Alcohol addiction is a complicated disorder that’s caused by a wide variety of different factors. Nearly 5.1% of U.S. adults engage in heavy drinking, but recovering from an alcohol addiction often requires much more than simply putting down the bottle.
One of the biggest contributors to addiction is mental health, which is why an effective alcoholism treatment program must include therapy. But many wonder what psychotherapy in alcohol addiction recovery actually does, how it works and why it’s so necessary for those who want to recover. Before answering these questions, it’s important to understand how an alcohol addiction develops in the first place.
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What’s Behind an Alcohol Addiction?
A number of factors influence a person’s risk for alcoholism. Gender, genetics, mental health, age and many others all play a part in the risk. Some are beyond any degree of control, like genetics and family history. Others, such as environment, lifestyle and mental health, can be identified and addressed in a treatment program.
Alcohol is a progressive disease, and people whose risk factors line up in certain ways can find themselves more prone to developing an alcohol addiction. Social drinking may progress to mild problems surrounding drinking. These then become moderate problems, which may include constantly thinking about alcohol, sneaking drinks and feeling guilty about drinking. Eventually, the person develops a severe addiction to alcohol.
Despite denials of alcoholism, the person constantly swings between periods of depression and anger due to alcohol. The substance makes them withdraw from family members and social networks; their job or academic performance suffers. Attempts to quit drinking are often short-lived because the cravings are too strong or the withdrawal symptoms are too difficult to endure.
Eventually, the situation reaches a breaking point, and the person seeks treatment for alcohol addiction. The first stage of treatment works on removing the physical dependence on alcohol — a process known as detoxification. In this stage, the patient is admitted to a safe, controlled facility where they are weaned off alcohol. They may be given anti-anxiety medications to help ease them through the process of alcohol withdrawal.
It is important to have medical supervision during the withdrawal process, as tachycardia, tremors, sweating, delirium and seizures can occur. Detoxification usually lasts a few days. Once doctors agree the patient is done detoxing, they’re ready to begin psychotherapy. If you are considering starting a detox, you should first research ways to cope with alcohol withdrawal.
Psychotherapy in Alcohol Addiction Recovery
Detoxification is a necessary part of the treatment process, but it does not get to the root of why the patient began abusing alcohol in the first place. It also does not give the client tools that can help them in their recovery. This is where psychotherapy comes in.
Psychotherapy offers a controlled, nonjudgmental environment where the patient can talk about their issues and problems. Talking through these problems is the heart of psychotherapy. Even if a patient is able to overcome their physical need for alcohol, they may have a deep void in their psyche that they were filling with alcohol.
These deeper issues need to be addressed before the patient is ready to re-engage with the world again. This may be done through private sessions between a therapist and a patient, through group therapy or both. The therapist’s goal is to help the addicted person understand how and why they reached the point where they continued abusing alcohol despite negative consequences.
Psychotherapy helps show clients how they can confront their moods, feelings and thoughts in healthier and more constructive ways than through alcohol. It teaches clients how to develop coping skills and techniques, respond positively to challenges and protect themselves from the ever-present threat of relapse. They can become more aware of themselves, understand their boundaries and limitations and learn how to use their strengths to compensate for their weaknesses.
The best form of psychotherapy depends on the patient’s situation, the extent and nature of their alcohol abuse and their therapist’s professional opinion. For a client to have a positive outcome in psychotherapy, it’s also important for them to have a good working alliance with their therapist.
Types of Psychotherapy
There are many forms of psychotherapy that a therapist might use to help clients in alcohol addiction recovery. Two of the most commonly used types include cognitive behavioral therapy and dialectical behavior therapy.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is based on the idea that harmful patterns of thought that lead to self-destructive behavior can be unlearned. In CBT, the therapist helps the patient make permanent changes to how they think about situations, which will affect their responses.
The Royal College of Psychiatrists shows how a therapist using CBT will treat their patient. In this instance, the therapist works to reframe the way a patient responds to five different areas:
- The situation (specific triggers that precipitate problematic drinking)
- Thoughts (thoughts that lead to drinking)
- Emotions (what the patient specifically feels, what their mood is)
- Physical feelings (rising temperature, clenched fists, sexual arousal)
- Behavior (alcohol use)
In CBT, every detail about what leads the patient to drinking creates a picture for the therapist. They can then navigate through it to find the psychological reasons behind the alcohol abuse.
