Starting therapy for substance use disorder

Research shows that therapy is one of the most effective ways to manage substance use disorder. However, one in four Americans with a substance use disorder received treatment in 2023, despite its importance in recovery. 

It can be uncomfortable to talk to a therapist for the first time about your substance use, but you deserve support and don’t need to try to quit on your own. A therapist’s role isn’t to judge you or tell you what to do — it’s to help you learn new skills and walk away from harmful substance use while continuing to respect you as the expert on your own life.

If you feel ready to start therapy for substance use, there’s support available to you.

Is therapy worth it for substance use issues?

It’s normal to have some hesitation about investing in therapy for changing your behaviors. You might wonder if therapy is the right approach for you. But therapy is a proven way for people to address their substance use and to support recovery. It can provide you with the necessary support to fight substance use cravings and develop healthier coping skills. 

Substance use also typically comes with other negative effects on your life. For example, you may’ve found that your relationships are suffering or you’re experiencing financial problems because of substance use disorder. Therapy can help you address these issues and find a way forward. 

If you’re unsure if therapy might be for you, ask yourself:

• How has substance use affected my daily life? For example, it may have impacted your relationships, professional life, or physical health. 
• Have I tried to stop using substances on my own before? Consider what worked before and what didn’t. Could having professional support make a difference this time? 
• Why am I using substances? You might find yourself reaching for substances, like drugs or alcohol, to cope with difficult emotions like stress or anxiety. 
• How would my life improve if I didn’t use substances anymore? You might imagine a future with more fulfilling relationships and more stable finances. Imagine the goals you could achieve without substance use getting in the way. 
• Am I ready to accept help? Therapy requires effort on your part, too. Consider if you’re ready to commit to regular appointments and approach treatment with an open mind.

What are the best types of therapy for substance use disorder?

Many different types of therapy can be useful for substance use disorder. So, you have some options to explore. In fact, many therapists borrow from different effective therapy techniques depending on your needs.

Here are some of the most effective therapy methods for substance use disorder, according to research:

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy, or CBT, is a common therapy technique used for a wide variety of mental health concerns, including substance use disorder, depression, and anxiety. Its main principle is that our thoughts, emotions, and behaviors are interconnected. By identifying and restructuring unhelpful thinking patterns, we can feel better, which often leads to improved behaviors.

For substance use disorder, a CBT therapist may provide information about how substance use affects your brain and why the habits are so hard to break. They may also help you examine thinking patterns that make you more vulnerable to using substances to cope. Lastly, they can teach you new skills to help you fight urges to use substances and manage painful emotions.

Motivational interviewing/Motivational enhancement therapy (MI/MET)

Motivational interviewing (MI) helps you uncover your internal motivations for both continuing and wanting to stop substance use. MI places you — not the therapist — as the expert on your own life. Only you know why you started using substances in the first place and what it would take for you to quit. A MI therapist may ask you questions about what you’ve already tried and help you envision a future in which you’ve successfully overcome substance use disorder.

Motivational enhancement therapy (MET) is a structured approach to motivational interviewing that can also be helpful for substance use disorder.

Multidimensional family therapy (MDFT) 

Multidimensional family therapy (MDFT) is specifically designed to address substance use and related concerns in adolescents. This approach involves the whole family, focusing on improving communication, building stronger connections, and addressing family dynamics that may contribute to substance use. MDFT also helps parents learn how to support their child in healthier ways.

Contingency management

Contingency management is a therapy approach that uses rewards to encourage positive behaviors, like staying sober or attending therapy sessions. For example, you might receive vouchers or small prizes for every negative drug test. Research has found this approach can be especially helpful for substance use disorders because it helps build motivation to stay on track.

Seeking Safety

Seeking Safety is a group or individual therapy method designed to help people who are experiencing substance use and trauma. It focuses on building safety in the present moment and developing coping skills without focusing heavily on traumatic memories. This can be especially helpful for people who feel overwhelmed by both trauma and substance use and need a more immediate, practical approach to healing.

Dialectical behavior therapy (DBT)

Dialectical behavior therapy is another approach that’s effective for substance use — especially if you grapple with intense emotions or impulsive behaviors. DBT teaches you skills in emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness. These skills can help you manage the emotions and urges that might lead to substance use.

Finding the right substance use therapist for you

Finding the right therapist for you depends on many factors, including your individual needs, personality, and mental health history. To start looking for a therapist to help you with substance use concerns, consider the following:

• Other mental health concerns: Do you have other mental health conditions that may be influencing your substance use? Research shows that many people who live with substance use disorder meet the diagnostic criteria for at least one other mental health condition. It’s important to look for a therapist who has expertise in both substance use as well as the mental health condition you’re living with.
• Your budget or insurance: Cost is undeniably a factor when looking for a substance use therapist. Insurance is one way you can bring down the cost, but it’s important to make sure your therapist works within your coverage network. Don’t be afraid to ask your therapist financial questions from the start to avoid surprises down the road.
• Your preferred approach: Do you want to meet with a therapist in an individual setting, or would you rather participate in a group? You can participate in both individual therapy, group sessions, or a combination of both. It’s important to be clear about what you’re looking for so that you can find a therapist who meets your needs.

Talking with a therapist about your history with substance use is an important step toward healing and growth. If you’re not ready to answer certain questions right away, it’s okay to share how you’re feeling. Trust takes time to build, and as your relationship with your therapist grows, it will likely feel easier to open up.

Find care with Rula

Starting therapy for substance use is an important step toward a healthier future. A therapist can help you identify the root causes for your substance use, strengthen your internal motivation to quit, and learn new strategies to fight cravings. 

You don’t need to go through this alone. Rula has helped hundreds of thousands of patients find affordable, quality, in-network therapy. You can meet with a provider via live video as soon as tomorrow. 

Find a therapist with Rula