Therapy for Addiction & Substance Use Disorders
Substance Use Disorders at a Glance
Are you curious, even if only slightly, that you have a problem with drugs or alcohol? Have others expressed concern about your use? Do you use drugs or alcohol privately or downplay how much you use to avoid judgment from others? If you answered “yes” to any of these questions, seeking an assessment from a mental health professional who specializes in substance use disorders would likely be helpful.
It’s difficult to describe one version of addiction because individuals vary when it comes to their desire and perceived need to stop using. The section below highlights the stages of change and the many faces of addiction. Identifying where you are in the stages of change is an important first step because it helps determine what type of therapy might serve you best. Which of the following stages of change resonates with you most?
If you'd rather jump straight to a description of recovery, click below.
If you’re in this stage, you have zero interest in change. Others may have expressed concern about your use, but you don’t view it as problematic. In fact, you may have thoughts that others are uptight and they’re the ones with the problem. If you’re in this stage and someone else is encouraging you to reach out for help, consider this: What do you really have to lose? If you’re right, meeting with a mental health professional who specializes in this area can help you develop skills to talk with your loved ones more effectively. Also, if you secretly have a few teeeeeny-tiny concerns, word on the street is that mental health professionals are great listeners. And if you don’t want to talk about your substance use at all, no problem. In many cases, it’s safe to start by focusing elsewhere.
If you’re in this stage of change, you feel ambivalent. You have mixed thoughts and feelings about your use. On one hand, you aren’t that concerned. On the other hand, you’re beginning to question your use, and these questions are getting harder to ignore. It may feel like you’re lost in the woods. One minute you’ve decided how you feel and you see the path forward. The next minute you have the sinking feeling you’re going in circles. You’re confused and emotionally exhausted. Perhaps a corner of your mind is concerned you’ll be lost in these woods forever. If you’re in this stage, please know that it’s common to have mixed thoughts and feelings about making any type of change. In fact, that’s the first step of change! Therapists understand this internal push-and-pull, and they know how to work with it therapeutically. If you feel ambivalent about substance use, it’s ideal to work with a therapist who is trained in Motivational Interviewing (MI). Well-meaning providers without this training can unintentionally nudge you deeper down the path of addiction.
If you’re in this stage, you’re taking the first steps toward change. You’re planning to curb your use significantly or stop using altogether. Your increased clarity feels nice. However, it also feels fragile. You may be experiencing some of your first cravings in early recovery and questioning your ability to change. It’s worth highlighting something here: no one likes the experience of wanting to change and feeling incapable of doing so. When we’re in this uncomfortable place we can pull some sneaky tricks on ourselves. For example, sometimes we try to feel better by convincing ourselves that we didn’t really want to change after all. If you relate to this, we have a proposition for you - instead of questioning your desire for change, consider questioning your doubt. People recover from substance use disorders every day. What’s more, every single one of them would tell you that they too were once in a place where change seemed impossible. Keep going!
If you’re in this stage, you’ve committed to change and you’re actively taking steps to reach your goals. Perhaps you’re in a group therapy program for substance use disorders or attending recovery meetings. Maybe you’re reading books about recovery and talking more openly with loved ones. You feel hopeful. That being said, you might notice increased feelings of depression or anxiety. You might also notice more tension in your relationships. If so, it may simply indicate that your use was masking other concerns. While this might feel like a step backward, it’s absolutely a step forward. We can’t change what we can’t see. Also, at this stage in your recovery you’ve already learned that you’re capable of doing hard things.
If you’re in this stage of change, you’ve been doing well in recovery for at least six months. Your cravings are few and far between. When you do experience cravings they’re less intense and you know how to cope with them effectively. You’re doing things on a regular basis to support your wellbeing. If you’re in this stage, congratulations! While you feel increasingly confident about your sobriety, you may need or want to continue therapy for other mental health concerns or to deepen your connection with yourself and others.
