Substance Abuse & Addiction Counseling Techniques
Addiction comes in many shapes and sizes. It isn’t a one-size-fits-all type of thing. That is why there are countless recovery techniques. Learn more!
Types of Therapy
There are many kinds of addictions, all of which can be fueled by any number of factors. Environment, genetics, the particular substance used, or how often it’s taken — those all can play a part.
It only makes sense, then, that there would be several addiction counseling techniques to address substance use disorders. It’s not a one-size-fits-all illness; rather, countless recovery approaches exist to help people overcome addiction.
Here’s a look at a few therapies used to combat dependency. Note: None of these are a cure for addiction, but they can serve as excellent supplements to the recovery process.
During motivational interviewing, the therapist becomes “a helper in the change process,” according to the Center for Substance Abuse Treatment.
Motivational interviewing has roots in the work of psychologist Carl Rogers, who believed that people have the ability to make choices and change via self-actualization.
In treatment, it’s assumed that the client holds some ambivalence about addiction (and changing behaviors), which is normal, but this ambivalence is a roadblock to recovery. The client and therapist collaborate to address the hesitancy to change. The counselor will gently direct the sessions and also offer support to spark motivation.
The motivational interviewing process consists of stages of change:
- Precontemplation: The client is willing to consider change, even though there are doubts.
- Contemplation: The client can see potential benefits.
- Preparation: The client begins to look forward to quitting, but may still have self-doubt.
- Action: The client is clean, but some old habits may hold appeal.
- Maintenance: The client has been abstinent for some time, but may still wonder if sobriety is truly necessary.
Even if a client is more hesitant at first, the hesitation could provide a foundation for future therapy. Motivational interviewing typically explores various motivational conflicts and works to resolve those trouble spots.
Confrontational behavior is viewed as an obstacle to success, so typically the therapist utilizes five principles:
- Showing empathy through reflective listening
- Noting differences between the client’s goals and his or her current actions
- Avoiding confrontation
- Adjusting to resistance instead of opposing it
- Supporting optimism and self-efficiency
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Eye movement desensitization and reprocessing (EMDR) therapy was originally developed in 1987 to treat post-traumatic stress disorder (PTSD). It also is used to treat anxiety, depression, and addiction. (A fair number of clients who have substance use disorder also have PTSD.)
EMDR usually includes eight stages. In early sessions, the therapist will educate the client, then identify memories he or she needs to work through. The client selects an image to represent each memory, and a positive thought will also be chosen to take the place of negative feelings.
In EMDR a client will follow the movement of a pen the therapist is holding while the client focuses on a traumatic memory. Besides eye movements, hand movements, lights, and tapping or tones can be used as focusing points.
When someone experiences a trauma, especially one that results in intense fear, the trauma alters the brain’s neural pathways. A victim can be triggered by something that reminds him or her of past traumas. It can result in extreme panic, and some people turn to addictive behaviors to cope or numb the pain.
When a person has suffered a trauma, it tends to be re-experienced fresh, like it’s happening in the moment, but EMDR seems to help the victim reprocess the memory. They won’t forget, but it does seem to mute the pain and enhance coping. To work, it doesn’t require retelling the experience, so it’s not as grueling an experience as other types of therapeutic approaches.
Dialectical Behavior Therapy (DBT)
Another form of counseling for drug addiction is dialectical behavior therapy (DBT). The name comes from dialectics, a philosophy of balancing opposites. Originally it was devised to treat borderline personality disorder, but it can also help with depression, PTSD, and drug addiction. It helps the client find ways to manage seemingly opposing views at the same time. It’s a both/and approach, instead of an and/or approach.
It’s a one-on-one therapy that helps the client develop new skills to manage painful emotions. It targets four areas:
- Mindfulness: Being aware and present in the now
- Distress tolerance: Learning to handle painful feelings and memories as opposed to escaping them
- Emotion regulation: Developing ways to cope with hurtful emotions
- Interpersonal effectiveness: Communicating in ways that are assertive as well as preserving self-respect and relationships
Typically, individual therapy and group sessions are key components of DBT. One-on-one treatment addresses motivation and obstacles, while group therapy lets the client practice skills, share experiences, and give and get support.
