Author: Kayla Gill

With 9 years in the rehab space, Kayla has overseen the creation of comprehensive addiction treatment content for online audiences worldwide. Her experience managing content for a luxury destination rehab, and her personal path to healing via residential rehab and various therapeutic modalities, inform her first-hand understanding of recovery. She takes inclusion seriously and is especially interested in how trauma and minority experiences shape readers’ journeys.
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Learning to Manage OCD in Rehab

Unmanaged obsessive-compulsive disorder (OCD) is often debilitating. Its unwanted thoughts and repetitive behaviors can take over your life. These symptoms can also damage your relationships, leaving you isolated from support.

Your intrusive thoughts don’t have to define you. With the right treatment, you can find relief from the symptoms of OCD. You can also learn to manage your response to any symptoms that remain. That way, you can live a rich and meaningful life—even if your thoughts are sometimes challenging. For many people, that journey begins in a rehab program that treats OCD.

Types of Treatment for OCD

Treatment for people with OCD usually includes medication, ((Obsessive-compulsive disorder. (n.d.). National Institute of Mental Health (NIMH). Retrieved June 6, 2022, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd)) talk therapy, or a combination of the two. And according to research, psychotherapy can be just as effective as medication. Your healthcare team can help you choose which options are best for you. And your treatment plan may change over time, as you get better at managing your symptoms.

Inpatient rehab is a highly effective treatment for patients with OCD. ((Grøtte, T., Hansen, B., Haseth, S., Vogel, P. A., Guzey, I. C., & Solem, S. (2018). Three-week inpatient treatment of obsessive-compulsive disorder: A 6-month follow-up study. Frontiers in Psychology, 9, 620. https://doi.org/10.3389/fpsyg.2018.00620)) This is especially true for people with co-occurring disorders. In one study, patients showed improvement after just 3 weeks of residential treatment. During your time in rehab, you might try a number of different therapies.

Cognitive Behavioral Therapy (CBT)

CBT is an extremely popular form of behavioral therapy. It is used as a treatment for several mental health conditions, including addiction. And there is a “wide consensus among researchers and clinicians that CBT is an effective treatment for OCD.” ((Pittenger, C., Kelmendi, B., Bloch, M., Krystal, J. H., & Coric, V. (2005). Clinical treatment of obsessive compulsive disorder. Psychiatry (Edgmont), 2(11), 34–43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993523/))

This treatment can be accurately described as either talk therapy or behavioral therapy. During a CBT session, you’ll sit in a therapist’s office and have a conversation with them. However, that conversation will focus on specific behaviors to help you through recovery. Over time, you’ll learn practical skills for responding to overwhelming thoughts and feelings.

Exposure and Response Prevention (ERP or EX/RP)

This specialized type of CBT is designed to target OCD symptoms. ERP is currently the best-proven behavioral therapy for OCD treatment. ((Pittenger, C., Kelmendi, B., Bloch, M., Krystal, J. H., & Coric, V. (2005). Clinical treatment of obsessive compulsive disorder. Psychiatry (Edgmont), 2(11), 34–43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993523/)) In ERP, like most other exposure therapies, patients are exposed to triggering situations. Your therapist will prevent you from responding with compulsive behavior.

For example, you might feel compelled to wash your hands after touching a certain object. In ERP, you’d start by touching that object. Then, you’d talk to your therapist about your intrusive thoughts. This process lets you work through triggers, instead of giving in to your compulsions. If this sounds too intimidating, you can always start small. Your therapist will help you eventually try it in a safe, supervised setting.

Medication

If a doctor prescribes medication to manage your OCD symptoms, ((Obsessive-compulsive disorder. (n.d.). National Institute of Mental Health (NIMH). Retrieved June 6, 2022, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd)) you’ll probably start by taking selective serotonin reuptake inhibitors (SSRI), such as Prozac. SSRIs are some of the most commonly-prescribed drugs for OCD. You may not see improvements right away—it can take up to 8-12 weeks—but these meds can be highly effective.

If you have co-occurring disorders, the right medication can help you heal from more than 1 diagnosis. Research even suggests that SSRIs can help some people with OCD heal from addictions. ((Virtanen, S., Kuja-Halkola, R., Sidorchuk, A., Fernández de la Cruz, L., Rück, C., Lundström, S., Suvisaari, J., Larsson, H., Lichtenstein, P., Mataix-Cols, D., & Latvala, A. (2022). Association of obsessive-compulsive disorder and obsessive-compulsive symptoms with substance misuse in 2 longitudinal cohorts in sweden. JAMA Network Open, 5(6), e2214779. https://doi.org/10.1001/jamanetworkopen.2022.14779)) If you’d like to try taking medication for OCD, make sure to share your complete health history with your doctor. They may be able to help you heal from more than 1 diagnosis with a single form of treatment.

Transcranial Magnetic Stimulation (TMS)

TMS is an alternative, non-invasive treatment for OCD. ((Obsessive-compulsive disorder. (n.d.). National Institute of Mental Health (NIMH). Retrieved June 6, 2022, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd)) If other treatments haven’t worked for you, this might be an effective solution. During each session, your provider attaches an electromagnetic coil to your head. The coil produces a magnetic field that creates changes in targeted areas of the brain. Your doctor will tailor your treatment plan to meet your needs, but you can expect to attend these sessions for several weeks. It may take a number of treatments to see improvements in your OCD symptoms.

Fighting the Stigma of Mental Illness

OCD is often misunderstood. People who don’t have this condition often use the term casually. This can be invalidating and even stigmatizing. There’s a big difference between liking cleanliness and having OCD.

OCD is a serious diagnosis. ((Sharma, E., & Math, S. B. (2019). Course and outcome of obsessive–compulsive disorder. Indian Journal of Psychiatry, 61(Suppl 1), S43–S50. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_521_18)) In fact, it’s 1 of the top 10 causes of disability around the world. Obsessive-compulsive disorder consists of unwanted, uncontrollable, and recurring thoughts called “obsessions.” ((Obsessive-compulsive disorder. (n.d.). National Institute of Mental Health (NIMH). Retrieved June 6, 2022, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd)) These thoughts are often accompanied by repeated or ritualistic behaviors called “compulsions.” You may experience either 1 or both of these sets of symptoms.

Your symptoms may affect your daily life and give you a constant sense of stress or anxiety. Intrusive thoughts can be disturbing, especially if they include hostile or violent imagery. You may feel some relief when you act out a compulsive behavior. But unfortunately, your anxious feelings will most likely come creeping back soon after.

You may also experience motor tics as a symptom of OCD. These are abrupt, involuntary, repetitive movements. Some people may also experience vocal tics, or repeated sounds. Common motor and vocal tics include, but aren’t limited to, the following:

  • Eye blinking and other eye movements
  • Facial grimacing
  • Shoulder shrugging
  • Head or shoulder jerking
  • Throat-clearing
  • Sniffing
  • Grunting sounds

These characteristics of OCD are very different from just liking a clean space. Caring about cleanliness doesn’t mean you have unwanted thoughts and compulsive behaviors. OCD can also make you vulnerable to other mental health issues—including addiction.

The Link Between OCD and Drug Addiction

OCD and drug abuse ((Substance Abuse and Mental Health Services Administration. (2016). Obsessive-Compulsive Disorder and Substance Use Disorders. Advisory, Volume 15, Issue 3.)) often appear together. Their exact rate of co-occurrence is unknown, because OCD is so underreported. ((Brock, H., & Hany, M. (2022). Obsessive-compulsive disorder. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK553162/)) This may be partly due to the stigma around this condition.

But several studies have estimated the prevalence of addiction among people with OCD. In one, people with OCD ((Virtanen, S., Kuja-Halkola, R., Sidorchuk, A., Fernández de la Cruz, L., Rück, C., Lundström, S., Suvisaari, J., Larsson, H., Lichtenstein, P., Mataix-Cols, D., & Latvala, A. (2022). Association of obsessive-compulsive disorder and obsessive-compulsive symptoms with substance misuse in 2 longitudinal cohorts in sweden. JAMA Network Open, 5(6), e2214779. https://doi.org/10.1001/jamanetworkopen.2022.14779)) appeared almost 7 times more likely to have a drug-related disorder. Another study found that almost ⅓ of veterans with OCD also had a history of addiction. ((Ecker, A. H., Stanley, M. A., Smith, T. L., Teng, E. J., Fletcher, T. L., Van Kirk, N., Amspoker, A. B., Walder, A., McIngvale, E., & Lindsay, J. A. (2019). Co-occurrence of obsessive-compulsive disorder and substance use disorders among u. S. Veterans: Prevalence and mental health utilization. Journal of Cognitive Psychotherapy, 33(1), 23–32. https://doi.org/10.1891/0889-8391.33.1.23))

Why Are People With OCD Vulnerable to Addiction?

There are several theories that may explain why likelihood of addiction and OCD go hand in hand:

  • Doctors often prescribe sedatives to people with OCD, ((Virtanen, S., Kuja-Halkola, R., Sidorchuk, A., Fernández de la Cruz, L., Rück, C., Lundström, S., Suvisaari, J., Larsson, H., Lichtenstein, P., Mataix-Cols, D., & Latvala, A. (2022). Association of obsessive-compulsive disorder and obsessive-compulsive symptoms with substance misuse in 2 longitudinal cohorts in sweden. JAMA Network Open, 5(6), e2214779. https://doi.org/10.1001/jamanetworkopen.2022.14779)) which can eventually lead to misuse.
  • Some people may start taking drugs to cope with OCD symptoms. ((Substance Abuse and Mental Health Services Administration. (2016). Obsessive-Compulsive Disorder and Substance Use Disorders. Advisory, Volume 15, Issue 3.))
  • OCD and addiction ((Apa psycnet. (n.d.). Retrieved June 7, 2022, from https://psycnet.apa.org/record/2019-72315-006)) might affect the reward processing center in the brain.
  • Genetics may play a role in both OCD and addiction.
  • People with OCD tend to be more impulsive, which may make them more likely to try substances.

If you attend rehab for OCD, you can get assessed and treated for other issues while you’re there. This is hugely important for people who are also recovering from addiction. It can also be helpful for people with other diagnoses.

OCD and Other Co-Occurring Disorders

OCD also frequently co-occurs with other disorders ((Substance Abuse and Mental Health Services Administration. (2016). Obsessive-Compulsive Disorder and Substance Use Disorders. Advisory, Volume 15, Issue 3.))—not just addiction. Research suggests that at least 90% of people with OCD also have at least 1 other diagnosis.

OCD & Behavioral Addictions (BAs)

Behavioral addictions, like internet addiction, can co-occur with OCD. ((Rai, D., Jaisoorya, T. S., Narayanaswamy, J. C., Arumugham, S. S., & Janardhan Reddy, Y. C. (2022). Behavioural addictions in obsessive compulsive disorder – Prevalence and clinical correlates. Psychiatry Research Communications, 2(1), 100016. https://doi.org/10.1016/j.psycom.2021.100016)) A person with a behavioral addiction can’t stop what they’re doing, in spite of obvious negative impacts. Common BAs include internet, gambling, and sex addictions.

These conditions might even look similar to OCD. In either case, you may feel relief when you do a certain activity, even if it causes measurable harm. Both people with BAs and people with OCD show increased impulsivity. And in fact, experts believe this trait might make people with OCD more vulnerable to BAs.

OCD & Other Mental Health Conditions

Because OCD affects so many aspects of your life, it can put you at risk for other mental health conditions. ((Substance Abuse and Mental Health Services Administration. (2016). Obsessive-Compulsive Disorder and Substance Use Disorders. Advisory, Volume 15, Issue 3.)) You may isolate yourself or stop doing activities you used to enjoy. Being in public, where you can’t control the environment, might make you even more anxious. These are some of the most common mental health issues to occur alongside OCD:

Like any other diagnosis, the issues on this list can have many causes. However, if they develop because of your OCD, then they won’t heal unless you treat it. And when you’re ready to make that change, inpatient treatment can help.

Visit our searchable directory of rehab facilities that treat OCD to learn what types of therapy they offer, which other conditions they treat, and their pricing information.

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What to Do When Grief Becomes a Mental Health Issue

Grief is one of the most painful experiences you can go through. If you’re grieving a loss, it can be difficult to imagine moving on. It probably seems unfair. But remember to be gentle with yourself. Try to avoid judging your own feelings, no matter what they are. This kaleidoscope of emotions may range from sadness to anger to resentment, and more. But remember that all feelings are valid, and any feeling might be part of the grieving process.

It’s normal to miss what you’ve lost—whether that’s a person, a place, or just a period of time. But it’s also important to stop your grief from interfering with your needs, goals, and values. You can still honor a memory while living a happy and fulfilling life.

If you’re unable to move forward, you can actually attend rehab for grief. In treatment, you’ll learn to cope with your loss in a healthy way.

