How Addiction Counseling Works

Written by Steve Rose

Steve Rose, PhD, is an addiction counsellor and former academic researcher, committed to conveying complex topics in simple language.

On the go? Listen to the audio version of this article here:

As an addiction counselor, I specialize in human motivation. Although every form of counseling needs to consider the role of motivation, it is especially relevant when dealing with addiction.

If you struggle with addiction, you may find yourself continually returning to a substance or behavior, despite the negative impact on your life. Like a war in your head, you try to control the craving but end up giving in, telling yourself “this time will be different.”

Despite rational evidence to the contrary, you feel emotionally driven to give it another try. As your sense of control fades, and it’s no longer a form of entertainment, you start to wonder why you’re continuing it and how you’ll ever be able to stop.

Addiction counseling works by intervening in the motivational processes that drive the addiction. It helps address underlying issues, unmet needs, and fosters a sense of self-efficacy through a collaborative planning process. 

Let’s take a closer look at how addiction counseling works and what makes it unique.

What is Addiction Counseling?

Addiction counseling is a collaborative conversation about behavior change, focused on meeting a client where they are at, building trust, motivation, and effective coping skills to navigate everyday life.

According to the transtheoretical model of behavior change, addiction counseling involves the following areas:

  • Stages of change
  • Processes of change
  • Levels of change 

Stages of change” refers to a person’s readiness to change. There are five stages:

  1. Pre-contemplation (not thinking of change)
  2. Contemplation (thinking of change)
  3. Preparation (planning for change)
  4. Action (doing the change)
  5. Maintenance (making it habitual)

Addiction counseling is unique due to the high level of motivational ambivalence. This means clients may want to change and don’t want to change simultaneously. It is important to recognize this fact and meet a client where they are in their current change stage.

Processes of change” refers to the actual intervention. This means delving into the specific factors driving the person’s behavior.

Although these factors vary depending on the person, I explore some common processes in my article on How to Stop an Addiction. This article is quite comprehensive and links to other articles I’ve written, breaking down how each specific process works.

Levels of change” refers to the level of focus, from micro (present/ individual) to macro (long-term/ societal) levels of complexity. Here are some of the levels of change from micro-focus to macro-focus:

  1. Current situational factors
  2. Cognitive factors
  3. Interpersonal factors
  4. Systemic familial factors
  5. Long-term societal factors

When working with a client, I consider a holistic picture of the client’s present stage of change, the processes of change relevant to their situation while determining the most appropriate levels of change to focus on at a given time.

Although this sounds highly technical, it is going on invisibly in the back of my head. At the same time, I hold space for the client to share their experience as I guide the conversation through specific questions before collaborating on the next steps.

Approaches to Addiction Counseling 

There are many different approaches to addiction counseling, and depending on the counselor, they may specialize in one or more of the following techniques.

Building on the previous section, these approaches are part of the “process of change.”

Motivational Interviewing

Motivational Interviewing is the foundation of addiction counseling. It is distinct because it was developed by psychologists specializing in addiction rather than the other approaches that generally originate in treating anxiety and depression.

Motivational interviewing is uniquely powerful because it directly targets ambivalence, the core motivational process in addiction. This means it helps facilitate a client’s progression through the stages of change listed above.

In short, motivational interviewing is a collaborative conversation style that builds a therapeutic relationship, evoking the client’s own reasons for change. Most of it involves active listening and empathetically holding space, guiding the conversation toward the client’s own strengths, resources, and reasons for change.

On the surface, motivational interviewing merely looks like really good listening, but there are quite a few technical things going on that should be largely invisible if done right.

If you want to take a look under the hood at the nuts and bolts of motivational interviewing, I’ve written a pretty comprehensive article on it here: How to Do Motivational Interviewing.

Although this is a powerful approach to addiction counseling, it does have its limitations.

For clients struggling with anxious thoughts or depressed moods, other treatment approaches are required to target these underlying issues.

Cognitive-behavioral approaches

Cognitive-behavioral approaches are a gold standard for treating anxiety and depression. These approaches delve into the specific unhelpful thoughts causing painful emotions, resulting in addictive behaviors.

These approaches look at how one’s thoughts, emotions, and behaviors are interconnected, developing insight around distorted beliefs at the root of maladaptive coping behaviors.

Mindfulness approaches 

Mindfulness approaches have also acquired a significant evidence base in the addiction field. These approaches can range from classic mindfulness meditation, mindfulness-based stress reduction (MBSR), or mindfulness-based cognitive-behavioral therapy.

Acceptance and Commitment Therapy (ACT) is a mindfulness-based behavioral approach I specialize in due to its high level of process-based compatibility with motivational interviewing.

In short, ACT fosters behavior change through six psychological change processes: 

  1. Acceptance, 
  2. Cognitive defusion 
  3. Present moment awareness
  4. Self-as-context
  5. Values
  6. Committed action.

