Therapy for Alcohol & Drug Abuse and Dependence

I take an integrative approach to working with clients struggling with the abuse of

  • Alcohol
  • Opiates/Opioids (heroin, painkillers, etc)
  • Cocaine
  • Marijuana

One of the most common causes of failed treatment for addiction is that only some of the main contributors to the addiction are treated. Typically, addiction counselors focus on strategies for establishing and maintaining abstinence, but have little or no training in understanding and treating psychological issues, such as a history of problematic relationships, depression, attention-deficit disorder or trauma, that can make maintaining abstinence difficult. Traditionally, the mental health field focused on psychological conditions but failed to see the importance of the know-how of establishing and maintaining abstinence as well as the need for support through groups such as AA and NA.

Research has shown that treating psychological issues with psychotherapy in conjunction with addiction counseling and 12-step participation generally has the best results.

Why is it critical to treat psychological issues to maintain abstinence?

I will address four of the most common psychological issues presented by alcoholics and drug abusers:

Trauma: If alcohol or substance abuse is motivated to a large extent by the desire to avoid traumatic memories, working only on the strategies of establishing abstinence is much less likely to succeed because abstinence may increase awareness of painful feelings and memories of the trauma. Treatment for the trauma can provide support and help find ways of coping with and expressing thoughts and feelings related to past trauma. 

Attention-Deficit Disorder: The impulsivity associated with untreated attention-deficit disorder (ADD), a known risk-factor for addiction, can hinder the decision-making necessary to implement strategies for maintaining abstinece. Psychotherapy can facilitate learning the strategies necessary to manage ADD and develop better self-management and decision-making. For some, medication can also improve concentration.

Depression: Some people self-medicate depression or bipolar disorder with alcohol or drugs, inadvertently worsening the depression in the long-run. Psychotherapy and, in more serious cases, medication can help alleviate the depression and thus lessen the emotional triggers.

Problematic Relationships: Chronically disappointing and hurtful relationship patterns can destabilize abstinence and motivate addictive behavior. These often begin in childhood and continue through current relationships. Psychotherapy can help transform these relationship patterns into more fulfilling ones.

Should I start therapy before I am clean/sober?

Many people believe that therapy is only for those in stable recovery. While it may be important to be careful not to destabilize early recovery with an over-emphasis on deeper psychological issues, many people need to work on problematic relationships or develop a trusting therapeutic relationship that can help with the resurgence of traumatic memories, depression or anxiety in order to make long-term abstinence possible.

My Approach

My approach varies depending on the particular needs of the client. If there is deep ambivalence about abstinence, it may be counterproductive to take a goal-oriented approach, but rather explore feelings about drugs or alcohol and why these are attractive and the loss of hope and trust in people. It is often because there is a loss of hope in relationships that one turns to alcohol or drugs.

Across the course of treatment, needs change with the stages of recovery. At times, the focus of therapy may need to be more on strategies for maintaining abstinence for pragmatic reasons and because deeper psychological work can feel destabilizing in early recovery. I often find that there is an initial phase of exploring the psychological and addiction issues, followed by a greater focus on how to establish and maintain abstinence in early recovery and then a re-exploration of the deeper psychological issues is needed to maintain stable abstinence.

I am experienced at both addiction counseling and psychotherapy for addictions. I often integrate these approaches, but I can also coordinate care with a seperate addictions counselor while focusing on the psychological issues. I also have experience coordinating recovery with 12-step sponsors.