When Should You Seek Inpatient Grief Treatment?

Grief is difficult ((Mughal, S., Azhar, Y., Mahon, M. M., & Siddiqui, W. J. (2022). Grief reaction. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK507832/))—there’s no doubt about that. But there’s a difference between a more natural grieving process and one that requires treatment. To quote a study published by the National Library of Medicine, most people will experience these 5 stages of grief:

  • denial and Isolation
  • anger
  • bargaining
  • depression
  • acceptance

Everyone moves through these 5 stages at a different pace. But some people get stuck in them for a longer period of time. This is when “acute grief” turns to “complicated grief.”

Acute vs. Complicated Grief

Immediately after a loss, most people experience “acute grief.” ((Mughal, S., Azhar, Y., Mahon, M. M., & Siddiqui, W. J. (2022). Grief reaction. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK507832/)) During this phase, a person may feel overwhelmed by painful emotions related to their recent loss. After about 6-12 months, most people move on from “acute grief” to “integrated grief.” They may still be grieving, but they’re able to return to their daily lives.

You can also expect that some of your grief symptoms may return occasionally. This often happens around certain times of the year, such as the anniversary of the event. However, that doesn’t necessarily mean you need treatment.

But for about 7-10% of people, painful emotions and sadness persist for over a year after the loss. This is “complicated grief.” With this condition, you may be unable to stop thinking about your loved one, feel empty, have a disinterest in your own life, and find it difficult to sleep.

There are several other terms that describe complicated grief:

  • prolonged grief disorder
  • traumatic grief
  • pathological grief

It’s important to note that the effects of prolonged grief disorder aren’t just mental—they can be physical, too.

Physical Risks of Prolonged Grief Disorder

If you don’t learn to cope with your grief, ((Mughal, S., Azhar, Y., Mahon, M. M., & Siddiqui, W. J. (2022). Grief reaction. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK507832/)) the effects can be very serious. Your emotional distress can manifest into physical symptoms. You can even develop serious health conditions, such as the following:

  • heart attack, which can lead to complications or death
  • heart rhythm disorders (arrhythmias), in which the heart beats irregularly
  • Takosubo Cardiomyopathy, also known as broken heart syndrome, where the left ventricle of the heart becomes weak
  • physical pain, such as headaches, muscle tension, or chest tightness

If you experience any of these symptoms, you should get immediate medical care. However, if the cause is emotional, you might also require mental health treatment. Currently, the gold standard treatment for traumatic grief disorder is complicated grief therapy (CGT).

Complicated Grief Therapy (CGT)

CGT specifically treats prolonged grief disorder. ((Iglewicz, A., Shear, M. K., Reynolds, C. F., Simon, N., Lebowitz, B., & Zisook, S. (2020). Complicated grief therapy for clinicians: An evidence-based protocol for mental health practice. Depression and Anxiety, 37(1), 90–98. https://doi.org/10.1002/da.22965)) This is the most effective treatment we know of for this condition. CGT is designed to help you accept and cope with loss. And at the same time, your therapist will teach you to adapt to the next phase of your life.

What is CGT?

Complicated grief therapy ((Iglewicz, A., Shear, M. K., Reynolds, C. F., Simon, N., Lebowitz, B., & Zisook, S. (2020). Complicated grief therapy for clinicians: An evidence-based protocol for mental health practice. Depression and Anxiety, 37(1), 90–98. https://doi.org/10.1002/da.22965)) uses elements of cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).

CBT teaches patients to change their negative thoughts and behaviors to positive ones. And in IPT, patients use therapy to work on improving relationships and reconnecting to their goals.

CGT implements 7 themes ((Wetherell, J. L. (2012). Complicated grief therapy as a new treatment approach. Dialogues in Clinical Neuroscience, 14(2), 159–166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384444/)) that help patients learn to handle their grief:

  1. acceptance of grief
  2. emotion management
  3. considering your own future
  4. improving relationships
  5. telling the story of the original loss
  6. tolerating reminders and triggers
  7. connecting with memories

CGT integrates these ideas through various exercises, such as exposure interventions. In an exposure intervention, your therapist guides you through a triggered grief response. For instance, you might tell the story of a loved one’s death, and then talk through your emotional reaction. But unlike classic exposure therapy, this is only one aspect of treatment. In the same session, you’ll also work toward your aspirations for the future.

What Happens During CGT Sessions?

CGT consists of 16 sessions, ((Wetherell, J. L. (2012). Complicated grief therapy as a new treatment approach. Dialogues in Clinical Neuroscience, 14(2), 159–166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384444/)) each about 45-60 minutes long. The treatment is typically split into 3 phases. In the first 3 sessions (the introductory phase), you’ll describe your situation, and learn what you can expect from CGT. Your therapist will also introduce various exercises that you’ll complete in the future, such as the following:

  • The grief monitoring diary is a journal where you’ll list your daily experience of triggers. You’ll also describe any times when your grief felt more manageable.
  • During imaginal revisiting, you’ll spend about 5 minutes telling the therapist how you first learned about the loss.
  • In situational revisiting, you’ll take an inventory of activities or places you avoid because they remind you of your loss.
  • Aspirations work happens in session, with your therapist’s guidance. This is a time for you to discuss activities you enjoy and your goals for the future.

Often, a person close to you will come to your third session of CGT. From sessions 4 to 9 (the intermediate phase), you and your provider will work together on various activities to cope with the loss and re-establish joy in life. During session 10, you’ll discuss your progress. The therapist will ask for your input about how to structure the remaining 6 sessions.

From 11 to 16 (the final phase), you’ll continue to work on the exercises listed above. In the last few sessions, the therapist may lead you through imaginal conversation, in which you’ll act as both yourself and a person you’ve lost. This type of therapeutic roleplaying lets you ask questions, offer reassurance, and find closure.

Medication for Prolonged Grief Disorder

Doctors sometimes prescribe antidepressants to help patients with traumatic grief. ((Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). Prolonged grief disorder: Course, diagnosis, assessment, and treatment. Focus: Journal of Life Long Learning in Psychiatry, 19(2), 161–172. https://doi.org/10.1176/appi.focus.20200052)) Data suggests that medication works better with psychotherapy, especially CGT.

Because depression often co-occurs with complicated grief, antidepressants are a way of treating both conditions at once. But this is just one of many possible co-occurring disorders.

Co-Occurring Disorders Can Make Grief Difficult to Diagnose

The most common disorders to co-occur with complicated grief ((Ito, M., Nakajima, S., Fujisawa, D., Miyashita, M., Kim, Y., Shear, M. K., Ghesquiere, A., & Wall, M. M. (2012). Brief measure for screening complicated grief: Reliability and discriminant validity. PLoS ONE, 7(2), e31209. https://doi.org/10.1371/journal.pone.0031209)) are major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Both conditions have several symptoms that overlap with complicated grief. This can make it difficult to get the right diagnosis.

Major Depressive Disorder (MDD)

Both major depressive disorder and prolonged grief disorder can include the following symptoms:

  • sadness
  • a sense of isolation
  • difficulty sleeping
  • guilt

Although the symptoms are similar, there’s an important difference between these conditions. With MDD, the symptoms are general. They may or may not have a discernible cause. But with complicated grief, they’re directly related to the loss itself. For example, someone with traumatic grief may avoid places that remind them of their loss. Their symptoms have a specific external cause, and aren’t only due to brain chemistry.

Post-Traumatic Stress Disorder (PTSD)

In either PTSD or traumatic grief, ((Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). Prolonged grief disorder: Course, diagnosis, assessment, and treatment. Focus: Journal of Life Long Learning in Psychiatry, 19(2), 161–172. https://doi.org/10.1176/appi.focus.20200052)) you may experience unwanted thoughts, and a sense of numbness or dissociation.

But again, there’s a differentiating factor: with PTSD, fear is the core emotion. You could be avoiding situations because you’re afraid of them. But in complicated grief, the primary feelings are sadness and a yearning for what’s lost. For instance, you might stay away from places where you have good memories with someone who’s gone.

People with an anxiety disorder or an addiction are more likely to develop prolonged grief disorder. And if these conditions are present before the loss takes place, it can be even harder to process your grief.

Grief and Addiction

There is a link between the loss of a loved one, prolonged grief, and drug abuse. ((Caparrós, B., & Masferrer, L. (2021). Coping strategies and complicated grief in a substance use disorder sample. Frontiers in Psychology, 11, 624065. https://doi.org/10.3389/fpsyg.2020.624065)) In fact, addiction can make you more vulnerable to traumatic grief ((Parisi, A., Sharma, A., Howard, M. O., & Blank Wilson, A. (2019). The relationship between substance misuse and complicated grief: A systematic review. Journal of Substance Abuse Treatment, 103, 43–57. https://doi.org/10.1016/j.jsat.2019.05.012))—and vice versa. This is partly because using drugs and alcohol can seem to help you cope with the symptoms of grief. But substance use can also make it more difficult for you to properly process your emotions.

In one study, subjects increased their drug and alcohol use after a loss ((Drabwell, L., Eng, J., Stevenson, F., King, M., Osborn, D., & Pitman, A. (2020). Perceptions of the use of alcohol and drugs after sudden bereavement by unnatural causes: Analysis of online qualitative data. International Journal of Environmental Research and Public Health, 17(3), 677. https://doi.org/10.3390/ijerph17030677)) for several different reasons:

  • as a way of honoring the one they lost, especially if substance use reminded them of the person
  • to experience pleasure and escape reality, especially as a distraction that also helped them connect with peers
  • to live life to its fullest, and gain new life experiences
  • as a sleep aid when experiencing insomnia
  • to cope with difficult emotions, and open up to others about them

A number of people in the study lost control of their drug and alcohol use for a period of time after experiencing loss. For some subjects, this issue resolved itself over time. But others developed longer-term addictions. If this is your experience, you might consider going to rehab for both drug use and traumatic grief.

Find Joy in Life Again

You may feel guilty for moving on—it can feel like you’re erasing the past. But moving forward doesn’t mean forgetting what came before. You can honor what you’ve lost by living a life that you love.

During and after treatment, you can try new activities, and maybe even have fun. By fully engaging in the present, you can start looking ahead to what comes next. And you can find ways to carry your best memories with you, in every phase of recovery.

Healing is easier with expert support. Visit our directory of rehab centers that treat grief to read about available treatments, including medication, talk therapy, and complementary therapies.

Reviewed by Rajnandini Rathod

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Heal Your Relationships—and Yourself—in Family and Couples Therapy

Addiction doesn’t happen in a vacuum. A single person’s mental health issues can affect a whole community. And in particular, addiction can wreak havoc on family dynamics, undermining every person’s mental health. This is true for blood relatives, spouses, and chosen family members.

Many rehab programs offer family therapy to people in residential treatment. This process might focus on one person’s addiction, but it can benefit everyone who attends. This is a chance to improve your relationships, and for each person to work on their mental health.

What to Expect From a Family Therapy Session

If you go to family therapy through a rehab program, you’ll probably start by talking about addiction. You may discuss the impact of one person’s behavior, and why they started using drugs in the first place. But these conversations are only the beginning.

Family therapy is an opportunity for everyone to really hear each other, and also feel heard. Each person shares their own perspective, and talks about what’s happening in their own life. You are a part of your family, but also, your family is just one part of you. In these sessions, you can share things you might never have mentioned before. It can even feel like you’re getting to know your loved ones in a brand new way.

“Family” doesn’t have to refer to your biological relatives. ((Substance Abuse and Mental Health Services Administration. (2013). Family Therapy Can Help For People in Recovery For Mental Illness or Addiction. https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4784.pdf)) According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “‘Family’ means a group of two or more people with close and enduring emotional ties.” And in most programs, the patient can choose to invite chosen family to join them in therapy.

Your family will probably be able to get this treatment even if the person in treatment travels to rehab. Most programs offer both remote and in-person sessions.

The therapist will spend the first couple of meetings getting to know everyone in the room. After that, they’ll guide you through exercises designed to help your family work through interpersonal issues. ((Substance Abuse and Mental Health Services Administration. (2013). Family Therapy Can Help For People in Recovery For Mental Illness or Addiction. https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4784.pdf)) For instance, the therapist might ask you to spend a week taking note of the kind things your family members say. Or, they might ask a family member to practice saying “no.”

These activities can teach you to communicate more clearly. They can also help you break out of unhealthy behavioral patterns. And when you process them in your next session, you can build on what you’ve learned.

Types of Family and Couples Therapy

There are many different types of family therapy. If you have a strong preference for one of these options, you can look for a rehab program that offers it. You may also be able to find a private family therapist in your area.

