Treating Addiction With Acceptance and Commitment Therapy (ACT)

Addiction can hijack your behavior. This condition makes it easy to lose sight of your goals, values, and even immediate needs. Instead, many people prioritize drug use over the things that matter most to them.

In rehab, you’ll have space to take a step back and look at your life as a whole. That perspective can inspire lasting change. Acceptance and commitment therapy (or ACT, pronounced like the word “act”) shows people how to make those changes. This treatment empowers you to behave in ways that align with your own highest ideals.

In a rehab with acceptance and commitment therapy, you won’t work toward standardized goals, or fight against your own needs. Instead, you’ll start building a life that works for you.

What is Acceptance and Commitment Therapy?

ACT is a type of behavioral therapy founded by psychologist Steven Hayes in the 1980s. In some ways, it resembles dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT). All of these behavioral treatments include talk therapy, but focus on teaching you practical skills. Between sessions, you’ll put those skills into action. Then you can tell your therapist about your progress, and strategize ways to do even better.

Dr. Russell Harris, world-renowned ACT therapist, explains that acceptance and commitment therapy is based on mindfulness.¹ He writes, “the goal of ACT is to create a rich and meaningful life, while accepting the pain that inevitably goes with it.” Therapists use metaphors and exercises to guide you toward your own values. The goal is to reach a state of balance, in which you can navigate life’s obstacles with grace.

This treatment gives you the tools you need to define your own personal values. Those values might be different from those of the people around you—including your therapist. And that’s okay.

In ACT, you’ll learn to do what’s right for you. Patients achieve this by focusing on a few core ideals.

The 6 Principles of ACT

ACT has 6 central principles² that inform all the exercises you’ll do with your therapist. These concepts aren’t prescriptive—meaning, they’re not there to tell you what to do. Instead, they describe a general approach to living well. To quote Dr. Harris, the principles are as follows:

1. defusion
2. acceptance
3. contact with the present moment
4. the observing self
5. values
6. committed action

You’ll learn how to put these into practice during rehab. Then, once you complete initial treatment, you can use them to build a meaningful life back at home.

Defusion

Think of defusion as de-fusing with overwhelming emotions. This principle asks you to take a step back. You learn to see thoughts, feelings, and events as what they are. You can assign meaning to anything—that’s a natural human impulse. But it doesn’t mean that you should. It can be helpful to recognize that some things don’t have greater implications.

This idea can be life-changing for people with addiction and co-occurring disorders. It’s all too easy to get lost in self-doubt, judging yourself harshly for your own experience. Defusion illustrates that you are not your thoughts or your feelings. These are experiences you have. They don’t need to define your identity or your behavior. You can just accept what’s happened, and move forward.

Acceptance

In ACT, acceptance is just what it sounds like³ —accepting present reality just as it is. This includes external events, and your own thoughts and feelings. The act of resisting a feeling is usually exhausting, and rarely effective. These strategies teach you to save that energy, and focus instead on ways you can affect change.

Acceptance isn’t passive. On the contrary, ACT teaches you practical skills to accept what’s happening in your life. For example, people with OCD and addiction can both benefit from urge surfing. In this ACT technique, Dr. Harris says patients learn to “ride urges like a wave.⁴ Let the wave crest and fall. Don’t resist it.” You can engage with your cravings as an observer, without acting on them. This mindfulness technique helps people stay present in their own lives.

Contact With the Present Moment

When we act mindfully, we stay in contact with the present moment. With this core principle of ACT, you’ll cultivate resilience.⁵ As Steven Hayes writes, the goal is for people to “experience the world more directly so that their behavior is more flexible and thus their actions more consistent with the values that they hold.”

To stay in touch with the present, you can implement a variety of mindfulness techniques. You might learn these from your ACT therapist, or from another treatment provider. For example, many rehab centers offer yoga and meditation. These strategies help you stay open and centered, even when you’re facing great challenges.

The Observing Self

This principle of ACT builds on the ideas established by defusion.² Dr. Harris writes that these strategies let you access “a transcendent sense of self; a continuity of consciousness that is unchanging.”

This greater self is always observing your life. You can go to rehab, relapse, move to a new city, get promoted, or take up swing dancing. It doesn’t matter how much you change. Your observing self will always be there, with you and for you. Once you recognize this, you can learn to trust yourself again. This can be powerful for anyone, especially people in addiction recovery.

Values Guide Your Recovery Process

Early in ACT, your therapist will take you through the process of defining your values.⁶ There are a few different ways to achieve this. They might have you go through a deck of cards with different values, and rank them in order of importance. Or, you might do a writing exercise. Whatever method you use, you’ll end up with a list of core values that are unique to you.

Your values serve as a guiding light, informing every decision you make. These ideals may change over time. But in any given moment, you can know what your highest values are, and act in a way that honors them.

Committed Action

When you take committed action, you act in accordance with your personal values. This principle is the culmination of ACT’s other ideals—but it doesn’t have to come last. Healing isn’t a linear process. For example, you can act on your values while you’re still learning to stay in contact with the present moment.

Committed actions are creative ways to work toward the life you want. You can examine your impulses, and reframe them in light of your ideals. For example: do you really value drug use? Or do you actually value feeling emotionally stable? If it’s the latter, you can achieve that by going to therapy, meditating, or engaging in a healthy hobby. And by doing those things instead, you can honor your values in a more sustainable way.