Known by the acronym ACT, Acceptance and Commitment Therapy is a psychotherapy approach that is applied in numerous contexts, including drug recovery treatment.
ACT fits within the larger framework of mindfulness-based therapies. For individuals who are unfamiliar with mindfulness, it is an approach to thinking and living that largely developed as a self-help measure, outside of a clinical setting, but has gained considerable traction in structured drug abuse and mental health treatment programs.
Mindfulness posits that each individual has the ability to step back from thoughts and witness them nonjudgmentally as a method of avoiding negative automatic reactions to people, places and things. Through greater mindfulness, practitioners believe that they can organically achieve personal transformation for the better.
The Core of ACT
According to the National Registry of Evidence-based Programs and Practices (NREPP), ACT focuses on six core areas. The first area is acceptance. As also theorized in Dialectical Behavior Therapy, a lack of acceptance of one’s reality can keep a person in a repeat pattern where he is continually enmeshed in the same emotionally and physically grinding problems. Acceptance of these feelings and circumstances is an effective way to begin to change them.
The second core area of ACT is defusion, or acceptance. ACT helps to train recipients in how to detach their identity and behaviors from thoughts. For instance, the thought “I would like to get high right now” does not have to lead to drug use, nor does this thought alone mean that the person is a drug abuser. In the process of examining thoughts, the thinker gains greater power over the thoughts. Then there is less likelihood that the thought will bully the person into engaging in unhealthy behaviors.
Presence is the third ACT core area. Similar to teachings in mindfulness, consciously being present of the moment is an effective way to catch oneself and restore mental harmony and balance. Early drug recovery is a moment-to-moment process, and being present is a helpful strategy to avoid relapse.
Presence relates to the fourth ACT core area: self-awareness. This quality is part of the benefits package of mindfulness; the more self-awareness a person has, the greater her self-empowerment and ability to effect personal change
Value identification is the fifth core area of ACT. Sometimes an individual’s life is commandeered by another person’s values or society’s general values, which leads to the person living an inauthentic life. Through ACT, a person can learn to identify his personal values and then begin to pursue them. ACT helps to shift individuals away from harmful behaviors, such as drug addiction, which undermines recovery. Value identification also helps to build a recovering person’s new foundation for living, as steps are taken to support and promote what really matters.
The sixth and last core area is commitment to action. All of the work in ACT sessions is intended to lead to positive changes, such as ending drug abuse and building a new sobriety-based life. The way to implement these changes is through an affirmative commitment to them. ACT clients who are willing to change are the ones best positioned to make healthy life changes.
As the overview of ACT suggests, the therapy works with an individual’s psychological state in order to bring about changes in behavior. At the start of ACT, a person may not be receptive to change. ACT understands this possibility. However, the good news is that the ACT approach has the ability to help recipients grow in acceptance of the process and mobilize toward change.
One reality of pain is that individuals will grow so accustomed to it that they unwittingly begin to protect it, even defending it in therapy or by avoiding therapy. Through the dynamic process of therapy, a psychotherapist can help an individual to build a new, healthier platform for thinking. It is from that less painful or pain-free platform that the person can take concrete steps to effect real life changes, such as to stopping drug use or other harmful behaviors, letting go of an abusive relationship, or starting on a new and better suited career or educational path.
The ACT overview provides a window into what to expect from this form of therapy in actual sessions, but acceptance, which is integral to the process, bears further exposition. As Psychology Today explains, acceptance can remove many of the internal emotions that obstruct the need to change for the better. For instance, it is well-observed in the mental health field and in popular self-health literature that obsessively trying to control or worrying about uncontrollable situations can keep a person stuck in asking “why” things are the way they are, and in this way, it can keep the person from making much needed life changes. During ACT sessions, a psychotherapist works with a client to help him to accept his current reality.
It may seem paradoxical, but acceptance does not lead to complacency and a failure to change, but rather acceptance leads to personal transformation, self-empowerment, and confers the ability to make significant life changes.
