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Psychotherapy Overview for Alcohol and Substance Abuse

Mark Dombeck, Ph.D.

Psycho-Social Treatments:

A variety of psychological and social (psychosocial) strategies for treating drug and alcohol dependence have been developed, each offering a different level and type of support to persons recovering from drug or alcohol dependence. Treatments are often mixed and matched to fit the individual, as resources (money and/or health insurance) permit.

Psychotherapy (Group and Individual Formats)

The term "psychotherapy" encompasses a broad spectrum of interventions led by therapists, for the benefit of patients. A partial list of the things that psychotherapy may attempt to accomplish would include but not be limited to:

  • providing a safe and trustworthy forum in which hurting people can discuss their present-day issues and problems
  • providing a safe and trustworthy forum in which hurting people can talk about how they came to be the way they are (exploration of past experience)
  • promoting the sharing and releasing of shameful and emotionally toxic experiences in a way that promotes personal empowerment and feelings of self-worth and belonging.
  • teaching specific coping skills for managing specific problems and symptoms
  • providing a place where people can make friends and give and get interpersonal support
  • providing a parental-style figure who gives authoritative guidance to those people who are in need of external guidance
  • providing a model and personal experience of what trust-worthy relationships look like (so that such relationships can be pursued outside of therapy)

From among this list, at least four specific therapy agendas may be discriminated:

  • Supportive psychotherapy aims to offer patients a safe and trustworthy forum in which they may discuss the troubling aspects of their lives. The therapist strives to listen to the patient, who is encouraged to share emotionally. When needed, the therapist may act as a strong guide/authority figure, outlining things that the patient should do and not do. This type of therapy is not exploratory and doesn't delve into the past histories of patients. It is most helpful for interpersonally and emotionally fragile patients, and/or patients who become disorganized when confronted with stressful situations and memories.
  • Coping-focused psychotherapy aims to teach patients specific and practical ways to cope with specific problems such as Depression, Anxiety, Panic and Substance Abuse relapse prevention. The best and most effective forms of coping-focused psychotherapy are those that are based on scientific research. Most any form of Cognitive-Behavioral Therapy is recommended. Relapse Prevention programs are highly recommended.
  • Social skills/interpersonal/growth psychotherapy aims to teach patients to become more emotionally and socially mature in their dealings with others. For a variety of reasons, many addicts tend to have poor interpersonal skills and to deal with their emotions in self-destructive ways. Social skills/interpersonal/growth psychotherapy (usually performed in a group therapy context) helps patients to learn about and practice (within the session amongst each other) healthy ways of communicating with others.
  • Exploratory psychotherapy aims at helping people to uncover the links between past experiences (trauma, violence, abuse, etc.) and present behavior. Because exploratory forms of psychotherapy often involve recalling painful past events, this sort of therapy can be disorganizing and itself traumatic to fragile recovering persons, and to dually diagnosed patients with psychotic or other severe symptoms, it is not recommended. There is much evidence in fact that healing from many forms of mental illness can proceed just fine with out any need to bring up past traumas (the most effective forms of psychotherapy for improving functioning being the coping focused varieties). However, exploratory psychotherapy (and particularly a behavioral form known as exposure therapy) is useful in treating many anxiety and trauma based disorders, and should not be ruled out as an option for recovering persons with stable sobriety under their belts.