There is no single effective treatment for addiction and any facility or treatment professional who claims otherwise needs to be given a wide berth. Addiction arises from a multitude of biological, psychological, social and spiritual reasons and can vary in nature and severity from person to person. Effective treatment needs to take into account what is driving and maintaining the addiction for each person individually, and use interventions which specifically target the underlying problems. In effect, you need to treat the person not just the addiction.
If someone uses substances to help manage anxiety then understanding the root of the anxiety and learning relaxation skills will help. If someone uses substances to suppress the effects of childhood trauma and abuse, then this needs to be addressed at some point during recovery. Many people use substances to deal with loneliness and lack of connection. If this is the case, then looking at what stops the person from having healthy meaningful relationships and helping them to change will be paramount to maintaining recovery.
Addiction treatment is complex, and looking for a quick fix won’t work. But when you are considering treatment options, choosing a facility or treatment professional that utilises some or all of the following interventions is a good start.
This targets and challenges dysfunctional thoughts and replaces them with more helpful and beneficial ways of thinking. It is the primary intervention used in Cognitive Behavioural Therapy, one of the most widely used evidenced-based treatments for addictions. It works on the principle that the way we think can generate difficult emotions and our ways of behaving or reacting are a way to cope with the difficult emotions. Substance abuse is viewed as behavioural coping method. Cognitive restructuring will help address the thoughts that could be playing into underlying conditions such as anxiety or depression and also the thoughts that directly lead to substance abuse.
Emotional Regulation Training
Substance use is a way of coping and managing a range of intense or uncomfortable emotions and sensations.. Substances will temporarily numb, suppress and change emotions quickly and efficiently. When someone tries to stop using they will have to learn how to manage and regulate their own emotions. This is not an easy task as intense emotions have the ability to over-ride rational thought. This is why it can be so difficult to over-ride cravings. Even though intellectually you might realize that your substance abuse is destroying your life, when the feeling or desire to drink and use takes hold, all rational thought goes out of the window. Learning ways to regulate emotions is essential for recovery and one type of evidenced based therapy incorporates this. Dialectical Behavioural Therapy includes cognitive restructuring and also skills training to deal with distressing feelings and emotions.
Mindfulness and Meditation Training
There is a lot of research that indicates mindfulness and meditation affect the brain in positive ways. The part of the brain – Pre-frontal cortex – that is responsible for managing intense emotions and impulsiveness is found to become more robust through meditation. It is now believed that people who are vulnerable to addiction are likely to have an underdeveloped or less effective pre-frontal cortex, which renders them less able to manage intense emotions and over-ride impulsive urges. In addition, the process of paying attention to the present, which is the essence of mindfulness, can provide valuable insight into the thoughts and feelings that are creating the urge to use. Mindfulness is about awareness and without awareness it’s difficult to change. Mindfulness Based Cognitive Therapy (MBCT) is an evidenced-based therapy that incorporates cognitive structuring and mindfulness.
Identification and reduction of unhealthy behavioural patterns
Drinking and using drugs are not the only destructive behaviours that are typical of addiction. Research has identified a number of unhelpful behaviour patterns that stem from childhood and repeat throughout a persons life. These patterns or “Schemas” as they are known, generate a lot of unnecessary emotional pain, wreak havoc on relationships, destroy self esteem, and cause us to repeat the same mistakes over and over again. They prevent us from getting core essential needs met, which can result in feelings of chronic emptiness and lack of fulfillment. Unless these patterns are addressed and broken, recovery from addiction will be difficult. An example of one of these schemas that is common in people with addiction is called “unrelenting Standards”. This schema involves belief that nothing is ever enough. Your work isn’t good enough, You’re not funny/ intelligent / smart / rich enough. It generates a great deal of pressure and stress and causes a person to constantly struggle with feelings of frustration, agitation inadequacy and disappointment. These feelings drive behaviours that include workaholism, excessive tidiness, hyper-criticalness towards others and a general inability to relax. It is a very difficult schema to have and being around someone with this schema can be very stressful. Drinking or drug use is often a way of coping with the constant relentless feelings of stress and pressure. Schema Therapy is an evidenced-based therapeutic approach that addresses these patterns. It includes both cognitive restructuring, mindfulness and focuses on managing the emotions that the schemas generate.
Working with resistance to change
Research has shown that people go through a number of cycles in the process of change before the change becomes lasting. Relapse is often unfortunately part of the process of addiction recovery and helping a client to identify reasons for relapse and renew motivation to keep trying is vital. The decision to give up using or drinking is not an easy one as substance use makes sense to the person using. It has been a way of coping with a variety of things and to give it up is a scary prospect. It is very common for clients to go from feeling highly motivated to change and then to feel totally despondent about it. Traditional approaches to addiction treatment often view relapse as failures of treatment and lack of motivation to change as denial. This is simply not the case. Motivational Interviewing is an evidenced based approach that has had a lot of success treating addiction and works with a client’s resistance to change and helps to increase and maintain motivation.
The five evidence-based therapeutic approaches mentioned above all have had success in treating addiction but research has shown that the relationship with the therapist is as important as the treatment method used. A good addiction therapist will have a good understanding of the complex nature of addiction, do a thorough assessment to screen for underlying mental health conditions, be able to draw on all of the above interventions, not focus exclusively on one approach, be empathic, non-judgmental and gain an understanding of what role the addiction is playing in the client’s life.