Behavioral Therapy Takes Many Different Shapes

Behavioral Therapy comes in many forms but the goal is always to affect change in someone’s behavioral habits. Some kinds of behavioral therapies are more well known than others. As a whole behavioral therapies of late have garnered much attention as being a sort of bedrock for substance abuse therapy treatment. In fact there has been a significant increase in focus on all kinds of behavioral therapies throughout treatment facilities in Florida. Drug detox and rehab that can be paired with some in depth behavioral therapy is more likely to result in a successful life lived in sobriety for the recovering user.

Behavioral therapy is a kind of treatment that includes teaching those who are  suffering from drug and alcohol dependence the life skills they need to be able to recognize their triggered responses to situations, be aware of the way their behavioral and emotional responses form all in an effort to effect change in behavioral habits, the very same habits that likely led them to this place in time. This kind of therapy affords the patient an opportunity to put away the kinds of coping mechanisms that were maybe even survival coping skills to begin with, but that are no longer functional for them, and indeed may be leading them down a path of self destruction.

Some of the more common behavioral therapies used for substance abuse and addiction recovery therapy are:

  • Cognitive Behavioral Therapy
  • Dialectical Behavior Therapy
  • Motivational Interviewing Therapy
  • Contingency Management Therapy


Cognitive Behavioral Therapy

Cognitive behavioral therapy is a therapy centered around teaching patients the kinds of skills they need to face challenging moments and behave in the way they want to. This takes underlying skills like being able to recognize shifts in mood and emotional response. It takes a profound and fundamental understanding of self for the person struggling with the chemical dependency, and an understanding of addiction and the substance used itself. This kind of deep dive teaches someone struggling with addiction how that person came to their addiction, what addiction itself is at its core, the way the patient’s prefered substance changes or shapes what that all means, how the patients individual addiction functions and how it feeds off of other elements in a person’s life. Learning all of this can be overwhelming. It can be intense to come to fuller understanding about what a drug has been doing to one’s body. It can be terrifying to confront our own shame and un dealt with trauma, but all of this allows the recovering user to learn the tools they need to alter the way they allow triggers to affect them, it helps them shift their reactions to cravings no matter how strong. One of the most important aspects of cognitive behavioral therapy is that it can help recovering addicts to be able to find compassion for themselves, resist the shame spiral this adds to not only higher quality of life, but generally increases the chances of success in the recovery of any person struggling with substance abuse and chemical dependency. This is especially valuable to the person who has a dual diagnosis, or co-occurring disorder. A dual diagnosis occurs when a person struggling with an addiction to a drug or to alcohol also suffers from some form of mental illness such as schizophrenia, personality disorder, generalized anxiety disorder or depression. Someone with a co-occurring disorder such as these will have a more complicated recovery ahead of them because in order to successfully recover and heal from either disorder, a person must treat both the mental health disorder as well as the chemical dependency and emotional addiction to the drug simultaneously. Cognitive behavioral therapy are some of the few treatments that attack both issues at their core and do so at the very same time.


CBT is created based on a few foundational principles. Those include:

  • Behavioral problems are often based on improper learning, incorrect or inappropriate understandings of one’s self and the world around.
  • Practice makes perfect but practice also makes a bad and wrong habit. If you practice 2 + 2 = 3 too many times you may solidify that thought as a habit. If you believe that you’re worthless and tell yourself that too many times, or hear it from someone else too many times, you will literally have a habit of believing that about yourself. This can drive anyone to addiction.
  • It is possible to unlearn thinking patterns and learn new ways to cope with the world around. Old coping methods may have started out as survival coping skills especially in abuse or neglect survivors, but have since become problem behaviors as you grew out of the need for them. CBT can help relieve the need for them, and not only that, CBT can make it so you fully realize that you no longer need them anymore.


Dialectical Behavior Therapy

Dialectical behavioral therapy was originally developed by Dr. Marsha Linehan, adjunct professor of psychology and psychiatry at the University of Washington in Washington State. Linehan received a lifetime achievement award due to the book she wrote on dialectical behavioral therapy, the therapy she developed. Linehan also has a practice and is still researching how to develop and treat serious mental health disorders.


