Therapy In Addiction Recovery
Therapy is a significant part of addiction recovery. It is the use of psychoanalysis in helping clients through the rehabilitation process. In cases of drug and alcohol addiction, therapy often takes place once medical detoxification is complete. Therapy is done as part of rehabilitation, which occurs either as inpatient (residential) rehab, or as outpatient services. Rehab usually involves a mix of individual and group therapies, with other activities included. Rehab centres offer many different therapy options for their clients, with the most common being cognitive behavioural therapy, 12 step, and motivational interviewing. Other types of therapies often used in addiction treatment are contingency management and dialectic behavioural therapy. Art and music therapy, food therapy and animal-assisted therapy are considered complementary therapies, while family therapy involves family members and often runs concurrently with other therapies.
Cognitive Behavioural Therapy
Cognitive behavioural therapy (CBT) is one of the most effective therapies for addiction issues. It was originally used to treat depression, but was later expanded used to address a wide range of mental issues. CBT focuses on enabling the clients to be aware of their thoughts and actions, as well as the consequences of both. It is postulated that feelings, thoughts, and behaviours are influenced by each other. This gives individuals the ability to change one aspect by addressing the other two. For example, you can change your behaviour by examining and modifying your thoughts and feelings.
In the addiction treatment process, CBT enables the individual to look at the reasons behind their addiction and how it has affected their lives. You are encouraged to examine your thought process and look for any negativity that could the reason for your addiction. This could be negativity in terms of how you view yourself or how you view others.
CBT sessions tend to be short, with each session lasting approximately 45 minutes. The sessions are personalized to the needs of each client. CBT practitioners often spend each session discussing irrational or negative thoughts, behaviours and any stressors that contribute to addiction. Eventually the session moves to activities that can be done to change those thoughts. The clients learn coping skills that would allow them deal with challenges in a more positive and less stressful manner. Clients learn other interventions such as cognitive restructuring to help change negative thinking patterns, relaxation techniques, self-monitoring and assertiveness training. These techniques are useful to clients long after the therapy sessions are done.
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Twelve-step (12 step) therapy does not follow the traditional format of therapy where a certified therapist guides the client through a process. Instead, it is a self-help system where recovering addicts come together to support each other to achieve and maintain complete abstinence from substance abuse. Many rehab centres have incorporated the 12 step method into their treatment programmes (known as 12 step facilitation), though it remains popular in the regular meeting format employed in different venues across the world.
The 12 steps are broken down into three major concepts. The first key concept is acceptance. Members accept that they have no control over addiction, it cannot be beaten by willpower alone, and abstinence is the only option. The second concept is that of surrendering to a higher power (God), surrendering to a spiritual and moral way for life, studying past errors and making amends for them. The third concept is active involvement in the 12 step fellowship. Members are expected to attend all activities and follow each and every step of the program.
12 step is one of the most popular self-help addiction programmes, and it is considered one of the most successful as well. Part of the programme involves sponsorship, where a new or less experienced member is ‘sponsored’ by someone who is more experienced in recovery. Sponsors guide their sponsees by sharing their own experiences and attending 12 step activities together. Sponsors are also involved in the atonement process, where members examine past transgressions and atone for them.
Due to the major role spirituality plays in 12 step programmes, it is usually not attractive to those who prefer a more secular method of recovery.
Motivational interviewing is a technique that places all focus on motivating clients to give up any destructive behaviour. Many people struggling with addictions simply do not have the motivation to give up their vices, even when they are aware of or are being affected by the negative effects of addiction. In motivational interviewing, therapists assist clients to conquer their fears and be courageous enough to change their destructive habits. There are three main reasons why addicts often lack motivation to change their ways. These include:
- Being unaware of the severity of the problem
- Fear of withdrawal symptoms
- Fear of losing the pleasant feelings associated with substance abuse
With motivational interviewing, the therapist is meant to guide the client to recognize their fears and motivate themselves to overcome them. It is important for the therapist to be non-confrontational. The clients should simply be nudged in the right direction. Essentially, the client is responsible for resolving their issues. The therapist merely acts as a guide to help them understand and resolve those problems. This way, clients enact changes in their behaviour because they want to, not because they are forced to. Addicts frequently change their minds on whether they want to quit their substance abuse or not. This is because to an addict, while there may be many reasons to stop their substance abuse, there are also many reasons not to. Thus, therapists assist the clients in debating the pros and cons of dealing with their addictions. Once the client has reached a decision on their own and is clear about the path they want to take, it becomes easier for the therapist to work with them to develop a practical plan to achieve their goals.
Contingency management is a type of therapy based on the psychological concept of operant conditioning. In theory, good behaviours are rewarded while undesirable behaviour is punished. Much of the practice focuses on rewarding good behaviour in the belief that rewards encourage the individual to continue to exhibit good behaviours with increasing frequency and intensity. On the other hand, bad behaviours are punished or ignored to ensure the frequency of occurrence decreases until the behaviour is eliminated completely.
