits from therapy even years after their last episode of substance abuse. Although it should not be seen as a guaranteed cure in itself, therapy is the single most important component of addiction treatment.
Why Therapy Is Essential in Treating Addiction
Overcoming addiction can effectively be divided into two phases: getting “clean” and staying that way. Whereas the first of these phases can sometimes be medically assisted – for example by the prescription of drugs to alleviate some withdrawal symptoms, medication does not get to the underlying causes of the addiction, the factors which led initially to the substance abuse and which repeated and sustained it while it became a chronic and increasingly deleterious condition.
Therapy, on the other hand, does reveal and address such fundamental causes. As well as bringing them to light, and enabling the addict to confront them, therapy can provide the addict with behavioural mechanisms to negate or overcome those causes, and thus to avoid engaging in further substance abuse. Although addiction can have a physical component, it is primarily a psychological phenomenon, and therapy is the most effective method of tackling it over the long term once any physical dependence has been overcome.
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When to go for therapy?
Therapy can be undergone at any time and does not have to form part of a structured treatment programme: if you feel under intense psychological pressure and are struggling with daily life, therapy will almost certainly benefit you. You can seek it out of your own volition. In short, if you feel you need or could benefit from therapy, it is definitely an option you should explore.
Alternatively, you may be recommended or prescribed specific therapies by your GP or another doctor, after you have been assessed and diagnosed with a substance abuse disorder. You could also engage in therapy as part of a holistic addiction treatment plan such as that provided in some private residential rehabs. In some extreme cases, therapy may also be mandated by a court if your substance abuse has led to criminal activity or if you are considered a danger to yourself or others.
How effective is therapy for treating substance misuse?
Therapy is regarded as the single most important and effective element of addiction treatment in terms of its long-term effect. In the short term, especially when dealing with substances such as opioids or alcohol which create a strong physical dependence, many addiction treatment programmes will not introduce therapy until the addict has gone through detoxification and withdrawal.
At this point, with the physical pressures of dependence removed, addiction becomes a purely psychological issue. Addressing the psychological factors and remediating the flawed thinking and damaging behaviours which perpetuate it become key. Therapy takes pole position and is an indispensable tool for anyone engaged in addiction treatment.
What to expect from therapy?
In general, regardless of the specific model of therapy in which you are engaged, it is vital to approach therapy with an open mind and to act sensibly and honestly, working with the therapist as far as possible. Therapy is for your own benefit and the more you can engage in it, and carry out the tasks required of you, the greater will be that benefit.
Therapy can be quite psychologically stressful – even distressing – at times, as you explore difficult thoughts and experiences and come to terms with the actions which have led to your addiction. Nevertheless, it is important to proceed as wholeheartedly and committedly as possible, working with your therapist to get through any such difficult moments. It is possible that great damage has been done both prior to and during your addiction, and profound healing may be required. As with physical ailments, such healing may be protracted and painful but in the long term it is required so that you could reach that feeling of happiness, to reach that healthy life you want and deserve.
Types of addiction treatment therapies
Some of the therapy models most commonly encountered in addiction treatment include:
Acceptance and commitment therapy (ACT)
ACT is a type of counselling and psychological intervention which encourages opening up to unpleasant feelings, memories and experiences and learn how to react sensibly and helpfully to them, accepting their place in the grand scheme of life and working towards so-called “valued behaviour”, dealing with such negative factors in a way which does not create problematic impulses. ACT considers many of the problems to stem from concepts represented in the acronym “FEAR” – “Fusion with your thoughts”; “Evaluation of experience”; “Avoidance of experience”; “Reason-giving for behaviour”. Instead of F.E.A.R., it requires us to “ACT”: “Accept your reactions and be present”; “Choose a valued direction”; “Take action”.
Alcoholics Anonymous (AA)
Alcoholics Anonymous is the most famous self-help fellowship for individuals suffering from substance abuse (alcoholism). It comprises many thousands of individual groups worldwide, hosting meetings at which individuals addicted to alcohol who wish to try to lead a sober life come to share experiences and advice, give and receive support, and enjoy simple companionship. Meetings are usually free and open to anyone committed to living a life free from alcohol abuse, their loved ones, and people who need advice regardless of their relation to alcoholism. AA is based upon the famous 12-step model where alcoholics are encouraged to follow each step and work towards a sober life.
Art therapy uses creative expression as a therapeutic technique, allowing patients to find benefits in the process of creating art as well as exploring the psychological experience of such creativity in dialogue between patient and therapist. Art therapy often includes a number of other therapeutic models and ideas. Each art therapist may have his/her own approach. However, at its core the value of art therapy rests in the creative experience and the analysis of what is created, and how. A simple definition is that given by the British Association of Art Therapists: “a form of psychotherapy that uses art media as its primary mode of expression and communication.”