Dialectical behavior therapy, or DBT, is a cognitive behavioral treatment that puts the focus on individual therapy as well as group therapy skills training sessions. Linehan originally created DBT to treat patients with borderline personality disorder, a serious mental health disorder that can have a side effect of a patient having chronic suicidal ideation. Indeed, DBT has become the best in class standard psychological treatment option for those with chronic suicidal thoughts, especially who suffer from BPD. But dialectical behavior therapy hasn’t stopped there. Linehan’s research and then development treatment has changed the lives of those suffering in so many different ways. There are  a myriad of disorders that find use of dialectical behavior therapy including:

  • Those with dual diagnosis substance abuse
  • Depression
  • Generalized Anxiety Disorder
  • Post Traumatic Stress Disorder, or PTSD
  • Eating Disorders
  • ETC


The Four Stages of Dialectical Behavior Therapy

  • 1st Stage of DBT: In the first stage the therapy is built to address a patient who is in chaos. Their behavior is chaos and their emotional landscape may feel like chaos. They are simply put out of control. This first stage is often met by a patient with suicidal ideation or who has expressed a desire to end their life. Maybe the new patient is coming to DBT because they are engaging in self harm, perhaps by cutting themselves, by overworking themselves, or by using an addictive substance, whether it is an illicit substance or just alcohol. The vital thing in the first step of DBT is that the client grow from being or feeling untethered to being able to control behavior.
  • 2nd Stage of DBT: Even as the patient has become more proficient at withstanding the urge to react inappropriately or destructively to themself, they still will likely feel desperate, hopeless and alone. This continued suffering could well be because of trauma or neglect that has remained unprocessed before now. This kind of quiet desperation cannot go unchecked or it may lead directly back to the self harm the patient was in at the beginning of the therapy. Step 2 has a goal of taking a patient from that silent despair they are living with to allowing themselves to feel their emotions in spite of the fear that may come with it.
  • 3rd Stage of DBT:  Now that the patient is no longer living in a dangerous chaos and that they have control over their behaviors and habits, now that they can allow themselves to experience the emotions they are feeling and fully experience each moment while still behaving the way they want to, it is time for the patient to rebuild their life. They will use these new understandings of self and tools built through DBT homework and therapy sessions to make goals and lead a normal everyday life confronting both happiness and sadness as they come.
  • 4th Stage of DBT: Not everyone engages in the fourth stage of DBT, but some patients find the therapy can play a role in a spiritual experience for them. Dr. Marsha Linehan created the fourth step to allow the person struggling to have a goal of spiritual fulfillment. In this step the hope is that the patient can move from feeling incomplete, like they have holes in their heart or like they are empty inside, to finding comfort and safety in a connection with something greater than themselves, a tiny pin prick on a huge canvas.


Motivational Interviewing Therapy

Motivational interviewing therapy is a kind of therapy that is meant to engender a kind of intrinsic thirst within the recovery patient to change their old detrimental behavioral habits and build the skills necessary to thrive in a sober life. This method of therapy starts with a therapist interviewing the patient about why they are seeking help with their addiction, and what kind of motivations are behind the change they are seeking. As the patient talks, they reaffirm their motivations and their need for change.


The goals of the therapist while in the first steps will be to first express compassion and solid support to the patient. This includes making the patient feel respected, cared for, and more important than anything else in this therapy, listened to. The therapist will hold a non combative stance within the therapy sessions. They won’t push back too much when the patient pushes back. This therapy requires that the person with the substance dependency be the one who must come to the decisions around their own life goals and come to their conclusions themselves first so that the interest in following those goals is central to the addict’s understanding of what it means to recover from their disorder.


