Types of Therapy for Substance Use: Finding the Approach That Fits You
When people start wondering, “What kind of therapy works for addiction?” It's rarely a casual search.
It’s usually asked during a moment that feels heavier than most. Sometimes it’s after another morning of piecing together the night before, or after the sting of a loved one’s worried voice, or in the middle of a quiet moment when you realize you’ve been living life on autopilot for far too long.
Maybe you’ve tried to cut back on your own, but it didn’t stick.
Maybe someone close to you has expressed concern, and it landed differently this time.
Or maybe you’ve been carrying the uneasy truth that something in your life needs to change — even if you’re not entirely sure what that change should look like yet.
Whatever brought you here, you’re not the first to feel this way. You’re also not alone in feeling uncertain about where to start.
Substance use is rarely just about the substance. It’s about what the substance represents: a way to cope with stress, to numb emotional pain, to fill silence, to avoid memories, or to create a temporary sense of ease in a world that feels too much.
That’s why the most effective therapy for substance use isn’t one-size-fits-all. It’s about finding the approach that meets you exactly where you are, honors your pace, and helps you build a path forward that actually fits your life.
Let’s walk through how this can look, from creating safety and trust, to learning everyday coping skills, to doing deeper work on the “why,” to finding the connections that help you maintain your progress.
Step One: Creating Safety and Trust
For many people, the hardest part of therapy isn’t the middle — it’s the beginning.
Jordan still remembers sitting in his car outside the clinic, engine running, debating whether to go in. He thought about canceling, about pretending he forgot, about telling himself he’d try again “next week.” But eventually he took a breath, opened the door, and walked inside.
That first step matters because therapy for substance use works best when you can speak openly without fear of judgment. Many therapists start this process with trauma-informed therapy or motivational interviewing.
Trauma-informed therapy isn’t just for people who identify as having trauma. It’s an approach that assumes many people seeking help have lived through difficult or overwhelming experiences — whether or not they use that label. In a trauma-informed space, the therapist is intentional about pacing, boundaries, and emotional safety. You won’t be pushed to share painful memories before you’re ready. The focus is on helping you feel grounded and in control.
If you’ve ever wondered, Can therapy help if my addiction is tied to trauma?, the answer is often yes — especially in a trauma-informed setting.
Motivational interviewing (MI) is a different kind of early approach. It’s not about telling you what you “should” do. Instead, it’s about helping you uncover your own reasons for wanting change. Your therapist might ask:
“What would your life look like without alcohol?”
“What’s one thing you’d want to feel more of if this habit wasn’t in the way?”
For Jordan, MI helped him realize his motivation wasn’t about “quitting forever” yet — it was about wanting to have more energy for weekend hikes with his kids. That simple, personal goal became the foundation for his early progress.
In these first sessions, the goal isn’t to have all the answers. It’s to establish safety, trust, and a shared sense of direction. Without that, it’s hard to do anything else.
Step Two: Building Everyday Coping Skills
Once there’s a foundation of trust, the next step is developing tools you can use in daily life — tools that help you manage stress, triggers, and cravings without relying on substances.
This is where Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) often come into play.
CBT is one of the most widely researched and effective treatments for substance use disorder. It works on the principle that your thoughts, feelings, and behaviors are interconnected — and that by changing your thoughts, you can influence your emotions and your actions.
Say you notice yourself thinking, “I can’t get through this stressful meeting without smoking.” In CBT, you’d learn to challenge that belief:
Is that really true?
Have there been times you handled stress differently?
What’s one healthy coping skill you could try instead?
Taylor, who had been drinking nightly after work, realized through CBT that her go-to thought was “I deserve this” — something she said to herself without even noticing. In therapy, she replaced that thought with “I deserve to feel good tomorrow,” and began experimenting with end-of-day routines that didn’t involve alcohol, like evening walks or reading on her porch.
DBT, meanwhile, builds on CBT but puts more emphasis on emotional regulation, distress tolerance, and mindfulness. While CBT might help you reframe a thought, DBT also equips you with skills to get through moments of emotional overwhelm without turning to substances.
For someone whose drinking is tied to intense emotions or conflict, DBT’s “ride the wave” approach — letting emotions rise and fall without acting on them — can be life-changing.
If you’re curious which might be right for you, check out CBT vs. DBT for Addiction: What’s the Difference?.
The beauty of both CBT and DBT is that you don’t have to wait months to see results. Taylor used a DBT breathing exercise the same week she learned it, walking past the bar she used to visit without going in. That small win built momentum for bigger changes later.
Step Three: Understanding the “Why”
For many, stopping the substance is only part of the work. The deeper challenge is understanding why it became such a central part of life in the first place.
This is where Internal Family Systems (IFS) and other insight-oriented approaches can be transformative.
IFS views the mind as made up of different “parts” — some that protect us, some that carry pain, and some that take on coping strategies like substance use. The goal isn’t to fight or eliminate these parts, but to understand them and meet their needs in healthier ways.
Renee came into therapy convinced she was “her own worst enemy.” Through IFS, she discovered the part of her that poured wine every night wasn’t trying to sabotage her — it was trying to protect her from the crushing loneliness she felt after her divorce. When she met that part with compassion, she could begin finding other ways to address her loneliness, like reconnecting with old friends and joining a community group.
This deeper work can bring up intense emotions, but it’s often the point where people stop feeling like they’re “white-knuckling” sobriety and start feeling more free.
Step Four: Connection and Community
No one recovers in a vacuum.
While one-on-one therapy can be powerful, group therapy offers something uniquely valuable: the experience of being understood by people who have walked a similar path.
Groups can be highly structured and skills-based, or they can be more open and focused on shared stories. Either way, they provide a mix of accountability, encouragement, and real-world strategies from people who’ve tried them.
If you’ve ever wondered what group sessions are actually like, you can read more here: What Is Group Therapy Like for Substance Use?
It’s worth noting that connection doesn’t have to mean traditional 12-step programs like AA. While AA has helped millions, it’s not the only option. In Chicago, there are alternatives to AA like SMART Recovery, Recovery Dharma, and secular peer-led groups that offer different approaches to community and accountability.
Luis had tried solo therapy before but found himself slipping back when he felt isolated. Joining a Chicago-based SMART Recovery group gave him the structure and connection he needed. Hearing “me too” from peers wasn’t just comforting — it reminded him that his struggles were human, not personal failings.
Step Five: Blending It All Into Your Unique Path
One of the most freeing realizations in recovery is that you don’t have to pick just one approach.
You might start with trauma-informed therapy to build trust, move into CBT for practical tools, add IFS for deeper insight, and join a group for ongoing support.
For Jordan, the blend looked like this: motivational interviewing to move past ambivalence, DBT to navigate conflict at home, and eventually IFS to address the root causes of his drinking. That combination gave him both the how and the why— practical coping skills and a deeper sense of self-understanding.
Recovery is rarely a straight line. Your needs will change, and so will the types of therapy that work best for you. The most important thing is to stay open to adjusting your path as you grow.
Therapy isn’t a magic fix. But it is a place where change becomes possible — where new skills replace old habits, where support meets you in your most vulnerable moments, and where the parts of yourself you once avoided can finally be met with compassion.
Whether you’re taking your very first step or returning to therapy after past attempts, there’s a path forward. And it starts with the next choice you make.