There’s an expression in the world of addiction treatment: “Relapse is part of recovery.” While not everyone experiences a relapse, most do. And while it may not seem this way initially, experiencing a relapse is an opportunity to strengthen your recovery. The truth is, we all fall. That’s what a relapse is by the way -a fall, not a failure. When we look closely enough, we can usually learn something helpful and potentially surprising about ourselves during these moments. So if you’re shaming yourself or being shamed by others, dust that off. It’s not accurate nor is it helpful. If you’ve progressed from being opposed to change to being active in recovery, it’s unlikely that a relapse is your final destination. We root for you, and there are rooms full of people in recovery who share our sentiment.
Therapy and Recovering from Addiction
You know what it’s like to live with addiction. Now, if you’re willing, we’d like to help you imagine what it’s like to live in recovery.
Imagine letting go of the constant chatter in your mind about whether or not you have a problem with drugs or alcohol. Imagine letting go of trying to find ways to use without it being a problem - “Maybe if I switch to beer… Maybe if I only use on the weekends… Maybe if I …” Imagine letting go of the energy it takes to hide, minimize, or defend your use to others. Imagine letting go of the anxiety, fear, guilt, and shame you may feel about your use.
Now that you’ve imagined what you’d be giving up, imagine what you’d gain. Imagine a team of caring professionals helping you through the process. Imagine meeting other intelligent, kind, creative, and hard-working people in recovery - people who get it, people who get you. Imagine learning skills to prevent cravings and cope with them effectively when they arise. Imagine learning to better identify and navigate your emotions.
Imagine having the bandwidth to examine your life through a sober lens and consider bigger picture changes you may want to make. Maybe you want to carve out more time for leisure, hobbies, and joy. Maybe you want to change or strengthen your relationships. Maybe you want to make some changes in your career. However you’d like to grow, imagine having the courage to do it.
Finally, imagine looking back on your life years from now at the moment you decided to take a leap of faith - the moment you decided to pursue recovery and reclaim your life. People do that, by the way. We’ve seen it many times over. We trust that when you’re ready, you can do it too.
“I understood myself only after I destroyed myself. And only in the process of fixing myself, did I know who I really was.”
~Sade Andria Zabala
Reasons to be Hopeful
It’s estimated that 20 million individuals in the United States have a substance use disorder. While that’s certainly not great news, it should bring you hope to know that 75% of adults who report having a substance use problem report being in recovery. From a chronic disease perspective, treatment for addiction is as effective as treatment for hypertension, type 2 diabetes, and asthma.
Among adults who report having a substance use problem, receiving evidence-based therapy is associated with being in long-term recovery. Effective therapy not only helps a person stop using, it can help them address variables that contributed to, coincide with, and stem from active addiction. For example, therapy can help a person address emotional concerns that may underlie addiction and cope more effectively with relationship, work, health, and legal concerns that have developed as a result of substance use. Of course, therapy can also help a person develop insight and coping skills for relapse prevention.
Medication-assisted treatment (MAT) may enhance the effectiveness of talk therapy by addressing changes in brain chemistry and function that result from substance use disorders. That’s worth repeating in a different way: addiction alters the most powerful organ in the human body - the brain. These changes result in cravings that place drug use on par with food, shelter, and sex. These changes also impair the prefrontal cortex, the area of our brain responsible for choice. Think about that for a moment- this means that a person in active addiction experiences powerful cravings alongside impaired choice. These changes in brain chemistry and function are what make addiction a chronic disease, and one that’s difficult to treat. Even if a person is sometimes able to “choose” not to act on a craving (in spite of an impaired prefrontal cortex) this person cannot choose not to crave. What an excruciating experience. Medication-assisted therapy is a godsend in the world of recovery. These medications are prescribed by psychiatrists and other healthcare providers. If you have questions and concerns about MAT, we encourage you to visit the FAQ section below.
Sharing with empathic people can be liberating. Being emotionally vulnerable with a trusted therapist, your fellow group members, or empathic loved ones can decrease the frequency and intensity of some of the most painful and destructive emotions we all experience. When you talk with a good listener, you walk away understanding yourself better and it’s from that place that real change occurs.
