There are a number of different schools of therapy and two major modes of therapy. Space limitations prevent mentioning every specific type of therapy, but there are several different major paradigms or schools of therapy that can be used in the treatment of substance use disorders. These schools include:
The psychodynamic paradigm of therapy: This paradigm was originated by the famous psychologist Sigmund Freud. Typically, the approach of this school of thought is to try and ascertain how the results of interactions during childhood relationships lead to problems in later life. Most often, this school looks at unconscious mental processes that are played out in everyday behavior. At one time, this paradigm was the most common school of therapy; however, over the years, it has generally lost a significant portion of its popularity. Part of the reason is that traditional psychoanalysis in the Freudian sense is very lengthy and expensive. Today, briefer forms of psychodynamic therapy are more popular, and there is evidence that they can be useful in the treatment of substance use disorders. Individuals who are interested in exploring how the early relationships may have affected their substance use and other issues, and who are interested in understanding their motivations, may find this type of therapy appealing.
Behavioral school of therapy: This school of therapy attempts to directly treat behaviors without trying to develop much insight into motivation as is done in the psychodynamic paradigm. For instance, the development of medications like Antabuse that result in a person becoming violently ill if they take the medication and drink alcohol is based on the principle of aversion therapy that comes directly from the behavioral school of psychology. Behavioral techniques are often combined with other forms of therapy to enhance their effectiveness. It is rare for anyone to engage in strictly behavioral therapy.
Cognitive therapy: This paradigm explores the individual’s thinking patterns, attitudes, and expectations as they relate to behavior. The cognitive paradigm of psychology has risen in popularity as a direct reaction to both the psychodynamic and behavioral schools of psychology. In addition, the style of therapy that is most commonly used in the treatment of substance use disorders and probably can claim the most research support for its use is known as Cognitive Behavioral Therapy (CBT). CBT applies the principles of cognitive psychology and behavioral psychology.
There are a number of different types of CBT or therapies that are heavily based on cognitive behavioral techniques that can be applied to treatment for substance use disorders:
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The humanistic school of therapy: The humanistic school of psychology was originated by the famous psychologist Carl Rogers who believed that the principles of psychodynamic psychology and behavioral psychology lacked a sense of real understanding of people. Humanistic psychology and humanistic therapy strives to help individuals “be all they can be.” The paradigm views many issues, such as substance use disorders, as situations that occur because people have a false impression of what is important in their lives, what types of things are worthy of striving for, and they place too much emphasis on what other people think. Even though Carl Rogers was the first famous psychologist to actually allow formal research to be done on therapy, and certain humanistic principles have been demonstrated to be very important in the success of therapy, therapists rarely adhere to a formal humanistic approach in the treatment of substance use disorders. Instead, most therapist apply Rogers’s notions of being empathetic, being genuine with clients in therapy, and having an unconditional positive regard for clients in therapy in their treatment of individuals with substance use disorders. These three qualities emphasized by Rogers have been demonstrated to be important in the success of any type of therapy.
In addition to the above four major paradigms of psychology, it is generally acknowledged that biological psychology is the fifth major paradigm in psychology that is applied to therapy. Biological psychology would be applied in such treatments as medication-assisted treatment for substance use disorders (see below).
Therapy can also be applied either in an individual or group format:
Individual therapy is a one-on-one type of therapy where a therapist and an individual work together on the individual’s issues. The advantages of individual therapy over group therapy include being the sole focus of attention, feeling more comfortable in disclosing personal issues in a more intimate setting, and having the therapy directed to just the individual as opposed to a group of individuals. Group therapy consists of one or more therapist addressing a group of individuals who usually have the same or similar problem. While group therapy is not as intimate and focused as individual therapy, groups provide social support, the chance to learn from others, and the opportunity to get different points of view. Groups can consist of family members or unrelated individuals who share similar issues.
The choice of getting involved in individual or group therapy depends on the individual. Research indicates that group therapy and individual therapy are generally equally effective in the treatment of substance use disorders.
Medication-assisted treatment also provides for the management of:
Medication-assisted treatment is not a standalone treatment for individuals to address substance use disorders, but will need to be combined with other forms of therapy in order for the person to engage in a full recovery program. In addition, this treatment is often applied in the detox phase. Going through a medical detox program is only the first stage of treatment; it is not sufficient treatment by itself.
Any type of medication-assisted treatment can only be administered by a qualified physician. In some cases, such as in the administration and prescription of opioid replacement therapies, physicians need to receive special qualifications beyond their medical training.
While support groups do not actually represent types of therapy given the definition of therapy used in this article, it is important to mention them briefly as many people attend them. Support groups differ from therapy groups in that support groups are not run by professional therapists. Support groups are typically run by individuals who have the same or similar problem as the members of the group, or they can be run by some expert who is not a licensed therapist. The most common support groups that are used in the treatment of substance use disorders are 12-Step groups, such as Alcoholics Anonymous, Gamblers Anonymous, Narcotics Anonymous, etc. Research on the actual effectiveness of these groups in treating substance use disorders is generally limited. Nonetheless, these groups do have several advantages:
Finally, it is important to mention the general principles of effective treatment for substance use disorders as they apply to different types of therapy. Based on the overall empirical evidence regarding addiction treatment, there are several principles that can be derived to ensure the treatment has the highest probability of helping the individual recover. The basis of any potentially successful treatment program for substance use disorders includes the following: