woman talking to girlThere’s far more to an alcohol addiction that simply picking up a bottle. An addiction is a confluence of a number of factors, covering a wide variety of bases.

One of the biggest determinants of whether a person will abuse drugs or alcohol is their mental health, which is why any program to treat an addiction must include therapy. But what does psychotherapy in alcohol addiction recovery actually do? How does it work? And why is it so necessary for someone who wants to get clean?

Answering these questions involves understanding how an alcohol addiction develops.

What’s behind an alcohol addiction?

The New York Times explains that there are any number of reasons behind why a person may become an alcoholic. Some are beyond any degree of control, like genetics and family history. Others, such as environment, lifestyle, and mental health, can account for a significant proportion of what tips the scales towards an addiction; however, these factors are what can be identified and worked on in a treatment program.

Alcohol is a progressive disease. People whose risk factors line up in just the right combinations find themselves on the proverbial slippery slope. The social drink gives way to mild to moderate problems surrounding drinking (constantly thinking about drinking, sneaking drinks, and feeling guilty about drinking), which eventually becomes an outright drinking problem. Despite denials of alcoholism, the addict constantly swings between periods of depression and anger, with alcohol at the heart of all their problems. They withdraw from family and social networks, and their job or academic performance suffers. Attempts to quit drinking are often short-lived, either because the lure of the alcohol is too strong, or the withdrawal symptoms prove too difficult to endure.

Such a broad scope makes alcoholism a tragically common condition; Medical News Today reports that 15 percent of the American population meet enough of the criteria to be diagnosed as problem drinkers.

Eventually, the situation becomes untenable, and the patient seeks treatment for alcoholism. The first stage of treatment works on removing the physical dependence they have developed 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, and often given anti-anxiety medications to help ease them through the process of their body withdrawing from the alcohol craving. Detoxification usually lasts a few days, following which (and pending observation by treatment doctors), the patient is ready to begin psychotherapy. If you are considering starting a detox, you should first research what helps with alcohol withdrawal.

Psychotherapy in alcohol addiction recovery

Psychotherapy does for the mind what detox does for the body. In the same way that detox provides a safe space for the patient to break free from the physical craving of alcohol, psychotherapy offers a controlled, nonjudgmental environment where the patient can talk about the issues and problems they have. Talking through these problems is the heart of psychotherapy; even if a patient is able to overcome their physical need for alcohol, they still have a deep void in their psyche that they attempted to fill by drinking.

  • This is where psychotherapy comes in. Detoxification is a necessary part of the treatment paradigm, but it does not get to the root of why the patient started their problematic drinking in the first place.

    Peel back the physical signs of alcoholism, and you find deeper issues that need to be addressed before the patient is ready to re-engage with the world again. This is done in the form of private, one-on-one sessions between a therapist and a patient. The goal is the therapist is to help the addict understand themselves better, to help themselves understand how and why the convergence of a number of factors brought them to the point where they were abusing alcohol to the detriment of everything else in their life.

  • While this will likely not be a pleasant experience for the patient, Mayo Clinic explains that the point of psychotherapy (which is, itself, a broad spectrum of treatment that can cover many different approaches) is to show the patient how they can confront their moods, feelings, and thoughts in healthier and more constructive ways than by turning to alcohol. They can do this by developing coping skills and techniques to learn how to positively respond to challenges and temptations, and how to hold fast against the ever-present threat of relapse. How exactly this is done depends on the patient, the extent and nature of their alcohol abuse, and their therapist’s professional opinion.

The end goal is to make patients more aware of themselves, their boundaries and limitations, and how they can use their strengths to compensate for their weaknesses.

There are many forms of psychotherapy that a therapist might use to treat a patient recovering from an alcohol addiction, but two of the most common methods are called cognitive behavioral therapy and dialectical behavior therapy.