CBT works well on its own or in combination with other therapies. The goal is to help people understand their disorder and find positive coping techniques they can use throughout recovery.
Dialectical Behavioral Therapy
Dialectical behavioral therapy (DBT) is a form of CBT. It focuses on helping clients build a life that is worth living through the use of two opposed tools: change and acceptance. This is consistent with the focus on change that many 12-step programs utilize. DBT looks at the problem of addiction and finds solutions, which it does by considering the patient’s social/environmental interactions and experiences.
DBT’s substance-related goals include:
- Decreasing substance abuse
- Reducing the physical discomfort of abstinence
- Reducing cravings and triggers for use
- Avoiding opportunities and triggers associated with use
- Reducing behaviors that lead to use
- Increasing reinforcement of healthy behaviors, friends and activities
This approach helps clients move away from harmful coping behaviors and begin using healthier patterns of coping when they encounter emotionally stressful situations.
People with alcohol use disorders are more likely to have mental health disorders, and DBT can be an especially effective therapy in these situations. It shows clients how they can untangle connections between a stressful situation and their behavior, which paves the way for clarity in thinking and action.
Psychotherapy and Relapse Prevention
Both CBT and DBT recognize the importance of relapse prevention. The goal of relapse prevention is to identify and address high-risk situations for the client and help them develop coping mechanisms to maintain sobriety.
One of the biggest goals of psychotherapy is helping clients anticipate challenges to sobriety and respond in empowering ways. CBT looks at the thought patterns behind addiction, while DBT looks at the psychosocial dynamics surrounding it. Both approaches help clients prepare for times when life gets tough and the temptation to drink grows.
Of course, staying sober can be much easier said than done. This is why aftercare support groups, such as 12-step programs, work to keep members connected with the principles they learned in therapy. The worst-case scenario for people in recovery is when the principles learned in therapy appear distant, irrelevant or unnecessary. In some cases, a person can feel so empowered by therapy that they think they don’t need it anymore. At this point, they may even believe they can drink again because they know themselves and they know their boundaries. Cases like these are why aftercare is such an important part of recovery and relapse prevention.
Finding the right type of treatment is important, and The Recovery Village is here to help. We offer a full continuum of care that addresses drug and alcohol addiction as well as any co-occurring mental health disorders. If you or someone you love is struggling with alcohol or other substances, contact us today to learn about treatment programs that can work well for your needs.
Gilbertson, R., Prather, R., Nixon, S.J. “The role of selected factors in the development and consequences of alcohol dependence.” Alcohol Research & Health, 2008. Accessed September 4, 2021.
Boersma, P., Villarroel, M.A., Vahratian, A. “Heavy Drinking Among U.S. Adults, 2018.” Centers for Disease Control and Prevention, August 2020. Accessed September 4, 2021.
Kattimani, S., Bharadwaj, B. “Clinical management of alcohol withdrawal: A systematic review.” Industrial Psychiatry Journal, 2013. Accessed September 4, 2021.
Cook, S., Heather, N., McCambridge, J., et al. “The role of the working alliance in treatment for alcohol problems.” Psychology of Addictive Behaviors, 2015. Accessed September 4, 2021.
McHugh, R.K., Hearon, B.A., Otto, M.W. “Cognitive behavioral therapy for substance use disorders.” The Psychiatric Clinics of North America, 2010. Accessed September 4, 2021.
Royal College of Psychiatrists “Cognitive Behavioural Therapy (CBT).” Accessed September 5, 2021.
Dimeff, L.A., Linehan, M.M. “Dialectical behavior therapy for substance abusers.” Addiction Science & Clinical Practice, 2008. Accessed September 5, 2021.
National Institute on Alcohol Abuse and Alcoholism. “Alcohol and Other Drugs.” 2008. Accessed September 5, 2021.
Menon, J., Kandasamy, A. “Relapse prevention.” Indian Journal of Psychiatry, 2018. Accessed September 5, 2021.
Carroll, K. M., Onken, L.S. “Behavioral therapies for drug abuse.” The American Journal of Psychiatry, 2005. Accessed September 5, 2021. Vaillant, G.E., Hiller-Sturmhöfel, S. “The Natural History of Alcoholism.” Alcohol Health and Research World, 1996. Accessed September 5, 2021.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.