Can Therapy Help with Substance Abuse? It Depends…
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Is therapy ever the right choice when you’re looking for help with issues related to substance use? While a growing number of people understand the value of therapy for mental health or personal growth, it’s less appreciated as a way to treat substance use disorders.
Yet therapy is an essential part of any treatment program and can sometimes be enough help on its own. Individual therapy isn’t always a high enough level of care for substance use disorders, but it can provide the right level of care at specific points along your journey.
For more information about getting help for a substance use disorder:
- You can read our article on levels of care for substance abuse treatment to learn more about other treatment options.
- You can read our article on the difference between a licensed substance abuse counselor and a therapist to learn which one might be right for you and how to make sure you find a professional who is qualified to treat substance use disorders.
In this article, we’ll focus on how therapy for substance use disorders works and what to expect if you get individual therapy for substance abuse.
How Does Therapy for Addiction Work?
Therapy is at the heart of every level of addiction treatment. It’s a multi-purpose tool in your recovery toolkit that can help you:
- Learn what contributed to the development of your addiction;
- Address the issues in your life that led to the problems you’re having;
- Identify risk factors and triggers in your life that increase your risk of relapse;
- Make effective plans for how to avoid or address triggers and stressors; and
- Heal the issues underlying your substance use, whether those might include trauma, untreated depression or anxiety, or issues in your home life or environment.
In both mental health and substance abuse treatment, therapy serves two primary purposes:
What Does Therapy Help You Do?
- It helps you develop insight into the nature of your problems and the solutions to them.
- It helps you heal the pain of shame, alienation, trauma, or other emotional wounds.
Part of therapy is problem-solving. That’s the insight-oriented, intellectual part. This aspect of therapy helps you analyze yourself and your life and come up with solutions to the challenges you face.
Relapse prevention is one of the problem-solving techniques used in addiction treatment. It’s a form of cognitive behavioral therapy (CBT) that can help you connect the dots between substance use and the thoughts, feelings, environments, and events that trigger it. After you’ve learned your relapse triggers, you can develop plans for how to limit exposure to them and how to cope when you can’t avoid them.
Another part of therapy is emotional repair. The relationship you build with a therapist—or, in the case of group therapy, with a therapist and fellow group members—helps you start to feel different and to see yourself differently.
This aspect of therapy is not intellectual. It works because it connects to a deeper, more primal part of you that responds in an instinctive way to human relationships—and heals through them.
The dynamics of group therapy often provide more of the emotional repair functions of therapy in a substance abuse program, especially early on in treatment. Being seen and feeling seen are essential to the therapeutic process. As you start to experience how you are respected, valued, and understood by others, you start to repair your relationship with your own life and emotions.
Who Should Get Therapy for Addiction?
This is a bit of a trick question. Therapy is an essential part of nearly every type and level of addiction treatment. Whether you’re in an inpatient rehab or an intensive outpatient program, you’ll be getting therapy. In this sense, everyone seeking recovery from addiction should get therapy, because there are almost no treatment programs that don’t include it in some form.
However, most substance abuse treatment programs include more than just individual therapy. They usually include a combination of individual and group therapy, support groups, and wellness activities. So, the real question is, when is individual therapy, outside of a formal treatment program, the right level of care for someone seeking recovery from a substance use disorder?
For More Information:
For a more in-depth answer to this question, and for more information about different treatment options, you can read our article on the levels of care for substance abuse treatment.
In the next section, we’ll provide a quick overview of when individual therapy is (and isn’t) the right level of care for a substance use disorder.
When Is Individual Therapy the Right Level of Care?
In general, individual therapy for substance use disorders is more likely to be the right level of care in later stages of treatment.
At that point, you likely have a sober support system and have integrated some relapse prevention skills. By the time you’ve gotten the “recovery basics” down, you’re ready to turn your attention to personal emotional issues that you need to heal.
At the start of treatment, individual therapy is less likely to be the right level of care because:
- Substance use disorders often come with legal, medical, financial, or other complications that require intensive levels of care at the start of treatment to address.