Structural Therapy

The structural method of family therapy ((Jiménez, L., Hidalgo, V., Baena, S., León, A., & Lorence, B. (2019). Effectiveness of structural–strategic family therapy in the treatment of adolescents with mental health problems and their families. International Journal of Environmental Research and Public Health, 16(7), 1255. https://doi.org/10.3390/ijerph16071255)) emphasizes achieving a well-balanced family system. This technique focuses on establishing healthy boundaries between members based on that system. For instance, a parent-child relationship has different boundaries and expectations than one between spouses.

Structural therapy begins with the therapist observing the family’s interaction patterns. ((Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family interventions: Basic principles and techniques. Indian Journal of Psychiatry, 62(Suppl 2), S192–S200. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_770_19)) Once they understand the family dynamic, they’ll suggest changes. The goal is to help everyone build sustainable relationships, and to empower your family as a whole. To achieve this, therapists may combine techniques from structural and strategic family therapy.

Strategic Therapy

During strategic therapy, ((Jiménez, L., Hidalgo, V., Baena, S., León, A., & Lorence, B. (2019). Effectiveness of structural–strategic family therapy in the treatment of adolescents with mental health problems and their families. International Journal of Environmental Research and Public Health, 16(7), 1255. https://doi.org/10.3390/ijerph16071255)) families focus on healing the symptom of a structural problem. If a family member is in rehab, you’ll likely focus on addiction as a symptom of your family’s overarching issues.

Symptoms serve a purpose—that’s why they exist in the first place. For example, a person might develop an addiction to cope with loneliness after a divorce. Even when you fix the symptom, you’re left with its underlying cause. Without expert help, families often get stuck in a cycle. Structural-strategic therapists call this a “symptom-maintaining” sequence. And it can feel like you’re bailing out a ship with a leak.

In this type of treatment, the therapist will guide your family ((Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family interventions: Basic principles and techniques. Indian Journal of Psychiatry, 62(Suppl 2), S192–S200. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_770_19)) toward a more sustainable solution. They’ll suggest practical ways you can support each other, instead of telling you what not to do. This can help you take action, and make lasting changes.

Brief strategic family therapy (BSFT) ((Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief strategic family therapy: An intervention to reduce adolescent risk behavior. Couple & Family Psychology, 1(2), 134–145. https://doi.org/10.1037/a0029002)) is a shorter version of this treatment, lasting only 12 sessions. This method is specifically designed for families with young people in treatment. The goal is to change the dynamics that encourage younger family members to act out.

Therapy With Teens

Family involvement is extremely important for teens attending rehab. Data shows that family therapy can help youth with mental health issues ((Jiménez, L., Hidalgo, V., Baena, S., León, A., & Lorence, B. (2019). Effectiveness of structural–strategic family therapy in the treatment of adolescents with mental health problems and their families. International Journal of Environmental Research and Public Health, 16(7), 1255. https://doi.org/10.3390/ijerph16071255)) work through behavioral problems. And adults who attended sessions with their teens felt more competent as parents.

Paradigm Teen & Young Adults Treatment offers family therapy for teens and their loved ones. This rehab center involves parents in every step of the recovery process. Family members can attend sessions in person, although remote therapy is also available. Teens also see their own 1:1 therapist, who debriefs parents about their child’s progress.

This rehab center also encourages relatives to connect with their peers. You can connect with other families who have similar experiences in Multi-Family Group Therapy. This lets you connect with people who play the same role as you do, in their own family. You can share mutual support, and gain new insight into your own behavior.

Couples Therapy

In couples therapy, 2 people work on their relationship as a team. It can be eye-opening to discuss your issues with a neutral 3rd party. It can also help you start conversations you’ve been delaying. You’ll learn to communicate respectfully, even when you’re talking about painful things. Therapy can help you define your needs, as individuals and as partners. And once each of you knows what you need, you can look for healthy ways to support each other.

Couples therapy isn’t just for romantic partners. It can also help roommates, best friends, siblings, and more. But no matter how your relationship is structured when you start this treatment, it might soon look very different. If you can, let go of expecting any particular outcome. Therapy isn’t about forcing yourself or your loved ones to achieve a certain goal. Instead, it’s a way of helping each of you define and then start living your best lives.

The Benefits of Family Therapy

Stronger relationships aren’t the only benefit of family therapy. This treatment can also improve the mental health of family members as individuals. And when you’re doing well, you may be able to give your loved ones more time and energy. At its best, family therapy inspires an upward spiral, in which you support each other every step of the way.

Benefits for the Person in Addiction Recovery

Family therapy isn’t only for family members; it’s also helpful for the person in rehab. Your loved ones can provide you and your care team with a fresh perspective. They might even be able to share factual information that you don’t remember, or forgot to mention. And this process isn’t about blame. Your therapist might even shut down any attempts to shame you for your addiction. Instead, family therapy is a chance for you to get to the root of the issue.

Social support is vital during addiction recovery. ((Atadokht, A., Hajloo, N., Karimi, M., & Narimani, M. (2015). The role of family expressed emotion and perceived social support in predicting addiction relapse. International Journal of High Risk Behaviors & Addiction, 4(1), e21250. https://doi.org/10.5812/ijhrba.21250)) According to research, family therapy minimizes the risk of relapse. ((Substance Abuse and Mental Health Services Administration. (2013). Family Therapy Can Help For People in Recovery For Mental Illness or Addiction. https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4784.pdf)) It can also lower treatment dropout rates. There are a few factors at work here. First, family members who join you in therapy might commit to holding you accountable. Also, knowing you have their support might inspire you to stay focused on recovery.

Benefits for Family Members

If you love someone who has an addiction, you may also need to heal. Family therapy can support your recovery process, too. Treatment can help you understand your own unhealthy patterns. And once you do that, you can start to change them.

Those patterns might be directly related to your loved one’s addiction. For example, many spouses of people in recovery show signs of codependency. While this condition is born out of love, it can interfere with your mental health. If you identify this issue in yourself, you might want to consider getting 1:1 treatment.

Once your loved one enters recovery, you may feel a sense of relief. But rehab is the first step on a much longer journey. And while they continue to heal, it’s important for you to do the same.

Benefits of Ongoing Treatment—Even After Rehab

After residential treatment, it might be helpful to keep seeing a family therapist. In most cases, you’ll have to find a new provider who works outside the rehab program. And if you plan in advance, they can help ease the transition out of rehab.

There’s always an adjustment period when you enter a new phase of recovery. And moving to a new space is difficult even under the best of circumstances. If your family is living together after some apart, it’s all too easy to fall back into unhealthy patterns. Therapy can help everyone navigate this challenging time.

The Limitations of Family Therapy

Family therapy isn’t a good fit for everyone. It might be unhealthy to stay in touch with the people you knew before you started recovery. You might even choose to step away from your closest loved ones. And if someone you love goes to rehab, you might need space from them.

As hard as it can be to set these boundaries, it’s important for each of you to prioritize your own healing process. There are many valid reasons why it might be better not to engage in therapy with family members.

Trauma

If you’re healing from trauma caused by family members, you might need to set strong boundaries with them. That might even mean cutting off all contact. This is a big decision, but it doesn’t have to be a permanent one. If you’re considering this step, it’s best to talk to your therapist before taking action.

This can be a concern for people in rehab, family members, and other loved ones. No matter how much you care about someone, it’s okay to take space. Sometimes it’s even necessary. When you’re further along in your healing journey, you may be able to go back to these relationships. Or, you might find that you don’t want to.

Setting New Boundaries

When a person goes to rehab, it’s a great opportunity to step back from unhealthy relationships. If you’re entering recovery, you might stop talking to people who pressured you to take drugs. Or, you might take a break from a partnership with someone who enabled your addiction. Even people with good intentions can sometimes undermine your healing process.

Family members can set boundaries, too. That doesn’t mean you don’t care about the person in recovery. In fact, it’s often the exact opposite. You can use this time to think about your role in the person’s life, how their addiction affects your mental health. If you’re not in a good place, you can’t effectively support them either. Stepping back from the relationship can give you some much-needed perspective. And then, you can start thinking about what comes next.

Learning to Let Go

In family and couples therapy, each person starts to understand and communicate their own needs and boundaries. And ideally, you’ll all start working toward your personal goals. In time, every one of you can learn to thrive.

That being said, your goals won’t always align with those of your loved ones. You might even find that your values are incompatible. In some situations—as with parents and minors—you’ll need to meet in the middle. But sometimes, the best outcome is for you to part ways. In some cases, ending a relationship is a sign of successful family or couples therapy.

Separating can be an act of love. This is a way of giving each other the space you need to live your best lives. You’ll both be free to put energy into the relationships that fulfill you. Or, you can take some time to yourself while you focus on recovery.

Family Therapy Can Help You Move Forward

Exploring your relationships can help you understand yourself better. And that understanding is an essential part of recovery. Whether you’re in treatment, or you love someone with an addiction, family therapy can help you heal.

Browse our list of rehab centers with family therapy programs to learn more about support groups, housing options, and other types of therapy they offer.

Reviewed by Rajnandini Rathod

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Burnout is a Serious Mental Health Condition That May Require Rehab: Here’s Why

Burnout is more than exhaustion. This term gets tossed around a lot—so much that you might not realize it’s a serious mental health issue. People with burnout may feel exhausted and negative, for a longer time than usual.

Stress serves a purpose. In the short term, it keeps us safe from danger. It can also be motivating. But long-term stress leads to burnout, and burnout can damage your health. It can even cause physical side effects. Fortunately, burnout doesn’t have to be permanent. When you reach your limit—or even before then—you can ask for help. And you can even attend residential rehab for burnout.

What Is Burnout?

Burnout is a mental health issue caused by ongoing stress. People with burnout feel chronically tired, apathetic, and detached. Over time, those feelings can get in the way of living a healthy life.

Rates of burnout and stress are on the rise. The WHO now classifies burnout as an “occupational phenomenon.”1 In other words, burnout is a very serious concern, but not a disease. The results of a recent survey paint a clear picture:

  • 52% of respondents said they feel burned out.
  • 27% of all workers feel “unable to unplug from work.”
  • 31% are working “much more” than they were 2 years ago.

Signs and Symptoms

Burnout is so widespread, it’s becoming socially acceptable. Because of this, it can be hard to know when you have a serious problem. Experts define these key components of burnout:2

  • Chronic exhaustion can make it hard for you to complete daily tasks. If you have limited energy, you may focus on work over other things you enjoy. And doing that can increase your stress levels.
  • Apathy can be debilitating. If you feel like life is meaningless, it’s hard to take pride in what you do. And on a neurological level, apathy can lead to addiction.3
  • Feelings of incompetency or inadequacy get in the way of recovery. When you lose faith in yourself, it’s hard to approach a new challenge. But there is joy in this healing process. With the right treatment, you can learn to love your life again.

Scientists measure these feelings with the Maslach Burnout Inventory (MBI).4 This scale was first developed by psychologist Christina Maslach in 1981. And while the MBI focuses on work-related burnout,5 that’s not the whole picture. “Sometimes the problem of work overload turns out not to be the most important,” Maslach said in an interview with the New York Times. Familial or financial issues can be equally stressful.

Causes of Burnout

Burnout is associated with stress.6 The term usually refers to job-related stress, but not always. More than most other mental health conditions, burnout is a behavioral issue. That doesn’t mean it’s your fault. But it does mean that you can recover by changing your daily habits.

In modern-day “hustle culture,” the pressure to work harder can be overwhelming. And even if you love what you do, working too much can drain the joy right out of your life. But there’s a bright side—burnout doesn’t have to be permanent. With the right treatment, you can find a healthy balance.

Treatment for Burnout Means More Than Therapy

Burnout is a complex condition7 that can affect all areas of your life. To get to the root of the issue, you may need to combine a few treatment methods. In rehab, you can start to restructure your life in a healthy way. Your providers may teach you some of the following strategies.

Mindfulness-Based Stress Reduction (MBSR)

In MBSR, patients use mindfulness techniques to manage stress.8 Mindfulness involves purposeful and nonjudgmental focus on the present moment. In this practice, you might meditate, do yoga, or do focused breathing exercises.

Studies show that mindfulness can treat burnout and improve emotion regulation.9 These practices are a core value in many holistic rehab programs. You can also learn these strategies in several types of therapy. Dialectical behavioral therapy (DBT) and mindfulness-based cognitive therapy (MBCT) both teach these techniques.

Physical Health Habits

There may be a link between burnout and diet.10 One study found that people with better nutrition were less likely to show signs of burnout. This research is still in its very early stages, but you don’t have to wait to improve your eating habits.

Getting good sleep, exercising, and eating well reduces exhaustion. This lowers your stress levels, and fights the effects of burnout.11 Improving your physical health can also build confidence. And that confidence can empower you to make lasting changes.

Social Support During Recovery

If you have a strong community, you’re less likely to burn out. That’s because people with more social support are better at handling stress.12

This is an emotional issue, but it’s also a chemical one. Neurotransmitters play a role in decreasing stress. When you’re around trusted friends and family, your brain releases oxytocin. This hormone has a calming effect. These relationships are crucial for your ongoing mental health.