Cognitive behavioural therapy (CBT)
CBT uses dialogue between therapist and patient to focus on, challenge and change negative thought processes, beliefs and behaviours, to improve emotional regulationand to develop personal coping strategies and psychological defence mechanism. Therapists work to help patients to identify their own negative cognitive distortions and to develop their own strategies in order to achieve identified goals and decrease negative behavioural manifestation. CBT dates back to the first half of the 20th century, and has since become a mainstay of therapy provision, used to treat a wide variety of different disorders.
The word “counselling” covers a very broad spectrum of activities. The technical definition of “counselling” and “counsellor” varies from one jurisdiction to another – but fundamentally refers to the provision of advice and support to a patient by an individual counsellor. Unlike many forms of psychotherapy, the counsellor will give their own opinions on what the patient should do and how they should address their specific challenges. Counsellors may be trained in other therapeutic techniques and may be professionals with additional qualifications.
Dialectical behaviour therapy (DBT)
DBT is a form of cognitive behavioural therapy (CBT) which combines typical cognitive behavioural techniques with concepts such as distress tolerance, mindfulness and acceptance, some of which have been taken from Buddhist meditative practices. It requires the patient to view their therapist as an ally in the treatment of their psychological issues. Meanwhile, the therapist works to accept and validate the patient’s emotions at any given point whilst at the same time showing them how some of their behaviours may be negative and offering superior alternatives. DBT seeks to have the patient change their behaviour and acquire new skills, working towards “a life worth living” as defined by the patient.
Experiential therapy uses activities such as acting or role-playing, and tools such as props, music, guided imagery and creative expression to recreate emotionally significant experiences which have affected the patient. Reliving such experiences enables the client to identify the emotions associated with factors such as disappointment and self-esteem, and to work to explore and overcome negative emotions such as shame, anger and distress which may be linked to the experiences which they are investigating and which may drive substance abuse. Experiential therapy is provided in a range of different settings and is often delivered in combination with other therapeutic models.
Family therapy – often known as family and systemic psychotherapy – enables family members and other people in close relationships to work together to identify and explore challenging thought processes and emotions in a safe environment. They can appreciate each other’s needs and desires, understand each other’s experiences and thoughtsand collaborate to make changes in their relationships when necessary. In addiction treatment, family therapy recognises the impact of addiction on other family members and seeks to make the addict aware of the damage caused by their addiction. At the same time,the therapist minimises the distress and shame which such awareness may cause, instead showing how the love and support of family members can help.
Unlike most forms of psychotherapy, group therapy involves one or more therapists working with a group of several patients (numbers vary, but typically between three and 10) at the same time. Working together to explore shared issues and challenges, the group may contain patients at different stages of treatment. Group therapy boosts self-esteem and confidence as patients work together, share strengths and offer support and advice. Patients may find it easier to explore difficult experiences and emotions in the company of others who feel similar things and have had similar obstacles to overcome. Different therapy models may be provided in group settings.
Holistic therapy considers the entirety of a person – mind, body and spirit – and aims to provide a correct balance in life by treating each element holistically. It is founded on the principle that if one part of the person is not working correctly, all other parts will be affected negatively. Hence, all need to be treated to ensure optimal health. Holistic therapy may include medical practices from a broad range of philosophies, not simply Western medicine. The therapist will consider the patient’s current physical, mental, spiritual and social well-being when determining the correct treatment plan.
A person who has engaged in chronic substance abuse, and/or is suffering from an addiction, may have neglected their physical fitness. Fitness therapy aims to improve physical fitness, and by doing so, to boost feelings of self-worth which may have been damaged by addiction. It provides the recovering addict with alternative and more positive ways to spend their time and gives them healthier ways of physical and mental health. Operating on the basis of “healthy body, healthy mind”, fitness therapy also aims to render the patient much more receptive to other forms of therapy as well as providing them with a more positive, healthy outlook on life and self-benefiting goals.
“Individual therapy” refers to therapy provided one-on-one between therapist and patient. Many different forms of therapy (including almost all forms of psychotherapy) can be provided on an individual basis. The full focus is on the person suffering from addiction and their own emotions, experiences, feelings.
A music therapist uses music – both heard and created – to improve mental health in areas such as emotional regulation, communication and even cognition and motor control. Music therapy can comprise listening to music and discussing a person’s emotional and psychological response to it, as well as creating music which can act as a catharsis. It can provide a starting point for discussion about the patient’s thought processes which led to the composition. Music therapy is known to reduce anxiety, improve brain stimulation and the capacity for learning and to have physiological effects including improved heart rate and pain relief. Music therapy can also be used in conjunction with other forms of therapy, in either individual or group settings.
Meditation – from a Latin word meaning “to think” or “to contemplate” – can take various different forms but fundamentally describes the practice of training attention and self-awareness so that mental processes can be brought under greater control, thereby improving overall mental well-being and the ability of a person to regulate thought processes and thus improve behaviour. Many different religions and philosophies include meditation as a means of achieving mental clarity and emotional stability. As a therapy, meditation is typically guided at first by an experienced therapist, but can be used independently at any stage and can be a very useful tool throughout, including long after an addiction has been overcome.
