Behavioral therapy has long been an important component of any addiction treatment, and involves identifying unwanted behaviors, self-monitoring for triggers and precursors, and eventually changing the negative behavior to a positive one. Modern practices have evolved from negative reinforcement approaches (such as aversion therapy) to be less confrontational and more person-centered, integrative, and cognitive-based.
Relapse Prevention Therapy (RPT)
Negative emotional states, interpersonal conflict, and social pressure are responsible for 75% of patient relapses, regardless of the type of addiction or the time elapsed since quitting. RPT was developed to help recovering addicts anticipate high-stress situations which may trigger relapse and learn effective coping responses as well as lifestyle changes like meditation and exercise.
Relapse prevention also teaches coping strategies for cravings and urges, as well as how to minimize the fallout if a relapse does occur. Patients are encouraged to see their recovery from addiction as a learning process, and to continue treatment even if there are setbacks.
Cognitive-Behavioral Therapy (CBT)
CBT was originally developed to treat alcoholism, but was soon adapted to treat cocaine addiction and is now considered an effective treatment for a range of issues, including smoking and methamphetamine abuse. The goals are similar to that of relapse prevention, but focuses on negative thinking patterns as the source of unwanted feelings and behaviors.
Therapists coach patients through dismantling their dysfunctional thinking, or cognitive distortions, and teach them to self-monitor for the thoughts and feelings that lead to drug use or other destructive behavior. Finally, affirmations and mindfulness exercises are used to rewire the brain, thereby altering the unwanted behavior.
Motivational Enhancement Therapy (MET)
MET, sometimes called motivational interviewing, is often used at the beginning of treatment to help resolve patients’ uncertainty, and identify ways to self-motivate and stay committed to the treatment process. MET begins with a patient assessment. In the following session, therapists provide feedback and stimulate conversation about the patient’s drug abuse and their personal reasons for quitting, as well as any positive results for which they can aim.
MET may be used throughout treatment to monitor the strategies being used and any high-risk situations that may occur to encourage patients to stick with their treatment goals.
Community and Family-Based Treatments
Family or community-based treatments take a range of influential factors into account, including family history, home environment, school or work, peer groups, and societal influences. Patients learn how negative relationships with these influences can lead to or reinforce drug use, and positive ways to interact with them.
For example, the community reinforcement approach seeks to replace the time patients would previously have spent pursuing or using the addictive substance with appropriate and fulfilling social and recreational activities. The goal is not just to fill time, however, but to positively reinforce drug abstinence with naturally-satisfying activities and experiences.
Contingency-Management (CM) Interventions
Contingency-Management recognize that individuals in recovery often struggle with poor health, interpersonal strife, and financial stresses. Without the reward or escape offered by the addictive substance, patients may feel overwhelmed or penalized for staying sober. CM programs offer cash prizes, vouchers, or other incentive contingent upon proven abstinence (such as through urine tests).
The governing principle behind CM therapy is that of conditioned behavior. Stimulants, opioids and other drugs saturate the pleasure centers of the brain with dopamine, creating a ‘reward’ that encourages drug use. Therapists work with each patient to find an equally desirable incentive for drug abstinence, rewiring the brain to reward healthy behaviors.
Depending on a patient’s particular needs, treatment program, or facility type, providers may recommend a single approach or a combination of therapies to better target and eliminate the underlying causes of addiction.