The next phase of motivational interviewing is a process wherein the therapist moves through the motivations and story of the recovering drug or alcohol addict. This confirms once again a patient’s need for change. It reminds them and makes real one more time and from a different and outside source that there is a need for change, and it requires that they agree that change is vital. As the person struggling with substance addiction affirms the determination to change something intrinsic changes in their priorities and the hope is that the therapy drives their recovery to its success.  The therapy itself is short term in nature, but the benefits can last forever. That kind of breaking down of goal and motivation is an education in how to effectively self evaluate and change bad habits as needed. Motivational Interviewing can be a valuable tool for some recovering addicts.


Some common reasons motivational interviewing could be because the recovering addict has

  • Depression
  • Generalized Anxiety Disorder
  • Compulsive Gambling Addiction
  • Illicit drug abuse or chemical dependency
  • Prescription drug abuse or chemical dependency


The most important elements of Motivational Interviewing:

  • Collaboration with the therapist
  • Evocation of intrinsic self care and preservation, intrinsic motivation building and then using that intrinsic desire to be the best a person can be to dedicate themselves to building a safe and functional sober life moving forward.
  • Autonomy is offered to the patient in motivational interviewing therapy because the power in this kind of therapy largely does end up in the hands of the addict. It is the recovering addict who is responsible for laying out their story and their motivations so the therapist can help them wrap those struggles into a picture of recovery through reaffirmed motivations and thirst for change.

Contingency Management Therapy (CMT)


Contingency management therapy is alluring in many ways, but some say that it is too impractical to be a viable form of treatment. Contingency Management Therapy plays out in a reward system that sometimes involves both negative and positive carrots for an addict to maneuver around, but the idea of it is based around the idea that positive reinforcement really is a better way to change behavior.


Kathleen M Carroll in her article Behavioral Therapies for Drug Abuse in The American Journal of Psychiatry says the following about contingency management therapy, “Contingency management, in which patients receive incentives or rewards for meeting specific behavioral goals (e.g., verified abstinence), has particularly strong, consistent, and robust empirical support across a range of types of drug use”  ( Carroll also says that contingency management therapy is based on the principles of behavioral pharmacology and operant conditioning – positive conditioning creating positive results.


The CMT strategy works because it focuses on working with the habit forming part of the human brain. It uses the reward system of the brain, the section of the brain known to be linked to and co-opted by some of the deadliest forms of drug addiction out there. Turning addiction’s own game around on itself, by targeting the reward center of the brain, can cause some impressive end game results.


Even though CMT has a tendency to produce good results and in many cases very sustainable success for those seeking to live a life of sobriety, however, many detox and rehab facilities in Florida do not utilize CMT for its sheer cost. Affording testing for consistent drug testing and for the physical rewards themselves, can indeed make CMT not a viable option for every treatment center. An addict should always research the specific treatment center they are going to attend to understand more fully the programs offered at the location where they will be a resident while they recover from addiction.


In Summary


Another added side effect of behavioral therapy is HIV risk reduction. Targeting the behavior of a drug addict, the way that behavioral therapy can do, can make some treatments for drug addiction like methadone programs more successful. As well as giving behavioral therapy a direct link the credit for helping to fight against the opioid crisis in our country.


There are other behavioral therapies like family behavioral therapy or partner behavioral therapy. These are also sometimes used and useful in the fight against a patient’s disorder.

Behavioral therapies have become a cornerstone of drug and alcohol substance abuse and dependency. The more extensive emphasis on an individuation of treatment due to the unique nature of these kinds of therapies leads to a higher success rate in not only completing the intensity of drug or alcohol recovery treatment but then following through as they move forward to restructure a life lived differently. The foundation of behavioral therapies can help them make decisions about every aspect of their lives. A person suffering from substance abuse and addiction can be assured that most rehab clinics do indeed offer these therapies. At FHE Health our qualified therapists can and do offer behavioral therapy.


Addiction Recovery Treatment

If a person is seeking out addiction recovery in Florida they may notice that the state has some of the best drug rehab centers in the nation. It can be intimidating to know what kind of program is right for you. At FHE Health we help the recovering drug or alcohol addict strive for recovery through a treatment program tailored to their personal struggles and challenges. Call us today to learn more.

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