Having to do that is heartbreaking, and in my work, I support families with strategies for creating more emotional safety in their relationship with their loved one so they can have the kind of positive influence on their loved one that will support them in making positive changes.

So for this episode of Hope for Families TV, I’m going to talk about 3 of the most promising evidence-based treatment approaches to substance abuse. I want to highlight these three approaches precisely because they model tools that family members can also adopt to create the emotional safety needed to have a positive influence, and also because, sadly, these methods are not commonly used in actual treatment programs, and they need to be.

And I want to talk about these approaches because I can’t tell you how many times I’ve had families tell me how they got their loved one to go through treatment, and then they relapsed they day after they got out. Now there are multiple contributors to relapse, but I have no doubt that one of the reasons these methods have the evidence behind them that they do is because they build emotional safety.

Other things that make these approaches so powerful is that they’re both customizable, they address motivation to change using evidence-based practices, and – most importantly to my work, they outline methods family members can use to have a positive influence on their loved one’s drug or alcohol use.

So these three approaches are: Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management

And I’ll go through what each of these approaches are right now

So, Cognitive Behavioral Therapy – often referred to as CBT, operates on the premise that our thoughts, feelings, and behaviors are interconnected. It acknowledges that substance abuse is often a coping mechanism. By identifying and challenging negative thought patterns and beliefs associated with substance use, aka – the drivers of the use, individuals can develop healthier coping mechanisms and responses to triggers. CBT equips individuals with practical skills to manage cravings, deal with stressors, and prevent relapse so they gain greater control over their behaviors and consciously choose healthier responses to their triggers.

Motivational Interviewing is a collaborative, person-centered approach that explores an individual’s ambivalence towards change. It uses a utilizes strategic questioning and reflective listening techniques to elicit “change talk” – statements that reflect an individual’s desire, ability, reasons, and need for change. By amplifying and reinforcing change talk, therapists help individuals strengthen their intrinsic motivation and commitment to recovery. By fostering empathy, acceptance, and evoking intrinsic motivation, motivational interviewing empowers individuals to explore their values, goals, and reasons for change. Through reflective listening and guided questioning, motivational interviewing’s collaborative, non-confrontational approach helps individuals resolve their uncertainties and strengthen their commitment to recovery and positive change by fostering intrinsic motivation and respecting the person’s autonomy and individual agency.

And finally, Contingency Management leverages the principles of behavioral psychology to promote positive change through reinforcement-based strategies. It operates on the principles of positive reinforcement, offering tangible rewards or incentives to reinforce desired behaviors such as abstinence or participation in treatment. Contingency Management allows for customization and individualization of reward systems based on the unique needs, preferences and circumstances of each individual. By providing immediate and tangible rewards, CM helps individuals stay motivated and engaged in their recovery journey. Whether through vouchers, privileges, or other incentives, CM offers an effective way to encourage and sustain positive changes.

All three of these approaches are evidence-based approaches that have been proved effective in motivating people abusing substances to either fully abstain, moderate, or make changes that lessen the negative impacts of the use.

But they’re rarely used in actual treatment settings. People with substance abuse issues typically have to work with an individual therapist to access any of these therapies.

Why is is this?

Because the treatment industry is largely either completely unregulated or poorly regulated. Which means there is no medical board mandating the use of evidence based approaches like there is in other areas of medicine.

And given that these approaches are highly individualized and require more 1:1 contact with a trained therapist in these modalities – the very thing that makes them so much more effective – for profit, and even non-profit treatment centers, have neither the regulatory nor the financial incentive to implement them.

Most of them are continuing to use non-evidence-based programs dating back to at least 50 years. These programs are rarely individualized, despite what the treatment centers claim, and rely almost exclusively on group therapy and other group programming.

And I think it’s really important that families understand the evidence-based methods out there so they can better understand what they are and aren’t getting for their treatment dollars, and start both demanding more evidence-based options from treatment centers and better regulation and higher standards of care for the treatment industry.

So, I’d love to hear what your experience was of the treatment industry. Feel free to share your story in the comments. I promise I’ll respond.