Acceptance and Commitment Therapy in Addiction Treatment


Published On: March 11, 2024

Quick links for Acceptance and Commitment Therapy

Struggling to identify potentially destructive habits, painful emotions and negative thought patterns can prove to be a major obstacle for many individuals struggling with drug or alcohol abuse issues or those who are in addiction recovery.

In this blog, we will talk about acceptance and commitment therapy, a mindfulness-based therapy which can offer a supportive and beneficial way for individuals to better identify negative thoughts and feelings, allowing them to overcome any stigma attached to these feelings and giving them the tools necessary to move past them.

If you need help accessing acceptance and commitment therapy for addiction treatment, call our helpline on 0800 111 4108

What is Acceptance and Commitment Therapy?

Patient speaking with a therapist during acceptance and commitment therapy for addiction

Patient speaking with a therapist during acceptance and commitment therapy for addiction

Acceptance and commitment therapy (also known as ACT) is a form of behavioural therapy (Like CBT or DBT) which is used to treat a range of psychological disorders, but can be particularly effective for those suffering from substance use disorders.

Broadly, behavioural therapies are “Based on the belief that your unwanted or unhealthy behaviours are a learned response to your past experiences. They focus on current problems and aim to help you learn new, more positive behaviours.” [1]

It aims to provide patients with insight into the ways in which their mind works, helping them to accept negative emotions instead of avoiding, resisting or controlling them, and as a result be more able to avoid patterns of reactive behaviour.

Essential to the ideas of ACT is the perspective that suffering– which might take the form of traumatic memories, social anxiety, or painful feelings- is part of human existence and it is entirely possible to live a meaningful life despite its presence.

Within the context of addiction recovery, this treatment approach is extremely beneficial, as it can help those on their journey towards recovery to identify the urge to use their substance of choice without acting upon it.

Being comfortable identifying this feeling and then choosing to take healthier, values-based actions can of course reduce an individual’s risk of relapse.

What are the Key Principles of Acceptance and Commitment Therapy?

Support group gathered and taking notes about acceptance and commitment therapy for addiction

Support group gathered and taking notes about acceptance and commitment therapy for addiction

ACT can be boiled down to a few key elements.

Firstly, and as already stated, ACT promotes the idea that, although suffering is a natural aspect of life, it does not need to dominate it.

As a result of this perspective, a key element of ACT is psychological flexibility: the idea that an individual has the necessary psychological capacity and abilities to process obstacles.

This is arguably the key aim of ACT, and within the context of addiction recovery, simply means being able to deal with challenging or unpredictable situations without using substances.

Another key principle is the development and application of positive personal values, such as peace or family.

Psychological flexibility can be guided and supported by the deployment of these core values, as they can help a person to retain perspective on negative feelings or reactions, and guide them in choosing how they would like to behave.

Psychological flexibility can also be strengthened and developed by using tools such as mindfulness techniques. Put simply, mindfulness means a heightened state of awareness focussed on the present moment.

It is often recommended to individuals experiencing anxiety or depression.

If you need help accessing acceptance and commitment therapy for addiction treatment, call our helpline on 0800 111 4108

Who Pioneered Acceptance and Commitment Therapy and Why?

Therapist listening to a patient during acceptance and commitment therapy for addiction

Therapist listening to a patient during acceptance and commitment therapy for addiction

ACT was developed by Steven C. Hayes in the 1980s, and first tested as a potential treatment for those with addiction problems in the 2000s. [2]

ACT is regarded by experts as one of multiple forms of third wave behavioural therapy; another therapy in this category which you may have heard of is dialectical behavioural therapy.

These followed behaviourism, the first wave, and cognitive behavioural therapy, which was the second.

Hayes has claimed that ACT was inspired by a concept he had pioneered called relational frame theory.  In essence, relational frame theory identified a connection between ineffective verbal communication and negative behaviour.

ACT instead focussed on the ways in which thought patterns such as avoidance and attempted control were connected to behaviour.

What are the Six Processes of Acceptance and Commitment Therapy?

Two people talking during acceptance and commitment therapy for addiction

Two people talking during acceptance and commitment therapy for addiction

ACT is underpinned by six interconnected core processes which, when applied together, can effectively support an individual in processing uncomfortable feelings and building a better quality of life: [3]

Values

The beliefs and principles which a person upholds and honours can have a powerful influence on the ways in which they choose to act.

In ACT, positive values are used to apply motivation and purpose to a person’s decision making, tolerating difficult or even painful feelings can become easier if it is the way in which a person can adhere to their values

Being Present

Being able to connect with and be grounded in the present moment allows an individual to be fully aware of their internal and external experience, focussing on what is without worrying about the past or speculating about the future.

