Therapeutic Approaches to Support Addiction Recovery

According to Dr. Anna Lembke, when it comes to treating addiction, there’s unfortunately no ‘one-size-fits-all’ solution. There are, however, three different established psychological therapies that have been proven to help, namely motivational interviewing, cognitive behavioral therapy, and dialectical behavioral therapy. 

Transcript

Three established psychological therapies for addiction treatment are motivational interviewing, cognitive behavioral therapy and dialectical behavioral therapy. Keep in mind as we’re going through different types of psychotherapy for addiction, that what works for one person won’t necessarily work for another and many patients benefit from receiving medications in combination with psychotherapy.

Motivational Interviewing

So let’s start with motivational interviewing. Motivational interviewing, also known by its initials, M.I., is a type of therapy that focused on enhancing motivation to change behavior. As the old saying goes, you can lead a horse to water, but you can’t make it drink, well, M.I. is a way to get the horse to drink.

For example, an M.I. therapist might say on a scale from one to 10, how motivated are you to change this behavior with one being not motivated at all, and 10 being very motivated? If the patient answers five, then the therapist asks, why isn’t it a four? Something very subtle just happened here and asking the patient why they’re a five and not a four the therapist is inviting the patient to reflect on what exactly makes them as motivated as they are, rather than asking them why they’re not more motivated, something a parent or a spouse might do. This intervention forces the patient to reflect deeply on their own motivations for behavior change or lack thereof.

Along these lines an M.I. therapist would avoid offering education or advice without first asking the patient’s permission to do so, emphasizing the autonomy of the patient. For example, an M.I. therapist might say, so I see from your initial assessment that you typically have more than seven drinks a week, which puts you in the at-risk zone, would you like to hear more about this? If the patient agrees, the therapist then explains the data on at-risk drinking and what it’s based on. The patient can decide for themselves what to do with that information. If the patient says no, then the therapist respects their autonomy and invites another topic.

But in truth, when patients are offered the option, they almost always say yes. In some, M.I. acknowledges that in a free world with unregulated access to addictive substances, the patient will ultimately have to decide for themselves if they’re willing to try to make a change. 

Cognitive behavioral therapy

Now let’s talk about cognitive behavioral therapy. 

Just as the essence of motivational interviewing is contained within its name, so too is the essence of cognitive behavioral therapy, also known by its initials, C.B.T., contained within its name. C.B.T. aims to improve mental health by addressing cognitions, thoughts that lead to unhealthy behaviors. C.B.T. therapists help their patients identify negative automatic thoughts.

Essentially, the subconscious scripts they play in their own heads. I have to drink because nothing else will take away my pain. I don’t deserve to be happy, so why not drink myself to death. By becoming consciously aware of negative automatic thoughts, patients are able to replace them with healthier, more accurate ways of looking at events and circumstances as well as enlist other healthier coping strategies, such as talking with friends, exercising and mind, body relaxation techniques.

Dialectical behavioral therapy

Finally, let’s talk about dialectical behavioral therapy. Dialectical behavioral therapy, unlike C.B.T., focuses first on emotions, and second on thoughts. The name originates from the word dialectical, which means concerned with or acting through opposing forces. One image to describe D.B.T. is two people holding opposite ends of the same rope like a game of tug of war. Those two people are the patient and the therapist, the harder each of them pulls the less progress they’ll make in coming to the same side. So instead, the D.B.T. therapist stops pulling, drops her end of the rope and walks over to where the patient is. This describes the early stages of D.B.T. therapy in which the therapist focuses on validating the patient’s experience, especially their emotions.

For example, the patient might say, my husband never listens to me. I don’t think he really loves me. That’s why I drink. Even when the therapist has met the patient’s husband and directly observed the husband’s caring, concern and attentive listening, the therapist might say that must feel awful to have the sense that you’re not being listened to or loved.

Note here, the therapist does not validate the invalid by agreeing with the patient. Instead, the therapist validates the patient’s emotional experience, which is true for the patient under any circumstance. In D.B.T. validating the patient’s subjective emotional experience is a key to effective therapy. The latter stages of D.B.T. therapy involve encouraging the patient to incorporate other perspectives and develop a more balanced narrative.

This is where the therapist goes back to her side of the tug of war and tries to bring the patient along with them. By seeing both sides of the story, patients are better able to see the full picture, which in turn informs better choices. The therapist might say, “You know, I observed that your husband was patiently waiting for you to finish talking, yet you said he doesn’t listen to you. Help me understand that discrepancy.”

This completes our brief summary of M.I, C.B.T, and D.B.T. Hopefully, now this is more than alphabet soup for you.