Behavioral Therapies for Addiction Treatment

Treating an addiction is a highly complex endeavor that’s best approached holistically. Recovery is a process of change that leads to better health, a higher sense of well-being and a self-directed life in which individuals are able to reach their full potential.1

A holistic approach is based on the idea that there are endless pathways to recovery. What works for one person may not be the best approach for another. Recovery is a highly individual process, and treatment should also be individualized in order to meet specific needs and address specific issues.

Recovery is a highly individual process, and treatment should also be individualized.

Behavioral therapies administered in individual, group and family settings are the most commonly used and effective forms of treatment for substance use disorders, according to the National Institute on Drug Abuse’s Principles of Effective Treatment.2 Behavioral therapies are treatments that helps people change self-destructive behaviors.

While a number of different and highly effective behavioral treatments have been developed over the years to treat people with addictions, one thing they all have in common is the innate ability to differentiate treatment based on an individual’s needs and preferences.

Why Treatment is Essential in the First Place

According to the National Institute on Drug Abuse, willpower and good intentions alone are rarely enough to overcome an addiction.3 Because addiction is a chronic, progressive and relapsing disease, it almost always requires professional treatment, just as chronic diseases like diabetes and heart disease require medical intervention.

Willpower and good intentions alone are rarely enough to overcome an addiction.

Treatment works. The first step of addiction treatment is detox, which is the process of allowing traces of drugs or alcohol to be flushed from the body so that brain function can begin to return to normal. Detox addresses the physical dependence of the brain on a substance, but it doesn’t address the highly complex issues behind the addiction.

It’s these issues that will continue to entrap you in an endless cycle of remission and relapse until you identify and begin to work through them. Behavioral therapies facilitate this complicated and highly individualized process.

How Do Behavioral Therapies Work?

Behavioral therapies work on a number of levels:

  • Helps keep individuals engaged in the treatment process
  • Provides incentives for staying sober
  • Facilitates changes in attitude and behavior that are conducive to sobriety
  • Helps you learn to honestly evaluate your thoughts, ideas, beliefs and attitudes
  • Facilitates developing new ways of thinking about old problems
  • Increases the repertoire of life skills that are needed to combat stress and handle environmental triggers

A number of behavioral therapies have been proven effective in leading to real and meaningful change and improving the chances of successful long-term recovery.

Cognitive Behavioral Therapy

Cognitive behavioral therapy, or CBT, is one of the most common and effective behavioral therapies used to treat addiction. Developed to help prevent relapse for people who suffer from alcohol addiction, the central tenet of CBT is that learning processes play a crucial role in the development of harmful behaviors like abusing substances.

Learning processes play a crucial role in the development of harmful behaviors like abusing substances.

By learning to evaluate attitudes, beliefs and thought patterns and replace those that are harmful with those that are healthy, CBT aims to stop self-destructive behaviors and arm participants with skills and strategies for coping with stress and other potent triggers.

Cognitive behavioral therapy is an individualized approach to treatment that trains participants to:

  • Cope with cravings
  • Plan for emergencies
  • Recognize and cope with triggers
  • Identify high-risk situations and plan ahead to maintain sobriety despite them

CBT also addresses the underlying cause of the addiction, such as trauma, stress or mental illness. Participants in CBT practice skills in each session and continually examine and reshape their thought processes surrounding substance abuse.

Research shows that the positive effects of cognitive behavioral therapy remain long after therapy sessions have been completed. A study published in the journal Psychiatric Clinics of North America found that 60 percent of participants involved in behavioral therapies who were addicted to cocaine provided clean urine samples at a 52-week follow-up.4

The positive effects of cognitive behavioral therapy remain long after therapy sessions have been completed.

Family Behavioral Therapy

According to the National Council on Alcoholism and Drug Dependence, addiction is a family disease that affects the functioning of the family system.5 Chaos, stress and negative experiences are common in households where a family member has an addiction, and this leads to unhealthy behaviors. Non-addicted family members often compensate for the chaos by living in denial, enabling the addiction or developing their own unhealthy behaviors as things spin out of control.

Family behavioral therapy treats the family as a system wherein a change in one part of the system brings about changes in the other parts, for better or for worse. Just as the addicted individual is in recovery from the addiction, so, too, are the affected family members, who need to replace their own unhealthy thought patterns and behaviors with healthier ones in order to effectively support their loved one.

Family therapy helps restore function to the household and family system by:

  • Improving communication among family members
  • Working to restore broken trust and repair damaged relationships
  • Reducing family stress
  • Problem solving
  • Educating family members about relationship patterns that may contribute to substance abuse
  • Setting goals
  • Developing coping strategies
  • Eliciting meaningful, long-term change within the family system

Family behavioral therapies are a essential component of treatment. Family therapy is particularly important for children and adolescents, who are at a higher risk of developing a substance use disorder as the result of living with someone who has one.

