It seems clear that people are hungry for alternatives to traditional treatment for addiction—aka "rehab"—and that many could be well-served by individual psychotherapy. Unfortunately, many therapists are hesitant to work with active substance use disorders because of a fear that they won't know how to help.

To address this, I've developed a broad framework that can serve as a foundation for effectively working with substance use issues. The three pillars are motivational assessment and enhancement, recovery skills and action-oriented approaches, and long-term psychotherapy using the conceptual framework of your choice (more on that below). By using these models, you can join me in one of the most rewarding corners of the field of therapy: addiction psychotherapy.

The first—and arguably, most important—place to start with someone wanting to address their substance use has to do with motivation. People come to addiction therapy for all kinds of reasons. Maybe their substance use is impacting their relationship and their spouse or partner is concerned. Or perhaps they got in trouble at work and need to make a change in order to hold onto their job. Whatever the situation, it is a guarantee that the person in front of you is ambivalent: on the one hand, they know what they're doing isn't working. And yet, on the other hand, they really enjoy drinking or getting high and would love to keep doing so if at all possible.

The first phase of the work involves spending time understanding how this person's substance use fits into their life and what their reasons for making a change might be. Instead of spending all of our time on the problems associated with their drug use, it's vitally important to talk about what is working for them, and why they love this substance, despite the problems.

The goal here is to explore and understand each individual's ambivalence about making a change so that we can address these specific concerns in our work together. One of the most common problems that therapists make is assuming that simply because they made their way to our office........

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