Overcoming addiction is an extremely difficult and arduous process. Preventing relapse, therefore, is a vital part of recovery. There are countless reasons why relapse prevention is important. Most people overcoming addiction will experience thoughts and urges to go back.
Knowing that the yearning will return and how to deal with those feelings is central to addiction relapse prevention. Addiction treatment therapy methods give people the tools to be able to fight of a relapse and continue on their road to recovery.
Dialectical Behavior Therapy
DBT (dialetical behavior therapy) is a cognitive behavioral treatment that therapists use to help stop the harmful behavior and help people live their ideal life. Dialectical behavior therapy for substance use disorders is designed with clear stages for the person to go through. Even if the person comes in with a single problem, more will often appear during treatment, and DBT helps address all of them.
This method of therapy has five components:
- Use DBT skills training to enhance capabilities.
- Improve motivation with individual psychotherapy.
- Help assimilate back into the natural environment with in-the-moment coaching.
- Structure the environment with case management.
- Enhance the therapists’ capabilities and support his or her motivation with a consultation team.
Skills Training to Enhance Capabilities
The first component focuses on teaching behavioral skills. It is usually taught in groups that function similar to a school classroom, with the leader teaching a skill and then assigning homework. Each group meets for two and a half hours each week, and the curriculum takes 24 weeks to complete.
Skills training involves four modules:
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Improve Motivation with Individual Psychotherapy
The individual therapy involved in the second component is meant to apply the skills to specific challenges in the person’s life. It takes place once a week and usually happens at the same time as the skills training.
Help Assimilate with In-the-Moment Coaching
In-the-moment coaching is meant to begin assimilating the person back into their everyday life. They have the ability to call their coach on the phone anytime between therapy sessions if they face a difficult situation and need help.
Structure the Environment with Case Management
In the fourth component, the therapist starts to put more responsibility on the client to manage his or her everyday life. The therapist will look to the client about what to do, only stepping in when it is completely necessary.
DBT Consultation Team Supports the Therapist
The consultation team is there to help the therapists. They are the support for the people who provide DBT addiction treatment. This keeps the therapists motivated and focused so that they can provide the best care possible to the client.
Because it tends to address multiple issues, dialectical behavioral therapy for substance use disorders has a hierarchy of priorities to work on throughout treatment.
The first priority is any life-threatening behaviors. If the person shows any suicidal or self-harm interests or tendencies, that is the primary focus.
The second focus is stopping behavior that is interfering with therapy. Therapy-interfering behaviors include canceling appointments, showing up late or not cooperating with any of the goals of the program.
Quality of life behaviors, the third priority, focus on everyday things in life that may be negatively affecting recovery – such as relationship problems, financial difficulties or mental disorders.
The fourth and final priority is skills acquisition. Skills acquisition focuses on replacing damaging or ineffective behaviors with skills that can help people reach their goals and improve their life.
Stages of DBT
There are four stages of treatment for DBT relapse prevention. There is no set time limit on any stage, allowing the therapist to adjust each one to best fit their client.
In the first stage, the person is usually miserable, unhappy and frequently out of control. The worst parts of their addiction and self-destructive behaviors are taking place. The priority for stage one is to help the client gain control of their behavior.
In stage two, the person is more under control, but is still undergoing immense suffering. Emotions could be limited in an effort to defend from past trauma or pain. The goal for the second stage is to help them feel comfortable with accepting and experiencing all of their emotions.
Stage three is focused on leveling out emotions so that they are more ordinary, helping the client move from extreme emotions to the more common, controlled emotions.
Stage four is not used for all people. It focuses on finding a deeper meaning in life through spiritual realization. Stage four is usually used for people who do not find true happiness in stage three and need more to feel fulfilled.
Cognitive Behavioral Therapy – CBT Drug Addiction Treatment
Cognitive behavioral therapy for relapse prevention focuses on shifting the way a client thinks away from dysfunction and negativity and to more positive and productive thoughts. The goal is to improve mood and overall functioning.
This therapy method is based on the idea that the way we perceive and think about situations directly affects how we feel emotionally. CBT and addiction recovery teaches people the skills to be able to identify and acknowledge when they are having bad, unproductive or unrealistic thoughts and then change them.
Some people who are having difficulties with addiction also struggle with mental health issues. These make for additional obstacles in overcoming addiction. CBT drug addiction treatment and CBT therapy for alcohol addiction use objective skills and strategies to change upsetting and negative interpretations into more calm and healthier responses. This addresses addiction and harmful mentalities simultaneously.
Unlike dialectical behavior therapy, CBT usually only lasts between 12 and 16 weeks. The goal is to teach the skills and principles in a short period of time so that addiction sufferers can use these techniques in daily life. Because it is such a vulnerable and emotional process, therapists focus on building trust and supporting the client so that he or she can feel comfortable being completely open during the process.