Healthy socializing can also help you change your behavior. Preliminary research has linked peer accountability with better mental health outcomes.13 One study even linked social support with “gainful employment, housing, and psychiatric stability.”

Changing Work Habits

Restructuring your work habits is one way to lessen burnout symptoms.14 Note that this is a behavioral strategy, more than it is a mental health treatment. Even so, it can make a huge difference.

If you can change your schedule, that’s a great place to start. Research shows that working fewer hours can boost job satisfaction. Of course, not everyone can afford to take time off. But you can still make big changes. And you have the legal right to alter your work habits for the sake of your mental health.15

In the U.S., workers are protected by the Equal Employment Opportunity Commission (EEOC). Under their regulations, you have “a legal right to get reasonable accommodations.” For example, you can change your break schedule, get written feedback from your boss, or ask to work from home.

Companies are not required to employ someone who can’t actually do their work. If you can’t lift 50 pounds, you might lose your job at a warehouse. But you can likely ask for time off for recovery. And you don’t have to tell your boss the details. The EEOC recommends saying “that you need a change at work because of a medical condition.”

The Long-Term Effects of Chronic Stress

If you don’t find ways to mitigate stress, burnout will undermine your physical and mental health.16

Physical Health

Burnout often follows a cyclical pattern. It leads to an unhealthy lifestyle, and an unhealthy lifestyle worsens burnout. These are some of the physical effects associated with that spiral:

  • Headaches
  • Fatigue
  • Gastrointestinal issues
  • Muscle tension
  • High blood pressure
  • Sleep issues

These symptoms can be very severe. In one 10-year study, burnout predicted industrial workers’ hospital visits. And chronic physical ailments can damage your mental health.17

Mental Health

Burnout can cause long-term mental health issues.18 For example, burnout is commonly associated with depression. According to one study, the two issues can come in cycles. When this happens, a depressive episode predicts burnout, and vice versa. Despite this connection, burnout and depression have very different causes. Specifically, “burnout is job-related and situation-specific,” while depression is “context-free.” The two should be treated as two separate issues, with a complex interplay.

Burnout is also related to higher levels of anxiety.19 Data shows that high anxiety increases emotional exhaustion, which is a primary symptom of burnout. This suggests that burnout and anxiety may have a reciprocal relationship, much like depression and burnout. Anxiety causes burnout, and in turn, burnout causes more anxiety.

The Relationship Between Stress & Addiction

Stress increases your risk of addiction.20 And if you’re already burned out, and looking for ways to cope, drug use might be tempting.

There’s a clear neurological reason for this. Both excessive stress and drug abuse can damage the brain’s reward system.21 This makes it hard to feel a sense of achievement. And drug use can seem like a simple way to change that.

Like burnout, addiction is a vicious cycle. Maybe you’re working harder and harder to try and finish your to-do list. Or maybe you’re taking drugs to try and feel better, and then feeling worse instead. In either case, you can only break free by changing your behavior. For many people, inpatient rehab is the best place to start that process.

Healing From Burnout on Your Own Terms

By definition, burnout is overwhelming. And the idea of recovery might feel like yet another burden. But healing can be joyful. With the right treatment, you can learn how to live a fulfilling and sustainable life.

After chronic stress, rehab can be a welcome respite. Break free of this stressful cycle by connecting with a treatment center. Visit our directory of burnout recovery programs to learn about their amenities, specialties, available types of treatment, and more.

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How Rehab Can Help You Learn to Manage Chronic Pain

Chronic pain can be as emotionally debilitating as it is physically. It can be frustrating to miss out on activities and events you normally love, and daily life can feel downright exhausting. Loved ones may not understand, and the loss of that social support can be draining.

However, you can find help. There are plenty of rehab centers that offer support for managing chronic pain.

Psychological Aspects of Chronic Pain

According to the Substance Abuse and Mental Health Services Administration, or SAMSHA, chronic pain is “persistent pain that may or may not have a known etiology.” ((Substance Abuse and Mental Health Services Administration. Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12-4671. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011)) That is, you may or may not know where your pain came from, but it’s not going away on its own.

This condition doesn’t just affect your physical health–it can affect your mental health, too. There are 3 different psychological aspects that people with chronic pain may experience ((Sturgeon, J. A. (2014). Psychological therapies for the management of chronic pain. Psychology Research and Behavior Management, 7, 115–124. https://doi.org/10.2147/PRBM.S44762)) that can either worsen or improve your mental state: pain catastrophizing, pain-related fear, and pain acceptance.

Pain Catastrophizing

Pain catastrophizing is a negative view of the actual or expected pain experience. You may magnify the negative effects of pain, encounter obsessive thoughts, and feel helpless in your ability to cope. Increased rates of depression, anxiety, and lower quality of life are all associated with pain catastrophizing. People who experience this report feeling a loss of control over their pain, worse emotional and social functioning, and a lower likelihood of responding positively to medical interventions. Research suggests that changing catastrophic thoughts about pain helps improve overall well-being and the likelihood of returning to work despite the pain.

Pain-Related Fear

You may also experience a fear of pain. This can include fear around a new injury or the worsening of your current condition. People with a fear of pain report higher pain intensity and may avoid any behaviors that can lead to more pain, even if they’re necessary in improving the person’s condition (for example, exercises prescribed by a physical therapist).

Pain Acceptance

In this process, patients learn to be nonjudgmental about their pain, to stop detrimental efforts to control their pain, and to live a happy and fulfilling life, regardless of their pain. This can help improve emotional functioning in 2 different aspects:

  • willingness to experience pain, which prevents negative emotional reactions to pain
  • continuing to do enjoyable activities despite pain, which helps increase positive feelings

Together, these 2 aspects can help decrease pain catastrophizing and increase positive well being, which minimizes the connection between pain intensity and negative emotions. Patients learn to cope with their pain, and no longer let it control their lives. This can be incredibly empowering, and is a vital part of any recovery plan.

Treatment Options

Chronic pain is no small problem. According to data gathered from the National Health Interview Survey, researchers estimate that over 50 million adults experience chronic pain. ((Yong, R. J., Mullins, P. M., & Bhattacharyya, N. (2022). Prevalence of chronic pain among adults in the United States. PAIN: The Journal of the International Association for the Study of Pain, 163(2), e328–e332. https://doi.org/10.1097/j.pain.0000000000002291)) More than 1 in 5, or about 20.5% of adults living in the United States, reported feeling pain on most days or every day.

While you may already be familiar with treatment options for the physical effects of chronic pain, it’s helpful to know that there’s also treatment available for its mental effects. Chronic pain may contribute to other mental health conditions, like depression or anxiety. But fortunately, these are all highly treatable.

Here are a few therapies that are commonly used in chronic pain management:

In Vivo Exposure Treatment

This treatment helps people dealing with pain-related fear. ((Sturgeon, J. A. (2014). Psychological therapies for the management of chronic pain. Psychology Research and Behavior Management, 7, 115–124. https://doi.org/10.2147/PRBM.S44762)) It’s based on the belief that chronic pain sufferers avoid pain to such a degree that they stop doing things that are, in fact, helpful. They may even avoid behaviors that don’t actually harm them but they’re afraid will, such as physical activity. In vivo exposure therapy aims to expose the patient to perceived “painful” activities to show them that they’re not actually as painful as they imagined. Research shows that this treatment helps reduce pain catastrophizing, depression, and anxiety in patients with pain-related fear.

Cognitive Behavioral Therapy (CBT) for Pain

CBT is a psychotherapy that focuses on changing negative thought patterns and behaviors. CBT can help people with chronic pain ((Sturgeon, J. A. (2014). Psychological therapies for the management of chronic pain. Psychology Research and Behavior Management, 7, 115–124. https://doi.org/10.2147/PRBM.S44762)) develop coping skills. Techniques therapists may teach include structured relaxation, simple ways to modify behavior that can reduce the number and length of pain flares, and assertive communication. In addition, CBT can help people identify negative thoughts about pain and change them to positive ones that promote healthy functioning.

According to research, CBT “shows effects on pain and functioning comparable to standard medical care for pain.” CBT is especially helpful in helping patients overcome pain catastrophizing.

Mindfulness-Based Stress Reduction (Mbsr)

Mbsr teaches you to manage chronic pain ((Sturgeon, J. A. (2014). Psychological therapies for the management of chronic pain. Psychology Research and Behavior Management, 7, 115–124. https://doi.org/10.2147/PRBM.S44762)) by using mindfulness meditation to separate the sensory feelings of pain from its emotional aspects. Like CBT, this method teaches you to reframe your thoughts around pain. You’ll also learn to become more aware of bodily sensations and to accept your current situation, whatever it may be.

Some meditation sessions can help participants learn not to catastrophize pain through exposure therapy. In these sessions, patients experience painful sensations, but without catastrophic consequences. This can help you increase your ability to tolerate negative emotions so you can have a better response to pain. Mbsr can also help with co-occurring conditions like depression and anxiety.

Acceptance & Commitment Therapy (ACT)

ACT teaches patients to respond non-judgmentally to negative or intrusive thoughts surrounding chronic pain, ((Sturgeon, J. A. (2014). Psychological therapies for the management of chronic pain. Psychology Research and Behavior Management, 7, 115–124. https://doi.org/10.2147/PRBM.S44762)) rather than changing the negative thoughts themselves. In ACT, patients learn to acknowledge thoughts and emotions without judgment, and to accept them. They learn to focus on adjusting their behavior, as opposed to figuring out how to minimize thoughts around pain and reducing the pain itself.

Why Attend Rehab for Chronic Pain?

People with chronic pain are more likely to have other co-occurring disorders, such as depression, anxiety, and post-traumatic stress disorder (PTSD). It can be extremely beneficial to have a team of experts all working together to treat all of your mental and physical conditions at once, especially if you do have another condition. For example, several studies show that treatment for chronic pain is less effective if the patient also has depression. ((Substance Abuse and Mental Health Services Administration. Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12-4671. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011)) Addressing all of your conditions means you can heal fully.

Having a team of treatment professionals who are in contact with each other means you won’t need to re-explain your issues in every session. Instead, you can focus on healing while your primary therapist tracks and adjusts your treatment plan.

Community is also important to recovery. While pain may make you feel isolated from loved ones, being around people with similar experiences can help you feel less alone. This social support allows you to help each other heal, and create new relationships with people who understand your reality.

Chronic Pain and Substance Use Disorders

Because of the emotional distress it causes, chronic pain can contribute to (or even cause) substance use disorders ((Abuse, N. I. on D. (–). Part 2: Co-occurring substance use disorder and physical comorbidities. National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-2-co-occurring-substance-use-disorder-physical-comorbidities)) (SUDs). Opioid addiction, in particular, is the most common of these. About 10% of people with chronic pain misuse opioids, and this may be due to changes in the brain that arise from chronic pain and the constant stress that comes with it.

Fortunately, there are many options for managing chronic pain without the use of opioids. ((CDC. (2021, June 11). Safely and effectively managing pain without opioids. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/featured-topics/pain-management.html)) These include over-the-counter pain medications (like ibuprofen), physical therapy, and alternative therapies like acupuncture or massage. If you’ve been using prescription opioids to manage chronic pain, your doctor or other qualified professional (including your treatment team in rehab) can help you explore alternative options.

Finding Happiness While Living With Pain

While chronic pain is no doubt difficult to deal with, you can get help for all of your symptoms—both physical and emotional. And if you decide to attend rehab, you can work on these issues at the same time and place, and learn to manage your pain in a way that feels healthy for you.

Find the support you need today—visit our directory of pain management rehabs to see program details, read reviews, take a virtual tour, and more.

Reviewed by Rajnandini Rathod

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Finding Addiction Treatment as a Neurodivergent Person

Everyone’s brain is unique. If you’re a neurodivergent person, you might be acutely aware of that. Fortunately, addiction recovery isn’t one-size-fits-all. You can find a rehab program designed to accommodate your needs.

Choosing the best rehab option for you can feel complicated for lots of reasons. For example, your sensory or communication needs might be unique. You might also remember bad experiences with past doctors, who didn’t have the expertise to help you. These issues can make it hard to trust that you’ll get the care you need in rehab.

Certain markers can show whether a facility is qualified to treat your concerns. These key points can help you find a rehab program that affirms neurodiversity.

What Is Neurodiversity?

History of the Neurodiversity Movement

The term “neurodiversity”1 is attributed to Judy Singer, an autistic social scientist. Some people also credit autistic advocate Jim Sinclair’s 1993 speech “Don’t Mourn for Us.”2 This piece addressed neurotypical people who viewed Autism as a “traumatic” event.

Accepted Terminology

Researcher and advocate Nick Walker argues against pathologizing neurodiversity.3

This “diversity of brains and minds,” she says, “is a natural, healthy, and valuable form of human diversity.

