Acceptance and Commitment Therapy (ACT) and Addiction

Acceptance and Commitment Therapy (ACT) and Addiction

What is Acceptance and Commitment Therapy?

Acceptance and commitment therapy (ACT) is a form of behavioral therapy designed to help a person cope with the strengths and weaknesses of their personality. It’s centered around discussing thought patterns and habits that one may view as undesirable. Acceptance and commitment therapy is used to separate changeable habits from unchangeable ones. In doing so, a patient can better process their emotions, traumas, and thoughts without the stress of trying to erase all of their perceived flaws.

For example, a person with addiction issues can accept that they will always feel cravings toward a substance and that it’s okay to feel this way. Acknowledging this fact about themselves puts them in a better position to recognize addiction triggers and pursue healthy coping mechanisms.1

Origins of Acceptance and Commitment Therapy

Dr. Steven C. Hayes originally developed ACT in 1999, and he is also behind relational frame theory. Dr. Hayes has published over 40 books relating to value-based mindfulness therapy.

Evidence for the Effectiveness of Acceptance and Commitment Therapy

Perhaps the greatest example of ACT’s effectiveness is that this form of therapy has been on the rise for several years. The American Psychology Association recommends ACT for the treatment of psychosis, mental illness, work and home stress, and addiction.

Furthermore, ACT is similar to cognitive behavior therapy. The biggest difference between ACT and CBT is how it’s practiced. The principles and mentality of the two treatment methods are largely identical. With that in mind, CBT is one of the largest forms of psychiatric treatment. It’s used to help children, the elderly, criminals, and everyone in between.

Relational Frame Theory

Relational frame theory, a large part of acceptance and commitment therapy, deals with the language one uses to describe themselves.

As an example, a person with negative self-verbiage tends to view themselves with negative thoughts and subconsciously internalized beliefs.

Phrases like, “I’m a loser” or “I never do well” tend to lessen self-image and contribute to insecurities.

Changing the way a person refers to themselves or at least making them aware of the negative thoughts and verbiage helps change their long-term mental state.2

Functional Contextualism

In short, functional contextualism is a form of self-awareness centered around future actions and events. If a patient can understand how the world affects them and how events change their mood, they’ll be better equipped to cope with these events and recover from setbacks. It also helps a patient make more sense of the world around them.3

Central Assumptions

Central assumptions, in terms of acceptance and commitment therapy, refer to the base assumptions a person has about themselves and how it affects them.

Assumptions such as “I’m not good at this” or “I’m this kind of person” can cause one to forgo opportunities due to perceived future failure.

Examples include not applying for work promotions, avoiding confrontations, or, more relevantly, identifying the bad habits to change.

Relational theory, functional contextualism, and central assumptions are the primary principles of acceptance and commitment therapy.

Parts of Acceptance and Commitment Therapy

In addition to the aforementioned concepts related to acceptance and commitment therapy, ACT can be further broken down into the following steps:

  • Cognitive Defusion: Cognitive defusion refers to removing one’s own emotions from an event. Being too close to an event can make it hard to see the big picture. Cognitive defusion allows one to process an event from the perspective of a 3rd party. The patient can recognize parts of an event that were well beyond their control and lessen the burden they’ve placed on themselves for allowing it to happen.
  • Acceptance: Acceptance, in terms of ACT, occurs when an individual accepts that the event has occurred and that it can never be changed – what’s done is done and in the past.
  • Mindfulness: Mindfulness is a long-hailed mediation practice that originated in the eastern world. Mindfulness is the active ability to allow emotions to pass through one’s thoughts without reacting to them. Mindfulness does not mean ignoring memories and emotions but rather not allowing them to control day-to-day events. Mindfulness also encourages one to be aware of how they think and what patterns to look for.


  • Commitment – Commitment is about commitment to oneself, goals, and acceptance commitment therapy. Commitment is often shown through action and is brought on by a deeper understanding of oneself and their needs.
  • Cognitive Therapy – Cognitive therapy is a form of therapy used to reshape how a person thinks, feels, and reacts. Cognitive therapy takes time to become effective but provides long-term mental changes.
  • Behavior Analysis – Behavior analysis is a matter of understanding why a person is the way they are. It’s the precursor to behavioral therapy. It serves to paint an overall picture of habits and reasonings. In terms of ACT, it refers to the self-awareness needed to make a long-lasting change.

ACT Application

ACT and Addiction

ACT with addiction helps substance users become more aware of who they are as a person and what they can do to overcome addiction. It’s often applied during prolonged treatment, such as outpatient rehab. Modern medicine has taught us that addiction isn’t a choice, but rather a culmination of poor environment, interpersonal relationships, culture, and genetics. While this doesn’t absolve a substance user from all culpability, it shows more to addiction than individual choices.

From this outlook, a patient can better understand the changes they as an individual need to make versus the changes that don’t contribute to their recovery. A psychiatrist often conducts both ACT and addiction treatment. Over time, a patient learns healthy coping mechanisms and comes to better understand their emotional triggers.

ACT and Psychosis

ACT has a long-lasting impact on psychosis treatment. Long-term psychosis is the result of a serious and permanent ailment. Because of this, ACT isn’t centered around changing an individual but instead pivots to teach coping mechanisms for psychosis episodes. Much like ACT and addiction, a patient suffering from psychosis learns what their triggers are, how to avoid them, and not to blame themselves for being who they are.4

ACT for LGBTQ Issues

A long-running societal belief is that LGBTQ individuals choose their sexuality, which studies have proven false. However, the needling thought that an LGBTQ person could simply choose their sexuality can wreak havoc on one’s self-confidence and lead to negative thoughts. ACT offers LGBTQ members the chance to accept who they are. This can lead to positive long-term changes, reduced negative thoughts, and overall better life experiences.

ACT for Service Members

Service members undergo great trauma during their day-to-day lives. The horrors of war, the stress of continual vigilance, and domestic responsibilities can lead to impaired self-image. ACT works to relieve them of their perceived wrongdoings, survivors’ guilt, and PTSD. By seeing the bigger picture, a service member can better accept the events that happened and disconnect their emotions from said event. This allows for a smoother transition into civilian life or longer military service.

Other Addiction Treatment Options

  • Detox – Detox treatment helps ease the symptoms of withdrawal and the transition into sober living.
  • Inpatient – Inpatient treatment is an option for anyone who requires around-the-clock care to overcome their addiction. Inpatient treatment offers addiction rehab programs, sober living homes, and direct hospital care. Inpatient treatments are typically short-term, anywhere from a week to a few months, but help establish the building blocks for long-term sobriety.
  • Outpatient – Outpatient treatment is for those that choose not to leave home or who have already graduated from inpatient care. Outpatient care provides a long-term recovery plan, regular check-ins, and support groups to help with future cravings. Recovery is a life-long process and requires constant adjustment. Long-term outpatient treatments make the process that much more bearable.


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