Cravings can threaten relapse for years after the therapy is complete. CBT helps people learn to mentally and emotionally detach from the experiences they had during addiction. Hence, they they will be able to focus on recovery and resist the urges to relapse.
Acceptance and Commitment Therapy (ACT)
Acceptance and commitment therapy (ACT) focuses on mindfulness and teaching people to recognize when they are creating emotional challenges for themselves so that they can incorporate more productive techniques.
The idea behind ACT is to help people be able to accept things as they come, instead of trying to change them. Unlike cognitive behavioral therapy, ACT does not work on changing negative thoughts and feelings. ACT works to help people appreciate them. Addressing negative things in this way teaches people to be open to all different kinds of situations and experiences.
Core Processes of ACT
Being able to address experiences this way happens through four core processes. The first process is reflecting upon times when efforts to ignore or escape negative experiences were ineffective. After reflecting on the failed strategies, the client is more open to new approaches.
The ability to accept emotional experiences is a foundational part of ACT. Embracing even the negative emotions gives the client the ability to be more free with their emotions and adopt a more accepting perspective on their experiences.
The third process of ACT is focused on identifying what you want. The client is encouraged to choose directions that they want to go in life and think about what their priorities are so that they can stay true to them.
The fourth core process is taking action. The client will begin taking steps to make changes and engage in behaviors that will make his or her desired life direction easier to follow.
Mindfulness
Developing mindfulness is central to ACT. Mindfulness in ACT is focused on being aware and engaged in life. It often helps people sharpen their five senses, along with their thoughts and emotions.
Mindfulness is meant to give people the ability to directly address their negative thoughts. This recognition helps them separate their perspective from the negativity.
Values Clarification
Part of identifying the direction you want to go, and what your priorities are, involves clarifying your values. ACT incorporates values clarification throughout the treatment. Overthinking problems can often get in the way of pursuing your values.
The combination of mindfulness and values clarification gives the client the ability to identify their values and pursue them unencumbered by self-destructive thoughts.
Motivational Enhancement Therapy (MET)
Motivational enhancement therapy entails helping someone develop the desire or motivation to change their behavior. People struggling with addiction often have a difficult time working up the motivation to change their self-destructive behavior; MET works to combat that. Therapists often use MET alongside other therapy strategies to help the person be more open and driven with the treatment plan.
Unlike other treatments, MET usually only happens in four sessions, with one assessment before so the therapist can have a clear understanding of where the person is – emotionally and mentally. The first session will focus around discussing the results of the assessment. The therapist will encourage the person to reflect on some of the issues that arose in the assessment and how those may affect short- and long-term goals.
MET accentuates being non-confrontational and nonjudgmental. Therapists enter the treatment with the belief that the person already has the tools to overcome their problems and to change. Therapists see their role as helping the person realize that they are capable, instead of needing to change them so that they are capable.
MET Goals and 5 Motivational Principles
The main goal of MET is to help people overcome any resistance to changing their behavior. The process works to raise awareness of the issue, adjust negative thinking and foster confidence in the person’s ability to change.
MET was created around five motivational principles: express empathy, develop discrepancy, avoid argumentation, roll with resistance, and support self-efficacy.
Express Empathy
MET therapists aim to create a comfortable, welcoming environment so that people can feel open and safe with being vulnerable. Instead of directly confronting the client, the therapist works to listen.
Along with listening intently, the therapist will reflect the person’s sentiments back to them. This lets the client know that someone is listening to and understanding them. The reflection will include some modifications that are meant to encourage the person to elaborate or dive deeper.
Develop Discrepancy
Throughout the therapy, MET therapists work to create a clear separation between how the person wants to be and how they actually are. By blatantly separating goals and reality, the therapist makes it easier for the person to recognize unproductive behavior and develop a stronger desire to change so they can become who they want to be.
Avoid Argumentation
Some therapists believe that aggressive confrontation is a productive way to help someone. MET therapists use more gentle techniques and avoid attacking or arguing over a person’s behavior.
The goal is for the person to identify their need for change, not for the therapist to do so. Less confrontational methods give the person the opportunity to realize things themselves.
Roll with Resistance
Resistance to therapy is not uncommon. If an MET therapist sees this in a patient, they will not directly address it. In MET, therapists focus on defusing resistance by being supportive and especially attentive listeners. They try to make the person feel more open and comfortable without accusing or confronting them.
If the person can reduce their resistance himself or herself, it is less likely that he or she will close off again later in therapy.
Support Self-Efficacy
Encouraging someone’s motivation to change is much more than showing the person how much they want to change. It’s also about showing the person that they are able to change.
Many people struggling with addiction may have a desire to change but do not believe that they are capable. In MET, therapists focus on helping the person realize that they have the ability to make the change on their own.
Preventing Relapse
The effectiveness of each of these therapy methods is dependent on the person. They address different skills and difficulties. For many people, the best way is to utilize multiple types of therapy along with processes like detox, rehabilitation, ongoing treatment, transitional living and aftercare.
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