The most common form of counseling for alcohol addiction is individual counseling, in which a client has one-on-one sessions with a trained therapist. Goals of individual counseling can include identifying ‘triggers’ that set off strong cravings for alcohol, and exploring family history or trauma that may have contributed to the addictive behavior. The identification of contributing factors and triggers is followed by the development of new, healthier coping strategies, improvement in decision-making skills, and creation of strategies for remaining abstinent or moderating consumption, depending on one’s individual goals. Individual counseling can also be useful for people who have other behavioral health issues occurring alongside their addiction, such as depression, anxiety, or other co-occurring disorders.
Group counseling meetings are held with other people who are in or seeking recovery and are moderated by a trained professional (as opposed to a peer leader as in most mutual help group meetings). Group therapy sessions offer the chance to share feelings, experiences, and goals with other people in recovery who are undergoing similar struggles and issues, and, as with individual counseling, to increase coping skills, decision-making skills, and create strategies for staying sober.
Alcohol use disorder has an effect on all family members. Even after drinking stops, its effects can still be felt. Anger, guilt, loss of trust, and other emotions may cause rifts within the family structure. Family counseling treats the family as an organism in which each individual plays an important part. Instead of focusing on any one person, it helps each person to identify the role they play within the family.
Family therapy works to rebuild trust and positive feelings that have been lost or damaged over the course of the addiction. Its goal is to help all family members understand alcohol addiction in general, so that they can understand how the addicted person’s disease has affected their relationship. In family counseling, each family member develops tools for healing and moving forward.
When a person has both a behavioral health condition, such as anxiety, depression, or a personality disorder, and a problem with drugs and/or alcohol it is called a co-occurring condition (formerly “dual diagnosis”). It is not uncommon for behavioral health issues and addiction to coexist. According to The National Alliance on Mental Illness (NAMI), more than one-third of people who struggle with alcohol use are also coping with a behavioral health condition. Almost one-third of people with all behavioral illnesses and about half of people with severe behavioral disorders (like bipolar disorder and schizophrenia) have issues with substance abuse.
Most addiction specialists and many counselors have training in co-occurring disorders, and some mutual help groups are specifically for people with co-occurring issues.
SAMHSA Integrated Treatment for Co-Occurring Disorders>
Motivational Interviewing (MI) is a clinical counseling style used to help people explore and resolve ambivalence in order to make changes for a better life. People with substance use disorders are usually aware of the negative effects of substance use. They may be conflicted about wanting to stop or wanting to continue. This ambivalence often leads to a lack of motivation.
When therapists view ambivalence as resistance or denial, clients can become defensive. Approaching a client from a place of understanding and collaboration and without judgement decreases defensiveness, allowing the client to explore their feelings and arrive at reasons for change on their own.
The communication techniques used by a therapist using MI are, by design, empathetic, non-judgmental, and supportive. Empathy in MI means respecting and accepting the client and their feelings, and not pushing an agenda. It is about eliciting a desire for change from within the client.
A main ideological pillar of MI is the concept of developing discrepancy. Helping a client see how their behavior conflicts with their desired goals can help motivate them to want to change. MI aims to help clients think differently about their behavior and see the benefits of making change, such as improved health, relationships or financial situation. Focusing on discrepancy can lead the client to presenting their own arguments for change.
Motivational Interviewing Resources (via SAMHSA)>
Cognitive behavioral therapy (CBT) is an evidence-based form of therapy that teaches people skills and strategies to help them change their behavior. CBT focuses on solutions, rather than trying to unearth underlying causes of conflict. It is usually more focused on the present and shorter in duration than other forms of psychotherapy. CBT helps patients understand how their thoughts and perceptions influence their feelings and behavior.
CBT helps people to identify distressing thoughts and evaluate how realistic they are. Challenging distorted thoughts and beliefs allows people to think more realistically, which can lead to modifying maladaptive behavior patterns and feeling better.
CBT is commonly used to treat a range of disorders including addictions, depression, anxiety and phobias. Therapists help clients examine unhelpful thinking patterns (such as overgeneralizing, catastrophizing, magnifying negatives, and minimizing positives) in order to replace them with more adaptive and realistic thoughts. Successful treatment with CBT leads to decreased distress and improved mood and functioning. CBT may be done one-on-one or in groups. There are also computer-based CBT programs, including one specifically designed for substance use disorder.
Meta-Analyses survey of CBT studies (2012)>
Related: Web-based CBT program shows promise for treating AUD>
While not stand-alone treatments for addiction, art and music therapy can be helpful in supporting the recovery process. Both serve to reduce stress, increase relaxation, and create outlets for thoughts and feelings that cannot be verbally expressed.
Music therapy is defined by the American Music Therapy Association as: “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship, by a credentialed professional who has completed an approved music therapy program.” No musical talent is needed in order to participate in music therapy. It can be done individually or in groups and can be used in a variety of ways, including:
Art therapy is similar to music therapy in that it can be useful for people who are new to the arts as well as those who are more accomplished artists and musicians. The participant’s experience or skill level and the finished outcomes are unimportant; it is the ability to explore and express oneself within a new medium that is beneficial. Both art and music therapy aim to ensure that the client is comfortable with the techniques that are used. Art therapy, as defined by the American Art Therapy Association, is “a mental health profession in which clients, facilitated by the art therapist, use art media, the creative process, and the resulting artwork to explore their feelings, reconcile emotional conflicts, foster self-awareness, manage behavior and addictions, develop social skills, improve reality orientation, reduce anxiety, and increase self-esteem.” Art therapy is facilitated by a trained therapist with a master’s degree in the field.
The American Music Therapy Association
The American Art Therapy Association
If you have health insurance, be sure to check what mental health services are covered under your plan. You may need to contact your primary care physician or insurance provider for a recommendation or referral for a therapist in your network.
Many addiction psychiatrists will work with you to create a treatment plan and prescribe medication when appropriate, then refer you to a psychologist in their practice who will manage your ongoing counseling. A psychiatrist is a medical doctor who has completed medical school and a one-year internship plus three years of residency in treating mental health disorders. They are able to prescribe medications and spend much of their time on medication management. A psychologist has a doctoral degree in psychology and 1-2 years of internship training. They spend much of their time engaged in therapy with the client.
Mayo Clinic advice to prepare for your first appointment:
Background and education. Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a master’s or doctoral degree with specific training in psychological counseling. Medical doctors who specialize in mental health (psychiatrists) can prescribe medications as well as provide psychotherapy.
Certification and licensing. Make sure that the therapist you choose meets state certification and licensing requirements for his or her particular discipline.
Area of expertise. Ask whether the therapist has expertise and experience treating your symptoms or your area of concern, such as eating disorders or PTSD.
The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.
SAMHSA’s Behavioral Health Treatment Services Locator
Psychology Today therapist database
National Association of Alcoholism and Drug Abuse Counselors (NAADAC)
American Psychological Association (APA)
American Counseling Association (ACA)
National Association of Social Workers (NASW)
National Council on Alcoholism and Drug Dependence (NCADD)
National Alliance on Mental Illness (NAMI)