Cognitive behavioral therapy (or CBT) is based on the idea that harmful patterns of thought that lead to self-destructive behavior (like drinking to the point of addiction) can be unlearned. In their place, a therapist can help the patient make permanent changes to how they think about situations that will affect their responses.

  • The Royal College of Psychiatrists shows how a therapist who decides to employ cognitive behavioral therapy to treat their patient will look at five different dynamics to shape the course of treatment:

    • The situation (the specific triggers that precipitate problematic drinking)
    • Thoughts (what specifically the patient thinks about that leads them to engage in drinking)
    • Emotions (what the patient specifically feels, what their mood is)
    • Physical feelings (rising temperature? clenched fists? sexual arousal?)
    • Behavior (the drinking)
  • In cognitive behavioral therapy, every detail about what leads the patient to drinking creates a picture that the therapist can then navigate through, to find the psychological reasons behind the alcohol abuse. The New York Times explains how this form of therapy doesn’t merely show alcoholics what leads them to drinking abusively; it helps them see it with their own eyes. Once this realization dawns, therapists then show them how they can channel their thoughts and feelings away from the need to consume alcohol when their situational triggers inevitably arise.
Cognitive behavioral therapy’s treatment counterpart is a form of psychotherapy known as dialectical behavior therapy (or DBT). DBT “treats a lapse into substance abuse as a problem” and looks at the problem of addiction and its solutions, by considering the patient’s environmental and social interactions and experiences.

The combination of risk factors mentioned above makes some people inclined to respond to emotional and stressful situations in injurious ways, such as drinking heavily. In the world of DBT, such people have higher levels of arousal, which makes them “primed” to drink, do drugs, or act impulsively as a way of coping with emotional and stressful situations.

Dialectical behavior therapy may also be the therapeutic method of choice for patients who present with co-occurring substance abuse and mental health disorders. The National Institute on Alcohol Abuse and Alcoholism points out that patients who have alcohol abuse disorders are more likely to have psychiatric disorders, such as behavioral problems. Showing the patient how they can untangle the connections between a stressful situation and their behavior is how dialectical behavior therapy (like cognitive behavioral therapy) paves the way for clarity in thinking and action.

Psychotherapy and relapse prevention

Circle of trust. Group of people are sitting in circle and supporting each other.Both dialectical behavior therapy and cognitive behavioral therapy recognize the importance of relapse prevention. There can be a number of things, says AddictScience.com, that contribute to a relapse. Even “normal” emotions and situations might be enough to push a patient from having a bad day, to hitting the bottle again.

With this in mind, both CBT and DBT look at different elements of an addiction (thought patterns and psychosocial dynamics, respectively) on how a newly clean patient can handle themself when life gets tough and the thought of having a drink becomes more and more alluring. One of the biggest goals of psychotherapy in alcohol addiction recovery is helping the patient anticipate the challenges to sobriety and then respond in empowering ways.

Of course, this is much easier said than done, which is why aftercare support groups (like 12-step programs) make it a point to keep addicts connected with the principles that they learned in therapy. A common exhortation in support groups is for members to “work the program” – that is, to always think of the tools and skills they learned as active and daily routines. The worst-case scenario for an addict is when the principles learned in therapy appear distant, irrelevant, or unnecessary. This can, ironically, be borne from overconfidence: a patient feels so empowered by therapy that they feel they don’t need it anymore and can afford to drink because they know themselves and they know their boundaries.

Such a reality says less about the patient and more about the insidiousness of relapse. But it also speaks to the importance of continuing treatment protocols long after the last therapy session, and this is where aftercare support plays an invaluable role.

WebMD mentions other forms of psychotherapy that can be used in a treatment setting, such as contingency management therapy, motivational interviewing, family therapy, and CRAFT, among many others. Whatever the exact form of therapy, there is always something that can be done to help you or a loved one with an alcohol addiction problem.

That’s why The Recovery Village is here: to answer your questions about getting clean and to help you make the first step towards changing your life. All you have to do is call, and that first step can be taken together.

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.

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