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Therapies

Explore therapy options for problems with drugs and alcohol​.

What is therapy?

Once you have recognized that you have a problem with drugs or alcohol, you may choose from many forms of therapy to begin the process of recovery. Each therapy can be more or less effective than others, depending on the substance you are using and the severity of your drug or alcohol problem. Other factors can improve the effectiveness of therapy, too, like having a stable living situation or the ability to count on support from family members and friends.

Your choice of therapy is personal, but a physician or specialists at an inpatient or outpatient treatment facility can help you determine which therapy — or combination of therapies — is right for you.

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Behavioral therapies

Behavioral therapy is the most commonly used method for treating substance misuse. It helps patients change their behaviors that accompany or trigger their use of drugs or alcohol. It also helps people develop a healthy lifestyle and follow through on other forms of treatment, such as taking prescribed medication. Behavioral therapy is provided on a regular schedule in both inpatient and outpatient settings. There are several common types:

  • Cognitive-behavioral therapy (CBT). CBT helps patients to recognize and avoid situations in which they are likely to use drugs or alcohol, and to manage the variety of circumstances, feelings, and behaviors related to their substance misuse. Through CBT therapy, you can learn how to identify your personal triggers for using drugs or alcohol, recognize and prepare for situations that increase your risk for misusing substances, and cope with your cravings.
  • Strategic/interactional therapy. Through this form of therapy, your counselor can help you identify personal strengths and create situations that make it easier for you to avoid using drugs or alcohol. Rather than focusing on your challenges or weaknesses, strategic therapy reinforces your ability to change what you experience and the situations and places where you find yourself.
  • Motivational enhancement therapy (MET). MET promotes rapid, self-motivated change, rather than guiding clients through a series of steps. The therapist first assesses the patient’s condition and history of substance use and then provides feedback to start a discussion. The goal is to identify the things that can drive the patient to change and then strengthen that motivation. Together, the therapist and client create ways to cope with high-risk situations and to track the client’s progress over time in avoiding drug or alcohol use. MET has been found more effective in encouraging people to seek treatment than in stopping their drug use.
  • Contingency management (CM). CM uses positive reinforcement or “rewards” to encourage people to resist using drugs, primarily opioids and cocaine. For every drug-free urine sample that patients provide, they may be eligible for a voucher they can exchange for certain goods and services or for a prize in a drawing.

Community reinforcement

The community reinforcement approach aims to make a lifestyle without drugs more appealing than continuing substance use, helping people stop using drugs long enough to develop life skills that support quitting altogether. Counselors offer guidance on improving family relationships, finding ways to avoid drug use, and developing new social networks and activities. Patients who have problems with alcohol receive Antabuse drug therapy, which causes side effects, such as headache and nausea, when combined with alcohol in the body. Patients who have a cocaine addiction regularly submit urine samples and earn incentive vouchers for drug-free test results.

Family therapy

Rather than treating one individual, family therapy focuses on how a patient interacts with his or her family members, in both positive and negative ways. In treating substance misuse, family therapy aims to improve the interactions among a patient’s entire family to create a productive environment for everyone. It taps the family’s strengths and resources to help its members develop ways to live without drugs or alcohol, while reducing the effects of substance misuse on the patient and the family as a whole. The therapist leads the whole family in discussions and problem-solving sessions, and sometimes works with select family members, to strengthen and develop positive relationships.

Brief therapy

Brief therapy involves a series of counseling sessions to assess and engage people with substance use problems and then give them tools to quickly change their attitudes and handle the issues that led to or worsened their substance misuse. Unlike longer-term therapies, brief therapy focuses more on the present than the past, emphasizes using treatment tools in a shorter time, and stresses a specific behavior change rather than large-scale changes in the patient’s life.

Studies show that brief therapy can be particularly effective for people who are functioning in society, like holding down jobs or attending school, and who have strong ties to their family, work, and community. This therapy also can be adapted for long-term treatment, dealing with one challenge at a time.

12-step facilitation therapy

This type of therapy aims to increase a patient’s likelihood of becoming involved in a 12-step self-help group, which offers support for long-term recovery from drug or alcohol misuse. The approach focuses on realizing and accepting that one’s substance use disorder is a chronic disease that will keep getting worse without treatment, and that willpower alone is not enough to overcome the problem. It stresses the importance of seeking the fellowship and support of other people in substance use recovery, following the 12-step program, and actively participating in the meetings and related activities. Twelve-step programs have proven effective in treating alcohol dependence and show promise for helping those who misuse other substances.

Pharmacotherapies

Pharmacotherapies use prescription medication to support other therapies. Commonly used medications include the following:

  • Methadone can reduce opioid cravings and ease withdrawal symptoms. Research has shown it is most effective when combined with individual and/or group counseling and other mental health and social services.
  • Buprenorphine reduces or eliminates withdrawal symptoms without producing a “high” and the sedation caused by heroin or other opioids. It can be provided by qualified physicians who have received a waiver from the Drug Enforcement Administration to prescribe it.
  • Naltrexone prevents the "high" and other effects of opioids and alcohol by blocking them from binding to their receptors in the brain, which may gradually reduce a patient’s craving for these substances. For opioid misuse, naltrexone should be prescribed after inpatient medical detoxification, which gradually removes drugs from the patient’s system, to prevent withdrawal symptoms.
  • Acamprosate is thought to reduce symptoms of alcohol withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (a general state of dissatisfaction and unease). It has been shown to help people who are alcohol dependent to stop drinking for periods of several weeks to months.
  • Antabuse® produces unpleasant reactions, including flushing, nausea, and palpitations, when a person drinks alcohol. Antabuse can be effective among highly motivated patients who commit to taking it. Some patients use it only for high-risk situations when alcohol is present.

Benefits

These various therapy options can be tailored to the specific needs and behaviors of a person with a drug or alcohol problem. They also can be combined or phased in to increase their effect at different stages of recovery, and they may be provided through outpatient or inpatient programs that accommodate the patient’s schedule.

Be sure to work with a physician to identify the right treatment option. Again, your needs and the severity of your drug or alcohol problem will help determine which type of therapy will work best to help you start your recovery.

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