Expressive Therapy for Substance Abuse

The term expressive therapy is one of many terms used to describe a form of art therapy; other terms include expressive arts therapy, creative arts therapy, and expressive therapies. In this form of therapy, the act and process of creation are the emphasis rather than the final product. There are many art forms that can be used in expressive therapy, including:

  • Dance
  • Theater
  • Music
  • Creative writing
  • Film or video production
  • Visual arts like painting
  • Psychodrama

Sometimes, horticulture therapy, which involves gardening, farming, or land maintenance, can be included in expressive therapies, but this is not universally acknowledged.

What Is Expressive Therapy, and How Does It Work?

According to Americans for the Arts, creating a work of art allows humans to feel fully engaged, effective, and vital. The absorbing process of creation helps to refocus thought patterns on the task, and completing the work can stimulate the reward centers of the brain, so the person feels successful and content. When applied to healthcare fields, arts programming, creative therapies, and evidence-based design can:

  • Enhance the ability to cope with stress
  • Build resilience
  • Reduce pain, which decreases the need for pain medication
  • Lessen depression and anxiety symptoms
  • Increase self-esteem
  • Reduce treatment needs, including hospitalization, length of hospital stay, and healthcare-related infections
  • Increase satisfaction

Expressive therapy is a great complementary therapy, alongside medication and counseling. It has been effectively applied to treating conditions, such as:

  • Anxiety
  • Interpersonal relationship difficulties
  • Learning disabilities
  • Grief and bereavement
  • Eating disorders
  • Alzheimer’s disease and other dementia conditions
  • Terminal diseases like cancer
  • Alcohol and drug addiction
  • Trauma, including from abuse

A Brief History of Expressive Therapy

Many people who work in expressive therapy fields state that the artistic and creative process has been used to help people throughout human history. For example, ancient Egyptians reportedly encouraged those struggling with mental illness to create works of art while the ancient Greeks used music and drama to understand trauma from war. However, the idea of incorporating art into healthcare and psychotherapy began in the late 19th century and developed alongside the field of psychiatry. Creative therapies were more solidly developed in the 1930s and 1940s, beginning to form a separate psychological field to help nonverbal patients.

While expressive therapies are complementary therapies to counseling and medication, these specific fields require separate certification and licensing because they are considered part of the medical field.

Fields within Expressive Therapy

Expressive therapies are especially effective as complementary therapies because they involve specific action on the part of the client. They are nonverbal, so they can help people who struggle to express themselves in words or sentences, and they are active, requiring the client to make choices. There are eight foundational types of expressive therapies, according to a research report published by Psychology Today:

  1. Art therapy:Various forms of visual arts, such as painting, collage, photography, and other media images, are used by clients to create responses to their therapy sessions.
  2. Music therapy:The act of playing an instrument, singing, or just listening to music has been shown to effect positive changes to mood, cognition, and social functioning among those with health or education problems.
  3. Drama therapy:Using various aspects of theater creation, especially acting and character development, this form of expressive therapy helps the individual actively create new scenarios, understand a condition from a different point of view, and increase their flexibility between roles, among other positive changes.
  4. Dance/movement therapy:This therapy improves physical awareness and spatial awareness, and release endorphins to improve mood. Cognition and behavior often improve with participation in this form of expressive therapy.
  5. Poetry/bibliotherapy:This therapy uses journaling, writing prompts, poetry creation, and poetry reading, among other ways of working with literature, to help a person understand their emotional reactions and changes they are facilitating in themselves, and keep track of personal growth.
  6. Play therapy:Just having fun can facilitate personal growth and change, improve interpersonal skills, and more.
  7. Sandplay therapy:This is a specific form of play therapy that uses a sandbox with miniatures, allowing the individual to uncover a deeper layer of their psyche by creating tableaus and sand art.
  8. Integrated arts therapy:This involves the use of two or more forms of expressive therapy in combination to foster awareness, cognitive improvements, and emotional and behavioral changes.

Using Expressive Therapy in Addiction Treatment

Expressive therapies that improve mood and mental health can reduce a person’s risk of substance abuse, so they are good complementary therapies during and after rehabilitation to help people who experience co-occurring disorders. However, even without an underlying mental illness, expressive therapies are very effective at improving recovery and helping people maintain abstinence from drugs and alcohol. One study found that expressive therapy can help people with severe substance abuse problems to improve and to maintain these improvements for a year after rehabilitation.

While there are still few studies indicating effectiveness of expressive therapies on overcoming addiction during and after rehabilitation, there are a few. Among people using methadone to withdraw from long-term, chronic opioid abuse, for example, those who attended expressive art therapy sessions required less methadone. They were also less likely to begin abusing cocaine.

A meta-analysis of 800 expressive writing studies found that participants, on average, experienced a 23 percent improvement in trauma symptoms – an amount comparable to other forms of psychotherapy. People who experience trauma, especially during childhood, are at a much higher risk for developing substance abuse and drug addiction issues later in life; as many as 80 percent of women, in particular, who seek treatment for substance abuse have at least one lifetime trauma. Expressive writing sessions were typically 15-20 minutes per day, making them cost-effective and efficient, especially for rehabilitation programs that do not prescreen for post-traumatic stress disorder or other mental conditions that indicate co-occurring disorders.

Rehabilitation programs are adding more options for complementary treatment approaches, including expressive therapies like music, drama, and play. While these are not specifically necessary for treatment, they can help people improve withdrawal symptoms, especially psychological symptoms. They can also effectively treat underlying mental health issues, alongside Cognitive Behavioral Therapy and other kinds of counseling. They can bolster traditional treatments like group therapy and medication-assisted therapy.