Although ACT was initially developed for panic disorder, it is ideally suited to addiction counseling because it targets unhelpful thoughts, like cognitive-behavioral therapy, and fosters motivation through its values and committed action processes.

For a practical deep dive into each of these ACT processes, I wrote an article here that goes through each of them, offering explanations, metaphors, and exercises.

Solution-focused approaches

Solution-focused approaches are particularly relevant in short-term counseling or single-session counseling. It is highly goal-oriented and focused on setting this goal early in the session.

Focusing on the present and the future rather than the past, this approach is particularly useful for getting quick results. Rather than spending a lot of time discussing why something has happened, it focuses on how you can move forward.

Over the last year, I’ve been developing an appreciation for this approach. Doing single-session counseling as part of my employment for a national counseling service, I have 50 minutes to get results for a client I will likely never talk to again.

I see too many people spending months in therapy without seeing results. Although someone dealing with an anxiety disorder may feel motivated to return to counseling each week, hoping the next session will finally unlock some kind of relief, this results-delayed approach is highly unmotivating when it comes to addiction.

If the client isn’t seeing some kind of short-term benefit from counseling, taking practical steps toward a bigger, better offer on the horizon, the addiction starts to seem like a better use of funds. This is why solution-focused approaches are a useful addition to an addiction counselor’s toolkit.

A solution-focused approach is also highly compatible with motivational interviewing because it draws out the other person’s strengths, past experiences, and resources to collaboratively problem-solve regarding the next steps.

Narrative therapy

Narrative therapy is another helpful approach to addiction counseling because it targets unhelpful stories we tell ourselves about ourselves. This is relevant to addiction since it is a highly stigmatized issue.

Many persons with addiction carry a great deal of shame, particularly if they grew up identifying as someone who always followed the rules, needed to succeed, or focused on others at the expense of themselves. A narrative approach specifically looks at identity narratives that may be holding someone back from self-compassion or self-care.

Spiritual approaches

Spiritual approaches are another powerful emerging area in the addiction field. Although I do not favor a particular religious tradition in counseling, a client’s spirituality can be a vital source of resilience and motivation.

There is also emerging evidence on the power of psychedelic substances in treating addiction, and it is an area I am interested in moving into when regulations allow them to be used in clinical settings.

12-step approaches

12-step approaches to addiction are the foundation of recovery culture. Focused on abstinence, this approach facilitates acceptance of one’s powerlessness over the addiction, providing a structured framework of steps for recovery. This approach has also been a widely-available source of peer support.

Although some people are drawn to it more than others, the consistent benefit I’ve observed among clients is the sense that they’re not alone. Since connection is the opposite of addiction, this approach provides a strong social component not offered in individual counseling.

It is important to note that the 12-step model is technically a form of peer support and not a professional counseling approach, but its lessons and language can be integrated into professional counseling.

Although I am not experienced with the 12-step approach, I am a big fan of the serenity prayer, often used in this approach. If you are interested, I wrote a psychological breakdown of it here: The Meaning of the Serenity Prayer.

Conclusion

Like mental health counseling more broadly, addiction counseling works by helping clients work through underlying pain and develop healthy coping skills so they can start living the life they want.

A counselor specializing in addiction brings a keen awareness of human motivation, in addition to experience working with clients in ways that further foster this motivation.

If you want to learn more about motivation, I highly recommend checking out some of my other articles on the topic:

How to Find Motivation

How Does Motivation Work?

How to Motivate Someone

Why Willpower is Overrated

For a more in-depth look at my counseling toolkit, you can check out my article here.

As always, if you have any questions, feel free to reach out here or leave a comment under this article.

Fascinated by ideas? Check out my podcast:

Struggling with an addiction?

If you’re struggling with an addiction, it can be difficult to stop. Gaining short-term relief, at a long-term cost, you may start to wonder if it’s even worth it anymore. If you’re looking to make some changes, feel free to reach out. I offer individual addiction counselling to clients in the US and Canada. If you’re interested in learning more, you can send me a message here.

Other Mental Health Resources

If you are struggling with other mental health issues or are looking for a specialist near you, use the Psychology Today therapist directory here to find a practitioner who specializes in your area of concern.

If you require a lower-cost option, you can check out BetterHelp.com. It is one of the most flexible forms of online counseling. Their main benefit is lower costs, high accessibility through their mobile app, and the ability to switch counselors quickly and easily, until you find the right fit.

*As an affiliate partner with Better Help, I receive a referral fee if you purchase products or services through the links provided.

As always, it is important to be critical when seeking help, since the quality of counselors are not consistent. If you are not feeling supported, it may be helpful to seek out another practitioner. I wrote an article on things to consider here.


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