Contingency Management Interventions

Contingency management involves offering tangible rewards in the form of cash or vouchers to reinforce positive behaviors like remaining abstinent, and it serves to increase retention in treatment and promote sobriety.

The elegantly simple underlying philosophy of contingency management is that if a behavior is rewarded and reinforced, it’s more likely to occur in the future. Two common types of contingency management interventions are voucher-based reinforcement and prize incentive contingency management.

Voucher-Based Reinforcement

Typically used for those with an addiction to opioids or stimulants—or both—voucher-based reinforcement offers vouchers to participants in exchange for drug-free urine samples. Vouchers have monetary value and are exchanged for food, movie passes and other goods and services that promote an enjoyable drug-free lifestyle.

The value of the vouchers starts out fairly low and increases with each consecutive negative drug test. If a positive sample turns up, the value goes back to the lower starting point.

Prize Incentive Contingency Management

Similar to voucher-based reinforcement, prize incentives operate on the same principle of positive reinforcement for negative drug tests and often include rewards for attending counseling sessions and engaging in goal-related activities. In this case, the reward is typically the chance to draw from a hat to win a cash prize. To begin with, participants get one draw, but with each consecutive negative drug test, the number of draws increases. A positive drug test resets the number of draws to one.

An article published in the journal Psychiatric Times points to several studies that have found contingency management to be particularly beneficial for keeping individuals engaged in treatment.6 One study found that 75 percent of participants in a contingency management program completed addiction treatment for cocaine compared to 40 percent who received the same type of treatment without tangible rewards. Additionally, over half of the participants who received vouchers or cash achieved at least 10 weeks of continuous abstinence, compared to just 15 percent in the non-voucher group.

12-Step Facilitation Therapy

According to an article published in the journal Recent Developments in Alcoholism, individuals who continuously participate in a 12-step program like Alcoholics Anonymous or Narcotics Anonymous are nearly six times more likely than those who don’t participate to enjoy continuous abstinence for at least a year after treatment ends, and they’re up to five times more likely to still be sober after three years. There are many forms of behavioral therapies that can help to contribute to recovery. 7

12-step facilitation therapy has its basis in 12-step fellowships, and it operates under the assumption that addiction is a chronic and progressive disease that has biological, psychological and spiritual aspects, all of which are addressed as an individual works through the 12 steps. 12-step facilitation helps clients:

  • Understand the principles of 12-step fellowships
  • Initiate abstinence
  • Begin working through the 12 steps
  • Get involved in a community-based 12-step group

Involvement in this type of peer support group is a critical component of the aftercare plan that’s implemented once treatment is complete. Getting involved in the 12 steps from the beginning offers the opportunity to begin forging relationships with other non-users early on to help improve the chances of long-term recovery.

Motivational Enhancement Therapy

Motivational enhancement therapy, or MET, addresses an individual’s ambivalence toward treatment and recovery and strives to spark motivation to change. During this therapy, which is comprised of up to four sessions, the therapist opens up a dialog about substance abuse. The goal is to lead the client to make self-motivational statements, build on that motivation and create a plan for change.

Together, therapist and client develop coping skills and strategies for reducing substance abuse. Changes in self-destructive behaviors are monitored in subsequent sessions, and strategies are reviewed and amended as necessary. The therapist encourages the client to continue working toward meaningful change for better health and a higher quality of life.

Together, therapist and client develop coping skills and strategies for reducing substance abuse through behavioral therapies.

The National Institute on Drug Abuse points out that MET is most beneficial for those who are addicted to alcohol and marijuana. MET has been found to successfully improve the level of engagement in treatment and reduce instances of substance abuse.8

Community Reinforcement Approach

The community reinforcement approach, or CRA, is a comprehensive program that aims to help individuals achieve sobriety by removing positive reinforcement for using drugs or alcohol and increasing positive reinforcement for abstinence.

CRA integrates a number of other approaches, such as family therapy and motivational interviewing, as it works to:

  • Build motivation to quit using drugs or alcohol
  • Initiate the path to recovery
  • Analyze drinking patterns and triggers
  • Increase positive reinforcement
  • Facilitate the development of new coping skills and strategies
  • Find new ways to enjoy life and find contentment without drugs or alcohol

The underlying philosophy of CRA is that abstinence can be achieved by rearranging your life so that sobriety is more rewarding than using. Through strong social and family support and a wide range of programs that may include job counseling, family therapy, skills training and drug therapy, participants work to change their environment into one that fully supports sobriety.

Abstinence can be achieved by rearranging your life so that sobriety is more rewarding than using.

