Acceptance and Commitment Therapy for Addiction Treatment

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Many people with an alcohol or substance use disorder turn to alcohol or drug use in order to retreat or escape from difficult – and often painful – emotions and patterns of thought. People in active addiction often isolate themselves from the world and avoid dealing with everything, from family, to work, to school, to friends. They often unconsciously practice and reinforce negative thoughts and feelings. When this unconscious practice continues long enough, they may believing they deserve the problems they experience.

They may believe they deserve addiction and all the pain and problems it causes.

There’s a specific type of therapy that helps people trapped in these cycles of thought. Therapists designed it to help people break free from patterns of thought that may undermine their wellbeing.

It’s called Acceptance and Commitment Therapy (ACT).

What is ACT?

Acceptance and commitment therapy is one of a group of mindfulness-based therapeutic approaches to the treatment of mental health and substance use disorders that first appeared in the late 1970s and early- to mid-1980s.

We’ll discuss the other two – dialectical behavioral therapy (DBT) and mindfulness-based cognitive behavioral therapy (MBCBT) – in a separate article. This article focuses on ACT and how therapists use it in addiction treatment.

ACT was created by therapist and psychology professor Steven Hays in 1986. Here’s a simple, straightforward way of thinking about ACT therapy, based on the acronym A-C-T:


The first step is accepting things that are hard to accept. This may include situations, personality traits, behaviors, or emotions. People with addiction often avoid the hard facts in their lives. The acceptance element of ACT recognizes that in order to move forward, each person must accept reality as it is, not as they wish it to be.


Once an individual accepts reality as it is rather than as they wish it to be – also known as cognitive defusion – they can then align their behavior with their values. This implies that they identify their values and understand how their behavior – in the case of addiction treatment, their addictive behavior – does or does not align with their values.

Taking Action

ACT is about changing behaviors. Therefore, this step is about putting acceptance and choice into practice. An individual accepts reality, chooses the values they want to embody, then takes concrete, tangible steps to match bring their values and behavior into agreement.

Acceptance and commitment therapy helps people in addiction treatment examine their character traits and understand how they affect their behavior. Two common counterproductive character traits of addiction include avoiding issues instead of addressing them and pretending things are not problems when they really are. These habits can perpetuate the cycle of addiction – but ACT can help break that cycle.

Creating Positive Change

ACT also helps people with addiction commit to making changes in their lives. When someone in treatment stalls at a certain point, ACT helps motivate them to do the work necessary to keep their behavior and their values on track. In the case of addiction, on track means staying in recovery – and living a value-based, goal directed life.

The Importance of Acceptance

Acceptance and commitment therapy enables people in addiction treatment to understand themselves and the facts of their life. This allows them to recognize and leverage their talents and strengths. Which, in turn, allows them to escape the sense of learned hopelessness that’s common in people with addiction.

Helpful acceptance strategies common to ACT include:

  • Allowing feelings and thoughts to process without acting on them
  • Recognizing weaknesses but choosing to see strengths
  • Accepting that no one is good at everything
  • Acknowledging the problems in life without avoiding them
  • Realizing that each person has control over their own reactions, thoughts, and feelings

These acceptance strategies all work to empower people with addiction. They can help people in treatment discover – or rediscover – the independent choice necessary to live life on their own terms, rather than terms dictated by their addiction. That’s why ACT is often an important part of individualized treatment plans at high-quality treatment centers. When acceptance – the capital “A” in A-C-T – is combined with choice and taking action, it’s possible to make the sustainable behavioral changes that support sobriety and recovery.