Types of Therapies

Addiction is a complex disease, and one that still isn’t well-understood. Among other things, that means there’s no one path to sustained sobriety for the person you love. Working with your loved one’s health care providers (therapist, doctor, addiction counselor and/or interventionist), you should assess the types of treatments that best fit your loved one’s needs and preferences.

The first step to treatment is usually detoxification, or the removal of the substance(s) or problematic behavior(s). With the exception of a few drugs (like inhalants), withdrawal symptoms occur when a substance or behavior is removed. These can include physical and/or psychological symptoms:

Physical symptoms of withdrawal:

  • Nausea
  • Vomiting
  • Muscle aches
  • Headaches
  • Shakiness
  • Seizures
  • Coma

Psychological symptoms of withdrawal:

  • Depression
  • Anxiety
  • Sadness
  • Anger
  • Upset

Once your loved one enters into treatment program for addiction (being admitted into an inpatient, outpatient or day treatment program), chances are they’ll have a mix of the following approaches as part of their treatment plan:

Drug Therapy: Withdrawal symptoms – both physical and psychological – can be intense. There are a variety of prescriptions that can be used to help ease the symptoms of withdrawal in the short term and to keep cravings at bay for the longer-term; this is called medication-assisted therapy (MAT). According to the Substance Abuse and Mental Health Services Administration (SAMHSA), prescription medications may help restore normal brain function (namely the production of dopamine) in people who have substance use disorders. While drug makers don’t have a prescription to help every addiction, here are some of the substance use disorders that have FDA-approved prescriptions available:

  • For alcoholism: Naltrexone (brand names: Depade, ReVia and Vivitrol, an injectable form) is used to quell cravings for alcohol (and opioids; more on that below), while acamprosate (brand name: Campral) reduces withdrawal symptoms. Disulfiram (brand name: Antabuse), the oldest medication for alcoholism, causes unpleasant symptoms like nausea and skin-flushing that deter patients from drinking.
  • For opioid addiction: Powerful painkillers, opioids are a class of drugs that include both the illicit drug heroin and prescription medications like morphine, oxycodone and hydrocodone. Addictions to these drugs can be treated with methadone, buprenorphine hydrochloride (brand name: Subutex) or buprenorphine hydrochloride and naloxone hydrochloride tablets (brand name: Suboxone). Methadone and Subutex are used to quell withdrawal symptoms, including cravings, while Suboxone blocks opioids’ ability to elicit a reaction from brain receptors. All of these drugs alleviate drug-seeking behavior, too. (Methadone, if used, should be managed with caution due to its risk for life-threatening breathing problems, says the National Institutes of Health; it’s also highly addictive).  The drug naltrexone (Vivitrol) also has FDA approval for treating opioid addictions; it works by erasing the drugs’ effects so that cravings eventually diminish.
  • For tobacco addiction: Nicotine is the addictive ingredient in tobacco products. Various nicotine-replacement therapies are available over-the-counter (OTC), including nicotine patches, sprays, gums and lozenges. Bupropion (brand names: Wellbutrin, Zyban) and varenicline (brand name: Chantix) are both FDA-approved for smoking cessation.
  • For video gaming addiction: The antidepressant bupropion (brand names: Aplezin, Budeprion, Buproban, Wellbutrin, Zyban) is sometimes used to treat gaming disorders; as with its use in treating some substance use disorders, it can help reduce cravings for gaming.

More medications are also in the pipeline to help with addiction. Several are currently under investigation for the treatment of gambling disorder, but none have been approved by the FDA. And drugs are being developed for treating addictions to stimulants such as cocaine and methamphetamine as well as marijuana addiction, reports SAMHSA. You should know that if your loved one is addicted to more than one substance (what’s called “poly-drug” use), this is common, and his/her treatment team should address each drug of abuse – as well as any other mental health issues – in treatment.

Psychotherapy: Counseling is considered an essential component in successfully treating addiction. What this means, however, varies a lot. It can mean that your spouse or loved one undergoes one-on-one “talk therapy” with a trained therapist, social worker, psychologist, psychiatrist or an addiction counselor, or he/she might be referred to group therapy. (This is when a group of people meet for counseling sessions to work on the same or similar issues with a trained therapist.) Your loved one might do both group and individual therapy, too.

The treatment plan for your family member or friend could include other types of therapy, too, and the approach that’s used could change over time. For instance, counseling sessions may at first focus on recognizing triggers and sidestepping them or identifying ways to self-soothe in the face of difficulty and anxiety. Other techniques may be incorporated to help him/her deal with any past hurts or trauma in more depth. How a treatment team helps your loved one depends on the techniques the counselor is trained in as well as research that’s proven to be effective for people who are facing similar challenges. In addition, counselors take into account who your loved one is and what kinds of therapies might work based on his/her interests and personality.

