The thing about addiction is that it's rarely about the substance or behaviour itself. The drinking, the drugs, the gambling, the scrolling—these are solutions, however destructive, to problems that often go much deeper.

This is why punishment and willpower so often fail as approaches to addiction. They address the symptoms without touching the root. And it's why therapy, at its best, offers something different: not just strategies to stop, but genuine understanding of why you started and what's keeping you stuck.

If you're considering addiction counselling—whether for yourself or someone you love—this guide explains what therapy actually involves and how it can support lasting change.

Understanding Addiction: More Than Just a Bad Habit

Addiction is a complex condition involving compulsive engagement with a substance or behaviour despite harmful consequences. It's not a failure of willpower or a character flaw. It's a pattern that develops through the interaction of biology, psychology, and circumstances.

The Addiction Cycle

Addiction typically follows a pattern:

Trigger: Something prompts the urge—stress, boredom, certain people, places, or emotions.

Craving: The mind fixates on the substance or behaviour. Other concerns fade.

Use: The substance or behaviour provides temporary relief, pleasure, or numbing.

Consequence: Negative effects follow—health problems, relationship damage, financial strain, shame.

Resolve: "Never again." Determination to change.

Trigger: Something prompts the urge...

The cycle continues, often intensifying over time. Each lap can erode self-trust, damage relationships, and deepen shame—which, ironically, fuels more need for the temporary escape the addiction provides.

What Qualifies as Addiction?

Key features include:

Loss of control: Inability to moderate despite wanting to
Compulsion: Strong urges that are difficult to resist
Continued use despite consequences: Knowing something is harmful but continuing anyway
Tolerance: Needing more to achieve the same effect
Withdrawal: Physical or psychological symptoms when stopping
Prioritisation: The addiction takes precedence over other activities and relationships
Failed attempts to quit: Repeatedly trying and struggling to stop

Addiction exists on a spectrum. You don't need to hit "rock bottom" to benefit from help.

Types of Addiction

Substance addictions:

Alcohol
Prescription medications
Illegal drugs
Nicotine

Behavioural addictions:

Gambling
Sex and pornography
Gaming
Social media
Shopping
Food
Exercise

The underlying mechanisms are similar—the behaviour activates reward pathways in the brain, providing temporary relief or pleasure that becomes increasingly necessary.

Why Addiction Develops

There's no single cause. Multiple factors interact:

Biological Factors

Genetics: Addiction runs in families. Certain genetic variations affect how substances impact the brain.
Brain chemistry: Some people's brains respond more intensely to addictive substances or behaviours.
Age of first use: Younger brains are more vulnerable to developing addiction.

Psychological Factors

Trauma: Unprocessed trauma often underlies addiction. The substance or behaviour numbs unbearable feelings.
Mental health conditions: Depression, anxiety, ADHD, and other conditions frequently co-occur with addiction.
Coping mechanisms: If you never learned healthier ways to manage difficult emotions, substances offer a readily available option.
Low self-worth: Addiction can both stem from and reinforce feelings of being fundamentally broken.

Environmental Factors

Availability: Exposure and access increase risk.
Social norms: If heavy drinking is normal in your environment, problematic drinking is easier to develop and harder to recognise.
Stress: High-pressure environments without adequate support increase vulnerability.
Lack of connection: Johann Hari's work emphasises that the opposite of addiction isn't sobriety—it's connection. Isolation fuels addiction.

Understanding these factors isn't about making excuses. It's about addressing root causes rather than just fighting symptoms.

How Addiction Counselling Helps

Therapy for addiction works on multiple levels simultaneously.

Understanding Your Addiction

Counselling helps you understand:

What needs the addiction has been meeting
What triggers your use
What patterns and cycles keep you stuck
What consequences have resulted
What function the addiction serves in your life

This understanding isn't academic—it's the foundation for sustainable change.

Addressing Underlying Issues

Addiction rarely exists in isolation. Therapy explores what lies beneath:

Trauma: Many people with addiction have experienced trauma. The substance or behaviour may have been the only way to cope with unbearable memories or feelings. Trauma-informed therapy addresses these root causes.

Mental health: Depression, anxiety, and other conditions often fuel addiction. Treating these alongside the addiction improves outcomes.

Relational patterns: How you learned to relate to others affects your vulnerability to addiction. Therapy can help develop healthier relationship capacities.

Core beliefs: Beliefs like "I'm broken," "I don't deserve happiness," or "I can't cope" maintain addiction. Identifying and revising these beliefs supports lasting change.

Developing New Coping Strategies

If addiction has been your primary coping mechanism, you'll need alternatives:

Managing difficult emotions without numbing
Tolerating discomfort without escaping
Soothing yourself in healthy ways
Communicating needs directly
Building genuine connections

These skills don't develop overnight. Therapy provides a safe space to practice.

Building a Recovery-Supportive Life

Recovery involves creating a life where you don't need to escape:

Meaningful activities and purpose
Supportive relationships
Manageable stress
Physical health
Spiritual or existential grounding (for some)

Therapy helps identify what's missing and how to build what you need.

Managing Relapse

Relapse is common in recovery—not a sign of failure, but part of many people's journeys. Therapy helps you:

Recognise early warning signs
Intervene before full relapse
Learn from lapses rather than spiralling into shame
Adjust your approach based on experience

Types of Addiction Therapy

Several approaches have evidence for treating addiction:

Motivational Interviewing (MI)

A conversational approach that helps you find your own motivation for change. Rather than arguing for recovery, the therapist helps you explore your ambivalence and strengthen your reasons for change.