But how does a person get to the point of acceptance? During ACT, a psychotherapist will introduce different acceptance strategies, such as:
- Guide the ACT patient to let thoughts and feelings flow through herself rather than feeling the need to impulsively react to them
- Coach the ACT patient to observe her weakness but not overexpress them, and to keep note of her strengths
- Dynamically teach the ACT patient to have compassion for the personal reality we all face, namely that none of us are perfect, and we do not have to succeed or excel at every single thing we do
- Help the ACT patient to acknowledge present challenges without feeling the need to avoid them or engage in escapism in an unhealthy manner
- Instill in the ACT patient that she is in control of how she reacts, acts, thinks, and feels
Empowerment through acceptance strategies may not seem obvious, but research and feedback from clinicians and patients supports that this is a positive outcome of ACT. This approach was not the first to discover the power of acceptance. Today, the Serenity Prayer is a well-known property of the public domain, although its exact origins and author remain unknown. Still, for those who are unfamiliar with the Serenity Prayer, it conveys that wisdom of needing to accept what we cannot change. The Serenity Prayer is often associated with Alcoholic Anonymous, a fellowship that realized that greater acceptance was an important psychological key to unlock sobriety. Today, the wisdom of the Serenity Prayer is at work in numerous complementary philosophies and therapies, such as ACT.
ACT in Drug Recovery
ACT has proven beneficial in the drug treatment context. ACT is considered to be an evidence-based approach to treatment, which means that there are research studies to support the use of ACT in drug rehab programs. Although not in the rehab center context, one well-noted study (written in Spanish and translated to English) published in Psicothema applied ACT to women in prison with substance use disorders. The study involved 31 female inmates diagnosed with a substance use disorder. Note that although the women were incarcerated, it should not be assumed that they were not also current drug users.
The 31 participants were either assigned to ACT therapy or a control group. The study focused on three timeframes: pre-ACT treatment, after ACT treatment and a follow-up at the six-month mark. The results support that ACT is an effective substance abuse treatment (in conjunction with other rehab services). After 16 ACT sessions, there was an abstinence rate of 27.8 percent, which increased to 43.8 percent as of the six-month follow-up. ACT also contributed to improvements in the ACT group that the control group did not experience, including a decrease in the percentage of the co-occurrence of mental illness and substance abuse, less anxiety, and an increase in psychological flexibility. Although the study was conducted in a prison setting, by extension it would work in other contexts, such as in drug rehab centers.
The addiction recovery workbook The Wisdom to Know the Difference provides tools for individuals who want to learn more about applying ACT to substance abuse recovery.
This book, and similarly themed ones, may be introduced in therapy or can be used as part of one’s personal efforts to increase acceptance as a pathway to change and recovery. The book reportedly complements the spirit of the 12-Step program and, for this reason, can be used in conjunction with Alcoholics Anonymous, Narcotics Anonymous, or other recovery groups centered on acceptance and change.
Finding ACT Care
All drug rehab centers will offer patients some form of psychotherapy, but not all will provide ACT specifically. Other psychotherapy approaches, such as Cognitive Behavioral Therapy and Dialectical Behavior Therapy, have also proven successful in the treatment of drug addiction. Each individual rehab center determines which psychotherapy approaches it offers to patients. A prospective rehab patient always has the option to inquire with rehabs about which psychotherapy approaches are offered. Outside of the rehab context, a recovering person who is seeking ACT sessions may ask for a referral from the treating rehab center, inquire with the insurance provider, or do a search on a comprehensive site such as Psychology Today.
At Black Bear Lodge, new patients start with a comprehensive intake interview with an expert admissions counselor. After the intake, the counselor will work with a multidisciplinary team of top addiction professionals to create a program tailored particularly to the client’s needs as revealed in the intake process. We offer our patients a host of evidence-based rehab services to optimize recovery success. At Black Bear Lodge, our treatment goal is to help you to achieve lasting recovery.