Recovering from a substance use disorder allows you to be more present in life as opposed to obsessing about or being under the influence of a substance. Being present increases feelings of gratitude and joy, both of which are correlated with mental health. Being mentally present, as opposed to being distracted by the past or the future, also improves relationships and work satisfaction. It leads to a heightened sense of mastery, meaning, and purpose.
Finally, recovering from a substance use disorder can be a beautifully humbling and empowering experience. It seems paradoxical, but with deep surrender comes profound strength and compassion. Individuals in long-term recovery have experienced first-hand the limits of willpower. They have known themselves at their most vulnerable. They have experienced addiction as it hijacked their values. They have forgiven themselves for their humanity. They haven’t stopped trying and growing. Knowing themselves in this way, not abstractly but in real-life, leads to greater compassion for themselves and others. They understand that addicts aren’t the only ones with these vulnerabilities; these vulnerabilities live within us all. A person in long-term recovery is a testament to the human spirit.
“What we don’t need in the midst of struggle is shame for being human.”
Drs. Casey and Christopher have considerable experience in the assessment and treatment of substance use disorders. They have both served as clinical directors for partial hospitalization treatment programs for substance use disorders, and they have worked to make these programs more consistent with psychological research.
Dr. Casey has experience with SBIRT, which involves helping large organizations provide screening, brief intervention, and referral to treatment. SBIRT is primarily about the prevention of substance use disorders. Drs. Casey and Christopher are skilled providers of CBT and Motivational Interviewing, two forms of therapy with demonstrated efficacy in the treatment of substance use disorders.
In addition to their education and employment experiences, Drs. Casey and Christopher are emotionally and interpersonally well-suited for this work. They are down to earth, encouraging, and accepting. They also know how to collaboratively hold clients accountable and share their concerns if they sense something is amiss. They genuinely admire and root for their clients who are pursuing recovery from substance use disorders.
Frequently Asked Questions
What type of therapist should I see?
Ideally, it’s important to see a therapist who specializes in the assessment and treatment of substance use disorders. As they say in the world of recovery, “addiction is cunning, baffling, and powerful.” While people can and do recover from substance use disorders, addiction can easily take a significant toll on a person’s life - families, jobs, and health are often at stake. Unfortunately, overdose, withdrawal, and risky behaviors while under the influence can be fatal; addiction is a serious disease.
Psychologists who specialize in substance use disorders know how to conduct a thorough assessment and talk with you about the most appropriate level of care. If a treatment program is needed, they’ll have recommendations about where to go and answer any questions you may have about the process. If individual or group therapy is appropriate, they’ll have the knowledge and skills to provide care that will increase your chances of success. Unfortunately, well-meaning therapists without experience in this area can say and do things that backfire and inadvertently nudge you deeper down the path of addiction. In this area of mental healthcare, expertise is particularly important.
What type of treatment do I need?
Most of us are accustomed to thinking about medication in terms of doses - there are low, moderate, and high doses of medication. It can be helpful to think about therapy this way as well. Sometimes you need a low dose, and sometimes you need more. If you’re going to spend the time, money, and resources on therapy, you want to make sure you’re getting the right dose. Below are examples of treatment settings for addiction. For the most part, they’re listed from highest to lowest dose.
Detox - The first thing your provider will assess is your physical safety. Some substances have higher rates of overdose. Others have higher rates of potentially lethal withdrawal symptoms, which is primarily what detox aims to prevent. By the way, alcohol (one of the legal substances), belongs in the latter category. If there are concerns about your physical safety in the first days of recovery, a medical detox at a hospital or treatment facility will be recommended. Detox can last anywhere from one to a few days. Ideally, detox is followed by one of the treatment options below.
Residential Programs - A person who is newly recovering from a severe substance use disorder will likely experience strong cravings alongside impaired choice. This isn’t due to a lack of willpower, ethics, or character - it’s biology. Residential programs allow clients to stay at a safe, drug free facility while receiving individual and group therapy along with psychiatric care as needed. Participants usually participate in group therapy several days per week, and they meet with an individual therapist and psychiatrist as needed. There are also opportunities for couples or family sessions. Ideally, residential treatment is followed by one of the treatment options below.
