Psychotherapy for Addiction

Addiction is a chronic and reoccurring brain disease that causes individuals to abuse psychoactive substances (substances that directly affect the brain). Addiction is classified as a brain disease because chronic drug use physically alters the brain and impacts how it functions. Sometimes the damage that drugs cause can be reversed, and in some cases, permanent damage results. The treatment of addiction is complex, often involving several activities, including social support, lifestyle changes, and psychotherapy.

What is Addiction?

Individuals who start using drugs don’t usually plan on becoming addicts, and once they become addicted, their drug use behaviors become involuntary – that is, initial drug use is voluntary, but as drugs alter important brain chemicals and processes, continued drug seeking is no longer voluntary. Addiction is that point in the drug user’s history when he or she could no longer choose to use or not use the drug.

How does this happen? Drugs stimulate the release of certain important brain chemicals (called neurotransmitters), mostly targeting those neurotransmitters associated with pleasurable sensations. Because the drug user’s brain is being exposed to more of the drug on a more continual basis, the brain starts to produce new receptor cells to “receive” these drugs. Certain areas of the brain are particularly affected. At the same time that new cells are being created, cells in certain areas – especially areas that are responsible for self-control and decision making – become under-stimulated, less active, or damaged.

Once an individual becomes chemically-dependent – meaning they cannot function without the drug, then they are likely to experience cravings at an increasing frequency, but will find that using the same amount of the drug they have previously used, is no longer effective. In response, they increase the amount of drug or alcohol. This cycle of increased cravings and increased use continues to escalate. Cravings are one of the main reasons that addicts tend to relapse, and research has demonstrated that at least one third of drug users who have stopped their drug use, will relapse within one year. Withdrawal from a drug is at minimum, extremely unpleasant, and in some cases, must be medically-monitored. Part of what makes withdrawal so unpleasant is that it involves cell death in the brain. Because the brain overproduced certain receptors to accommodate the drug, when that drug is withdrawn, these cells begin to die off.

Research has established some key risk factors for addiction. Poverty is an important environmental risk. Drugs are more likely to be available in poor neighborhoods. Young people who demonstrate early aggressive behavior patterns and poor social skills are at higher risk for addiction. Parenting also plays a role. Children who are not closely monitored and supervised by their parents are also more at risk. Scientists also believe that the predisposition for addiction is hereditary – potentially 40% to 60% of vulnerability to addiction may be due to genetic factors.

What is Psychotherapy?

In modern times, most people would credit Sigmund Freud for initiating our contemporary research and understanding of “talk therapies.” Freud developed a type of talk therapy called psychoanalysis, which emphasized the patient’s “free associations.” It was not the role of the analyst to guide the discussion. Freud simply encouraged his patients to talk about whatever was on their minds. As people became more used to discussing their lives with him, surprising and troubling issues would emerge, which Freud would then interpret for the patient. Freud also encountered what he called catharsis occurring during psychoanalysis. During the re-telling of painful memories, individuals would re-experience the emotions associated with the memory they were discussing, and this would result in a catharsis, or release of previously held negative emotion.

Using Psychotherapy for Addiction

All forms of psychotherapy have the overall goal of increasing or restoring individuals to healthy functioning. Examining and overcoming the psychological causes of addiction can help you on the road to recovery. This generally involves several interrelated areas of exploration.

Examination of life problems:
Individuals are encouraged to examine both past and current life problems, understand where these problems came from and what they are connected to, and generate potential solutions for solvable problems.

Examinations of Negative/Distorted patterns of thought:
Addicts tend to think negatively about themselves, their lives, and the world, and these distorted thoughts may be one reason why they initiated drug use in the first place. Challenging these negative thought patterns, and creating new, more realistic patterns is an important goal of therapy.

Examinations of maladaptive (counterproductive) behavior patterns:
Individuals are encouraged to explore the ways they cope with stressful situations – especially cravings. Some ways of coping may be helpful, some may just add to their problems. Understanding why certain behaviors aren’t helpful, and learning to behave in new ways can be an important goal.

Examinations of social relations:
In psychotherapy, the patient is forming an intimate relationship with the therapist. They are disclosing difficult feelings and are depending on the therapist to help them resolve complex issues. Often, the issues that patients present involve troubles in their major relationships, and in the general way they relate to others. Examining these issues in the context of a trusting and intimate relationship with a therapist helps in two ways: 1) patients begin to see their own unique relational problems, and 2) these problems are partially addressed by the reparative nature of the relationship they form with their therapist. This can be especially important with addiction, where research has established a lack of early social skills as a contributor.

There are many different types of psychotherapy (i.e., cognitive-behavioral therapy, interpersonal therapy, etc.) and contemporary research is helping us understand which types of therapy work best for which individuals. Most research on addictions advocates for the use of multiple approaches, like social support, drug testing, acupuncture, as well as psychotherapy to produce the best results.