Cognitive Behavioral Therapy

Cognitive behavioral therapy focuses on learning to reduce problematic behavior associated with
substance abuse. A key theme in CBT is anticipating risky situations and applying coping
strategies, such as avoidance or self-control, to prevent relapse.

CBT is one of the most popular therapies in addiction medicine, and counselors use it to treat a
variety of addictions

During CBT, patients learn to recognize and modify risky behavior by using a variety of skills. They learn
the underlying causes of problematic behavior so they can fix the problems at their source. They’re able
to recognize cravings or triggers and develop strategies for handling those situations. Research shows
that patients who learn skills during CBT are able to apply them during real situations later in life.

Dialectical Behavior Therapy

Dialectical behavior therapy is effective for patients who struggle to regulate emotions and have
thoughts of self-harm or suicide. The therapy emphasizes an acceptance of uncomfortable
thoughts, feelings or behaviors to allow patients to overcome them.

DBT has been proved to treat several disorders that co-occur with addiction, including:

 Mood disorders
 Personality disorders
 Eating disorders
 Self-destructive behavior

DBT involves relaxation techniques, such as yoga, that help the patient become more aware of thoughts
and emotions. They learn skills such as controlled breathing and muscle relaxation to tolerate self-
destructive thoughts or urges. The goal is to decrease the frequency and severity of self-harming
behavior and encourage healthy change.

The Matrix Model

The Matrix model gives individuals in recovery from stimulant addiction a framework for
maintaining abstinence. It’s primarily used in patients recovering from methamphetamine or
cocaine addiction.

Therapy using the Matrix model involves a variety of evidence-based therapies that promote
relapse prevention and encourage family therapy, education and support-group participation.
Therapy sessions usually include detailed worksheets or manuals for the patient to reference.
The therapist is a teacher and coach, developing a positive relationship with the patient and
promoting behavioral change. The therapist promotes dignity and self-worth in the patient who
avoids confrontational communication. However, the Matrix model does involve drug testing.

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing therapy alleviates distress associated with
traumatic memories and symptoms of post-traumatic stress disorder, which commonly cause or
worsen substance use disorders.

helps the patient reprocess the memory of a traumatic event so it is less painful. The patient
performs external eye movements while thinking of the traumatic event. The process teaches the
brain to associate the memory with less upsetting feelings so it can heal.

Studies indicate EMDR can relieve symptoms of PTSD after three 90-minute sessions. Patients
with severe PTSD symptoms, such as combat veterans, usually require more sessions than
individuals with less severe symptoms.

Motivational Therapies
Motivational therapies are the second-most-common therapies used by drug rehab facilities. The
therapies help patients find internal motivation to begin or continue treatment. They often
provide incentives for maintaining sobriety and are used in combination with behavioral
therapies.

Motivational Enhancement Therapy

Motivational enhancement therapy is a specific type of motivational interviewing for substance

abuse. It reduces patients’ doubts or uncertainties about engaging in treatment or stopping drug
use. The goal is to encourage change as opposed to teaching patients how to change.

Multiple studies have shown that motivational enhancement

therapy is effective in patients addicted to:

 Alcohol
 Marijuana
 Nicotine
 MET begins with an assessment and is followed by two to four individual counseling
sessions. The therapist begins by eliciting motivational statements. He or she supports the
patient’s self-motivation, and the pair discusses ways to cope with risky situations. The
remaining sessions involve monitoring change, reviewing strategies and continuing
support of internal motivation.
 Other forms for therapy, such as CBT, commonly follow MET. It’s effective at getting
people into treatment but should not be the sole therapeutic approach.
  Contingency Management and Motivational Incentives
 Contingency management and motivational incentive approaches to therapy reinforce
positive behavior with tangible rewards. The therapies augment other forms of therapy to
increase abstinence during counseling.

Studies show contingency management and motivational incentives reduce drug use in patients
in recovery from addiction involving:

 Alcohol
 Cocaine
 Methamphetamine
 Marijuana
 Nicotine
 Prescription stimulants
 The therapies incorporate vouchers or chances to win prizes to promote abstinence.
Voucher-based therapy involves rewarding clean drug screens with vouchers that can be
exchanged for food, movies and retail goods.
 Prize-based incentives reward drug-free screens with a chance to win a prize by drawing
from a bowl. Some experts worry that prize-based incentives might promote gambling
behavior, but studies do not show an association between the therapy and gambling.
 Community Reinforcement
 The community reinforcement approach plus vouchers is commonly used on an
outpatient basis. The therapy involves motivational incentives in the form of familial,
social and recreational rewards in addition to vouchers to motivate abstinence from
substance abuse.
 The goal is to help patients maintain sobriety so they can develop skills for long-term
recovery.
 Research indicates CRA can effectively treat addiction to:
 Alcohol
 Cocaine
 Opioids

CRA usually lasts 24 weeks, and patients attend individual counseling once or twice per week.
During counseling sessions, they learn skills to minimize substance abuse, improve relationships,
develop hobbies, build social support and receive vocational counseling. Patients also undergo
urine tests

two or three times per week and are awarded vouchers for retail goods for drug-free tests.