An article published in the journal Alcohol Research & Health points to a large body of research that has found CRA to be among the most effective addiction treatment methods. It’s also associated with better outcomes regarding employment and family relationships.9

The Community Reinforcement Approach with Vouchers

This program is a 24-week intensive outpatient program for people with a cocaine or alcohol addiction. According to the National Institute on Drug Abuse, the goals of the program are to help ensure participants maintain abstinence long enough to learn the necessary skills to help sustain long-term recovery and to reduce the consumption of alcohol among those whose drinking typically leads to cocaine abuse.10

Participants of the program attend weekly counseling sessions, learn skills and coping strategies that reduce drug use, discover recreational activities that make a life of sobriety enjoyable and develop new and healthy social networks. Those who suffer from alcohol addiction are put on a clinic-supervised disulfiram (Antabuse) therapy program.

In exchange for clean urine samples each week, participants receive vouchers that can be exchanged for goods and services that promote a drug-free lifestyle.

A paper published by the Alcohol and Drug Abuse Institute at the University of Washington points to a 1994 study that found participants in a CRA Plus Vouchers program stayed in treatment longer and enjoyed more consecutive weeks of abstinence than subjects who participated in CRA alone.

Matrix Model

The matrix model provides a scaffolded framework for recovery from stimulant addiction in particular, but it can also be successful for other drug addictions, including alcohol. Because relapse rates are fairly high for stimulant addiction, this comprehensive and structured treatment approach builds the foundation for a life of sobriety through a variety of interventions that encourage new habits to take root and grow into permanent and meaningful lifestyle changes.

The foundation of this 16-week treatment approach is the close relationship between client and therapist. The therapist acts as coach and teacher, and the tone of the sessions is positive and encouraging. The therapist is never confrontational or parental and is trained to ensure each session promotes a high level of self-esteem and self-worth.

The program itself takes place in an intensive outpatient setting and follows a manual that includes a range of components like family therapy, relapse prevention programming, social support and 12-step groups and early recovery skills groups.

Drug testing is an important component of the matrix model. A positive drug test may indicate that the pace of the individualized program needs to slow down or that a different approach or therapy technique may be needed to get an individual back on track.

According to the Substance Abuse and Mental Health Services Administration, studies show the matrix model to be highly effective for reducing drug use, improving social stability, promoting resources for recovery and even preventing HIV infection by reducing risky behaviors associated with stimulant and other drug abuse.11

Complementary Therapies

A truly holistic approach to treatment will include a variety of complementary therapies that are used in conjunction with traditional behavioral therapies. Complementary therapies may include:

  • Art or music therapy, which helps you synthesize experiences in different ways as well as reduce stress and bolster coping skills
  • Biofeedback, which trains you to reduce your body’s response to stress on command, such as lowering your heart rate and blood pressure, by engaging in activities like progressive relaxation or deep breathing
  • Neurofeedback, which trains you to interact with your brain waves and alter their frequencies to help reduce triggers like insomnia, anger and stress
  • Meditation and other mindfulness practices, which help you become more keenly aware of your thoughts and emotions to help you better regulate your mood, cope with triggers like cravings and stress, and improve the functioning of your immune system

Choose a Holistic Approach

There is no single pathway to recovery. If you’re ready to begin working through the issues that led to an addiction to or chronic abuse of drugs or alcohol, choosing a high-quality, holistic-based treatment program is essential for increasing your chances of enjoying long-term success in recovery.

Through a variety of traditional and alternative behavioral therapies that address issues of body, mind and spirit, you’ll learn to evaluate your thoughts, ideas, feelings and attitudes and replace those that are self-destructive with those that are healthy and conducive to a life of sobriety. In the process, you’ll rediscover the joys of life without drugs or alcohol, improve your overall physical and mental health and vastly improve your quality of life.

Sources:

  1. SAMHSA’s Working Definition of Recovery: 10 Guiding Principles. (2012). Retrieved from https://store.samhsa.gov/shin/content/PEP12-RECDEF/PEP12-RECDEF.pdf
  2. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of Effective Treatment. (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
  3. DrugFacts: Understanding Drug Abuse and Addiction. (2012, November). Retrieved from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction
  4. McHugh, R. K., Hearon, B. A., and Otto, M. W. (September, 2010). Cognitive-Behavioral Therapy for Substance Use Disorders. Psychiatric Clinics of North America. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/
  5. Family Disease. (2016, February 24). Retrieved from https://www.ncadd.org/family-friends/there-is-help/family-disease
  6. Petry, N. M. (February, 2002). Contingency Management in Addiction Treatment. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/addiction/contingency-management-addiction-treatment-0
  7. Laudet, A. B. (2008). The Impact of Alcoholics Anonymous on Other Substance Abuse Related Twelve Step Programs. Recent Developments in Alcoholism. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613294/
  8. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Motivational Enhancement Therapy. (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-2
  9. Meyers, R. J., Roozen, H. G., & Smith, J. E. (2011). The Community Reinforcement Approach: An Update of the Evidence. Alcohol Research & Health. Retrieved from http://pubs.niaaa.nih.gov/publications/arh334/380-388.pdf
  10. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Community Reinforcement Approach Plus Vouchers. (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-1
  11. Treatment Improvement Protocols: Intensive Outpatient Treatment Approaches. (2006). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64102/
 
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