There are a few similar and related terms in common usage today:

  • Neurodiverse: A neurodiverse group includes people whose brains function in different ways.
  • Neurodivergent: If someone’s brain works differently from the societal standard, they are neurodivergent.
  • Neurotypical: A neurotypical person’s brain functions in a way that matches societal standards.

There is no positive or negative value to being neurodivergent or neurotypical. These are just varieties of what it means to be human.

Neurodiversity Is Not a Medical Model

A neurodiversity perspective is different from the traditional medical model. Differences are celebrated, not stigmatized. Instead of symptoms, we can talk about traits. There are some common traits of being neurodivergent,4 including the following examples:

  • Bottom-up thinking: Neurodivergent people process the world in a systematic way. They analyze details and look for patterns. This can make it hard to adjust to sudden changes.
  • Emotional regulation and sensory sensitivities: As a neurodivergent person, you might be highly aware of sensory input.5 And when you get overwhelmed, you may experience meltdowns6 or shutdowns.
  • Executive functioning:7 This term refers to your ability to plan, start, and complete tasks. Neurodivergent people may do this less quickly or simply than neurotypical people.
  • Experience of time: Marta Rose, neurodiversity advocate and creator of Divergent Design Studios, explains that neurodivergent people experience time differently8 than neurotypical people do. “We don’t identify a goal and move toward it in a linear, efficient, straightforward manner, free of distraction and passion,” Rose writes. “Our minds are all about connection.”
  • Communication needs: Some people struggle with auditory processing.9 You might ask people to repeat themselves, or turn on captions during movies. You may also need to communicate in a specific way,10 like writing or using an augmentative and alternative communication (AAC) device.
  • Deep and passionate interests: You may have one or more topics or activities that bring you great joy. Spending time on special interests promotes well-being11 for autistic people.

Each person’s experience of neurodivergence is unique. You may have some of these traits, all of them, or different ones. In any case, you probably navigate the world differently than neurotypical people. That’s not a problem. And you can get help during recovery without trying to “fix” the traits that make you who you are.

The Prevalence of Neurodivergence

Neurodivergence can encompass neurological differences, developmental differences, intellectual differences, and mental differences. Experts estimate that 15-20% of people are neurodivergent12 in some way. Neurodiversity is underidentified in several populations. These include women, transgender and non-binary people,13 and Black, Indigenous, People of Color (BIPOC).14

How do you know if you are neurodivergent? Here are some identities, conditions, diagnoses, and neurotypes under the neurodiversity umbrella:

Everyone experiences their neurodivergence differently. Even if 2 people use the same term to describe themselves, they may mean different things. You can identify as neurodivergent whether you’ve gotten a formal diagnosis or not.

There are many co-occurring types of neurodiversity. For example, it’s common for one person to have both autism and ADHD.15 Also, as much as 17% of autistic people may have OCD.16 And according to one study, “an even larger proportion of people with OCD” may also have autism.

Is Neurodivergence a Risk Factor for Addiction?

Neurodiversity may increase the risk of addiction. One study found that autistic people with average or above-average IQs were more than twice as likely to develop addictions.17 The risk is even higher for people who are also ADHD. But neither autism or ADHD causes addiction. And no matter what your diagnosis, treatment can help.

If you are neurodivergent, you may encounter more stressors than most neurotypical people. These stressors can affect your mental health. They may even make you more vulnerable to addiction.

Environmental and Systemic Barriers

Neurodivergent people experience many barriers that can increase the risk of substance misuse. Doctors, mental health providers, educators, and other authority figures may underestimate your capabilities. Perhaps because of this, neurodivergent people have lower employment levels18 than neurotypical people.

Trauma History

A history of trauma can be a major risk factor in the development of a substance use disorder. This is especially for neurodivergent people with more than one marginalized identity. People who experience systematic oppression may be more vulnerable to traumatic events.

Trauma history can also include relational traumas,19 like bullying and disconnection from caregivers. Many neurotypical parents don’t know how to meet their neurodivergent children’s needs. Even if your parents had good intentions, you might have experienced childhood trauma.

Masking and Social Disconnection

Surrounded by enforced neurotypical norms, many neurodivergent people develop masking behaviors.20 Masking is an adaptive response, in which people learn to hide neurodivergent characteristics. By appearing neurotypical, you may feel safer or get less negative feedback. For example, you might force yourself to make eye contact even when it feels painful. If you use these coping strategies often, you may or may not even realize that you’re masking. People with many forms of neurodivergence often show masking.21 This can be an especially important issue for people who are autistic or ADHD.

A neurodivergent person might use these strategies to cope with certain social situations. For example, you may copy other people’s body language and facial expressions. You might also base your behavior off of social cues you learned from movies and books.

Finally, you might use assimilation strategies as a way to fit in with others. For example, you might force yourself to interact with others even when you feel burned out. On the other hand, you might avoid social settings completely.

Sensory Differences

Many neurodivergent people are easily distressed by both over- and under-stimulation. Either can lead to meltdowns, shutdowns, and unhealthy coping strategies—like drug use. And once you start taking drugs, you might be especially vulnerable to addiction.

Some neurodivergent people have an especially high sensitivity to substances. You may also be less aware of their effects. This is because some neurodivergent people have differences in interoception22 (body awareness).

These factors can combine to make addiction a common challenge among neurodivergent people. Jesse Meadows describes their experience of alcohol use and neurodivergence:23

As a teenager, I could not deal with the school day sober, but despite being under some kind of influence on a daily basis, I also managed to get through it with average grades. In college, I drank heavily (among other substances), worked a job, took a full course load, and still somehow managed to make the Dean’s List every semester…I didn’t consider that I was autistic because of alcohol, and I didn’t consider that I was an alcoholic because alcohol was not hindering my functioning—in many ways it was facilitating it. This is called ‘self-medication,’ and it’s something most people do with alcohol to some degree, although it seems to be somewhat different for autistic people.

The Experience of Neurodiversity and Addiction

Many people develop addictions because it feels like drug use helps them socialize. This is true for both neurodivergent and neurotypical people. Drugs like ecstasy (MDMA) can also increase feelings of emotional connection.

In the right context, medication can be extremely helpful for people with neurodivergence. One study demonstrated that MDMA-assisted therapy can decrease social anxiety24 in autistic adults. Some neurodivergent people use substances,25 including alcohol, to achieve these effects:

  • Dulled sensory sensitivities, and relief from sensory overwhelm
  • Courage in intimidating social situations
  • Relaxed inhibitions
  • Increased energy to get through a demanding world
  • Sensory stimulation
  • Entertainment for an anxious or preoccupied mind
  • Silencing the inner critic

There is a significant overlap between addiction and neurodivergence. Because of this, it’s important to find a rehab that can provide affirming care. Certain indicators can tell you whether a program is a good fit for you.

Signs of a Neurodiversity-Affirming Treatment Center

At a neurodiversity-affirming rehab, providers will advocate for you. The staff will listen to you, and accommodate as many of your needs as they can. For example, you might be able to adjust your room’s lighting so it’s not too bright or overstimulating. You should also be able to give feedback about the type of treatment you receive.

Physical Environment

Many neurodivergent people are very attuned to their surroundings. To be accessible, the physical space of a treatment center should take this into account.26 For example, rehab centers can offer some of these amenities:

  • Soft or natural lighting
  • Lighting accommodations (such as sunglasses)
  • A quiet space with gentle white noise (such as a fan, white noise machine, or gentle music)
  • A variety of sound accommodations (such as earplugs or headphones in several materials)
  • A clean space with no strong or overpowering scents
  • A variety of seating options, including different sizes, shapes, and textures
  • A comfortable temperature, and ways to make adjust it (such as small fans and space heaters)
  • Blankets and sensory items (hand fidget toys, rings, chewy necklaces, etc.)

Treatment Program Format

You’ll feel most at ease and supported at a rehab with programming designed to be affirming. You’ll also be able to engage in treatment more fully and benefit as much as possible.

Here are some important aspects to look for in a neurodiversity-affirming treatment program:27

  • Therapy goals center on your needs and your values.
  • Support animals are welcome in the space.
  • You can see an overview of what processes look like from intake to end of the program. This should tell you what to expect at each stage, and what you should bring with you or how to prepare.
  • The team asks how you communicate best (ex. speech, text or writing based, or symbolic or graphic), and invites you to communicate in that way.
    You have the freedom to stand, change your position, or leave to take breaks during sessions.
  • Therapists are willing to slow down or pause to make sure you have enough time to process.
  • You have the option to meditate and do deep breathing exercises.
  • You can use a consistent structure and session agenda, if you find that helpful.
  • Providers regularly check in about your comfort with pacing and speed of sessions.
  • You can access printed or recorded copies of any homework assigned between sessions.

When you’re first starting recovery, these adjustments can make all the difference. Remember that, as you select a rehab program, you have the right to ask for what you need. That may include certain approaches to treatment, types of therapy, or other resources.

Selecting a Treatment Approach as a Neurodivergent Person

There’s a great deal of variation under the umbrella of neurodiversity. Even within a single neurotype, certain therapies may be a good fit for some people, and not for others. In rehab, you’ll work with a team of providers to find the treatments that work best for you.

Occupational Therapy

During addiction recovery, a focus on sensory needs is key. This helps neurodivergent people practice self-regulation through healthy coping strategies.28 Jesse Meadows shares their thoughts on what has worked for them:

What’s really helped me need less alcohol are sensory-based techniques — designing a ‘sensory diet‘29 for myself, understanding what triggers and what soothes, and setting up my life in a way that accommodates my needs.

For example, Meadows limits the time they spend masking. This helps them navigate triggers and cravings.

Community-Based Group Therapy

During recovery, you can work against shame by connecting with other neurodivergent people.30 This is a crucial part of healing. In these community spaces, you can learn to unmask in a way that makes sense for you. It can be helpful to do this around people who share some part of your experience.

Devon Price, an autistic social psychologist and the author of Unmasking Autism: Discovering the New Faces of Neurodiversity,31 dreams of how these relationships can change the world:

I want autistic people to experience less shame about who they are, and to learn to take off the restrictive masks that have trapped us for decades. The first step to unmasking is accepting who you are, and finding others with similar experiences. You don’t need a piece of paper from an assessor to begin to do that.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR)32 can help you reconnect with your body. Sessions can decrease the intensity of your physical response to triggers. This approach is especially helpful for people with a history of trauma.

Less Effective Treatments

Cognitive behavioral therapy (CBT) can be highly effective—for neurotypical patients. But, data shows that CBT can be far less effective for autistic people.33 When providers are first taught how to communicate with autistic people, the CBT they offered is more likely to help with addiction recovery.

Most importantly, any program that requires you to mask or work toward neurotypical goals that you don’t value will not be a good fit. The important thing is to find a rehab whose values align with your own. In an affirming environment, you’ll get support from providers who view you as the expert in your own needs.

Embrace Healing as a Neurodivergent Person

In this neurotypical world, many things aren’t set up in a way that works for neurodivergent people. Because of this, you might not trust healthcare providers to understand what you need. And that can make the idea of getting help feel stressful and confusing.

The right rehab program won’t ask you to change to fit in. Instead, your team should be sensitive to your needs, and willing to support you in any way they can.

When you’re ready to start addiction recovery, you have the right to accessible, affirming treatment. Connect with a rehab that specializes in neurodiversity to get your questions answered.

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Treatment–And Hope–for People With Co-Occurring Disorders

Addiction doesn’t happen in a vacuum. For some people, drug abuse is related to another mental health diagnosis. If you have a co-occurring disorder, you may need specialized care during rehab.

Pre-existing mental health conditions can make addiction more likely. And, some addictions can also cause emotional problems. If either of these applies to you, it’s important to find highly specialized care. Even if a rehab treats both your conditions separately, they may not be qualified to help you heal from both at once.

Because of this, it’s very important for you to find a rehab facility that specializes in treating co-occurring disorders.

Do You Have an Underlying Mental Health Condition?

You may have more than one condition and not even know it. Many people turn to drug use to self-medicate their underlying mental health issues. And what’s more, the symptoms of drug abuse can mimic those of other conditions. This can make it hard to diagnose and treat substance abuse co-occurring mental illness. ((Myrick, H., Cluver, J., Swavely, S., & Peters, H. (2004). Diagnosis and treatment of co-occurring affective disorders and substance use disorders. The Psychiatric Clinics of North America, 27(4), 649–659. https://doi.org/10.1016/j.psc.2004.06.003)) Fortunately, once you have the right diagnosis, both addiction and mental health issues are highly treatable.