Outpatient Programs - A person experiencing moderate to severe symptoms may be a good candidate for an outpatient program. There are two types of outpatient programs. First, there are partial hospitalization programs, often referred to as PHP. When a client is in PHP, they typically attend group therapy five days per week for several hours a day. They also periodically meet with an individual therapist and/or psychiatrist. Second, there are intensive outpatient programs, often referred to as IOP. A person in IOP typically attends group therapy three days per week for a couple of hours each day. Similar to PHP, those in IOP periodically meet with an individual therapist and/or psychiatrist. Similar to residential programs, both types of outpatient programs allow for couples and family sessions.
Sober Living Environments - A sober living environment is not a treatment, per say, but it’s often used in conjunction with treatment. A sober living environment is what it sounds like - a safe and sober environment where a person can live as they strengthen their recovery in individual or group therapy. A person in PHP, IOP, or individual therapy might support their recovery by staying in a sober living facility. Sober living environments vary in terms of cost and restrictiveness. Ultimately, they support healthy choices in a person’s pursuit of recovery.
Individual Therapy - Clients often initiate treatment by reaching out to an individual therapist. Sometimes, that’s the perfect dose of therapy. An experienced provider will be able to talk with you, over the course of one or many sessions, about whether or not individual therapy is the wisest place to begin. Clients who are ambivalent about stopping drug or alcohol use are great candidates for individual therapy. Sometimes clients need the time and space to talk honestly with a trained mental health professional about what they want, why, and when they want to pursue change. Clients who are newly sober or even many years sober often continue participating in individual therapy. They may choose to do so for a variety of reasons - to maintain recovery, to address other mental health concerns, to strengthen their relationships, or or consider career changes.
Group Therapy - In lieu of or in addition to individual therapy, a client who is fairly solid in recovery may choose to participate in a weekly therapy group. These sessions are typically 60 to 90 minutes, and they have an average of six to eight members. These groups are typically interpersonal process (IP) groups as opposed to educational and skill building groups. An IP group helps clients in recovery identify and work through emotions that impact their relationships, jobs, etc. Unfortunately group therapy is often avoided by clients. However, most clients who take a chance on group therapy report being pleasantly surprised by how easily they bond with, learn from, and are able to help their fellow group members.
Recovery Meetings - Recovery meetings include Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Crystal Meth Anonymous (CMA), and Marijuana Anonymous (MA), to name a few. These aren’t treatment groups because they’re not conducted by mental health professionals. There’s often limited oversight in terms of who shares and what is said. Sometimes this results in messages that contradict what a person hears from their therapist. However, for the most part, recovery meetings provide an invaluable resource - the opportunity to connect with and learn from people with years of sobriety. In time, they also offer the opportunity to help newcomers. Recovery meetings are often spiritual in nature, and unfortunately many folks write them off before ever attending a meeting. Many agnostic and atheist clients are able to find recovery meetings that feel like a good fit. In addition to the “anonymous” meetings, there are SMART recovery meetings. These groups are facilitated by community volunteers who are often in recovery themselves. SMART recovery meetings are more structured, and they focus on building skills in early recovery.
How honest should I be with my therapist?
If you have a good relationship with your therapist, it’s generally helpful to be honest. Clients early in recovery are often reluctant to acknowledge that part of them wants to change and part of them doesn’t. Therapists, particularly those who work in this area, understand that ambivalence is common and they know how to talk about it therapeutically. Anytime we’re engaging in a behavior we’d like to change, it’s important to listen to and acknowledge the benefits. There are always benefits - even if they’re only short-term solutions to longer-term problems. For example, a lot of clients report that using drugs and alcohol makes it easier to talk with others and helps decrease stress, anxiety, or sadness. If these needs aren’t acknowledged and addressed, any change a person makes in recovery is likely to be short-lived.
