Treatment, self-help and other responses to addiction or dependence, changing consumption patterns, detox, residential treatment, self-help programs, pharmacotherapy, talking therapies

Talking therapies

NOTE: Quotes are presented word for word apart from minor editing for readability and clarity. Identifying details have been removed. Square brackets show text that has been added, e.g. ‘I want to maintain [my current level of drug use]’. Ellipses within square brackets […] show where text has been removed, e.g. ‘Counselling was good but […] I would have liked more information about other treatment options’.

Undertaking counselling or psychological therapy (sometimes referred to as ‘psychotherapy’) is one way some of the people interviewed for this website talk about changing their patterns of consumption. Often referred to as ‘talking therapies’ or ‘talking treatments’, these treatments involve talking to a psychotherapist, psychologist, psychiatrist or counsellor in group or individual sessions. Talking therapies can help people cope with emotional issues, health problems, distressing experiences and everyday challenges. Many approaches deal with trauma and early childhood effects, and aim to create transformational change. In relation to alcohol and other drug consumption, they can help people address issues they see as related to consumption, or help them cut down, stop or otherwise change their patterns of consumption. Counselling and other talking therapies are usually done face to face, but can also take place over the phone or online. The number of sessions varies from a few to lengthy periods, and depends on individual needs, aspirations and resourcing.

Many of our participants with experience of talking therapies undertook alcohol and other drug counselling, which is a range of counselling techniques for those specifically concerned about their alcohol or other drug use. Some have experience of general psychotherapy with a counsellor, psychologist or psychiatrist. A few took part in cognitive behaviour therapy (CBT), which is a short-term talking treatment aimed at changing unwanted patterns of thinking or behaving. While talking therapies differ, our participants describe a number of general benefits, including the opportunity to talk about problems in confidence with a qualified professional and gain insight into how to address them. Some described developing a better understanding of their feelings, decisions and consumption patterns. Others say it helped them to learn life skills and coping strategies.

Some of our participants also describe negative experiences with talking therapies, and comment on what they find unhelpful or in need of improvement. Limited access to information before starting treatment, difficult therapy sessions, and treatment approaches not tailored to individual needs are all mentioned. Others say that while they find counselling helpful, it’s costly and they can’t afford it. For some, when their government-subsidised sessions ran out they couldn’t afford to continue having counselling (see also Work, study & making ends meet).

Read on to find out more about experiences of alcohol and other drug counselling, group therapy, psychotherapy and CBT.

Alcohol and other drug counselling

Our participants identify a number of benefits of counselling including professional advice on how to manage consumption or initiate and maintain change. Some say it helps more generally to deal with difficult experiences and gain insight into problems. Others describe the features of counselling they see as most beneficial. A non-judgmental counsellor, the use of complementary treatments and a trusting relationship between the counsellor and client are all mentioned as important.

Sydalicious (F, 44, works in the health sector, cannabis) says it was a ‘shock’ when she was told she didn’t need alcohol and other drug counselling any more as she valued having someone to talk to.

It was six and a half years I had with that lady and she was fantastic, you know. And then I was told I don’t need drug and alcohol counselling any more. And that was like a shock because I’d had this therapy once a week that I could go and talk to someone about everything. And just that one person for all those years, you know. And I’m like, ‘Oh okay, so you’re just dumping me. You can’t do that. I need my vent’. And yeah, I may not be needing drug and alcohol counselling and I know there’s heaps of people that do need it. However, I need to still talk about things so that I can maintain [control over my use] you know?

John (M, 34, works in the health sector, ice) says that seeing a counsellor gave him ‘insight’ into his patterns of consumption.

[I was] feeling nervous and anxious all the time. So I decided to get some help. I went to a psychiatrist who I saw fairly regularly. I think it was every three to four weeks but in between those visits I would see a drug counsellor at the same place […] One suggestion that my drug counsellor made was to keep a diary of my use and then to go back over that diary [and] do some revision at the end of the month, for instance. And just see how much [I was…] using and when […] and perhaps why [I was] using. Yeah, things like that. And that sort of gave me a bit of an insight into my own use.

Luke (M, 44, works in retail, alcohol) attends counselling at his local alcohol and other drug service and values his counsellor’s non-judgemental, caring approach.

Well [my local alcohol and other drug service] has been really, really good. The person I speak to is super nice, non-judgmental. It’s not confrontational. It’s kind of like counselling but more psychology in there. Asking you how you feel and that sort of stuff. But really super nice. Like I’ll get texts through the week, like, ‘How you feeling? Are you still coming next week?’ […] which is nice.