MI recognises that motivation fluctuates. You might feel determined one day and resistant the next. The approach works with this reality rather than against it.

Cognitive Behavioural Therapy (CBT)

CBT for addiction focuses on:

Identifying thoughts and beliefs that maintain use
Recognising and managing triggers
Developing coping strategies for cravings
Challenging cognitive distortions
Building relapse prevention skills

It's practical, skills-focused, and has substantial research support.

Dialectical Behaviour Therapy (DBT)

Originally developed for borderline personality disorder, DBT has proven helpful for addiction, especially when emotion regulation is a core issue.

DBT teaches:

Mindfulness
Distress tolerance
Emotion regulation
Interpersonal effectiveness

These skills address the underlying difficulties that often drive addictive behaviour.

Psychodynamic Therapy

Explores the unconscious conflicts and early experiences contributing to addiction. May take longer but can address deep-rooted issues that more behavioural approaches miss.

Person-Centred and Humanistic Approaches

Focus on the therapeutic relationship and creating conditions for self-understanding and growth. Particularly valuable when shame and self-condemnation are significant barriers to recovery.

Trauma-Focused Approaches

EMDR, somatic experiencing, and other trauma therapies can be crucial when trauma underlies addiction. Sometimes addiction can't shift until the trauma is addressed.

Integrated Approaches

Many therapists combine approaches, tailoring treatment to individual needs. What works for one person may not suit another.

What to Expect in Addiction Counselling

Assessment

Your therapist will want to understand:

Your history with the addiction
Previous attempts to change
Your current situation and support system
Other mental health concerns
Your goals and motivation
What's at stake if things don't change

This isn't interrogation—it's building a shared understanding so you can work together effectively.

Early Sessions

The beginning of therapy often involves:

Building trust and rapport
Understanding your patterns and triggers
Exploring what the addiction has provided
Clarifying goals (abstinence? Moderation? Harm reduction?)
Developing initial coping strategies

Ongoing Work

As therapy progresses:

Deeper exploration of underlying issues
Processing difficult emotions and experiences
Building new skills and capacities
Addressing relationship patterns
Navigating setbacks and challenges

The Therapeutic Relationship

Research consistently shows that the quality of the relationship between therapist and client is one of the strongest predictors of outcomes—perhaps especially in addiction, where trust has often been damaged and shame runs deep.

A good therapist offers:

Non-judgmental acceptance
Genuine care for your wellbeing
Belief in your capacity to change
Honest feedback when needed
Stability and reliability

This relationship can itself be healing, particularly if safe relationships have been scarce in your life.

Medication in Addiction Treatment

Therapy often works alongside medication:

Alcohol:

Naltrexone (reduces cravings)
Acamprosate (supports abstinence)
Disulfiram (causes unpleasant reaction to alcohol)

Opioids:

Methadone (maintenance therapy)
Buprenorphine (maintenance therapy)
Naltrexone (blocks effects)

Other:

Antidepressants for co-occurring depression
Anti-anxiety medications (carefully, given cross-addiction risk)
Medications for ADHD (when ADHD contributes to addiction)

Medication isn't a replacement for therapy but can support the process significantly.

Group Therapy and Support Groups

Individual therapy isn't the only option:

Group therapy: Led by a professional, offers the benefit of shared experience and mutual support alongside therapeutic expertise.

12-step programmes: AA, NA, and similar groups provide community, structure, and a spiritual framework. They help many people, though they're not for everyone.

SMART Recovery: An evidence-based alternative to 12-step programmes, emphasising self-empowerment and cognitive techniques.

Support groups: Peer-led groups offering mutual support without therapeutic structure.

Many people benefit from combining individual therapy with group support.

Frequently Asked Questions

Do I need to want to change for therapy to work?

You need some motivation, but it doesn't need to be total conviction. Mixed feelings are normal. A skilled therapist can work with ambivalence.

Should I be sober before starting therapy?

Not necessarily. Some therapies work well while you're still using. Others require abstinence. Discuss with your therapist what approach makes sense for your situation.

How long does addiction therapy take?

There's no standard timeline. Some people make significant progress in months; others need years of support. Recovery is often ongoing rather than complete.

What if I've tried therapy before and it didn't work?

Different approaches and different therapists suit different people. What didn't work before might not have been the right fit. Don't write off all therapy because one experience was unhelpful.

Will my therapist tell anyone about my addiction?

Confidentiality applies to addiction counselling as to other therapy. There are limits (safeguarding concerns, legal requirements), which your therapist will explain. But they won't be reporting to employers, family, or anyone else without your consent.

Can I recover without professional help?

Some people do. But professional support significantly improves outcomes for most people, particularly with severe addiction or underlying mental health issues.

What about my family?

Addiction affects the whole family. Family therapy or individual therapy for family members can help. Support groups for families (like Al-Anon) also exist.

Taking the First Step

Reaching out for help with addiction takes courage. Shame, denial, and fear often create barriers. But the very act of acknowledging a problem and seeking support is itself a step toward recovery.

Recovery isn't linear. It involves setbacks, learning, adjustments, and persistence. It's not about perfect willpower or never struggling again. It's about building a life where you don't need to escape from yourself.

If you're struggling with addiction, know that help exists and change is possible. The patterns that have developed over time can shift, sometimes in ways that surprise you.

I work with people experiencing various addictions and dependencies as part of a broader therapeutic approach. If you're ready to explore whether therapy might help, I offer a free initial phone call to discuss your situation.

The path forward starts with one step. This could be yours.

Addiction Counselling: Taking the First Steps Toward Recovery