- Cravings to use substances can be overwhelming in early recovery and can require more structure to stabilize than once-weekly sessions can provide.
Treatment programs provide extra structure and support that can be essential in early recovery. They help you build relapse prevention skills while holding you accountable and connecting you with the community. If you just get individual counseling, the pressure is on you to do a lot of what you’d do in a treatment program on your own. (Your counselor can only do so much.)
However, it’s important to note that one size doesn’t fit all. There are, in fact, circumstances in which individual therapy can be the right level of care even in early recovery.
Weekly individual sessions can be enough if you:
- Are just starting to worry about your substance use and it hasn’t yet progressed to a high level of severity;
- Haven’t had any severe consequences or complications of substance use and are functioning fairly well in your daily life;
- Have been able to stop on your own, don’t have withdrawal symptoms, and may be having some cravings, but they aren’t severe or overwhelming;
- Live and work in a stable, supportive environment that isn’t dangerous, unsafe, toxic, or threatening to your recovery.
Individual therapy for substance abuse is even more likely to meet your treatment needs if you already have a good support system. A fully effective sober support system includes at least some people and groups that understand addiction and the recovery process. These can include 12-step groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) or secular support groups like SMART Recovery and LifeRing.
Should You Get Group or Individual Therapy for Addiction?
One thing that makes substance use disorder treatment different from mental health treatment is its emphasis on group therapy.
While we believe that group therapy is an excellent, often overlooked treatment option for mental health, it’s already widely embraced as part of the standard of care for substance abuse treatment. Chances are good if you enroll in an addiction program—whether inpatient or outpatient, intensive or non-intensive—you’ll be getting group therapy.
One reason is historical. Twelve-step groups were already becoming an established method for helping people overcome addiction when outpatient behavioral health treatment was in its infancy.
Where Did the Group Treatment Model Come From?
In the 1940s and 1950s, there weren’t that many outpatient mental health or outpatient substance abuse programs, but there were many chapters of Alcoholics Anonymous. Outpatient substance abuse treatment took a lot of inspiration—and notes—from AA.
There’s more to it than just history, though. Group affiliation can accelerate insights and healing. Building community and connection is an essential element of recovery from any behavioral health condition, but it may be especially important in the treatment of addiction.
As Johann Hari said, "The opposite of addiction is not sobriety—it is human connection."
All of that said, yes, we recommend getting group therapy for addiction, but we think the best approach is a combination of group and individual therapy. There are things group therapy can do that individual therapy can’t—but the opposite is true, too. So, we encourage you to seek both group and individual sessions in your treatment program (or on your own) if you can.
How Is Therapy for Addiction Different from Therapy for Mental Health?
Therapy for substance use disorders isn’t necessarily different from therapy for mental health conditions, but it often is, especially in the beginning.
DEEP DIVE
Here are a few ways therapy for substance use disorders may be different:
- It may be more directive. The therapist or counselor may take a more active role and provide more active guidance.
- It may be more systematized. Treatment is more likely to follow a standard format in early stages. Treatment groups may have set topics that go in a set order.
- It may be more focused. The therapist is more likely to try to keep you on topic and less likely to encourage you just to talk about whatever comes up.
- It may be more pragmatic. Goals at the beginning of substance abuse treatment are often more concrete than goals at the beginning of mental health treatment.
In general, therapy for substance use disorders is focused on here-and-now issues. You’ll be doing a lot of problem-solving with your therapist to address complications in your life caused by substance use. You’ll be figuring out how to approach familiar environments and people in a different way and finding new ways of living and socializing.
On the other hand, therapy for mental health rarely starts with the same kind of laser focus. It takes a therapist a little more time to figure out which problems you’re trying to solve and what approach will work best.
In general, mental health therapy:
- Tends to be explorative and open-ended;
- Leaves it up to you to determine what your goals are and what you want to change; and
- Is designed to help you delve into the deepest parts of your psyche and confront your past.