Phone coaching and support for therapists (provided by other therapists) are part of DBT as well. Phone work builds coping skills and can help clients out-of-office when need arises. Therapists receive their own coaching, typically in consultation teams where they work on motivation and developing the best possible treatment.
Animal-Assisted Therapy (AAT)
Animals do more than make funny internet memes. They can provide a slew of health benefits. Physically, they can help lower blood pressure, boost relaxation, and reduce physical pain. Mentally, they provide comfort, lessen anxiety, and serve as icebreakers.
It’s no wonder, then, that dogs, cats, birds, and horses have been introduced to some people’s treatment plans. While petting Fido isn’t going to truly cure much of anything, animals can do a wonderful job of enhancing and complementing traditional therapies.
Various organizations have trained handlers and animals who work with people in hospitals, nursing homes, rehab centers, and other types of facilities. All kinds of animals are recruited, including dogs, cats, horses, rabbits, birds, guinea pigs, rats, and llamas.
Bringing an animal into the drug addiction counseling process has more pros than cons. (Unless you’re allergic.)
Physically, horseback riding can improve strength, flexibility, and balance, but it can also reduce stress and boost confidence.
Dogs are most commonly used in AAT. Typically dogs are paired with a handler, and the animal (be it dog, cat, bird or whatever other creature) helps take the individual’s mind off trauma.
AAT has been utilized more on children or adolescents who have experienced some kind of physical trauma or violence, or animals may be used to boost the spirits of people in nursing homes or hospitals. Simply petting a dog, walking with it, or speaking to the animal tends to be calming, especially since animals don’t have emotional baggage or judgment associated with them.
In general, AAT may elevate self-esteem and improve mental health. The jury may still be out on how valuable critters might be in combating addiction, but they do improve people’s quality of life, so anyone receptive to them may very likely benefit.
Yoga for Addicts
Yoga traditionally focuses on health and mindfulness, typically mixing postures, breathing exercises, and meditation.
There is evidence that the self-awareness and skills developed in yoga can help addicted individuals better manage stress and cravings.
Mindfulness-based relapse prevention (MBRP), for example, is an eight-week process that blends cognitive behavioral relapse prevention tactics with meditation and movement. The goal is to help clients better manage cravings and difficult emotions.
It’s not yoga like you’d see in movies, with people twisting themselves into human pretzels. Rather, it’s mostly light stretching exercises and gentle movements. Studies found that when the MBRP was blended with traditional therapies, substance use was reduced when clients followed up at the two-month mark.
Other studies, including those of veterans with PTSD, found that breathing practices and yoga also helped curb trauma symptoms.
Again, none of these therapies are cures, but they pair well with addiction treatments. There is no true cure for addiction, after all. Rather, addiction is a condition to be managed, and working with a therapist, handling animals, focusing on poses and mindfulness — any one of or all may help an individual better manage triggers and emotions, providing a more healthful alternative to self-destructive behaviors.
- ncbi.nlm.nih.gov – Enhancing Motivation for Change in Substance Abuse Treatment: Chapter 3 — Motivational Interviewing as a Counseling Style
- ncbi.nlm.nih.gov – EMDR beyond PTSD: A Systematic Literature Review
- ncbi.nlm.nih.gov – Effectiveness of EMDR in Patients with Substance Use Disorder and Comorbid PTSD: Study Protocol for a Randomized Controlled Trial
- ct.counseling.org – EMDR for the Co-Occurring Population
- mhc.cpnp.org – Personality Disorders
- depts.washington.edu – Dialectical Behavior Therapy
- uclahealth.org – Animal-Assisted Therapy Research
- petpartners.org – Pet Partners at Your Facility
- ncbi.nlm.nih.gov – What is hippotherapy? The indications and effectiveness of hippotherapy
- ncbi.nlm.nih.gov – Animal-Assisted Intervention for trauma: a systematic literature review
- ncbi.nlm.nih.gov – A Narrative Review of Yoga and Mindfulness as Complementary Therapies for Addiction
- ncbi.nlm.nih.gov – The Effect of a Yoga Intervention on Alcohol and Drug Abuse Risk in Veteran and Civilian Women with Posttraumatic Stress Disorder
- emdr.com – What is EMDR?
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