The process of operant condition is believed to help individuals change existing behaviours or learn new ones. Rewards are often given in form of vouchers or prizes. For example, if a recovering addict returns a clean drug test or attends a meeting, a voucher is given. The value of the voucher or prize may increase with subsequent evidences of good behaviour.
In theory, bad behaviour should be punished. In reality, punishments are rarely handed out. This is because the having a disciplinary attitude is counterintuitive to therapeutic settings. Punishments also inspire fear, leading to patients often withholding information from the therapist or key worker, which is detrimental to recovery.
The first step in contingency management is to identify the behaviour that needs to be encouraged or eliminated. A reward system is established, making sure that the reward is something that the patient actually wants. If the patient does not like the reward, the system will not work. The reward is often given immediately after the desired behaviour is achieved, in order to ensure that the behaviour is strongly associated with the reward. The goal of this conditioning is to make sure that the desired behaviour continues especially after the rewards are stopped.
Contingency management can be done as a stand-alone therapy, but is often used alongside therapies such as CBT and motivational interviewing.
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Dialectic Behavioural Therapy
Dialectic Behavioural Therapy (DBT) is based on CBT, but with a few modifications. While CBT focuses on changing behaviours, DBT adds the concept of validation and dialectics. Validation is used to explain why a patient acts the way they do. It does not excuse negative behaviours or emotions. Dialectics introduces the idea that change is constant and everything is connected in one way or another. DBT explains that emotional imbalance and invalidating environments are key to several mental health issues, including addiction. DBT in addiction treatment focuses on treating addiction as a symptom of environmental issues and emotional imbalance. There are cases where people abuse substances to cope with negative or painful emotional experiences. Abusing drugs enables them to escape their feelings, at least temporarily. There are also cases where people resort to drug abuse because they live in invalidating environments, where they are often told that their feelings are wrong or subjected to ordeals that lead to low self-esteem.
DBT encourages recovering addicts to accept they are doing their best to improve their situation, providing an air of optimism in the process. DBT practitioners promote the concept of dialectic abstinence. Some addiction treatment processes favour complete abstinence for recovery. Some others focus more on harm reduction. With dialectical abstinence, the therapist helps the client to try and achieve complete abstinence, while also educating them on harm reduction in case of relapse.
This allows the client to remain committed to abstinence, while knowing that they will be supported to get back on the right path if a relapse occurs. Regardless, the client maintains control over their recovery.
DBT is anchored on skills training and therapist consultations. Skills training sessions are conducted with groups of clients who are taught life skills that are influential in changing negative emotions and behaviours. Skill include mindfulness, where one learns to be aware of their own thoughts and emotions; distress tolerance, where one learns how to cope with distressing scenarios in a positive manner; emotional regulation, learning how to control emotions that could lead to addictive or destructive behaviour; and interpersonal effectiveness, learning how to be assertive while maintaining healthy personal relationships with others. Individual therapy sessions and phone coaching are also integral to the DBT process.
Art and Music Therapy
Art and music therapies are often categorized as alternate or complementary forms of therapy. Art therapy is the use of art techniques to enable the individual express their feelings and aid in the addiction recovery process. Spending time on artistic approaches may reveal underlying feelings and emotions related to substance abuse. Art therapy is also an avenue to decrease anxiety and achieve relaxation. A certified art therapist is often involved in the process, and works with the individual to interpret any hidden meanings and explore the thoughts and behaviours present in the finished artwork. Art therapy involves visual arts techniques such as drawing, painting, sculpting and collaging. It is always meant to be a form of teamwork between you and the therapist.
Music therapy, like art therapy, involves the use of creative self-expression, this time through music, to explore the mental processes underlying an individual’s addiction. Through music, therapists aid the clients in improving self-awareness, examining emotions, relaxing and focusing on positive feelings, developing coping strategies. Music is especially beneficial for young adults, as it is a large part of young adult culture. Most young adults are comfortable with expressing themselves through music, whether through singing, playing an instrument or even by their song choice. Music therapy incorporates the following activities:
- Song writing
- Creating beats and sounds
- Listening to music
- Discussions centred around beats, lyrics and genres
- Playing an instrument
- Musical games
As with art therapy, music therapy should be conducted by a certified music therapist. Music and art therapy are often important in enabling clients to relax, accept that they have addiction problems and find the courage to face them. Due to their ability to express themselves creatively, clients are more open and find themselves motivated to work hard to live a sober-free life.
To a recovering addict, eating well may not be a top priority. In reality, healthy nutrition is an integral aspect of recovery. Food therapy involves not only ensuring that the recovering addict is eating well, but also training the individual to understand the importance of nutrition in addiction recovery.