Not only do clients worry about relinquishing the benefits of using, they often worry about the consequences of recovery. For example, it’s not uncommon for clients to worry that their relationships may suffer if they stop using, particularly if using together is a significant part of those relationships. For others, drinking is part of their work culture and they understandably worry about career setbacks if they stop drinking at work events. There are countless other reasons why a person might have mixed thoughts and feelings about stopping or curbing the use of drugs and alcohol. A good therapist can hold space for all of your thoughts and emotions.
Lastly, clients are often tempted to hide the fact that they’ve relapsed or that they’re planning to relapse at an upcoming event. These are both helpful topics to discuss in therapy. At the end of the day, you make your own choices. We’re here to help you listen to your thoughts and feelings, reflect emotions that may be outside of your awareness, and support your efforts to view situations from different perspectives. When needed, we’re also here to help you minimize risk when you decide to continue using or plan a relapse. That’s not our hope for our clients, but we’d rather you be here using than not be here at all.
What types of medications are approved for the treatment of addiction and how do they work?
FDA approved medications are available for treating nicotine, alcohol, and opiate use disorders. These medications work in a couple of ways. Some medications are partial agonists, meaning they mimic the effects of drug use on a smaller scale. Examples include nicotine gum for cigarette addiction and buprenorphine for opiate addiction. Other medications are antagonists, meaning they block the “high” an individual experiences from drug use, making drug use less appealing. Examples here include naltrexone for the treatment of opiate and alcohol use disorders. Prescription medications are prescribed by medical doctors, and it’s often helpful to work with a psychiatrist who is board certified in addiction medicine.
Is medication “taking the easy way out” or “replacing one drug for another”?
No and no. Unfortunately, medication-assisted therapy has been judged harshly in some recovery circles, and many sober living environments still prohibit the use of medication-assisted treatment. These attitudes stem from historical and misguided views of addiction as a moral failing. Critics of this approach tend to view medication as “cheating” or “allowing the patient to get off too easily.” They might also view medication as “just another drug of abuse.” These views are harsh and inaccurate. We don’t take this approach with other healthcare concerns and, similar to type 2 diabetes and hypertension, addiction is a chronic disease that impacts the most powerful organ in the human body - the brain.
I only have a problem with one substance. Do I have to stop using everything?
If a person has a history of addition with one substance, they have a greater risk of developing an addiction to other substances. Unfortunately we’ve worked with many individuals who have coped with the loss of one substance by picking up or doubling down on another, and they often find themselves addicted to those substances as well.
What is low-risking drinking?
The safest choice from a purely physical perspective is not to drink. Likewise, the safest choice from a purely physical perspective is not to eat donuts. But we’re more than physical beings, and we like what we like. Still, it can be helpful to have some parameters. Generally speaking, for healthy individuals without a history of addiction, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) states that men should have no more than 4 drinks per day and no more than 14 drinks per week whereas women should have no more than 3 drinks per day and no more than 7 drinks per week. Serving sizes are also specified. Sorry about that.
I’m concerned about a loved one with a substance use disorder. What should I do?
This is such a painful experience. Trying to get a loved one to reach out for therapy is hard under any circumstances, and the challenge is amplified when it comes to addiction. This is a complex question because no two clients or family members are the same. That being said, below are some considerations.
First, if you haven’t already, ask to find a good time to talk. When that time comes, gently highlight the behaviors you’ve noticed and share your feelings about them. For example, you might share that you’ve noticed your loved one is drinking daily and you’re concerned it may be negatively impacting their health. Depending on your loved ones reply, their personality, and the severity of their use, you might offer to help them look into treatment options or accompany them to their first visit.
It may help to remember that your loved one is likely doing the best they can at this particular moment, and they aren’t trying to hurt you. Addiction alters the structure and function of a person’s brain which makes healthy choices difficult, particularly in early recovery. It’s more than reasonable to talk with a therapist yourself about all of this. It’s a difficult situation to navigate. Lastly, if you haven’t already, it’s worth looking into Al-Anon meetings in your area. These meetings are similar in structure to AA and other anonymous meetings, but they’re intended to support those impacted by a loved one’s addiction.