How Animals Can Assist Patients in Drug and Alcohol Addiction Treatment Butler Center for Research Update | July 2, 2016 Treating Substance Use Disorders With Animal-Assisted Therapy Service animals have played a significant role in modern health care practices, and therapy animals have begun to emerge as a popular addition to conventional psychotherapy for mental and behavioral health treatment. While animal-assisted therapy (AAT) is generally well regarded among patients, scientists have long been interested in its impact on patient well-being and outcomes following treatment for a variety of conditions, including treatment for substance use disorders. AAT is not an independent modality but is instead a therapeutic technique that is used alongside an established evidence-based practice in order to maximize the benefits of treatment.1 Animal-assisted therapy offers a vast array of applications to meet patient needs for a variety of conditions—they include equine/riding therapy to assist with balance and minimizing aggression, using observation and identification of animals as part of cognitive rehabilitation, and training service animals to assist patients with specific tasks in their daily routines.1 For psychotherapy applications, including treatment sessions for substance use disorders (SUDs), a trained therapy animal is generally included in individual and group therapy sessions, and patients are able to interact with the animal as the session is conducted.1, 2 The inclusion of animal-assisted therapy with evidence-based practices has had marked success with a number of populations in improving outcomes among patients. Studies have found that AAT is significantly effective with adult substance use disorder patients in residential addiction treatment programs,2 individuals mandated to substance abuse treatment as part of the criminal justice system,3 and adolescents/young adults in inpatient and day treatment settings.4 How Does Animal-Assisted Therapy Improve Outcomes? The inclusion of therapy animals in evidence-based treatment practices provides a number of therapeutic benefits that explain its success in improving patient outcomes. In treatment for substance use disorders, therapy animals improve therapeutic alliance and general regard for the treatment environment, in addition to reducing patient anxiety about receiving treatment, both of which have been found to increase patient adherence to their recommended treatment plan. Differences in patient-reported therapeutic alliance (as measured by the HAQ-II) for patients who completed sessions with a therapy animal (experimental group) and without a therapy animal (control group) Source: Wesley, Minatrea, & Watson (2009). Therapeutic alliance refers to the quality of the interpersonal relationship formed between a patient and therapist, and it has been shown in several studies to significantly impact the likelihood of sobriety following an substance use disorder treatment intervention, as patients are much more likely to complete their addiction treatment plan as recommended when they share positive therapeutic alliance with the therapist.2 Therapeutic alliance is a complex aspect of therapy and includes various elements, including a shared understanding of the goals and activities for each session and the emotional bond between the patient and therapist.5 The strongest predictor of the quality of therapeutic alliance is the patient's level of motivation at admission,5 although therapeutic alliance can also be significantly impacted by demographic and personality characteristics of the patient and therapist, as well as the level of similarity between patients' and therapists' backgrounds and attitudes.2, 6 The inclusion of therapy animals during sessions often creates a platform for initial verbal communication between patient and therapist regarding shared positive attitudes about the animal, which can accelerate the development of a positive interpersonal relationship and improve therapeutic alliance in early sessions.2 Research has also found that patients tend to trust therapy animals significantly sooner than therapists in a new treatment environment, and therapists are trusted sooner as a result of their affiliation with the therapy animal.7 Outside of the benefits to the patient-therapist relationship, animal-assisted therapy offers a number of benefits directly to patients. The anxiety and feelings of discomfort associated with the therapeutic environment can negatively impact the outcomes of substance use disorder treatment, as anxiety has been found to correlate significantly with patient relapse.8 Therapy animals have been found to significantly reduce patients' physiological symptoms of anxiety during sessions.9, 10 Animal-assisted therapy also provides the opportunity for the use of therapeutic touch for reducing patient anxiety and distress. Therapists are generally unable to use physical contact with the patient as an opportunity to provide support or reassurance, as it can easily be perceived as inappropriate; however, patients experiencing anxiety or distress may benefit a great deal from the nurturing feeling gained from gentle contact.7 Therapy animals provide a patient initiated opportunity for physical contact in the form of petting or even hugging the animal, which provides the therapeutic benefit of touch without the threat of discomfort.7 Best Practices for Using Animal-Assisted Therapy While animal-assisted therapy provides a multitude of benefits for patients receiving treatment for substance use disorders, it is not universally appropriate for all patients, treatment settings, or therapeutic situations. A practitioner who is considering the use of AAT must be able to follow best practices in doing so. In her handbook, Animal-Assisted Therapy in Counseling (2005), Cynthia K. Chandler outlines five critical AAT competencies for counselors: (1) orchestrating a therapy animal to enact appropriate behaviors and comply with appropriate commands; (2) evaluating a facility or counseling environment for appropriateness of animal-assisted therapy; (3) networking with facility and program staff regarding the intent and activities of therapy animals working in a facility; (4) following facility and program policies and procedures regarding the practice of AAT and establish policies and procedures where none exist; and (5) evaluating client appropriateness for participation in animal-assisted therapy.7 While it is expected that therapy animals are well trained, the counselor is responsible for ensuring that the animal maintains proper behavior, while also watching out for patient and animal safety and well-being.1, 7 Similarly, before initiating animal-assisted therapy, the counselor must assess the appropriateness of the patient for AAT sessions; patients with animal phobias, highly aggressive patients, and patients with allergies may be threatened by, or pose a threat to, the therapy animal.7 Summary For many people, the interaction with a therapy animal while undergoing treatment for substance use disorders can transform the therapeutic environment in a positive way, improve rapport with counselors, reduce anxiety, and increase the odds of a successful recovery from addiction once treatment is completed. Practitioners may find that the inclusion of animal-assisted therapy to existing evidence-based practices may be a welcome improvement to many patients' treatment plans, although it is critical that AAT core competencies and best practices are observed in order to ensure a safe and positive experience for all. Download the Animal-Assisted Therapy for Substance Use Disorders Research Update.