Understanding Addiction
Explain why therapy is a core part of addiction treatment, including how these therapies address the mental, emotional and behavioural aspects of addiction. Emphasise that therapy can be effective with or without medication, depending on the person and the type of addiction.
Whilst there are lots of amazing addiction programmes available in the UK, including programmes for people impacted by a loved one who is in addiction; I believe that therapy is a really important part of the recovery journey. I have worked with people in active addiction, as well as people who are in maintenance mode and although everyone’s story is unique, the themes that underpin addiction are common. My client base is almost exclusively women, and many of my clients are neurodivergent. As a trauma informed therapist, there are many overlaps between the symptoms of trauma and the symptoms of neurodivergence. The intersection of these for many of my clients, increases the likelihood of dependence and addiction.
As a trauma informed therapist, much of my focus with clients is understanding the impact and extent of adverse childhood experiences [ACEs]. Research has shown that the higher the number of ACE’s, the more likely someone is to experience addiction. Substance addiction is particularly highly correlated with ACE’s. However, process (or behavioural) addictions and compulsive behaviours are in my view largely underreported and under researched. This is in part, because of the lack of physical harm caused by substance addiction. Someone with a gambling addiction or an internet addiction is less likely to end up in A&E.
Explain how these therapies help e.g. identify triggers and high-risk situations; change unhelpful thought patterns and beliefs; build coping and emotional regulation skills; strengthen motivation for change; reduce relapse risk; improve relationships and daily functioning.
As an integrative therapist - which means I draw on a number of psychological theories and approaches - I see my role in two parts: the first is to provide emotional scaffolding for clients. This includes: identifying triggers, practicing self care, putting boundaries in place, and enlisting support (from friends/family/addiction programmes). The second part is to understand what gets in the way of doing all of this. We all get triggered, but how we respond to this depends on what gets ‘activated’ from our past. If we have a high number of ACE’s then there is more to activate. I help my clients understand the impact of their ACE’s and why they respond to them in the way they do. Addiction is like an ‘escape hatch’ and when we are suffering with the symptoms of trauma which include: depression, hyper vigilance, paranoia, panic attacks, repetitive behaviours, flashbacks, dissociation and social anxiety; it’s understandable that we feel the pressure to escape.
For clients with ADHD or ASD, both involve dopamine dysregulation. Women with ADHD in particular, often suffer with both substance and behavioural addictions. This is due to the ADHD paradox whereby our brains seek additional stimulation and rewards, which inevitably results in sensory overload and emotional overwhelm. For both of these reasons, it makes sense that women are prone to addiction: impulsive, novelty seeking behaviour for the ‘high’ and/or the escape hatch to counter the impact of a dysregulated nervous system.
What are the main types of therapy approach to help with addiction?
Some of the key approaches I integrate in therapy, particularly when working with addiction are: EMDR, Internal Family Systems Therapy (IFST) and Acceptance and Commitment Therapy (ACT). EMDR and IFST are both trauma informed therapy approaches.
EMDR is a type of psychotherapy that helps us process traumatic or disruptive memories and experiences. EMDR is recognised by the World Health Association and NICE guidelines. It is available on the NHS, but it’s usually provided to people who don’t feel significant improvement through talking therapy. It’s similar to cognitive behavioural therapy (CBT) (also available on the NHS), in that it’s based on helping our brains adaptively process difficult experiences. However, it uses something called bilateral stimulation to access these memories. EMDR is usually a brief intervention - it takes between 3 and 6 sessions - and is incredibly effective. Research shows that EMDR is effective in reducing cravings, but it also reduces symptoms of PTSD and trauma, which makes it easier for clients to engage with therapy and other support systems.
IFST is a standalone, but highly complementary therapy to EMDR. I often introduce IFST to clients with addiction following EMDR processing. My approach to EMDR is to capture a number of adverse experiences (both from childhood and in other stages of life), and identify if there are any common limiting beliefs. In addition, processing often illuminates previously suppressed memories or behavioural patterns that help me identify how a client responded to challenging situations. These patterns are what kept them safe or helped them survive, so it makes sense that they deploy them in later life. For example, if a woman was sexually abused as a child, she is likely to have experience of dissociation. This defence mechanism prevented her from experiencing the emotional effects of trauma, whilst her body was experiencing it. IFST seeks to identify previous versions [or parts) of ourselves that experienced trauma and their responses to it.
Once we reduce the distress levels and high dysregulation caused by trauma, together with understanding our parts and how and why they responded in the ways they did; ACT is a brilliant way to build resilience and move towards sobriety and growth. The key principles of ACT are mindfulness and awareness. An ability to accept our emotions, rather than try to suppress or fight them. The overriding principle is to increase our awareness of both our actions and our feelings, and focus on moving towards our goals rather than moving away from them.
