A specialty of mine is working with people who have drinking and drug problems. This involves working to end or to moderate the substance use, and helping people repair their lives once the substance use itself is under control.
Dealing with an alcohol or drug problem can be complicated and quite challenging. Therapy can play an important role, but addiction often requires getting help from other places in addition to therapy. Since this website is designed to tell you about my therapy practice, I will begin with the role therapy can play, and then will offer some information about some of the other forms of help that might be needed.
In addition, I often work with people in therapy who are already in recovery from their addictions, but are trying to repair their lives, or deal with some of the emotions that they had previously numbed somewhat by using. If you fall into that category, you may want to look at Part 3 below.
Part 1: Assessment of the Problem and Preparation for Change
Since psychologists are extensively trained in assessment, there is an important role at the beginning that involves assessing the problem, and making a game plan about what might be needed to deal with it. There are several important questions to be answered at this stage.
- How serious is the drinking or drug use? What are the patterns of use, the family history, and the history of any past attempts to cut down?
- Is it possible to cut down to a healthy level, or is abstinence the most appropriate goal? (This is a question that we may not be able to answer until we have tried some experiments. Sometimes the evidence is clear, but often it isn't. You may find it helpful to look at my article on Signs and Symptoms of Alcoholism. ) Reducing drinking or drug use to a more moderate level is a very appropriate focus for individual therapy. Sometimes this works quite well. Other times the attempt to cut down is part of what makes it clear that there is a more powerful addiction process at work.
- If abstinence is indicated, is the person ready to quit? Most people are torn between wanting to quit because of the problems it is causing, and not wanting to give up their recreation, their way of socializing with friends, or their way of numbing some of their painful emotions. Individual therapy can play an important role as a person struggles with ambivalence, and works to make a decision about what to do next.
- If the person is ready to quit, what will it take to accomplish that? For a serious addiction, it may take some combination of therapy, inpatient or outpatient treatment, 12 step groups, group therapy, or other settings that provide strong social support for sobriety. Often times therapy is one piece among several as a person works to stop drinking and stay sober. Therapy can play a role in arranging and coordinating all of these so that a person stays on track in his or her efforts.
Part 2: Therapy for Continuity, Ongoing Treatment Planning, and for Relapse Prevention
- If a person is going to inpatient treatment, and /or using AA or other resources, therapy can provide continuity and encouragement, and assess how things are going and whether anything else is needed. The goal at this stage is to stay on track, to deal with anything that comes up along the way, and to interrupt anything that might derail the recovery process.
- If a person has successfully stopped drinking, relapse prevention becomes the goal. Unfortunately there is a fairly high rate of relapse in the first year of sobriety, even after going through inpatient treatment. Relapse prevention involves understanding yourself, your areas of strength and weakness, and preparing ahead of time for the situations and emotional states that might lead to using again.
Part 3: Therapy to Deal With the Psychological Side of Things
Addiction is typically tied to family issues and emotional issues in a variety of ways. Here are several ways that therapy can be used to address these things.
- Exploring and resolving the underlying emotional and psychological issues that fueled the addiction. This is the process that allows the recovery to be solid and enduring. Often when people have been using substances as an escape, or as "self-medication" for emotional pain, getting sober means feeling more of the depression or the anxiety. The danger is that unless these things are dealt with, they will make it all the more tempting to go back to using, especially during difficult emotional times.
- Repairing the damage done to your life and your relationships while the addiction was going on. This may involve individual therapy to rebuild parts of your life, or possibly couples therapy to repair the damage to a current relationship.
- Dealing with the after effects of growing up with an addiction in the family. There are a number of tragic experiences that are often part of growing up in an alcoholic family. Inconsistency and neglect can be very hard on the child's self esteem, and can make it very hard for a person to feel secure and trusting, even toward loved ones. Often children never learn the skills of talking through family problems, talking about painful emotions, or handling conflicts in appropriate ways. For a longer discussion of some aspects of this, see my article on Codependency.
- Therapy can help spouse or family member figure out how to deal with addiction in a loved one.
The Role of Inpatient Treatment, Alcoholics Anonymous, and Other Resources
Addiction can be incredibly powerful. Many people have tried to get addictions under control and failed, even with the help of therapy, inpatient or outpatient treatment, and 12 step groups like AA. But many other people have tried to get clean and sober and succeeded, using some combination of these strategies. If it becomes clear to you that you are alcoholic, or have an another addiction, my best advice is to get all the help you can. Here are some things to consider:
- Inpatient Treatment: Often to break the cycle of addiction, it is necessary for a person to get out of their environment entirely, go somewhere that alcohol or drug use isn't possible, and do a large dose of therapy and recovery work. Inpatient treatment involves going into an addiction treatment facility and staying there for several weeks, doing intensive group therapy, usually along with Alcoholics Anonymous (AA) meetings, individual therapy, and various forms of education about addiction and recovery. There is very good research that longer inpatient treatment is far more effective than shorter inpatient treatment. Some places have people stay for 21 or 28 days, but it is more effective to have inpatient treatment last for 60 days or sometimes more. If someone goes through a shorter program, it is extremely important to have good long-term follow-up care. I will often work with people who have recently come out of inpatient treatment.
- Outpatient Treatment: Outpatient treatment typically involves living at home, going to group therapy and other therapies several nights per week. The relapse rate for outpatient treatment is quite high. There are several reasons for this. One is that the craving for alcohol or drugs is quite strong just after getting clean. Because outpatient treatment doesn't keep you away from them, many people use during treatment and keep it a secret. Also, if you are considering an outpatient treatment program, ask what proportion of their patients are court-referred. Avoid a program that has a significant portion of the patients there involuntarily. You will be in therapy groups with them, and if they are resistant or half-hearted, it will affect the quality of your treatment.
- Intensive AA Participation: AA (Alcoholics Anonymous) isn't the only way to get sober, but it is one that has worked for many people; it is available almost everywhere, and it is free. If you want to get clean or sober by using AA, especially if you are trying to do it without going to treatment, you will probably need to use AA intensively rather than half-heartedly. Think of it this way: There may be more than one way up a mountain, but if you want to climb a mountain (Mt. Rainier comes to mind), you have to pick a route, commit yourself to it, and put out a full effort. With AA that means using most or all of their recommended strategies, like getting a "sponsor," finding a "home group," working the "12 steps," and going to frequent meetings, such as the recommended "90 meetings in 90 days" for someone just getting sober. As a therapist, I often work with people who are also using AA to work on their addictions. By the way, there are also 12 step meetings for particular drugs, such as Narcotics Anonymous (NA), although people with addictions to other drugs often attend AA meetings as well. In the Seattle area, you can find them at www.seattleaa.org.
- Non-AA Support Groups: There is a lot of evidence that it is quite hard to overcome a serious addiction by working on it alone. To overwork my mountain climbing metaphor, it helps to have other people on your rope for support, and it helps to have a guide who knows how to get to where you are going. For those who have trouble with AA, or with their emphasis on the spiritual, there are other support groups available. If you would prefer to avoid group meetings completely, you may want to look at the Rational Recovery website listed below. But I would also suggest that you ask yourself why you are so determined to tackle this alone. Having others involved for encouragement and accountability seems to help a great deal. Several non-AA addiction groups in the Seattle area can be found at www.scn.org/crisis/dependency .
- Rational Recovery: Rational recovery provides a web site at www.rational.org, which has a structured program that a person can work through individually to get sober and stay sober. They do not have meetings. They are ferociously anti-AA, to such a degree that I think it detracts from the rest of their message. As with any other method, if you decide to try RR, you should try it fully, doing everything recommended, and going back to try again if you slip up.