Negative or mixed experiences of counselling were also described, with several commenting on the limitations of some approaches. These include not having time to reflect on questions raised in counselling, a lack of connection between the counsellor and client, and a narrow treatment approach not tailored to individual needs. Some link their negative experiences to pressure from others to attend counselling (see also Relationships, confidentiality & telling others). They say they didn’t think that counselling was necessary and didn’t get much out of it.

Lala (F, 35, works in health services, cannabis) says it would have been useful to have information on what to expect before her first alcohol and other drug counselling session. (Played by an actor)

Yeah, I’ve been to [a community alcohol and other drug treatment and support service] I went once and I do want to make a follow-up appointment […] It was good [… but] I would have liked to get some information before the appointment. I think [it] would have been useful because he asked me all these questions about my use that I just didn’t really have time to consider. So now reflecting back […] on the answers that I gave him then, I’ve realised just how they weren’t accurate. Like, I totally underestimated my use. So I felt like it could have been more useful for me to reflect and maybe keep a diary before I go for my first appointment. So I’m coming armed with the information, rather than just kind of all the mix of emotions of shame, stigma, embarrassment and fear. And then being put on the spot and asked [about my use]. You know, for me to reflect honestly, but immediately, about my use was a little bit too much.

Louise (F, 19, studying, cannabis) attended alcohol and other drug counselling at the request of her parents, but says it wasn’t helpful because she felt she was ‘being forced to [go]’.

[The counsellor said] ‘You are so much better than other people that are here for serious addictions. Like, you don’t really have a problem’ […] I was like being forced to [go] to make my parents happy, you know. I guess we just talked about my family and […] how that’s the sort of biggest issue with [my cannabis use…] I mean she seemed to think my life was on track, so I don’t really have anything to worry about [….It wasn’t really helpful] because I wasn’t really there for me. Like, I don’t really have a reason to be there for me, so I just like went there because I had to […] Mum just wanted me to go […] It just like reconfirmed my ideas that I really have no problem.

Group therapy

Some of our participants have experience of group therapy and comment on its benefits. They say it can provide a support network and a setting where they feel comfortable to share experiences with others facing similar issues. Group counselling can also offer a chance to share coping strategies, overcome problems and ‘get better’.

John (M, 34, works in the health sector, ice) attends group therapy for gay men looking to change their ice use. He says it makes him feel less alone.

It’s a group of people, probably about eight or nine of us, specifically gay men who are drug dependent and […] either want to minimise their use or stop all together […] So we meet each week for about six weeks [with a professional counsellor] and talk about different issues regarding the drug itself [ice] and the drug addiction […] It’s been good to be able to talk about my own experiences each week, but not only that, to be able to listen to others and realise that […] you’re not alone. There are other people out there who are going through the same, similar, things [It’s helpful] knowing that I’m not the only one feeling this way, or having these feelings or experiences, there are other people out there going through the same thing.

Some had negative or difficult experiences that made them feel anxious and distressed.

Emma (F, 42, works in retail, alcohol) describes a difficult experience of group therapy as part of a residential treatment program.

Through group therapy it was like, I call it ‘emotional boot camp’ […] Everyone’s different, but guaranteed nearly all people with addictions either had no coping skills or if they did, they lost them all through drug use. So getting back to, how are we going to cope with everyday things? So we had things like conflict resolution. So we’d have to sit in a circle with all the other residents and people would write conflicts about you, or you could write a conflict about someone and you’d have to sit opposite that person and then sort of say, ‘When you didn’t clean up the other day I felt really angry’ […] Conflict was my biggest fear. It was like, ‘Oh my God’, you know. And then being so exhausted by the end of the day, I’d sit there and think, ‘How did I even drink?’ Like, it’s eight o’clock and I’m falling asleep because I was dealing with all of this stuff, you know. All my anxieties and having to sit in that room covered in sweat just going, ‘Oh my God!’ It was like I was about to be shot and thinking you’re the only one. You know, I think I’m the only one who’s this nervous or I’m the only one who hates this so much and then in group therapy I’d sit there and say, ‘I think I’m really abnormal’ and everyone would be like, ‘No way’.