Family Counseling and Therapies

Counseling and therapy for addiction often involve counseling for family members in addition to
the person in recovery. Therapy teaches families the underlying causes of addiction, how to
reduce risk factors for relapse and how to properly support their loved one in recovery.
Family counseling is beneficial for family members negatively affected by another person’s
addiction. It helps each family member learn about the impact his or her actions have on others,
and it teaches families how to effectively communicate and function.

Family Behavior Therapy

Family behavior therapy addresses problems that affect the entire family. The goal is to reduce
risk factors for addiction, such as unemployment, family conflict, abuse and conduct issues. It
uses techniques such as contingency management and behavioral contracting, in which a patient
agrees to a written contract with a therapist.

Therapy sessions involve multiple family members, such as spouses or parents and their
children. Therapists teach strategies and skills for improving communication and the living
environment. Each patient sets behavioral goals that are reviewed during each session by other
family members.

Multisystemic Family Therapy

Multisystemic family therapy is primarily used to correct severe antisocial behavior in children
and adolescents affected by addiction.

MST has multiple goals:

 Correct attitudes toward drug abuse.

 Improve family discipline.
 Teach conflict resolution skills.
 Eliminate parental drug use.
 Improve school attendance and performance.
 Eradicate environmental prevalence of drugs.

Treatment occurs in natural environments such as the home, school or neighborhood, and it has
been proved to reduce rates of incarceration and substance abuse.

Multidimensional Family Therapy

Multidimensional family therapy is an outpatient treatment for teens who abuse drugs. It focuses
on individual, family, peer and community networks to reduce problematic behavior and
encourage healthy behavior.

MDT occurs in clinics, family court, school or homes. It usually involves individual sessions and
family sessions in which the adolescent learns decision-making and problem-solving skills.
During family sessions, parents examine their parenting style and learn to positively and
effectively influence healthy behavior.

Brief Strategic Family Therapy

Therapists use brief strategic family therapy to reduce family interactions that support or
exacerbate teen drug abuse or problematic behavior. Such behavior includes problems at school,
delinquency, association with anti-social peers, aggressive tendencies and high-risk sexual
behavior.

BSFT is founded on the concept that each family member’s behavior affects the entire family.
The therapist identifies and corrects family interactions that provoke problematic behavior. The
approach can be used in mental health facilities, rehab clinics, homes and a variety of other
settings.

Functional Family Therapy

Functional family therapy is also based on the idea that dysfunctional family interactions create
and support problematic behavior. The goal of FFT is to improve communication, problem-
solving skills and parenting skills. Each therapy session involves the adolescent and one or more
family members.

FFT engages families in the treatment process to encourage motivation for change. It also
incorporates contingency management techniques and other types of behavioral therapy.

Adolescent Community Reinforcement Approach

Adolescent community reinforcement approach is similar to the community reinforcement

approach used for adults, but it involves standardized procedures for improving communication,
solving problems and coping with stress. Role playing and behavioral rehearsal techniques are
key aspects of the therapy.

Assertive Continuing Care

Assertive continuing care involves weekly home visits during the three-month period after a
teenager is discharged from a drug rehab facility. The therapy teaches teens and their caregivers
problem-solving skills, communication techniques and other tools for promoting recovery.

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12-Step Facilitation Therapy

Therapists often encourage patients to participate in 12-step programs such as Alcoholics
Anonymous and Narcotics Anonymous to support long-term recovery.

Studies on 12-step programs show they effectively help many people in recovery abstain from:
  Alcohol
 Cocaine
 Methamphetamine
 Opioids

Such 12-step programs are founded on a few key principles: Individuals with substance use
disorders have no control of the disease, must surrender to a higher power and actively
participate in support group meetings. Many therapists refer patients to 12-step groups, and some
treatment facilities host support group meetings.

Alternative & Holistic Therapies

Decades of scientific research on addiction treatment have found behavioral, motivational and
family-based therapies to effectively treat substance use disorders. Other therapies such as
EMDR and 12-step facilitation therapy are also backed by a plethora of research.

There are no other evidence-based replacements for these traditional therapies, but studies do
support a variety of complementary treatments for addiction.

Yoga, Meditation and Mindfulness

Yoga is an exercise that emphasizes controlled breathing and body postures to promote physical
strength, concentration and serenity. Clinical trials involving yoga and mindfulness found the
therapies were effective complements to preventing and treating addiction, according to a study
published in Complementary Therapies in Medicine.

A meta-analysis of studies on meditation published in Alcoholism Treatment Quarterly found

that the technique can reduce stress, anxiety, tobacco smoking, and alcohol and drug abuse.
Additionally, a clinical trial on mindfulness therapy published in the Journal of Consulting and
Clinical Psychology found yoga was a feasible and effective treatment for opioid abuse and
chronic pain.

Animal Therapy

Several therapies for addiction involve animals. During equine therapy, one of the most popular
animal-assisted therapies, patients interact with horses. The horses give feedback through
nonverbal cues. The patients learn to understand their own emotions and overcome negative
emotions such as frustration and fear.

Other therapies involve people in recovery voluntarily helping animals at shelters or having
animals during traditional therapy sessions. Research indicates animal- or pet-assisted therapy
can improve a patient’s participation in treatment and willingness to talk about any history of
trauma or substance abuse. Animal-assisted therapy can also reduce stress, fear and anxiety.

Acupuncture