Experts estimate that about 50% of people with an addiction have a co-occurring disorder. ((Substance use and co-occurring mental disorders. (n.d.). National Institute of Mental Health (NIMH). Retrieved from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health)) If you think you might be 1 of those 50%, there are some signs to watch out for. According to the team at White Manor River, some common signs of dual diagnosis include the following:

  • withdrawing from relationships
  • sudden behavioral changes, including erratic or risky behavior, and changes to sleep and appetite
  • feelings of confusion, hopelessness, despair
  • anxiety that is only relieved by ritualistic behavior
  • trouble at work
  • mood swings and emotional dysregulation
  • coping with any of the above symptoms by taking drugs

If you notice these signs, you should get a formal assessment from an addiction or mental health expert. They’ll be able to guide you toward the right type of treatment.

How Mental Health Affects Addiction—And Vice Versa

Many people with mental health issues take drugs to self-medicate. While that can make you feel better in the short-term, it only makes your condition worse over time. This creates a vicious cycle. You might take drugs to control symptoms, and then feel worse, leading right back to drug use. Without professional support, it can be very hard to break free of this pattern.

What’s more, long-term drug use can change your brain chemistry. ((Abuse, N. I. on D. (2020, August 20). Commonly used drugs charts. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/commonly-used-drugs-charts)) No matter why your addiction started, you can develop mental health issues because of this behavior. Substance abuse can interfere with every part of your life, including your relationships, career, and physical health. Co-occurring disorders can make those effects even worse. They also make it harder to seek treatment.

Recovering from your co-occurring disorder ((Chance, K. (2020, September 9). Kara anne. Faces & Voices of Recovery. https://facesandvoicesofrecovery.org/story/kara/)) might be complex, but it’s not impossible. Kara Anne’s story is proof of that. “Major depressive disorder became my dark cloud reality around 6th grade,” she says. “To an outside observer, my life seemed more than fine; if only they were right.”

In college, Kara Anne found alcohol. “Drinking at the pubs became my established norm,” she says. She spent the next several years going in and out rehab, caught in a cycle of recovery and relapse. Finally, “recognizing that treatment of each disease separately was not showing success,” she tried dual diagnosis treatment.

With the right kind of support, Kara Anne found relief. “Finally, I have found freedom, peace, gratitude, acceptance, purpose, introspection, and self-awareness. My recovery is my new beginning.”

There are countless stories like Kara Anne’s. And there are plenty of different treatments to help you write your own recovery story.

Starting Recovery From a Dual Diagnosis

People with co-occurring disorders usually need specialized care. It’s also possible to have more than just 2 diagnoses. The more conditions you have, the more complex your treatment will need to be. And your treatment plan may change over time, especially if you undergo medical detox. This is because your emotional state will likely change after you stabilize your brain chemistry.

Remember that you’re a whole person, and so much more than your symptoms. Treatment for co-occurring disorders honors not only the complexity of your diagnoses, but the complexity of your needs for long-term recovery.

Talk Therapy

Almost any rehab experience includes 1:1 talk therapy. In these private sessions, you’ll build a close relationship with your provider. They’ll help you understand your emotions, work through triggers, and set goals for recovery. Over time, you can also process the feelings that come up during other types of therapy.

This treatment is often the cornerstone of residential treatment. Your therapist may even design your overarching plan of care.

Behavioral Therapies

Behavioral therapies can be used to treat co-occurring addiction and mental health disorders. ((Substance use and co-occurring mental disorders. (n.d.). National Institute of Mental Health (NIMH). Retrieved from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health)) Once in rehab, a team of specialists will evaluate you, and help you determine the best form of treatment. The list below is an example of some psychotherapies that are commonly used to treat people with a dual diagnosis. However, the experts at your rehab center will ultimately help you choose the most effective therapies for your unique needs.

  • Dialectical behavior therapy (DBT): Participants learn mindfulness strategies to help them regulate difficult emotions. You’ll also practice tolerating triggers, and building healthy relationships.
  • Contingency management (CM): Patients get rewards for healthy behaviors, like testing negative for drug use.
  • Cognitive behavioral therapy (CBT): This form of talk therapy helps you work through negative beliefs, thoughts, and behaviors.
  • Assertive community treatment (ACT): This program offers personalized mental health services to people in their own homes or communities.
  • Family therapy: Involving the entire family can be beneficial for recovery. Family members learn how to best support the person with an addiction. They also work through their own issues, learning how to build stronger relationships.

Medications That Can Treat Dual Diagnoses

In some cases, people with co-occurring disorders benefit from medication. ((Murthy, P., Mahadevan, J., & Chand, P. K. (2019). Treatment of substance use disorders with co-occurring severe mental health disorders. Current Opinion in Psychiatry, 32(4), 293–299. https://doi.org/10.1097/YCO.0000000000000510)) For example, research suggests that the antipsychotic drug clozapine works best to treat patients with addiction and schizophrenia. In addition, lithium and quetiapine have been helpful for some patients with bipolar disorder and addiction. If you’re curious about medication, start by talking to your mental health team about what options are safe for you. Every person has unique brain chemistry. Just because the meds listed here can be helpful, it doesn’t mean they’re right for everyone.

Many other medications are effective for various co-occurring disorders. It’s just a matter of finding what works best for you. You may even continue taking them after you complete rehab. If you have a history of addiction, though, ongoing medications have some risk. To guard against relapse, you should stay in close contact with your prescriber whenever you’re taking meds.

Social Support from Your Network

Your community can make a huge difference throughout recovery. Your loved ones can inspire you, motivate you, and help you live a happy and fulfilling life–that’s also a sober one.

Relationships With Friends & Family

Social support is an important part of treatment for dual diagnoses. ((Horsfall, J., Cleary, M., Hunt, G.E., & Walter, G. (2009). Psychosocial treatments for people with co-occurring severe mental illnesses and substance use disorders (dual diagnosis): a review of empirical evidence. Harv Red Psychiatry, 17(1), 24-34. https://sites.bu.edu/sswhrsaseminar/files/2013/09/Psychosocial-Treatments-for-People-with-Co-occurring-Severe-Mental-Illnesses-and-Substance-Use-Disorders-Dual-Diagnosis-A-Review-of-Empirical-Evidence.pdf)) As Don Lavender, the program director at Camino Recovery says, “If you don’t have family involvement, you run the risk of clients returning to an environment where they don’t have support or understanding.” If you’re no longer in touch with your family of origin, most rehabs also offer support for chosen family members.

In addition to family therapy, social support can have a huge impact on your healing journey. You may be able to repair long-term relationships by practicing the interpersonal skills you learn in rehab. And if that’s not possible, you can always build a new support network.
Support Groups for Co-Occurring Disorders
Self-help groups can provide invaluable support for people with co-occurring disorders.. For example, Dual Diagnosis Anonymous (D.D.A.) is a 12-Step group specifically for people with multiple conditions, including addiction and mental health concerns. You can attend their frequent online meetings from anywhere in the world. Membership is free.

Recovery is not a cure, but rather, a new way of life. As you build healthy habits, it can be inspiring to surround yourself with people who share your experience. Groups like D.D.A. can help you transform into a new version of yourself—a version that’s happy, healthy, and drug-free.

Recover in a Sober Living Home

Sober living homes, or therapeutic communities (TCs), are a great fit for some people. You may be able to attend rehab in this type of environment, or join 1 for longer-term residential support. Sober living helps reinforce positive behaviors, like attending therapy and refraining from substance use ((Substance use and co-occurring mental disorders. (n.d.). National Institute of Mental Health (NIMH). Retrieved from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health)). The people you meet there can become mentors, friends, and even chosen family.

Research suggests that therapeutic communities are beneficial for people with a multiple conditions ((Abuse, N. I. on D. (–). How do therapeutic communities treat populations with special needs? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/therapeutic-communities/how-do-therapeutic-communities-treat-populations-special-needs)). A meta analysis reviewed 4 different studies on TCs, and found that people with co-occurring disorders had better outcomes after living in these communities than from standard care alone.

Choosing the Right Rehab

Before starting treatment, look for a rehab center that specializes in your specific diagnoses. For example, a rehab facility that treats bipolar disorder may or may not be qualified to treat post-traumatic stress disorder (PTSD). The following questions can help you choose the best facility for your particular needs. Don’t be afraid to discuss them at length with the admissions team.

  • How do you evaluate clients for dual diagnoses?
  • If I complete detox at your facility, will I be reevaluated for co-occurring disorders before beginning inpatient treatment?
  • Which specific mental health concerns do you treat most often?
  • Which mental health diagnoses does your staff specialize in treating?
  • What experiences does your team have in treating my specific diagnoses?
  • What types of therapy do you offer for various co-occurring disorders?
  • Do you create individualized treatment plans for each client? If so, how involved is the client in co-designing their treatment plan?
  • For clients with dual diagnoses, how do you integrate different types of therapy to address each person’s unique needs?
  • Do you prescribe psychiatric medication for clients with dual diagnoses?
  • How do you manage medications for clients detoxing from substance misuse?
  • How do you help clients with co-occurring disorders plan for ongoing mental health care after residential rehab?

No matter how many diagnoses you have, healing is possible. Remember to be patient and kind to yourself during your recovery journey. This road may not be easy, but it’ll certainly be worth it.

Dual diagnoses are highly treatable. Visit our directory of co-occurring disorder rehabs to search by price, insurance, specializations, treatments offered, and more and connect with a treatment center today.

Reviewed by Rajnandini Rathod

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When Drinking Doesn’t Help: The Connection Between Alcohol and Social Anxiety

Alcohol and anxiety are closely related. Many people with social anxiety disorder (SAD) feel like drinking alleviates their symptoms. In the short term, that might even be true. But over time, any alcohol consumption can make matters worse. Heavy drinking not only increases anxiety; it can also turn into addiction.

If you have either of these conditions, treatment can help. You can attend inpatient rehab to treat a drinking problem, social anxiety, or both at the same time. During recovery, you’ll learn better ways to cope with your symptoms. And with those skills in hand, you won’t have to self-medicate with alcohol.

“Getting to the Root of My Anxiety”

If you’re using alcohol to cope with social anxiety, ((Efilnikufecin. (2021, October 18). I became an alcoholic due to Social Anxiety [Reddit Post]. R/Socialanxiety. www.reddit.com/r/socialanxiety/comments/qau9cf/i_became_an_alcoholic_due_to_social_anxiety/)) you might feel stuck in a cycle. But according to one anonymous Reddit user, there’s always a way out:

Alcohol “was like a miracle cure,” they write in a post. “Super confident, I’d walk up and talk to anyone. And embarrass myself obviously. I’d blackout drunk every single time because I never wanted the feeling to end. I didn’t want to go back to being scared.”

Over time, this person’s symptoms got worse, but “the increasing anxiety made me drink more.” They would experience withdrawal whenever they were sober. It turned into a vicious cycle. When drinking got in the way of their parenting, they knew something had to change.

“Getting to the root of my anxiety and feelings of self hatred was the important thing,” they explain on the Social Anxiety subreddit. “It’s been 4 years now and I haven’t had a drop.” It may feel like you need alcohol in order to function—but in reality, drinking just compounds the problem.

When Social Drinking Becomes a Problem

Many people feel like they need alcohol to be social. And it can be hard to spend time around drinkers without joining in. But anxiety disorders and alcohol addiction go hand in hand. ((Book, S. W., & Randall, C. L. (2002). Social anxiety disorder and alcohol use. Alcohol Research & Health, 26(2), 130–135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683821/)) If you have SAD, you may be at a higher risk of developing a drinking problem.

Defining Alcohol Abuse

The official criteria for alcohol abuse ((Drinking levels defined | national institute on alcohol abuse and alcoholism(Niaaa). (n.d.). Retrieved July 5, 2022, from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking)) might surprise you. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as follows:

  • For men: Over 4 drinks in 1 day, or 14 drinks in 1 week
  • For women: Over 3 drinks in 1 day, or 7 drinks in 1 week

(These definitions are based on biological differences between cis male and female drinkers. They may not be accurate for people of all genders.)

These numbers might help you identify an addiction. But any quantity of drinking can cause anxiety. ((Social anxiety disorder and alcohol abuse | anxiety and depression association of america, adaa. (n.d.). Retrieved July 5, 2022, from https://adaa.org/understanding-anxiety/social-anxiety-disorder/social-anxiety-and-alcohol-abuse)) According to the Anxiety and Depression Association of America, “Even moderate amounts of alcohol can affect one’s mood and anxiety level.”