It’s important to note that this depends on what method a therapist uses. Cognitive-behavioral therapy is used in both mental health and substance use disorder treatment, and in CBT, you don’t have to delve into your past at all. Instead, you can just focus on the present-moment connection between certain thoughts, feelings, and behaviors and work on changing the thinking that leads to negative experiences.
What Are Co-Occurring Disorders?
One important point to make in the discussion about therapy for substance use disorders is that at some point in your recovery, you may need to address a mental health condition as well. This is where getting individual therapy—or another level of mental health care—can become a really important part of your recovery.
DEEP DIVE
According to SAMHSA, people with substance use disorders (SUDs):
- Are 1.5 to 1.9 times more likely to have a mood disorder than people who don’t have an SUD.
- Are 1.7 to 1.8 times more likely to have bipolar I disorder than people who don’t have an SUD.
- Are 1.7 to 1.8 times more likely to have borderline personality disorder than people who don’t have an SUD.
- Are 1.5 to 1.6 times more likely to have post-traumatic stress disorder than people who don’t have an SUD.
- Are 1.2 to 1.3 times more likely to have major depressive disorder and 1.3 to 1.5 times more likely to have dysthymia than people who don’t have an SUD.
- Are 1.2 to 1.3 times more likely to have an anxiety disorder than people who don’t have an SUD.
According to Substance Abuse and Mental Health Administration (SAMHSA), eating disorders, other personality disorders, psychotic disorders, and attention-deficit/hyperactivity disorder (ADHD) also frequently co-occur with SUDs.
It’s important to note that substance use can cause symptoms that “look like” mental health conditions. Substance-induced mood, anxiety, or psychotic disorders can develop into long-term mental health conditions or can go away on their own after you’ve gone without using substances for a while.
But even if it takes a while to clarify which diagnosis or diagnoses you might (or might not) have, there is no reason to delay treating or addressing the symptoms you’re experiencing. No matter what caused them, there are things you can do to start feeling better right away.
Why Is It Important to Address Co-Occurring Disorders?
Part of recovery is addressing and healing what was driving you to use substances in the first place. Otherwise, to use an old-fashioned AA term, you’re “white knuckling” it—abstaining from substance use through sheer willpower, in the absence of relief from painful underlying issues. You’re “sober” in the sense that you’re not using substances, but you lack the positive social and lifestyle changes that provide a sense of well-being and that are part of what recovery is all about.
Substances can only numb or blunt emotional pain. They can’t heal it. When you stop the cycle of a substance use disorder and treat the emotional, psychological, or personal issues that have been causing you pain, you can get to a point where you feel better than you ever did when you were using substances. That can’t happen if you don’t address your mental health.
Some treatment programs advise against delving into painful or traumatic memories too early in recovery, but you don’t have to do that to start addressing mental health issues. You can take medications, do here-and-now work in CBT to manage your symptoms, and/or address issues in your life that are affecting your mental health—then delve into those memories later (if at all).
Ideally, if you’re in a substance abuse treatment program, you can get the mental health care you need from that program. If not, it can help to work with an individual therapist or primary care doctor alongside the work you’re doing in your program.
If you’re not sure what to do, ask counselors at your program, peers in support groups, your personal doctor, or a behavioral health professional. You can also call a behavioral health crisis or information line for more help and guidance.
Conclusion
Therapy is an essential part of substance abuse treatment. It can help you address the issues in your life that led to the problems you’re having. It can help you learn what your triggers are, how to avoid them when you can, and how to deal with them when you can’t. It can help you start to heal the issues underlying your substance use, whether those include trauma, untreated depression or anxiety, or issues in your home life or environment.
Individual counseling or therapy is less emphasized in early recovery than group therapy, but both are essential to the recovery process. Whether you get individual sessions right from the beginning, or get them later on, they can help you hone in on and address personal issues and realize a fuller vision of recovery.
Recovery is more than just not using substances. Recovery is healing. It’s getting to the point where you’re living a vibrant life full of human connection. It’s being able to feel joy again. To get there, you have to heal the things that made you want to use substances in the first place. And that’s exactly what therapy can help you do.