Alternative therapy is any therapy used to treat addiction or another psychological disorder that isn’t proven to be widely effective in evidence-based studies. That means, even though an alternative therapy might be helpful for an individual, it hasn’t been proven to be significantly effective in a broader context. In some cases, alternative therapies just don’t hold up to scrutiny. They are shown to be ineffective in what they claim to do. In other cases, it can be difficult to determine if a therapy is successful because of the therapy or because of other factors.
For instance, eye movement desensitization and reprocessing therapy (EMDR) is a therapy option in which a clinician guides a patient in moving their eyes back and forth to simulate what the eyes do in REM sleep. The therapist then talks with the client and helps them to reprocess traumatic events. Researchers have pointed out that it’s difficult to say that eye-movement has played a role in EMDR’s success, and it isn’t just because of talk therapy.
Alternative therapies are alternative to what is called evidence-based therapies. These are treatment options like behavioral therapy that have shown to be effective in studies and can be implemented in a wide variety of treatment settings. Most experts, including the National Institute on Drug Abuse, recommend that addiction treatment programs be grounded in evidence-based approaches, moving alternative therapies to the fringes of treatment known as complementary therapies.
But are alternative therapies useful at all, or should they be ignored in favor of more scientifically supported approaches?
There is a wide variety of alternative therapies that can be found in addiction treatment programs. With the opioid epidemic gaining ground across the United States, more and more researchers, clinicians, and specialists are looking for new ways to treat addiction. However, not all are equally effective. That being said, addiction treatment is most effective when it is tailored to a person’s needs, so a therapy that would be a waste of time for one person can be vital to another person’s recovery. While there are hundreds of alternative therapy options, some have become standard fare in many programs. Some of the most common options include:
Yoga and mindfulness are some of the most widely used alternative therapies in addiction treatment programs. Most people are familiar with yoga and its physiological and stress-relieving benefits. Yoga often involves clearing the mind and focusing on the postures and stretches you are doing. The principle of slowly breathing from your diaphragm and keeping your mind in the moment is called mindfulness, and it can be applied to a broader range of psychological applications. The concept is more than 2,000 years old, but it has only fairly recently been introduced into mainstream psychological therapies.
Mindfulness focuses on the way the mind and body are interconnected. Mindfulness exercises focus on the body, muscles, blood vessels, and nerves, forcing the person to keep their mind from wandering. The idea in translating this practice to addiction treatment is that the skills and self-awareness a person can learn through mindfulness can be applied to relapse prevention. In fact, mindfulness has some loose similarities with cognitive-behavioral therapy, an evidence-based approach that involves learning to recognize how thoughts can lead to relapse or prevention.
Mindfulness has shown to be effective when it’s used alongside evidence-based options as a complementary therapy. However, there is no evidence to suggest that it would be effective as a primary or exclusive treatment option for substance use disorders.
Equine therapy is an alternative therapy option that sounds extremely strange and even whimsical, but it’s also one of the most widely practiced alternative therapies. Equine therapy, also called equine-related treatments (ERT) or equine-assisted therapy (EAT), is therapeutic interactions between people and horses. The specifics of these therapies can vary widely from taking care of the animals to riding to a broad range of activities. The most reputable ERT programs are overseen by medical professionals like psychotherapists or physical therapists. Horses are used in therapies for more than just addiction. They’ve trotted into therapy options for autism, depression, PTSD, and even pain management.
Supporters of equine therapy often point out some of the benefits that are associated with therapy animals, including that they lower blood pressure, reduce stress, and help people get out of their heads. Horses, in particular, require maintenance and care, which can help clients learn structure and caring for others. Horses are also large animals compared to other therapy animals like dogs, cats, and monkeys. According to Constance Scharff Ph.D., a Psychology Today contributor, getting a horse to do what it needs to do and go where it needs to go can require communications skills. She writes, “If you are unaccustomed [to] being honest and communicating clearly, the task becomes more difficult.”
ERT advocates often claim that the benefits of horses in therapy have been proven. While this may be true on an individual basis, it’s not necessarily true from a scientific standpoint. A 2014 review of the efficacy of ERT in treating various mental health disorders came out against the therapy option. The authors write, “The current evidence base does not justify the marketing and utilization of ERT for mental disorders.” Still, people who have gone through ERT successfully often say it made all the difference.
Art therapy for the treatment of substance use disorders has been used since the 1950s. Music therapy began two decades later in the 1970s. Art therapy involves giving clients an artistic outlet for non-verbal expression. It can help develop abstract virtues such as creativity and imagination, but it can also offer more concrete benefits like working through traumas or stress.
In some cases, clients are given an opportunity to freely express themselves through art, while in other cases, clients are instructed to paint specific things like traumatic events, their emotions, or their stress level. Music therapy involves a variety of music-based activities including songwriting, lyrical analysis, games, and improvisational music.
The effectiveness of music and art therapy has been studied extensively, and unlike other alternative therapies, it has shown some evidence-based effectiveness for very specific purposes. It has shown to help patients process emotions in a safe environment. Drumming was also shown to have a calming effect and may be effective in people who have experienced a chronic relapse.
However, many of these studies looked at art and music as complementary therapies and rely on patient reporting. Overall success in treatment may have very little to with these therapies, except to make treatment more pleasant, which in itself, could be valuable.
Research shows that alternative therapies are most useful in the roles of complementary therapies, which are treatment options that are offered alongside evidence-based therapies. They should be used in addition to other therapies that form the basis of a treatment plan, and they should probably not be compulsory. However, therapies like art therapy and equine therapy are, if nothing else, interesting. When they are offered in addition to evidence-based practices, they can serve to increase a person’s motivation to stay in and complete treatment.
For instance, one study showed that art therapy seemed to breakdown resistance to alcohol treatment. If an alternative therapy has shown to be safe and doesn’t interfere with an evidence-based treatment plan, then offering variety that can help people engage with treatment can only help.
Anestis, M. D., Anestis, J. C., Zawilinski, L. L., Hopkins, T. A., & Lilienfeld, S. O. (2014, June 20). Equine‐Related Treatments For Mental Disorders Lack Empirical Support: A Systematic Review of Empirical Investigations. from https://onlinelibrary.wiley.com/doi/full/10.1002/jclp.22113
Arkowitz, H. (2012, August 01). EMDR: Taking a Closer Look. from https://www.scientificamerican.com/article/emdr-taking-a-closer-look/
Baker, F. A., Ph.D., Gleadhill, L. M., MMThy, & Dingle, G. A., Ph.D. (2007, April 24). Music therapy and emotional exploration: Exposing substance abuse clients to the experiences of non-drug-induced emotions. from https://www.sciencedirect.com/science/article/abs/pii/S0197455607000469
Lieber, M. (2018, July 10). Equine therapy may help autism, PTSD and pain. from https://www.cnn.com/2018/06/18/health/equine-assisted-therapy-cfc/index.html
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