Alcohol use is so socially acceptable that it can take time to even realize you have a problem. But this addiction is all too common in people with anxiety. A study found that “about ⅕ of patients with social anxiety disorder also suffer from an alcohol use disorder.” ((Book, S. W., & Randall, C. L. (2002). Social anxiety disorder and alcohol use. Alcohol Research & Health, 26(2), 130–135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683821/))

How Alcohol Impacts Anxiety

Drinking has a complex effect on mental health. On one hand, alcohol is an anxiolytic ((Gilman, J. M., Ramchandani, V. A., Davis, M. B., Bjork, J. M., & Hommer, D. W. (2008). Why we like to drink: A functional magnetic resonance imaging study of the rewarding and anxiolytic effects of alcohol. Journal of Neuroscience, 28(18), 4583–4591. https://doi.org/10.1523/JNEUROSCI.0086-08.2008)) —meaning that it reduces anxiety. However, data shows that alcohol abuse “can also lead to increased anxiety.” ((Lingford-Hughes, A., Potokar, J., & Nutt, D. (2002). Treating anxiety complicated by substance misuse. Advances in Psychiatric Treatment, 8(2), 107–116. https://doi.org/10.1192/apt.8.2.107)) And when the same behavior makes your symptoms both better and worse, it can be hard to imagine recovery. But with expert support, you can absolutely break out of this cycle.

Treatment for Co-Occurring Social Anxiety and Alcohol Addiction

It may feel like drinking is the best way to manage your symptoms—but in rehab, you’ll find healthy alternatives. If you’ve been drinking to self-medicate your anxiety, ((Turner, S., Mota, N., Bolton, J., & Sareen, J. (2018). Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and Anxiety, 35(9), 851–860. https://doi.org/10.1002/da.22771)) you can recover from both. Experts say that treating these issues at the same time is “the current ‘gold standard’ model of care.” There are several ways you can approach treatment.

Detox

When you first quit drinking, medical detox is almost always necessary. This process can have serious side effects, and some people need 24-hour care. Your specific needs will depend on the amount you’ve been drinking and your physical health.

Anxiety is a common symptom of quitting alcohol. ((Saitz, R. (1998). Introduction to alcohol withdrawal. Alcohol Health and Research World, 22(1), 5–12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761824/)) If you have SAD, your symptoms may get worse during detox. In an inpatient program, you might get a prescription to help with this side effect.

Medications for Social Anxiety Disorder

A wealth of data supports treating social anxiety disorder ((Rose, G. M., & Tadi, P. (2022). Social anxiety disorder. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK555890/)) with medications. You might take SNRIs (ex. Cymbalta, Effexor) or SSRIs (ex. Prozac, Zoloft). A doctor or psychiatrist can determine whether any of these are the right fit for you.

Your physical and mental health should stabilize during your time in rehab. As that happens, your needs will change, too. Some people keep taking meds long after they start recovery, while others stop after a short time. No matter how long you spend taking meds, you should stay in close contact with your doctor the whole time. This is an important way to guard against relapse.

Cognitive Behavioral Therapy (CBT)

Research shows that CBT is a highly effective therapy for social anxiety disorder. ((Evren C. An overlooked combination in treatment: addiction and social anxiety disorder comorbidity. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2020;33:331-333. https://dusunenadamdergisi.org/storage/upload/pdfs/1614849083-en.pdf)) It is also a well-regarded treatment for alcohol addiction. ((Kiluk, B. D., Ray, L. A., Walthers, J., Bernstein, M., Tonigan, J. S., & Magill, M. (2019). Technology‐delivered cognitive‐behavioral interventions for alcohol use: A meta‐analysis. Alcoholism: Clinical and Experimental Research, 43(11), 2285–2295. https://doi.org/10.1111/acer.14189)) If you’re healing from both these conditions, it could be very helpful.

During CBT, you’ll meet with a therapist in 1:1 sessions. They’ll teach you practical skills that help you live with your anxiety. You’ll learn to reframe your thoughts and respond to triggers in a healthy way.

CBT is no substitute for traditional talk therapy. As a behavioral treatment, it’s designed to help you change your daily habits. However, you won’t spend much time talking about your past. And in order to move forward, it’s important to look back on where you’ve been. If you do CBT in rehab, it will likely be combined with other types of therapy.

Exposure Therapy

In exposure therapy, patients face stimuli that would normally trigger them. This involves creating a hierarchy of situations that cause anxiety and includes telling the story of a time you were triggered in real life. You’ll speak in the present tense, describing the event in great detail. Then, you and your therapist will talk through your emotional response. Preliminary research also shows that virtual reality exposure therapy can reduce social anxiety. ((Chesham, R. K., Malouff, J. M., & Schutte, N. S. (2018). Meta-analysis of the efficacy of virtual reality exposure therapy for social anxiety. Behaviour Change, 35(3), 152–166. https://doi.org/10.1017/bec.2018.15))

Some data suggests that a version of this treatment called cue exposure therapy (CET) can treat alcohol addiction. ((Mellentin, A. I., Nielsen, B., Nielsen, A. S., Yu, F., & Stenager, E. (2016). A randomized controlled study of exposure therapy as aftercare for alcohol use disorder: Study protocol. BMC Psychiatry, 16(1), 112. https://doi.org/10.1186/s12888-016-0795-8)) However, much more research is needed on the subject.

Mindfulness

Mindfulness strategies can treat many mental health issues, including anxiety and addiction. One study looked at mindfulness-based interventions (MBIs) as a treatment for social anxiety. ((Liu, X., Yi, P., Ma, L., Liu, W., Deng, W., Yang, X., Liang, M., Luo, J., Li, N., & Li, X. (2021). Mindfulness-based interventions for social anxiety disorder: A systematic review and meta-analysis. Psychiatry Research, 300, 113935. https://doi.org/10.1016/j.psychres.2021.113935)) Researchers found a “a dose-response relationship between MBIs duration and effect size.” In other words, the longer you spend practicing mindfulness, the more effective it can be in reducing anxiety.

For people recovering from an alcohol addiction, mindfulness can help prevent relapse. ((Zgierska, A., Rabago, D., Zuelsdorff, M., Coe, C., Miller, M., & Fleming, M. (2008). Mindfulness meditation for alcohol relapse prevention: A feasibility pilot study. Journal of Addiction Medicine, 2(3), 165–173. https://doi.org/10.1097/ADM.0b013e31816f8546)) Learning mindfulness techniques early in recovery may set you up for future success.

Support Groups

For people with social anxiety, the very idea of going to a meeting can be a trigger. But for people with alcohol addiction, support groups can improve treatment outcomes. ((Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance Abuse and Rehabilitation, 7, 143–154. https://doi.org/10.2147/SAR.S81535)) Talk to your primary therapist about whether attending a support group is a good idea for you.

If you decide to try it out, there are many options available. Most peer-led support groups host free meetings all over the world. You can even connect with your peers online, from anywhere. In these groups, you can connect with people who share some part of your experience. If you feel anxious to be around them, that’s okay. They might feel that way, too. Talking about it can help you build meaningful relationships. And that’s an essential part of healing.

Specialized Care, in a Protected Space

And it can be hard to treat just one of these issues at a time. Instead, experts recommend integrated treatment for addiction and social anxiety. ((Nguyen, A., Mirbaba, M., Khaleghi, F., & Tsuang, J. (n.d.). Current treatment options for co-morbid anxiety and alcohol use disorders: A review. Journal of Addictive Behaviors and Therapy, 1(1), 0–0. Retrieved from https://www.primescholars.com/abstract/current-treatment-options-for-comorbid-anxiety-and-alcohol-use-disorders-a-review-106758.html)) In layman’s terms, that means starting recovery for both diagnoses at once.

Many rehabs offer this kind of specialized care. A team of providers can design a treatment plan to meet your needs. And in the privacy of an inpatient program, you can focus on what’s most important: your own recovery process.

In the right program, you’ll get the coordinated care you need. Connect with a rehab that specializes in treating co-occurring anxiety and alcohol addiction here.

Reviewed by Rajnandini Rathod

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Traumatic Brain Injuries and Your Mental Health

Traumatic brain injuries (TBIs) can be extremely serious. Unlike most injuries, they can directly alter brain function, and have a severe impact on your mental health. Some patients even develop addictions following TBI, whether or not they have a history of substance abuse.

Even a relatively mild concussion can cause long-term symptoms. And because those symptoms won’t necessarily appear right away, it can be hard to see the connection between TBI and subsequent mental health issues. After sustaining any type of head trauma, it’s important to see a doctor and learn about your options for recovery. Depending on your exact experience, you may benefit from getting treatment at a residential rehab.

Mental Health Symptoms of a Physical Injury

Although they’re caused by physical trauma, TBIs are strongly related to mental health and addiction issues. Because these injuries can affect brain function, mood and behavioral changes are common symptoms of traumatic brain injury.1

In some clients, head trauma can lead to serious mental health conditions,2 like depression or anxiety. This is even true for people with mild TBIs, like concussions. According to one study, “both moderate to severe and mild TBI are associated with an increased risk of subsequent psychiatric illness.3 Whereas moderate to severe TBI is associated with a higher initial risk, mild TBI may be associated with persistent psychiatric illness.”

The connection between TBIs and mental health conditions goes both ways. Many TBI patients experience emotional changes, regardless of their prior health history. People with a preexisting mental health diagnosis may also be at a higher risk for traumatic brain injury.4 No matter what your mental health history looks like, you may be especially vulnerable to certain issues after a TBI.

Depression

TBIs are correlated with major depressive disorder.6 One study found that this condition “occurs with sufficient frequency to be considered a significant consequence after TBI.” And unfortunately, these symptoms may get in the way of your recovery. Many people with depression have trouble finding the motivation to get the help they need.

Anxiety

Anxiety disorders are quite common after traumatic brain injuries.7 TBI is associated with a number of anxiety disorders, including (but not limited to) the following:

  • Social anxiety disorder
  • Phobias
  • Panic disorder
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)

In some cases, these conditions are simply emotional responses to the event that caused traumatic brain injury. For example, you might develop PTSD after being in a serious car accident. However, they may also result from changes to the brain itself. Experts have found that anxiety is “a strong predictor of social, personal, and work dysfunction” in people with TBIs.

Post-Traumatic Stress Disorder (PTSD)

PTSD commonly co-occurs with traumatic brain injuries. This might be true because of the prevalence of TBI among military veterans,8 who are at risk of PTSD for additional reasons. However, research has found that civilians with a history of head trauma are also at risk for developing PTSD.9 If you’re experiencing the symptoms of PTSD, whether or not you have a history of TBI, consider attending a program that offers trauma-informed care.

Choosing the Right Therapy for TBI Recovery

Treatment for TBI depends on your exact symptoms, and on their severity. Because these injuries may affect any area of the brain, different clients have vastly different needs during recovery. Most people benefit from a combination of physical and psychotherapeutic interventions for traumatic brain injuries.10

If you’re experiencing mood or behavioral changes, or other mental health symptoms, the following types of therapy can be especially helpful:

Cognitive Behavioral Therapy (CBT)

CBT is the most widely used mental health intervention for people with TBI.10 In this type of treatment, you’ll regularly meet with a therapist to discuss your emotional experience. During each session, you’ll identify challenging thought patterns and emotional responses, and learn practical tactics to help you navigate them. These skills empower you to approach difficult emotions and situations with equanimity.

Mindfulness Practices

Mindfulness techniques may be helpful for TBI,11 especially for people with both cognitive and psychological symptoms. Preliminary research shows that therapies like meditation, yoga, and mindfulness-based cognitive therapy (MBCT) are highly effective in treating a wide variety of symptoms. These techniques can help you come into the present moment, accept your emotions as they are, and find a sense of peace. More research is needed into this form of treatment in the context of TBIs. If you do engage in meditation as part of recovery, it’s important to combine it with other healing methods.

Pharmaceutical Treatment

Depending on your symptoms, you may be a candidate for pharmaceutical treatment for mental health issues following a TBI.12 If you decide to try taking medication after a brain injury, it’s important to stay in close communication with your prescribing doctor. Any prescription can have side effects, and you could be at risk for developing serious cognitive or even physical symptoms due to your health history. Some medications, including tricyclic antidepressants, may not be safe for people with a history of TBI.

all points north lodge indoor pool
All Points North Lodge offers specialized programming and facilities for both active and former professional athletes.

TBI and Addiction

There is a high rate of substance use disorders among people with a history of TBI.13 Although more research is needed into the exact link between these two conditions, data supports the idea that addiction can make people more vulnerable to brain injuries, and vice versa.

Drug and Alcohol Use Can Cause TBI

Like other mental health conditions, substance abuse can increase your risk of traumatic brain injury.12 One study suggests that problem drinking is an especially common risk factor for these injuries, because it interferes with physical coordination. Drinking post-TBI can lead to severe mental health symptoms.

Any history of addiction can have an impact on your recovery from these injuries. One study found that people who had already entered recovery for substance misuse, and then sustained a traumatic brain injury, were at an increased risk of addiction relapse after their TBI.13 And since new symptoms can appear long after the original injury, it’s important to make a long-term plan for your recovery.

Neurological Changes Following TBI

Evidence suggests that people who sustain early-life TBIs are at a greater risk for developing substance use disorders.14 Head trauma can impact brain development, and it sometimes changes the way you respond to certain stimuli. In particular, research shows that the “regions of the brain associated with the perception of reward” may be directly affected by brain injuries.