Self as Context

Simply observing the self, including parts which might once have caused distress or dislike, is fundamental to developing a sense of identity which is not defined by those negative aspects (such as, for example, addiction).

Being able to do this can ultimately help to develop a stable and enduring sense of self.

Therapist and patient sat on a sofa talking during acceptance and commitment therapy for addiction

Therapist and patient sat on a sofa talking during acceptance and commitment therapy for addiction

Cognitive Defusion

Cognitive defusion is the process of identifying potentially triggering thoughts, memories or emotions in a neutral, objective way.

Instead of attempting to banish the idea, identifying it as a temporary experience (rather than, for example, an absolute truth or rule which must be observed) reduces its power and influence.

Acceptance

Just as potentially upsetting ideas and sensations need to be observed neutrally, they must also be accepted.

While it is potentially difficult to accept ideas which have the potential to cause psychological pain, embracing them instead of supressing or avoiding them, it is a necessary step towards being able to choose your responses to them in a deliberate way

Committed Action

In order to support long-term recovery, it is essential that an individual makes a commitment to action.

Guided by their personal values, individuals can set achievable, meaningful goals which help them to alter damaging patterns of behaviour.

If you need help accessing acceptance and commitment therapy for addiction treatment, call our helpline on 0800 111 4108

How is Acceptance and Commitment Therapy Different to Cognitive Behavioural Therapy (CBT)?

Two women discussing acceptance and commitment therapy for addiction

Two women discussing acceptance and commitment therapy for addiction

Whereas Cognitive Behavioural Therapy (known as CBT) is a form of therapy which emphasises intervening in patterns of thoughts and feelings with the aim of altering symptoms, ACT emphasises instead an acceptance of thoughts and emotions with the goal of improving a patient’s perception.

ACT is very often offered as a treatment alongside various other talking therapies, [4] including CBT as well as others like motivational interviewing or holistic therapy.

How does Acceptance and Commitment Therapy Work as part of Treatment of SUDs?

Therapist taking notes and talking to a patient during acceptance and commitment therapy for addiction

Therapist taking notes and talking to a patient during acceptance and commitment therapy for addiction

It would be a dramatic misconception to imagine that the process of treating addiction as a purely physical one.

While it is of course crucial to safely detox and seek proper treatment for physical side effects, a complete understanding the psychological symptoms, causes, and factors related to addiction is an essential part of any treatment plan.

Addictive substances are often adopted as a simple method to ease suffering or discomfort. ACT can help individuals to find healthier ways to process such unhappiness and face challenges as a part of daily life, without feeling the need to turn to their substance of choice.

ACT can also specifically help those facing addiction to challenge negative belief systems they might have formed about themselves and the relationship they have with addictive substances.

This ultimately can weaken cycles of self-sabotage, improving the patient’s perception of themselves.

By supporting individuals in this way and cultivating psychological flexibility, ACT can not only support those suffering from addiction through recovery,  but give them tools which will help them to maintain long-term sobriety and pursue a meaningful life.

If you need help accessing acceptance and commitment therapy for addiction treatment, call our helpline on 0800 111 4108

What are the Benefits of Acceptance and Commitment Therapy for Addiction Treatment?

Person walking on a country road after acceptance and commitment therapy for addiction

Person walking on a country road after acceptance and commitment therapy for addiction

The benefits of acceptance and commitment therapy for addiction can include:

  1. An greater capacity for managing cravings
  2. Improvement in related disorders such as anxiety disorder or post-traumatic stress disorder
  3. A happier and better adjusted life with decreased risk of relapse
  4. Development of long term focus built on a foundation of positive values
  5. Greater personal resilience and empowerment
  6. An improved relationship with the self

Are there any Drawbacks of Acceptance and Commitment Therapy?

Patient leaning on a fence and thinking about acceptance and commitment therapy for addiction

Patient leaning on a fence and thinking about acceptance and commitment therapy for addiction

ACT is a low-risk treatment option for those in addiction treatment. However, there are some potentially negative factors worth considering:

  1. Time: Like many psychological treatments, ACT is a complex process which requires a patient attend multiple sessions in order to begin experiencing positive effects .
  2. Accessibility: Not all rehabilitation centres will offer ACT as part of their treatment programmes, as it requires a specialised practitioner to be delivered. As a result, some patients choose to seek ACT from a separate private practice.

If you need help accessing acceptance and commitment therapy for addiction treatment, call our helpline on 0800 111 4108

What goes on in Acceptance and Commitment Therapy Sessions?

