Counseling and Substance Use Disorders

Medically Reviewed by Jennifer Casarella, MD on December 03, 2021
4 min read

Kicking the habit of prescription drugs, street drugs or alcohol -- or any other substance use disorder -- is a major achievement. You have a lot to be proud of, yet you still have some work ahead of you. Detox is only the start of a long process through which you’ll learn to manage cravings and avoid relapse.

Counseling is a mainstay of substance use disorder treatment for many people. Cognitive behavioral therapy, family counseling, and other types of therapy can help you stay clean. Psychotherapy can also treat other mental health conditions that often play a role in substance abuse.

A substance use disorder is more than a physical dependence on drugs or alcohol. Even after detox, when your body is no longer dependent, you’re at high risk for relapse. Certain psychological and social factors can be powerful triggers that lead to relapse:

  • Stress, especially sudden life stresses
  • Cues in the environment, like visiting a neighborhood
  • Social networks, like spending time with friends who continue to use 

These things can create a strong ongoing urge to use again. Counseling helps you escape cravings and learn to manage what life throws at you without drugs or alcohol.

Several counseling therapies treat substance use disorders. No one method is known to be better than another. Likewise, no one approach works for everyone with opiate addiction. The right treatment plan will be tailored to your addiction and individual needs.

While any counseling therapy for drug abuse treatment is better than none, group therapy is generally preferred over individual therapy. In group therapy, you’re more likely to be both challenged and supported by peers who are also going through rehab.

Twelve-step programs like Narcotics or Alcoholics Anonymous are also peer support groups. They can be a useful part of your recovery program. But keep in mind that they aren’t led by a trained psychotherapist and, thus, aren’t the same as group therapy.

Individual therapy can help when you have depression, bipolar disorder, or another significant mental health condition that requires treatment in its own right, separate from your substance use disorder.

Residential therapy separates you from the place and things that led you to use drugs. You’ll go away to a special facility for a period of weeks to months. While there, you’ll learn new habits or skills for sober living.

While this approach works well in the short term, there’s no proof it helps you stay away from drugs any longer than outpatient programs, which you’ll attend for anywhere from a few hours to several hours a day while you live somewhere else.

In fact, relapse may be more likely if you go from a controlled, inpatient environment back to your home, where it’s easy to start using again. Also, residential treatment programs are expensive. They can cost tens of thousands of dollars, and insurance plans don’t always cover them. Learn more: What does insurance cover for substance use disorder treatment?

Outpatient treatment programs are the usual setting for drug and alcohol abuse treatment.

Cognitive behavioral therapy, or CBT, teaches you how to recognize moods, thoughts, and situations that fire up drug cravings. A therapist teaches you how to avoid these triggers. You’ll learn to replace negative thoughts and feelings with healthy ones that will help you stay clean.

The skills you’ll learn can last a lifetime, so this is a powerful treatment method. But not all therapists are trained in cognitive behavioral therapy techniques.

Dialectical behavior therapy (DBT) focuses on acceptance and change. Started in the 1970s to treat people who were suicidal, DBT has been adapted for other uses, including substance use disorders. In treating substance use disorders, the emphasis is on curbing substance use and behaviors that lead to it and boosting healthy behaviors (like starting positive relationships) that help the person avoid using.

This method gives you positive incentives to stay clean. Vouchers for goods and services, or privileges in a more rigid treatment setting, are common.

In this method, therapists try to motivate you and help you maintain your abstinence from drugs or alcohol. If you’re prompted by love of family or returning to work, these issues may become the focus of your treatment.

Addiction doesn't only affect your life; your whole family is transformed. Successful treatment is more likely when you have strong relationships with family and friends. Various counseling methods include your spouse and other family members.

Why try family or couples therapy?

  • Family members can be a powerful force for change in your life.
  • Including them can make you more likely to stay in therapy.
  • They can begin to heal the damage your addiction has caused in their life.

Studies show family therapy results in lower relapse rates, increased happiness in the family, and helps children of addicted parents manage their situation.

Narcotics Anonymous (NA) is an international network of community-based meetings for people recovering from drug addiction. It’s modeled after Alcoholics Anonymous (AA), so it’s a 12-step program with a defined process for overcoming addiction.

It’s aIso an abstinence-based program. In principle, NA is opposed to the use of maintenance therapy, although many groups and individuals are more accepting now than in the past. Methadone Anonymous is a 12-step program that acknowledges the value of methadone and other medications in recovery from narcotic addiction.

Other popular recovery meetings include SMART Recovery and Celebrate Recovery.

Addiction is a chronic illness. People who have it are likely to relapse.

Once you’re through detox, you’ll probably need lifelong treatment that includes counseling and possibly medication. Currently, the FDA has three drugs approved for the treatment of opioid addiction and three for the treatment of alcohol addiction.

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Narcotics Anonymous web site.

National Institute on Drug Abuse, "Treatment Approaches for Drug Addiction."

National Library of Medicine, "Estimating the Client Costs of Addiction Treatment: First Findings from the Client DATCAP."

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Van den Brink, W. Canadian Journal of Psychiatry, 2006.

National Institute on Drug Abuse: “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)."

Addiction Science & Clinical Practice: “Dialectical Behavior Therapy for Substance Abusers.”

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