Psychodynamic therapy – also known as psychodynamic psychotherapy and psychoanalytic psychotherapy – is a mode of depth psychology which aims to reveal the unconscious content of the patient psyche in order to relieve mental and emotional stress and improve behaviour. It draws heavily upon the ground-breaking work of Sigmund Freud and employs techniques such as free association and dream interpretation, as well as more familiar therapeutic techniques such as discussing difficult memories and experiences and developing psychological defence mechanisms. It is usually provided on a one-to-one basis.
Narcotics Anonymous (NA)
Inspired by the success of Alcoholics Anonymous, NA is a similarly organised fellowship catering to drug users and addicts specifically with thousands of groups meeting around the world. Meetings are free to attend with the only requirement being a commitment to a sober life. Meeting attendees provide support and advice as well as companionship. NA is founded on a 12-step model. There are also similar fellowship groups for users of specific substances (for example Cocaine Anonymous and Marijuana Anonymous).
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Psychotherapy refers to the use of psychological methods in order to overcome problems and change behaviour. It encompasses the majority of the specific forms of therapy discussed hereand, indeed, over a thousand different recognised psychotherapy techniques. Psychotherapy is differentiated from physical therapy (such as physiotherapy) in that it focuses on the psychology and mental health rather than their physical health.
Several renowned self-help organisations including Alcoholics Anonymous and Narcotics Anonymous are based upon a 12-step programme initially created by the founders of AA. The American Psychological Association summarises the 12-step process as: “admitting that one cannot control one’s alcoholism, addiction or compulsion, recognising a higher power that can give strength, examining past errors with the help of a sponsor (experienced member), making amends for these errors, learning to live a new life with a new code of behaviour, helping others who suffer from the same alcoholism, addictions or compulsions.” Some individuals may be philosophically averse to the “recognition of a higher power” but there is no fundamental requirement to observe any particular religion.
Yoga is a set of physical, mental and spiritual practices and disciplines originally emerging in ancient India. It is one of the six orthodox schools of Hindu philosophy. Therapy involves the practice of yoga as a means of achieving physical and mental well-being, partly based on the premise of “healthy body, healthy mind” which also underpins fitness therapy. It combines the different aspects of yoga including physical manipulation and meditation as a holistic approach to treatment. The principles of yoga can be deployed long after an addiction is overcome with ongoing benefit t the person suffering from addiction. It is typically provided in group settings, though one-to-one yoga therapy is also an option.
Facts and Statistics about Therapy
- Therapy can be engaged in at any time; you do not need to be diagnosed with a substance use disorder to participate in and feel the benefits of therapy.
- There are over 1,000 different recognised forms of psychotherapy.
- An NHS study has shown that talking therapy is as effective as antidepressants in treating major depressive disorder.
- Over 1,000,000 people are referred for therapy by the NHS each year.
- A 2012 report by Aviva surveying over 200 GPs found that 75% prescribed medication despite feeling that psychotherapy would be more effective in those cases.
- Mental health issues are estimated to cost the global economy over £1.6 trillion each year.
- Studies by the Mental Health Foundation show that mindfulness therapy can lead to a 70% reduction in anxiety levels.
- Engaging in aerobic exercise at least three times a week for three months has been proven to have a significant positive effect on mental health.
- The most common form of therapy in the UK is cognitive behavioural therapy (CBT) representing nearly 40% of total referrals.
Paying for Therapy
The cost of therapy varies significantly from one practitioner to another – and depends on how the therapy in question is obtained: therapy can be provided free on the NHS or funded by private health insurance; it can also be obtained independently. Therapy can also form part of an integrated addiction treatment programme such as that provided in rehab, in which case the cost will constitute part of the overall bill.
If you have private health insurance, check the specific terms of your policy to see whether therapy is covered. If you are without insurance, your GP may be able to refer you for therapy on the NHS (though waiting lists can be substantial).
Whatever your situation, an addiction specialist will be able to discuss your options with you and may be able to give advice on the most cost-effective therapy options available to you.
Get Help Today
If you are suffering from a substance abuse disorder and are experiencing significant psychological and emotional distress as a result, therapy can help you regain control of your life and get you back on the path to happiness. Speak with your GP and/or an addiction specialist as soon as possible to discuss the options which may be available to you and which are appropriate to your particular resources and life constraints. For example, you may not have funding for private residential rehabilitation, or you may feel that your personal and professional obligations do not allow you to take weeks or months out in an inpatient setting. What you may think you want may not actually be the most appropriate course of action.
Most importantly don’t let your addiction cause you any more pain: pick up the phone today and take the first step back to the healthy life you want and deserve.
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