Opioid Use Disorder Therapy and Counseling: What To Expect

Therapy and counseling can be powerful tools in the treatment of opioid use disorder (OUD). While medication is often essential, many people find that emotional and psychological support also helps them stay on track.

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One member of MyOpioidRecoveryTeam shared, “Counseling has been helping.”

Another reflected on a recent breakthrough, saying, “I had a meeting with my case manager and a therapist at the hospital yesterday. I finally admitted I have an opioid habit.”

Understanding the different types of therapy available, how counseling supports addiction treatment, and what to expect from the process can help you feel more prepared and empowered, whether you’re supporting a loved one or making positive changes in your own life.

Types of Therapy for OUD

According to the National Institutes of Health (NIH), research shows that behavioral therapy and counseling are essential parts of a comprehensive treatment plan for opioid use disorder. These approaches can help address the emotional, mental, and behavioral challenges that often accompany substance use disorder.

There are several evidence-based approaches commonly used to treat opioid addiction. Your healthcare provider or a substance use disorder specialist can provide referrals and explain which type of treatment is most appropriate for you based on your individual needs and goals.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a widely used form of talk therapy that helps people identify and change negative thought patterns and behaviors. It’s commonly used to treat mental health conditions like depression, anxiety, and post-traumatic stress disorder (PTSD). When used as an intervention for opioid use disorder, CBT can help people imagine a healthier future, make more intentional choices, and replace harmful habits with more constructive and positive routines.

CBT encourages people to explore the connection between their thoughts, feelings, and actions, and develop coping strategies that reduce the risk of relapse. It’s a structured, goal-oriented approach that can be helpful in building long-term recovery skills.

Contingency Management

Contingency management is a behavioral therapy that uses positive reinforcement to support lasting change. Working with a trained provider, people in recovery set specific goals and earn tangible rewards for meeting them.

These goals might include staying drug-free, taking treatment medications as prescribed, or participating in counseling sessions or support groups. By linking positive behaviors with immediate incentives, contingency management can increase motivation, strengthen engagement in treatment, and improve outcomes.

Motivational Interviewing

Motivational interviewing is a short-term counseling approach designed to help people increase their willingness to engage in treatment. It’s often used at the beginning of substance use disorder treatment, especially when someone feels uncertain or ambivalent about changing their behavior and stopping opioid use.

In this approach, a therapist works with the individual to explore their personal motivations for change, whether that’s becoming a better parent, finding a new job, improving relationships, or simply living a healthier life. By helping people connect with their own reasons for recovery, motivational interviewing can build the internal motivation to take the next steps.

These three evidence-based therapies — CBT, contingency management, and motivational interviewing — can be used on their own, in combination, or as part of a larger treatment plan. Depending on your specific needs, your healthcare provider may also recommend group therapy, family therapy, or counseling through an inpatient or outpatient treatment center. Make sure you understand your treatment options and the reasons behind your provider’s recommendations before moving forward.

What To Expect From Therapy

Each person’s recovery journey is unique, but there are some common aspects of therapy you can expect as you begin treatment.

Your Therapist or Counselor

A variety of licensed professionals can provide therapy or counseling for substance use disorder treatment, and each brings a different background and approach to treatment.

You might work with a:

• Licensed professional counselor (LPC)
• Licensed clinical social worker (LCSW)
• Licensed clinical alcohol and drug abuse counselor (LCADAC)
• Doctor of psychiatry or psychology
• Addiction counselor
• Substance abuse counselor
• Another type of mental or behavioral health specialist

Credentials and titles vary by state, and therapeutic methods vary by training and specialization. Ask your potential therapist about their experience, treatment philosophy, training, and the types of therapies they use. Understanding their approach can help you feel more comfortable and get the most out of your treatment plan.

Individual or Group Sessions

Therapy may be offered one-on-one (individual therapy) or in a shared setting (group therapy). Both formats can be effective, depending on your comfort level, needs, and preferences.

Individual therapy provides focused, personalized support and may allow for deeper exploration of your thoughts and personal experiences. It’s customized for you, your goals, and your schedule.

Group therapy offers a sense of community and a reminder that you’re not alone in your struggles. Some find it helpful to hear others share their experiences and to connect with people who understand what they’re going through.

What Happens During a Session

While every therapist has their own style, most sessions will involve open conversations about your thoughts, feelings, behaviors, and goals. Your therapist may help you explore past experiences, identify triggers for substance use, and develop practical strategies for managing stress and relapse prevention.

Some therapists assign homework between sessions, like journaling, practicing new coping skills, or tracking moods and behaviors. These exercises are designed to reinforce progress and help you apply what you’re learning in real life so you reach your treatment goals.

Staying Consistent and Engaged

No matter which type of therapy or therapist you choose, consistency is key. Recovery can be challenging, and it’s not uncommon to feel worse before you feel better. It’s important to keep showing up and to stay engaged.

Try to be open and honest during sessions, even when it’s uncomfortable. Follow through on any assignments your therapist gives you and think of therapy as a partnership. Your therapist is on your team and wants to see you succeed. They are there to support you, not judge you. With time, trust, and effort, therapy can be a powerful part of your recovery process.

Combining Therapy and Medication

Medication-assisted treatment (MAT) combines therapy with medication to improve recovery outcomes, reduce the risk of relapse, and prevent or reduce opioid overdose. While mental health support services address the psychological, emotional, and behavioral aspects of opioid addiction, medications can help manage cravings, ease withdrawal symptoms, and lessen other physical side effects of opioid withdrawal.

Three commonly used medications for opioid use disorder (MOUD) are methadone, buprenorphine, and naltrexone. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), these medications work by normalizing brain chemistry, relieving cravings, restoring normal body functions, and more. All three are approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid use disorder.

Behavioral therapies like CBT can enhance the effectiveness of these medications and support long-term recovery by helping people stay engaged in treatment. If a healthcare provider recommends medication-assisted treatment for you or a family member, ask them to explain the full treatment program so you have a clear understanding of the goals and what to expect throughout the treatment process.

Treatment for OUD is not one-size-fits-all. It may take time and more than one attempt to find the most effective treatment for you or your loved one.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

What has been your experience with therapy or counseling for opioid use disorder? Let others know in the comments below.