If these areas of your brain are changed or damaged, you’ll be more vulnerable to addiction. A wealth of neuroscientific research confirms that drug use hijacks the brain’s reward system.15 According to neuropharmacologists Wilkie A. Wilson, Ph.D., and Cynthia M. Kuhn, Ph.D., “when addictive drugs enter the brain they artificially simulate a highly rewarding environment.” This modifies brain chemistry, provoking behavioral changes. Habitual drug use causes “the reward system to modify the brain to crave the drug and take action to get it.”

Professional athletes may also be more vulnerable to developing addictions16 following TBI. According to one study, athletes are “more susceptible to the intoxicating effects of substances and may get in trouble more easily due to the disinhibiting effects of the brain injury.” Because addiction often starts as an attempt to self-medicate mental health symptoms, early treatment may help you avoid more serious consequences.

If you have a history of either drug abuse or brain injury, be sure to inform your doctor when you seek treatment for either condition. Healing is absolutely possible, but you may need specialized care during recovery.

Rehab for Professional Athletes

Traumatic brain injuries are common among athletes.17 Experts estimate that 10% of all TBIs “are due to sports and recreational activities.” And if you’re a professional athlete, this type of injury can directly interfere with your ability to do your job.

Fortunately, several luxury rehab programs are designed to meet your unique needs. Orenda at Futures offers the Orenda Athletes Track, in which clients can continue physical training during residential treatment. This empowers you to recover without sacrificing your long-term career goals in the process. At this facility, “a team that has provided training and physical therapy to MLB, PGA, and more helps athletes heal and train while receiving comprehensive care for mental health and substance use disorders.”

You may be eligible for one of these specialized programs even if you’ve already retired from professional sports. All Points North Lodge treats both active and former professional athletes. Their experts continue offering support even after clients complete inpatient treatment. With their guidance, clients can start planning for long-term recovery from the moment they enter rehab. For some, that recovery plan may need to include medical care alongside mental health treatment.

orenda at futures athletes track
Orenda at Futures’ Athletes Track allows clients to continue physical training during residential treatment.

Other Symptoms of Traumatic Brain Injuries

If you develop mental health symptoms after a TBI,18 you may be at greater risk for additional symptoms. Specifically, mental health issues could be a warning sign for functional limitations, like memory loss and difficulty performing regular activities. Your healthcare team may be able to recognize those signs in advance, and help you prepare for challenges.

TBIs may be classified as mild, moderate, or severe. According to the CDC, symptoms may last as little as a few hours, or they may linger for the rest of a person’s life. These injuries are especially dangerous for children and older adults. For children, TBI symptoms can affect brain development and result in long-term cognitive issues. Older adults are often misdiagnosed, and fail to receive the care they need as a result.

In mild cases, common symptoms of a traumatic brain injury5 include, but are not limited to:

  • Headache
  • Confusion
  • Dizziness
  • Blurred vision
  • Fatigue
  • Mood or behavioral changes

Moderate or severe TBIs present with the same symptoms, and may also cause the following issues:

  • Seizures
  • Nausea
  • Pupil dilation
  • Loss of coordination
  • Agitation

If you exhibit any of these symptoms after a head injury, no matter how minor, it’s very important that you consult a doctor.

Long-Term Recovery for Body and Mind

Traumatic brain injuries can have long-term health impacts. And if your brain functions differently than it did before, it can be difficult to imagine what healing will look like. Recovery might not mean returning to life as it used to be. Instead, this is your opportunity to get to know yourself again, and decide how you’d like to move forward.

It’s extremely important to get comprehensive care after a TBI. Physical and mental health are always connected, especially if you’re healing from a brain injury. By working with a skilled team of doctors and therapists, you can decide on a plan of care that feels right for you.

If you’re concerned about the impact of an injury on your mental health, talking to a treatment facility can be a good place to start.

Frequently Asked Questions About Traumatic Brain Injuries and Mental Health

What are the mental health symptoms associated with traumatic brain injuries?

Traumatic brain injuries (TBIs) can lead to various mental health symptoms, including mood and behavioral changes, depression, anxiety disorders (such as social anxiety, phobias, panic disorder, OCD, and PTSD), and post-traumatic stress disorder (PTSD). These symptoms can occur regardless of your prior mental health history.

Can traumatic brain injuries lead to addiction?

Yes, traumatic brain injuries (TBIs) are associated with a higher risk of developing substance use disorders and addiction. Addiction makes people more susceptible to brain injuries, and vice versa. Substance abuse, including problem drinking, can increase the risk of TBIs and worsen mental health symptoms. Early treatment and specialized care are important for individuals with a history of addiction or brain injury.

What types of therapy are effective for TBI recovery and mental health symptoms?

Cognitive behavioral therapy (CBT) is widely used for people with traumatic brain injuries (TBIs) and mental health issues. It helps identify challenging thought patterns and emotions and provides practical tactics to navigate them. CBT is only one kind of available talk therapy; your treatment provider can help you decide which therapies are best for you.
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Demystifying Transcranial Magnetic Stimulation (TMS)

Traditional therapy and medications aren’t always effective for treating mental health disorders. If this is the case for you, transcranial magnetic stimulation (TMS) could be a viable alternative. This non-invasive treatment works by stimulating different parts of your brain to alleviate symptoms of mental health conditions like depression and PTSD.

Your primary care physician, mental health treatment provider, or rehab treatment team can help you determine if TMS is right for you.

Health Conditions TMS Can Treat

TMS can be used to treat1 several conditions:

About 20-30% of patients with MDD continue to experience depressive symptoms2 despite therapy and medication. For those patients, looking for alternatives to traditional treatment approaches is often a logical next step. TMS shows significant potential to improve depressive symptoms among people with treatment-resistant depression and PTSD. It may take several weeks to see results, so it’s imperative for patients to consistently attend the number of sessions prescribed by their doctor.

Repetitive TMS, or rTMS, has also been shown to be successful for anxiety and bipolar disorders,3 although it’s more effective in treating depression than manic episodes. It may also speed up recovery after a stroke, and help alleviate symptoms that arise after the event. In addition, low-frequency rTMS can help control the symptoms of Tourette syndrome and OCD. High-frequency rTMS helps people quit smoking by reducing cravings. rTMS can even reduce cocaine use and cravings4 in people struggling with addiction.

What Exactly Is TMS?

TMS is a non-invasive procedure that stimulates brain tissue5 by producing a high- or low-intensity magnetic field through a copper wire. There are 3 main methods of TMS used today:

  • Single-pulse TMS (spTMS) stimulates the motor cortex while a machine measures and records electrical activity.
  • Paired-pulse TMS (ppTMS) delivers 2 pulses through the same coil, with long or short intervals in between.
  • Repetitive TMS (rTMS) is a popular variation of TMS that applies repeating pulses to a specific area of the brain. This method treats the symptoms that come from mental health disorders. Deep TMS (dTMS)6 is a newer type of rTMS that stimulates deep brain areas because their larger helmet allows for more surface area. All Points North Lodge is one rehab center that offers dTMS treatment.

Typically, spTMS and ppTMS evaluate brain functioning, while rTMS actually creates changes in the brain. If you’re treated for a mental health condition, you’ll most likely undergo rTMS. There are several different coils available for use in TMS treatment. The specialists who deliver your treatment will determine the best one for your needs.

You can either complete TMS sessions at an inpatient rehab center (Inspire Malibu, for example, offers this in partnership with a physician’s office) or at a private clinic as an outpatient. In the latter option, you’d stay at home and commute to your sessions each day.

What Happens During a TMS Session?

Before you undergo any TMS procedures,7 you’ll take a physical and mental health screening to confirm your candidacy. This includes discussions of symptoms, conditions, and any medications you take with your treatment team, who will then guide you through the process.

During your session, you’ll sit in a reclining chair with earplugs (or some sort of hearing protection) with an electromagnetic coil attached to your head. The Dawn Rehab in Thailand even lets you listen to music so you feel as comfortable as possible. During rTMS (the most common type of TMS procedure), the operating physician will turn the coil on and off repeatedly to deliver pulses to your brain. During this process, you’ll feel a tapping sensation, called “mapping.” The professional administering rTMS will slowly increase the dose of magnetic energy to determine the right amount for you.

Most people don’t find TMS painful,8 but some people may feel slight discomfort. The Dawn Rehab describes their TMS sessions:

“A TMS-trained nurse will place an electromagnetic coil against your head which will painlessly deliver brief magnetic pulses – the same as those used in MRI (Magnetic Resonance Imaging) machines – to the region of the brain involved in mood control and depression.”

After your session, you can continue your regular daily routine as usual.

How Long Are TMS Sessions?

Duration can vary from person to person, and will also depend on your diagnosis. Standard rTMS treatment for major depressive disorder,9 for example, averages around 20-30 daily sessions for around 4-6 weeks. However, research recommends a minimum of 6 weeks. One study found that 38.4% of MDD patients responded well to just 4 weeks of treatment, but then surveyed patients who didn’t respond well to the initial 4 weeks after an additional 12 weeks of biweekly sessions. 61% of those patients responded well to the longer treatment phase.

Some studies have explored another, faster form of rTMS called “accelerated rTMS” or arTMS. During rTMS, people undergo multiple sessions in one day. Some studies suggest promising outcomes from this procedure, but more research will determine if this is actually a more viable option. Theta burst stimulation (TBS) is another, newer form of rTMS that can produce quicker results.10 Some studies found that, after only 5 days, patients enrolled in TBS arTMS trials reported success rates of 90%.

Some people may continue to attend “maintenance sessions” after their first set of TMS sessions. This involves slowly reducing the number of sessions per week from 3 to 1, which is eventually reduced to 1 session every 2 weeks. However, some people stop rTMS altogether, and go back to therapy and medications after completing their sessions. Unfortunately, rTMS maintenance isn’t well studied, and needs more research before making any determinations.

Should You Try TMS Therapy? Consider the Cons

While TMS has relatively few drawbacks, they do exist. Side effects are possible, but are usually minimal. And, TMS can be expensive and time-consuming. However, it may still be worth it for you, since lifting your depression to any degree can greatly impact your quality of life. Here are some factors to consider before trying TMS:

Possible Side Effects

Although TMS is non-invasive and seldom produces side effects,11 it can cause seizures in rare cases, and doctors do not recommend it for patients with epilepsy. While the risk of a seizure is small (less than 0.01% if you don’t have epilepsy, and less than 3% if you do), it’s still a possibility. If any of the following apply to you, you may be more likely to experience seizures:

  • Pre-existing neurological conditions
  • Adolescent
  • Changes in medication
  • Active substance use

You should talk to your doctor if you have any metal or electronic implants that will be near the TMS coil. This includes cochlear implants. These may cause problems with the therapy, and can be dangerous.

You may feel some slight discomfort in your scalp or neck during the procedure or pain afterward. You might also become more sensitive to sounds or experience ringing in your ears—which is why treatment providers should always provide ear protection. Some people report feeling fatigued afterward. However, it’s unlikely that you’ll encounter any of these side effects, and if you do, they will most likely be mild and short-lived.

Cost

rTMS is expensive,12 ranging from $200-300 USD per visit in a private clinic. If you complete the full course recommended by your doctor, you may end up paying $5,000-10,000 USD. Of course, this can differ depending on the duration and number of sessions you attend. Check with rehabs you’re considering to see if TMS is included in the cost of your program, or how much additional costs are.

Could TMS Provide the Relief You’ve Been Looking For?

Being unresponsive to treatment is incredibly frustrating when you’re living with depression or other mental health issues. But the good news is, you still have options. Alternative treatments like TMS just might do the trick for you, and the simple act of being open to trying something new can empower you to move forward in your recovery journey.

To learn more about residential treatment programs that offer this and other alternative therapies, browse our collection of rehabs and connect with centers directly.

Frequently Asked Questions About Transcranial Magnetic Stimulation for Addiction Treatment

How does Transcranial Magnetic Stimulation (TMS) work for addiction treatment?

Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate specific areas of the brain. It works by delivering targeted magnetic pulses to activate or inhibit brain cells, which can help regulate mood and alleviate symptoms of mental health conditions.

Is Transcranial Magnetic Stimulation safe for treating depression and anxiety?

Yes, Transcranial Magnetic Stimulation is considered a safe procedure for treating conditions like depression and anxiety. It has been extensively studied and approved by regulatory authorities. Common side effects may include mild headache or scalp discomfort during or after the session, but these are generally well-tolerated.

What are the potential benefits and risks of Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation offers several potential benefits, including its non-invasiveness, minimal side effects, and efficacy in treating certain mental health conditions. However, it may not be suitable for everyone, and some individuals may experience rare side effects such as seizures. It’s essential to consult with a qualified healthcare provider to determine if TMS is a suitable treatment option.