Here are some of the more common psychotherapeutic approaches to treating addiction:

Cognitive Behavioral Therapy (CBT): CBT is a term for a well-documented and widely used treatment approach for mental health problems and substance and behavioral addictions. It’s a general term for a group of therapies in which the therapist aims to help her client shift negative, inaccurate and unproductive thoughts and beliefs (such as, “How do you know everyone was looking at you? Isn’t it possible you just felt they were?”), thereby improving the client’s overall emotional health and behavior. When your loved one is in counseling for an addiction and/or mental health problem, it’s very likely that a therapist will incorporate some CBT techniques. This approach tends to be a more rapid form of therapy, and “homework” is often assigned to help clients unlearn unhealthy habits and behavior.

Dialectical Behavioral Therapy (DBT): According to the National Association of Cognitive-Behavioral Therapists, Dialectical Behavioral Therapy is a form of CBT that is used when patients dealing with trauma or a difficult childhood require more support and acceptance to overcome addiction or other issues. In DBT, the clinician offers the client total acceptance, helping the client to open up and letting the client know when a behavior or belief is unhealthy. During counseling sessions, the patient reports the problems encountered in the previous week. The therapist tries to work with the addict to teach coping skills for dealing with life’s everyday challenges – both big and small – while at the same time helping the client to learn how to deal with the present situation and not see or experience these through the lens of the past.

Motivational Interviewing (MI):  This type of psychotherapy is used by counselors who want to help clients feel empowered to make positive changes in their lives. Motivational Interviewing is a collaborative form of counseling in which a therapist seeks to strengthen the individual’s desire to reach goals and make effective life changes.

Group Therapy:  Group work can be very effective for people who share similar issues – including an addiction or a co-occurring mental health issue (like depression, bipolar disorder or ADHD). The certified group therapist (or sometimes a certified group facilitator) helps guide members to have focused conversations about their experiences and also participate in group activities that can help the healing process. By taking in the perspectives of others who have walked a similar path, members can learn from each other and feel less alone in their struggles. The therapist effectively uses group dynamics to help members change any negative behavior or thought processes that might underlie an addiction.

Family & Couples Therapy: Family therapy (also sometimes called Multidimensional Family Therapy, or MDFT) brings family members together to work to improve relationships, communication and cohesiveness. When a family goes to therapy because one or more members has an addiction and/or a mental health issue, there’s an opportunity to solve problems and past hurts among the group. The family learns not to feed into an addiction, so they don’t enable it to continue. In couples therapy sessions, partners work with a therapist to deal with an addiction and all the ways the substance or behavior has wounded their relationship by eroding trust and interdependence. The couple works to reconnect – or if they’re unable, to part ways. Therapy might unearth unresolved trauma or unmanaged mental health issues. Depending on the situation, the therapist may decide to hold individual sessions with one partner or even refer a patient for more specialized care, such as Eye Movement Desensitization and Reprocessing (EMDR) if indicated.

Other Treatment Options: As part of treatment for addiction, your loved one might also encounter these therapies:

Adventure therapy: These programs welcome nature into the healing process. Programs vary but may include adrenaline-pumping sports or activities such as rock climbing, orienteering and zip lining. The premise is that Mother Nature dishes up unique, unpredictable challenges, allowing addicts to learn how to manage problems on the fly and that problem is insurmountable.

Art therapy: Certified art therapists help bring out patients’ inner artist, using a variety of media (watercolors, oil pastels, clay) as a means to address and sort through difficult feelings and experiences. According to the American Art Therapy Association, art therapy helps patients to resolve inner conflicts, gain self-awareness, change behavior, strengthen social skills, manage anxiety and increase self-esteem.

Equine therapy: Sometimes animals can heal when nothing and no one else can. Your loved one may get a lot out of caring for and riding horses as part of his/her treatment program. Some centers offer equine therapy on property to help those with addictions and/or mental health issues to develop deeper emotional connections and promote healing.

Eye Movement Desensitization and Reprocessing (EMDR): This form of psychotherapy aims to relieve anxiety, trauma, post-traumatic stress disorder (PTSD) and depression. A trained EMDR therapist uses a technique in which the client follows the therapist’s fingers with his/her while recalling a negative memory. The combination of the repetitive eye movement and memory recall is said to help the client process memories and relieve negative emotions. Because events such as past trauma may contribute to a drug addiction and because co-occurring disorders need to be addressed in treatment, EMDR is sometimes used when more intensive therapy is needed. EMDR may be repeated until the client fully processes his/her distress over past events.

Motivational incentives: To encourage clients to reach treatment goals and stay sober, clinicians may reward those who are making good strides in treatment. Rewards might include a weekend pass to go home, a voucher for an outing or a privilege like getting their own room in a sober living home. This positive psychological approach encourages clients in residential treatment programs or sober living communities to stay the course.

Recreational therapy: Addicts often need to re-learn healthy ways to have fun, relieve stress and build relationships. By participating in scrapbooking, knitting or bowling, for example, recreational therapy helps addicts build community and begin to experience healthy ways to have fun, relieve stress and form relationships.

Wilderness therapy: Usually geared towards teens and young adults, wilderness therapy teaches skills that allow participants to subsist in nature for a period of days or weeks, depending on the program. The self-reliance learned in the wild translates into real life following the program. These programs may include individual treatment plans and 12-step work, too.

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