Two men sat down discussing acceptance and commitment therapy for addiction

Two men sat down discussing acceptance and commitment therapy for addiction

ACT sessions will always be conducted by a specialist. Their first priority will be individualising sessions in order to meet the unique needs and goals of the patient, which will be identified by a comprehensive assessment of the patient’s psychological wellbeing.

However, it is possible to give some examples of content which might be included in an ACT session.

Specific values exercises can be a useful first step for a patient commencing ACT.

These exercises are particularly beneficial for individuals who do not already feel they have strongly determined values, and are in need of defining their key motivation to guide them through the process.

Group of people engaging in acceptance and commitment therapy for addiction

Group of people engaging in acceptance and commitment therapy for addiction

Once a patient has identified core values, their therapist will choose from a whole range of techniques with which they can begin to experience and examine their painful memories, thoughts, and emotions.

Mindfulness techniques are often an effective way to begin identifying thoughts and feelings it would be beneficial to focus on.

One popular way to begin defusing these negative ideas is the ‘sing it’ technique.

Simply put, this technique requires the patient to sing the thought out loud.

The aim is to strip the thought of its power and expose it as not necessarily as accurate or important as the patient may have previously believed.

A similar technique with the same desired effect requires the patient to express the painful thought in a variety of silly voices.

If you need help accessing acceptance and commitment therapy for addiction treatment, call our helpline on 0800 111 4108

What are the Ultimate Goals of Acceptance and Commitment Therapy?

Two people holding hands and talking about acceptance and commitment therapy for addiction

Two people holding hands and talking about acceptance and commitment therapy for addiction

The long term goal of ACT is for patients to have developed:

  • An arsenal of mindfulness and acceptance techniques.
  • A stable perception of who they are and what their values are.
  • An ability to set meaningful and fulfilling life goals.
  • A healthy perspective on suffering and discomfort within the context of human experience.
  • An ability to accept obstacles and challenges using psychological flexibility.
  • A sensation of calm and presence in the moment.

Is There Evidence for the Effectiveness of Acceptance and Commitment Therapy?

Patient and therapist sat down together discussing acceptance and commitment therapy for addiction

Patient and therapist sat down together discussing acceptance and commitment therapy for addiction

Below, we outline evidence in factor of the effectiveness of ACT:

    1. A randomised controlled trial in 2012 [5] concluded that ‘an approach to shame based on mindfulness and acceptance appears to produce better treatment attendance and reduced substance use’.
    2. A 2013 study conducted by Steven Hayes [6] and colleagues identified ‘signs that the ACT/RFT development strategy is succeeding in areas where success has not been common in applied psychology’.
    3. Analysis published by Psychology Faculty of Utah State University in 2015 [7] concluded that ‘ACT appears to be a promising intervention for substance use disorders.’
    4. A review of studies in ACT [8] published by Joy Osaji, Chiedozie Ojimba, and Saeed Ahmed in 2020 declared that ‘Most of the studies showed that ACT was effective in the management of SUD showing significant evidence of a reduction in substance use or total discontinuation with subsequent abstinence.’
    5. Research conducted in 2022 [9] by Lucia Díez-Bejarano and Covadonga Chaves found not only that that ‘ACT showed equal or better results in reducing consumption compared with other forms of treatment’, but also that it was ‘more effective than other treatments in generating positive changes in the quality of life and the dimensions of acceptance and flexibility among patients’.

If you need help accessing acceptance and commitment therapy for addiction treatment, call our helpline on 0800 111 4108

Final thoughts on Acceptance and Commitment Therapy for Addiction Treatment

Group of people holding hands after rehab

Group of people holding hands after rehab

In conclusion, acceptance and commitment therapy is one of many effective and evidence-based therapies beneficial for treating substance use disorder and its associated difficulties.

As a means of addressing the thoughts and feelings that drive addictive behaviour it provides a unique approach, offering a way to overcome addiction that relies on building the victim up rather than simply tearing the addiction down.

When practiced properly, it can offer a foundation for a lasting recovery and a fulfilling life.

If you need help accessing acceptance and commitment therapy for addiction treatment, call our helpline on 0800 111 4108

References for Acceptance and Commitment Therapy in Addiction Treatment

[1] https://www.bacp.co.uk/about-therapy/types-of-therapy/

[2] https://stevenchayes.com/about/

[3] https://stevenchayes.com/tools/

[4] https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/types-of-talking-therapies/

[5] https://pubmed.ncbi.nlm.nih.gov/22040285/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635495/

[7] https://www.utahact.com/uploads/5/1/3/4/51340265/2015_leeanlevin_twohig__jd_ad_.pdf

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524566/

[9] https://journals.healio.com/doi/10.3928/00485713-20220504-01

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