Substance abuse often interferes with the uptake of proper nutrients needed by the body, leading to nutritional deficiencies. Vitamin and mineral deficiencies are very common among addicts. Poor nutrition can also result in low blood sugar levels. Nutritional training serves to teach the individual what foods to include in their diet in order to feel strong and balanced during and after recovery. All-natural or organic foods are highly recommended.
Proper nutrition helps the body remain strong during the detoxification process, and also helps to flush out the toxins left behind by the abused substance. It also gives the body strength and materials needed to repair any physical or internal damage caused by substance abuse. This includes the brain damage. The brain is a resilient organ that will try to return to its pre-addiction condition. This cannot happen if the individual is suffering from nutritional deficiencies. It is also known that a healthy body contributes to good physical and mental health, encouraging the recovering addict to maintain a positive attribute and continue to strive for a sober lifestyle. Many addiction centres promote food and nutrition as part of their recovery programmes. Food is planned according to nutritional value and a chef is usually on hand to prepare meals in residential rehab.
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Animal-Assisted Therapy (AAT)
AAT is offered by some addiction treatment centres as a form of therapy geared towards relaxation and promoting positive attitudes. AAT works only for animal lovers, as non-animal lovers may experience feelings of anxiety near the animals which, coupled with the stress of addiction recovery, is detrimental to their mental state.
For animal lovers, introducing AAT into their recovery programme usually occurs by bringing the animals into the rehab centre or visiting the animals in another location. Small animals, such as hamsters and dogs are often brought into sessions to induce calmness and a positive mood. Stroking the fur of an animal is known to be calming, and may enable shy speakers to find their voice and be more open to sharing their experiences. For larger animals such as horses, or animals that require specific conditions, such as dolphins, excursions are usually taken off site to visit and connect with these animals. Therapeutic animals are bred to be docile and are properly cared for to avoid health complications.
AAT has been shown to improve positive attitudes among rehab clients, reduce anxiety, alleviate feelings of sadness and loneliness, boost confidence, improve social interactions, and reduce feelings of anger and insecurity. AAT is also particularly effective for children whose lives have been affected by a parent’s addiction.
Family involvement is often an instrumental part of the addiction recovery process. This is because the effects of addiction are felt not only by the addict, but extend to the family as well. As such, the strength and health of the family unit plays a major role for many as they go through addiction recovery. Family therapy focuses strengthening the mental and physical state of the family, ensuring that support is provided for the substance abuser. This is achieved by helping the family members to:
- Identify enabling behaviours and learn how to avoid them
- Address any co-dependent behaviour
- Learn self-interventions to improve the well-being of the family as members deal with addiction
- Understand the addiction recovery process and the systems in place to help the substance abuser
Family therapy also ensures that other members of the family do not follow in the same path of addiction. It can be done in combination with medical detox and the individual therapy and group therapy done in residential rehab. Family therapy is often extended to include anyone who has a close relationship with the substance abuser, including friends, dating partners, and co-workers.
The first step on the road to recovery from addiction is recognizing that you have a problem and you are willing to do what it takes to it. It is important to seek treatment for addiction as soon as you can, rather than waiting until a life-threatening event takes places. Some individuals are aware of their addiction, but do not seek treatment due to the amount of work and commitment involved in the process. Addiction is not a disease that one can easily overcome on their own, which is why there are treatment centres that cater to the needs of addicts. Treatment involves medical and psychosocial components.
The medical aspect of addiction treatment is detoxification. Detoxification occurs as patients go through withdrawal symptoms under the strict supervision of medical staff. During this process, the patients are regularly monitored, and underlying physical health conditions, such as any reversible damage done by abused substances are treated. In cases where the withdrawal symptoms are severe or cannot be handled by the patient, substitute drugs are prescribed to help the patient become less dependent on the abused substance. Some treatment centres offer counselling and therapy to help patients through the withdrawal process, while others prefer the keep the medical separate from the psychosocial.
Detoxification is not the cure for addiction; it is only the first step. Addiction as mental health issue must be treated with proper psychoanalysis. This is done through various therapies during rehabilitation. These therapies include those listed earlier in this article. In severe cases of addiction, patients are often referred to residential rehabs. They have to move into the facility for the duration of their programmes and are provided with round the clock care in comfortable setting to ensure that they remain on the path to recovery.
Some prefer to undergo their rehabilitation from the comfort of their own homes. This usually involves attending regular therapy and key working sessions at the designated centres. However, some addiction service providers will bring rehab to you, allowing you undergo the rehabilitation process in your own home, or a location that is more comfortable for you. Once the rehabilitation programme is complete, you will be connected to aftercare support groups to try and maintain your new lifestyle.
It is important to begin the path to recovery as soon as possible. Therefore, you should take action as soon as you notice signs of addiction in yourself or a loved one.
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