Substances that alter the state of consciousness have been used for centuries. Priests and shamans ingested plants to fall into dissociative trance states and the Ebers papyrus, one of humanity’s oldest medical documents, refers to the use of poppy seeds for medicinal purposes. However, many also realized the negative effects of these substances and their addictive power. Aristotle, for example, warned that drinking during pregnancy could be harmful, and the Roman physician Celsus held that dependence on alcoholic drinks was a disease.
However, the first therapies for addictions were very rudimentary and often even dangerous or iatrogenic. In the 1800s, for example, addictions to alcohol and opium were treated with morphine, cocaine, and other so-called “drugs” that actually created a new addiction. Later spread therapies such as thermal shock with cold water, induction of coma with bromide or insulin, or lobotomies and electroshock, which ended up causing more problems than they solved.
Everything began to change in the mid-1920s when was introduced the supportive treatment to facilitate detoxification based on mutual understanding and help. Today, thanks to advances in Neuroscience, we can better understand addictive behaviors and design really effective addiction prevention and psychological treatment programs that put the persons and their well-being at the center. These treatments are carried out by professionals with a university degree in Psychology or Psychiatry specialized in Drug Addiction, so that they follow a scientific method, contrasted in clinical practice.
The main approaches in the psychological treatment of addictions
“There is no single treatment that works for everyone. Effective treatment is one that covers all the needs of the patient, not only with respect to drug use, and that extends for as long as necessary,” said the National Institute on Drug Abuse of the United States.
It also noted that “Counseling and other behavioral therapies are the most common forms of treatment.” In fact, addictions are a psychophysical problem, so it is necessary to address the psychological and environmental causes that are at their base, as well as help the persons to deal with the negative emotional states that they experience and provide them with the tools to avoid relapses.
In Psychology there are different ways to help people who want to detoxify. Although cognitive-behavioral therapy was the first to respond to the problems caused by addictions and continues to be the most widely used and scientifically researched, there are other approaches that are also valid and effective.
1. Cognitive behavioral therapy
This type of therapy for addictions integrates the principles of behavioral theory, social learning theory and cognitive therapy, making it a fairly comprehensive and effective approach to treating problems arising from substance use and preventing relapse.
The cognitive-behavioral therapist teaches the person self-control strategies that allow him to better manage his impulses. He works with the person to make him learn to recognize the situations in which he is likely to use substances and find ways to avoid them. He also enhances his abilities to successfully deal with risky situations and trains him to avoid recidivism.
Through functional analysis, cognitive-behavioral therapy identifies the antecedents and consequences of addiction, so that the person can understand its impact. The psychologist helps him analyze the cognitions and beliefs related to addictive behavior to promote more adaptive strategies aimed at eradicating behaviors, thoughts and emotions linked to substance abuse or other types of addictions.
2. Humanistic and existential therapies
Humanistic and existential therapies emphasize the need to understand the human experience, so they focus on the person, rather than the symptom. Psychological problems, including addiction, are addressed as the result of the inability to choose the most appropriate way of life.
This type of therapy for addictions emphasizes freedom and personal responsibility by promoting acceptance, growth, and commitment. The humanistic approach, for example, considers that we all have the potential to stay healthy and that we can make positive and beneficial decisions for ourselves and others, so the therapy focuses on promoting personal growth instead of focusing solely on the disorder.
In the case of the existentialist approach, The therapist helps the person to find the meaning of his life, as well as to think and act in an authentic and responsible way. In this psychological treatment for addictions, it is assumed that the main cause of the problem is the restlessness and anguish generated by loneliness, isolation and lack of meaning, so these are the issues that are mainly addressed in the sessions. In general, they are therapies based on empathy and reflective listening that encourage acceptance and commitment.
3. Brief psychodynamic therapy
Psychodynamic therapy focuses on how unconscious processes manifest in the person’s current behavior. Its main objective is to understand how the past influences present behavior to promote awareness of those unconscious aspects that are generating or feeding addiction.
In the brief modality, the person analyzes his symptoms, unresolved conflicts and dysfunctional relationships that come from the past and are manifested through the need of substances. In this case, the therapist usually focuses the intervention on a narrow focus related to the addiction.
Supportive-expressive psychotherapy, for example, is a type of psychodynamic therapy tailored to substance abuse that is also based on the idea that addiction is shaped by formative life experiences. In this case, the support techniques are combined to enable people to talk comfortably about their personal experiences and emotions with expressive techniques that allow them to identify and solve problems in their interpersonal relationships.
4. Brief family therapy
Problems caused by substance abuse do not occur in isolation. In many cases, the dynamics of the family of origin or the current acts as a trigger for substance abuse or may be perpetuating that dysfunctional behavior. In other words, interactions with family members can aggravate the problem or, on the contrary, contribute to its solution.
Family therapy is based on the theory that when a person is addicted, he is strongly influenced by family members, their behaviors and/or communication style. To understand this dynamic, the psychologist analyzes factors such as the hierarchy of power, roles and communication styles in the family. For that reason, the sessions often involve other people, such as parents, partners or children.
Through family therapy, the person is helped to identify dysfunctional areas and replace inadequate communication and relational patterns with clearer, more direct and effective communication in which there are healthy limits. This type of therapy is often used when the family can help the person recover or is experiencing the cascading effects of one of its members’ addiction.
5. Group therapy
Group therapy is one of the most used modalities in the treatment of addictions. It is useful because it allows people to observe the progress of their addictive behavior through themselves and the observation of the others, in addition to generating a commitment to the group, which facilitates the recovery in a climate of support, understanding and hope.
There are also different models of group therapy for addictions:
• Psychoeducational groups. Its primary goal is to raise awareness of the behavioral, medical, and psychological consequences of addictions. They also provide tools for people to learn to identify, avoid, and manage the internal states and external circumstances associated with addiction.
• Skills development groups. They are essentially training groups in coping skills so that people can achieve and maintain a state of abstinence. They teach their members to refuse drug offers, avoid triggers for use, tame urges to use, deal with feelings like anger, and relax.
• Support groups. In these groups, the work and commitment of the members is reinforced to develop social skills and management of thoughts and emotions related to consumption as they recover. People support each other and share practical advice on staying abstinent and managing the challenges of everyday life. This type of addiction therapy is also used to improve self-esteem and build self-confidence in members.
In summary, there are different psychological treatments for addictions. Each of them follows a different approach, but in the long run they all contribute to developing the psychological skills that people need to cope with addiction. The most important thing is to take the first step and ask for specialized help.
(2019) Enfoques de tratamiento para la drogadicción. In: National Institute for Drug Abuse (NIDA). – no follow
Crocq, M. (2007) Historical and cultural aspects of man’s relationship with addictive drugs. Dialogues Clin Neurosci; 9(4): 355–361.
Substance Abuse and Mental Health Services Administration (2005) 2 Types of Groups Commonly Used in Substance Abuse Treatment. In: Treatment Improvement Protocol (TIP) Series; 41.
Sánchez, E. & Gradolí, V. (2001) Intervención psicológica en conductas adictivas. Trastornos Adictivos; 3(1): 21-27.