Alternative Therapies for Addiction Recovery

Most people believe their choice is to enter 12-step, addiction-as-disease therapy or to have no treatment at all for addiction problems. In fact, there is a broad array of treatments for addiction. What unites them is:

(a) their not focusing on the disease of addiction,

(b) instead exploring the person’s psychological functioning and interpersonal and social contexts,

(c) developing practical solutions and skills for addressing problems in their functioning and their social lives,

(d) an essential belief that the person is capable of change and managing their lives.

A List of Alternative Therapies

Solution-Focused Therapy is a goal-oriented, patient-driven approach that uses people’s personal strengths to reach their intended goals. It includes the following elements:

  • discussing and defining the patient’s goals for treatment built on a specific time frame and number of sessions
  • identifying solutions that have worked in the past, are currently working and may be effective in the future
  • developing strategies for overcoming any potential barriers to achieving the person’s goals
  • identifying further steps and resources following treatment to ensure continued progress and to access additional help for recurrent problems

Cognitive Behavioral Therapy (CBT) is an expansion of classical behavioral psychology which presents that people (and other animals) respond primarily to rewards and punishments. In the strictly behavioral approach, a therapist treats a person by rewarding desired behaviors and punishing disapproved ones. The “cognitive” in CBT came about because people interpret events so that their thinking is essential to what they fund rewarding and how they behave in response to various rewards.

Rational Emotive Behavior Therapy (REBT) (REBT) is the best known brand of CBT. Developed originally by psychologist Albert Ellis, it has been spread broadly through the addiction support group SMART Recovery ®. REBT’s central theme is that events themselves don’t cause our problems. Instead, how we think about these events is the crucial variable. This idea is captured in the acronym ABC:

A – The activating event or adversity
B – Our beliefs about the event, ourselves, and the world in general
C – The consequences of our emotions and behaviors

Motivational Interviewing is a client/centered style of therapy. In MI a helper (professional or peer) explores by questioning a person about their views of their problems and concerns and their underlying values. The person themselves then sets goals and finds solutions that merge their perceptions and values. It is characterized by:

  • respectful, open/ended questioning of a client by the helper
  • non-judgmental responses from the helper to the client’s views and expressions
  • the underlying attitude that the client is the driving force in finding solutions, which are consistent with their values and goals
  • a fundamental belief that the person is themselves the best at finding solutions that work for them

Contextual Therapy focuses on the environment in which a person lives and functions. This includes all of the external factors that have an impact on mental health. It includes identifying primary external forces in the client’s life, including:

  • personal relationships and family dynamics
  • work, educational and community engagement, success and stress
  • free time and recreational activities and associations
  • social support networks

Family and Partner Therapies

All family therapies believe that: people are essentially formed and their behavior maintained by their roles in their families and intimate relationships.

Family Systems Theory and Therapy views substance abuse as a symptom of dysfunction within the family. This view emphasizes that the whole family is affected by one member’s substance problem. Likewise, change for that individual requires positive movement by the entire family. Family impacts a member’s problem by:

  • passively supporting the addictive behavior, called “enabling,” for example by allowing the individual to shunt aside family responsibilities
  • possibly even expecting or “requiring” the person to be addicted in order to cover over their own deficiencies

Reciprocal Partner Therapy. Marital and intimate partners often feed into one another’s addictions. For example, one partner may drink, take drugs or overeat when they are abused by another person in the family, including their being denigrated, or even simply when they feel ignored. Here again both people must change together because their negative behavior feeds off of one another in a cycle or pattern. Specific types of reciprocal partner steps that support successful change include:

  • decreasing negative or controlling behaviors that provoke drinking or other negative behavior
  • increasing supportive and problem-solving communication
  • reinforcing positive behavior change by the partner with an alcohol or other addictive problem
  • increasing joint positive activities together
  • reducing or changing the helping partner’s own drinking, drug taking, eating etc. behavior to support changes sought in the addicted partner

Community Reinforcement and Family Training (CRAFT) is an approach for families who have a loved one struggling with substances but who hasn’t demonstrated an interest in making changes or getting help. CRAFT uses the following techniques:

  • learning a different method of dealing with the person with a problem that decreases their likelihood of acting out — for instance, by excluding them from family affairs or activities when they are using or overusing
  • requiring others in the family to take care of themselves if the person is misusing substances or behaving negatively
  • learning how to respond to the family member in a way that increases the likelihood of their changing — i.e., responding positively towards, or rewarding, their positive behavior

Principles of Successful Alternative Therapies

  1. Future (rather than past) oriented. Treatment does not dwell on the past, and especially past failures, but instead focuses on ways forward.
  2. Goal-oriented focus on solutions. Identifying goals and finding doable steps and actions that improve the person’s situation.
  3. Realistic consideration of contextual factors. The person develops insights about what in their situations, including their relationships, is holding them back, but in manageable, non-alarming terms.
  4. Emphasis on person’s strengths and personal assets. The resources and skills the person has are recognized and expanded.
  5. Positivity. Successes — even small ones — are noted and celebrated.
  6. Optimism. Further progress and success is expected and projected into the future.
  7. Agency and empowerment. The driving force is seen to be the person and not the addiction, the person’s lack of control, or their permanent, inherent flaws.
  8. Belief in self-efficacy and agency. The message is conveyed that the person is capable of improving their situation.
  9. Using maintenance strategies and skills (called “relapse prevention”). that the therapy has developed in place of becoming discouraged and giving up when the person has a lapse away from their improved performance.

Conclusion

Successful alternative therapies are practical, optimistic, and empowering. Indeed, they are the essence of common sense, as in discovering the answers to the following questions : (1) What do successful lives look like? (2) When have I or a family member functioned best? (3) What does my or a family member’s best possible life look like? (4) What can I do to center my life, or help a family member center their lives, on these things? Finally, rather than indicating the powerlessness of people with problems and the permanence of their conditions, these therapies (5) inspire people with the belief in their personal capability and that they can make positive changes in their life.

Stanton Peele

Dr. Stanton Peele, recognized as one of the world's leading addiction experts, developed the Life Process Program after decades of research, writing, and treatment about and for people with addictions. Dr. Peele is the author of 14 books. His work has been published in leading professional journals and popular publications around the globe.

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