Counseling and Addiction

Kicking the habit of prescription drugs, street drugs or alcohol -- or any other addiction -- 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 drug cravings and avoid relapse.

Counseling is a mainstay of substance abuse 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.

Why You Need Counseling

Addiction is more than a physical dependence on drugs or alcohol. Even after detox, when your body is no longer hooked, 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 abuse. 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.

Individual vs. Group Therapy

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 drug 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 addiction.

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Outpatient vs. Residential Treatment

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 drug abuse 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 addiction treatment?

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

Cognitive Behavioral Therapy

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.

Contingency Management Therapy

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

Motivational Interviewing

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.

Couples and Family Therapy

An addiction doesn't only affect your life; your whole family is transformed. Successful treatment requires 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.

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12-Step and Community Programs

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. 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.

Maintenance Therapy

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.

WebMD Medical Reference Reviewed by Jennifer Casarella on December 04, 2019

Sources

SOURCES:

Carroll, K.M. American Journal of Psychiatry, 2005.

Dennis, M. Addiction Science & Clinical Practice, December 2007.

FDA. "FDA approves first buprenorphine implant for treatment of opioid dependence."

Harvard Mental Health Letter, "Treating opiate addiction, part II: Alternatives to maintenance," January 2005.

Medline Plus: "Opiate withdrawal."

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."

O'Brien, C. The Journal of the American Medical Association, 2008.

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)."

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