Psychotherapy, or individual counseling, has become one of the cornerstones of drug treatment services. Most rehab programs feature two key treatment elements: detox and medication therapy (where applicable) and counseling (individual and group programs often based on the 12-Step model). Some centers also offer complementary services, such as acupuncture, massage and yoga.
The important role psychotherapy plays in rehab should come as no surprise. While detox and medication treatment (such as methadone in the cases of heroin addiction treatment) address the physical aspects of dependence, this approach is generally not sufficient on its own to defend against relapse. The mental dimension of addiction must be addressed in treatment.
A patient of the renowned psychoanalyst Sigmund Freud coined the term “the talking cure” to describe Freud’s approach to therapy. As Freud discovered, talking is instrumental to healing mental afflictions because it allows repressed thoughts, feelings and anxieties to be expressed. Talking, in Freud’s view, was not only about communication but had a direct physical benefit (i.e., talking about physical pain could relieve it). As applied to substance abusers, talking with a therapist/counselor can help to get to the root causes of addiction and address any experiences underlying it. Once the experiences and perceptions contributing to drug abuse are brought to light and examined, the resulting self-awareness can work as a defense against relapse.
According to the National Institute on Drug Abuse (NIDA), as of 2008 research, 40 to 60 percent of substance abusers relapse. In view of this high rate of relapse, individual drug counseling is also dedicated to teaching the substance abuser new decision-making strategies and life skills. Recovery is not a fix as much as it is an effort to solidly restructure a substance abuser’s life as a means of preventing relapse and building a future on sober footing.
The Individual Counseling Model
As NIDA describes, individual counseling addresses both the symptoms and root causes of substance abuse and serves as a monitor of the recovery process itself. In this way, therapy works to address the past drug addiction, present recovery, and the client’s future. During ongoing individual counseling sessions, a recovering substance abuser can expect the therapist to incorporate the following approaches into therapy:
- Acceptance: Helping the recovering substance abuser to admit that he or she suffers from addiction (i.e., overcoming the denial common in this illness)
- Cravings management: Teaching strategies to make new, healthy decisions at critical trigger times, like when experiencing drug cravings
- Motivation: Encouraging abstinence through different life-affirming techniques, such as reminding the substance abuser of his progress and improvement
- Commitment: Working to create a lifelong recovery plan, such as joining a recovery group (which may or not be a 12-Step program)
Individual counseling is a dynamic process; since the patient in recovery is constantly evolving, the therapy must continue to change and adapt to the patient’s needs. From the patient standpoint, individual counseling should be a clear process (follows a set schedule, for a set duration, and the counselor is continuously reliable and trustworthy). However, the patient directs much of the session (in terms of responses to the counselor’s guidance), and the more a patient is committed and involved, the more she will benefit from the process.
In each session, a therapist may follow a structure that can include:
- Checking urine results
- Inquiring about any drug abuse since the last session
- Bringing up themes raised in earlier sessions
- Raising and discussing topics that are uniquely appropriate to the client based on where the client currently is in the recovery process
Although each session is different, predictability in the process can help the recovering substance abuser to learn to trust the therapist and the individual counseling method. As individual counseling, in part, is about helping the substance abuser to heal damaged relationships and learn how to build new healthy ones, the counselor and patient relationship serves as a guide. Counselors can give appropriate feedback on progress without unduly burdening the therapy process with expectations. In many ways, therapy is like a classroom where the client is both the student and the teacher. A counselor acts as a guide, but ultimately serves to direct the client towards a level of self-awareness that supports the recovery process for life.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy, also known as CBT, is a method of psychotherapy within the general field of mental health counseling. As NIDA explains, CBT has proven successful in substance abuse treatment. This form of therapy focuses on the learning processes that play a central role in addiction formation. During CBT, clients learn to identify and work on those behaviors that led to addiction and other self-harm experiences. The CBT therapist helps the recovering substance abuser to learn new skills to overcome destructive behaviors such as drug abuse.
A main component of CBT involves anticipating problems that are likely to develop in the patient’s life and using those scenarios as a learning tool to teach and explore:
- Self-control, including developing coping strategies that do not involve abusing drugs
- The consequences of continuing to use drugs
- Engaging in self-monitoring to gauge whether signs of relapse are present
- Recognizing people, places and things that may trigger drug use and implementing strategies to avoid them
One of the main benefits of CBT is that research shows that skills learned during CBT treatment continue even after treatment ends. This is explainable, in part, because CBT essentially helps to build a new system of thinking. Once this system is in place, even discontinuing therapy may not rupture its operations. Although substance abuse sufferers may feel at times like they are prisoners of their own thoughts, addiction-based thoughts can be changed and replaced with life-affirming thoughts. A thought is a thought, and though it may not seem like it at times, the same energy that goes into creating an unhealthy thought can be channeled into a positive one. As substance abusers and addicts report how drugs took over their lives, CBT and other methods of individual counseling help them to gain control over their thoughts, and thereby their lives.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.