Counseling in the Treatment of Addiction

Counseling, also called "talk therapy," is among the most important ingredients in addiction treatment. A number of behavioral therapy approaches offer the best assistance for successfully treating individuals with drug and alcohol disorders. Behavioral therapies are an important part of treatment in residential and outpatient programs and are frequently used together with medications. The techniques focus on helping drug and alcohol users change the way they live their lives (their behavior) so they can successfully stop alcohol and drug use and develop healthy, productive lives.

What is good addiction counseling? Counselors and therapists who provide treatment for addicted individuals and their families need special training in behavioral treatments for addiction. Counselors and therapists teach their addicted patients about addiction, encourage them to make changes in their lives, praise them when they make progress and support them when they run into problems.

Specific behavioral counseling approaches improve treatment success. These techniques:

  • Improve motivation for recovery: Many, if not most, addicted individuals resist entering addiction treatment. They are ambivalent about stopping their alcohol and/or drug use. It is as if part of them wants to stop their substance use and part of them wants to continue using. Motivational Interviewing and Motivational Enhancement Therapy are techniques that help addicted individuals recognize the damage that substance use is doing to their lives, encourages them to stop use and supports positive steps toward recovery.
  • Teach skills for stopping drug and alcohol use and avoiding relapse: Once a person becomes dependent upon alcohol or other drugs, they truly don't know how to stop their use and avoid relapse. Cognitive-Behavioral Therapy, CBT teaches patients why they crave drugs and how to cope with craving; how to avoid the people, places and things connected to drugs; how to cope with difficult feelings that can trigger relapse; how to prevent a minor slip or "lapse" from becoming a major relapse.
  • Use positive incentives to encourage treatment participation and reward progress: Addiction recovery takes time. Longer stays in treatment produce greater success. Changing friends, habits and lifestyle is difficult. Incentives, such as small prizes (movie tickets, gift certificates, restaurant coupons) can promote behavior changes and provide positive reinforcement for treatment progress. When patients make progress in treatment (for example, 30 sober days or perfect attendance at treatment sessions) these small bonuses can help encourage and reward these accomplishments.
  • Involve family members in treatment activities: Family members who are well informed about addiction and who participate in treatment activities can greatly improve the success of treatment for the addicted individual. Family and couples therapy provide appropriate help and support for involving family members in the recovery process.
  • Encourage participation in recovery support groups: Alcoholics Anonymous (AA) and other 12-step groups (Narcotics Anonymous, Cocaine Anonymous, etc) are extremely valuable support systems for recovering individuals. In addition there are counseling approaches which help teach patients about the value of 12-step programs and encourage meeting attendance called 12-step facilitation therapy.

Questions to ask when choosing a therapist or counselor and type of therapy:

  • Does the therapist/counselor have a professional license or certification?
  • Psychiatrists, psychologists, social workers, marriage and family therapists and certified addictions counselors are the main categories of qualified professional practitioners.
  • Has the therapist or counselor received special training in the use of effective behavioral therapies?
  • Asking a therapist or counselor if they have had training in cognitive behavioral therapy, motivational enhancement therapy, family therapy or the other approaches specially developed for addiction is an important first step. Just as medical doctors need special training to treat complex diseases, therapists and counselors need to be trained in addiction treatment.
  • Is urine testing and breath alcohol testing used as a part of treatment?
  • In addiction treatment, testing is an essential tool. Testing is used to monitor treatment progress in the same way blood tests are needed to monitor high cholesterol or blood sugar levels. Testing should not be used as a way of "catching" patients or as a basis for punishing drug/alcohol use, but it is an invaluable tool in documenting treatment progress and recognizing when treatment plans should be modified.

Home Box Office, Inc.
The Addiction Project
written by: Richard Rawson, Ph.D.

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