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In the UK, drug and alcohol difficulties are understood as biopsychosocial conditions, shaped by a complex interaction between neurobiology, emotional regulation, learned behaviour, life experience and social environment (NICE, 2017; DHSC, 2025; BPS, 2019). Research shows that long-term patterns of substance use are rarely caused by a single factor; rather, they develop through repeated coping responses to stress, trauma, social pressure or emotional discomfort (Public Health England, 2017).

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For this reason, effective treatment does not focus solely on stopping substance use. Instead, it aims to help people understand what may be maintaining their current patterns, develop alternative coping strategies, strengthen emotional resilience, and build a more stable and meaningful life (DHSC, 2025).

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All treatment is guided by a personalised treatment and recovery plan, co-created with each client and reviewed regularly with a keyworker. This collaborative planning approach is a requirement of national clinical guidance and ensures that support remains flexible, person-centred and responsive to changing needs (DHSC, 2025).

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Key Areas Commonly Explored in Sessions

Psychological & Emotional Wellbeing

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Many sessions draw on principles from Cognitive Behavioural Therapy (CBT), which proposes that thoughts, emotions and behaviours are closely linked (Beck, 1976). When someone experiences distress, negative automatic thoughts can increase emotional discomfort and reinforce unhelpful behaviours. CBT-informed work therefore supports clients to:

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• Identify recurring thought patterns that increase urges to use substances

• Recognise cognitive distortions such as catastrophising, emotional reasoning or self-blame

• Explore alternative ways of interpreting situations

• Practise new behavioural responses to stress and cravings
  (NICE, 2017; NHS, 2025)

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Substance use is also conceptualised as a learned and reinforced behaviour, shaped through classical and operant conditioning (Marlatt and Donovan, 2005). For example, alcohol may temporarily reduce anxiety, which reinforces future use. Over time, environmental cues such as certain places, people or emotional states become triggers (NICE, 2017). Treatment therefore focuses on:

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• Identifying personal triggers

• Breaking habitual stimulus–response cycles

• Replacing substance use with healthier coping strategies
  (DHSC, 2025)

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UK guidance also highlights the high prevalence of trauma, loss and chronic stress among people who access addiction services (BPS, 2019). Such experiences may affect emotional regulation, attachment patterns and self-esteem. Sessions may gently explore these influences and support the development of safer emotional coping methods (DHSC, 2025).

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Motivation, Change & Identity

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National guidance recognises that people vary in their readiness to change. Many services draw on the Transtheoretical (Stages of Change) Model, which describes change as a gradual process involving phases such as ambivalence, preparation, action and maintenance (Prochaska and DiClemente, 1983; NICE, 2017).

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Sessions may also be informed by Motivational Interviewing (MI), a collaborative and respectful approach that helps people explore their own reasons for change and resolve mixed feelings about substance use (Miller and Rollnick, 2013). MI supports autonomy and avoids confrontation, which is associated with better engagement and treatment retention (NICE, 2017).

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Social, Family & Lifestyle Factors

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UK policy highlights that recovery is influenced by the social determinants of health, including housing, employment, relationships, community connection and access to support (Public Health England, 2017; DHSC, 2025). Substance use can both affect and be affected by these wider life factors.

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Sessions may explore:

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• Relationship dynamics and communication patterns

• Peer influences and social environments

• Daily routines, work–life balance and stress

• Practical challenges such as finances, housing or isolation
  (NHS, 2025)

• Unmet needs

• Long-term medical conditions​

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This reflects principles from Social Learning Theory, which proposes that behaviour is shaped through observation, modelling and reinforcement within social contexts (Bandura, 1977).

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Values, Responsibility & Meaning

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Substance use can impact identity, confidence and personal values. Some people wish to explore feelings of guilt, shame or loss of direction, and the effects of substance use on relationships and life goals (BPS, 2019; DHSC, 2025).

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This reflective work may be informed by Self-Determination Theory, which suggests that wellbeing is supported when people experience autonomy, competence and meaningful connection with others (Ryan and Deci, 2000). Sessions may therefore help clients clarify values, strengthen self-respect and explore new sources of purpose.​

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References

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Bandura, A. (1977) Social Learning Theory. Englewood Cliffs: Prentice Hall.

Beck, A.T. (1976) Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.

British Psychological Society (2019) Evidence-based practice for the treatment of substance misuse. Leicester: BPS.

Department of Health and Social Care (2025) Clinical guidelines for alcohol treatment. London: DHSC.

Marlatt, G.A. and Donovan, D.M. (2005) Relapse Prevention. 2nd edn. New York: Guilford Press.

Miller, W.R. and Rollnick, S. (2013) Motivational Interviewing. 3rd edn. New York: Guilford Press.

NHS (2025) Alcohol misuse: treatment. NHS.

NICE (2017) Alcohol-use disorders: diagnosis, assessment and management (CG115). London: NICE.

Prochaska, J.O. and DiClemente, C.C. (1983) Stages and processes of self-change. Journal of Consulting and Clinical Psychology, 51(3), pp. 390–395.

Public Health England (2017) An evidence review of the outcomes that can be expected of drug misuse treatment. London: PHE.

Ryan, R.M. and Deci, E.L. (2000) Intrinsic and extrinsic motivations. American Psychologist, 55(1), pp. 68–78.

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