Psychotherapy

Those with experiences of psychotherapy describe some of its benefits. These include having the opportunity to gain deeper insight into thoughts and feelings, and a ‘safe space’ to talk about distressing or difficult experiences. Some describe what makes a good experience of psychotherapy. Features described as most important include an understanding, caring therapist and a good personal connection between client and therapist.

Sean (M, 48, works in education, OTC painkillers) describes what he found most helpful in his therapist. (Played by an actor)

I think, most importantly, I found [my psychiatrist] incredibly […] engaged and engaging. Like, incredibly sort of present whenever I was with him […] I think it was actually really liberating to […] go along and see someone at a time when I was incredibly vulnerable […] I think he’s a really smart guy and he continues to say things that surprise me and resonate with me personally […] I’ve just always had the sense that he […] cared and he did, you know. And I genuinely really like his company.

While Fozz (M, 59, works in employment services, alcohol) found psychotherapy helpful, he eventually stopped going because he didn’t feel the psychoanalytic approach he was given suited him.

Part 1

The [doctors at the hospital] recommended that I go into psychoanalysis. They did twig that maybe I’d be a good fit given my skills […] And funny enough I was given a highly, highly qualified […] professor of psychiatry. And he was my analyst until I ended it. We lasted about nine months […] And the test for me in it was, you know, not to play games with him. But just to see if […] I could actually still move in this […] highly structured, highly probing, highly charged human interaction. Was I able to be human in it? And I was. So I was able to miss appointments, I was able to tell him off.

Part 2

It was [a helpful experience] but again [it had] a limited tenure for someone like me. I think I’m not in any way psychologically structured to be cooperative.

Barry (M, 40, unemployed, heroin) has undertaken a number of alcohol and other drug treatments and explains why he finds psychotherapy the most helpful.

For me, the best [kind of treatment] is one-on-one therapy […] I had a great […] narrative psychologist and she was fantastic. But she’s just pulled the plug because she’s going [overseas…] so she’s put me in touch with another mental health nurse. I’ve got an assessment with a psychiatrist […] I’m just trying to put many […] strategies in place to keep me safe […] because […] I could never confront the grief [of losing a close family member when I was a child] I couldn’t, you know, because I was the man of the house. I never got a chance to [grieve] you know. And I grew up in a heavy drinking family too so if you feel a bit down, you know, just skull some beer and you’ll be all right […] You know, my way of dealing with it was drinks, drugs […] and ignoring it. Turning a blind eye to it. Whereas now I’m confronting it head on [in therapy] you know. So it’s pretty intense, but it has to be done.

A few people describe negative experiences of psychotherapy. For example, Nick (M, 50, not working due to illness, heroin) says he finds it ‘very repetitive’. As he puts it, therapists ‘ask the same questions. They always start [by asking about my] childhood […Over the years] I kept on repeating myself all the time [when I saw a new therapist]’. Others say that while they find psychotherapy helpful, they stopped going when their government-subsidised sessions ran out and they couldn’t afford to pay for it themselves (see also Work, study and making ends meet).

Misja (M, 40, not working due to illness, cannabis and heroin) found psychotherapy helpful but could not continue when his Medicare allowance ran out.

I was seeing a counsellor. I was seeing him for quite a while about two years ago […] I had to sit down and talk about whatever, all kinds of stuff. That’s probably the only counselling that I’ve done. It was helpful at the time because I could blurt everything out and [it was helpful to talk to] someone who actually listens to me, apart from my missus. But yeah, I found it quite okay. There was nothing bad about it […] I just stopped going because you can only get like 18 sessions a year on Medicare.

Cognitive behaviour therapy

A few of our participants describe experiences of cognitive behaviour therapy (CBT), which is a short-term talking therapy that aims to address unwanted thought patterns or behaviours. Those who had taken part in CBT say it helped them to address emotional issues linked to consumption and change their patterns of consumption (see also Changing patterns of consumption).

Dean (M, 32, works in hospitality, ice) took part in CBT at a residential treatment facility and says it helped him address the ‘emotional stuff’ linked to his drug use. (Played by an actor)

I found the experience [of CBT] very good and I think that’s the way to go for me, the more CBT route [rather] than 12-step […It’s] not necessarily better for everyone but for me […] there’s a lot more emotional stuff behind why I started taking drugs. And when I went [to the rehab that offered CBT…] I had recently been diagnosed HIV-positive. And […] I knew where I needed to be […] So my psychologist […] was one of the first people I contacted and I said, ‘Look […] get me back in [to that rehab]’.