Art therapy in substance use recovery: benefits and gaps

Art therapy asks people to make art as part of psychotherapy, so that images, materials and the act of making become a way to explore feelings and experiences. One systematic review notes that professionals in addiction treatment use creative arts therapies and anecdotally report beneficial outcomes. The honest summary of the research is that people often report it as valuable, while rigorous trials testing whether it reduces substance use are close to absent. This page separates those two things.

What art therapy is

The American Art Therapy Association (AATA) defines art therapy as a mental health profession that enriches the lives of individuals, families and communities through active art-making, the creative process, applied psychological theory and human experience within a psychotherapeutic relationship. Its fact sheet says art therapists are credentialed mental health professionals who hold master's-level or higher degrees, and that the credentials to look for are ATR (art therapist registered) or ATR-BC (board-certified art therapist registered).

The association's reasoning is that when people are struggling, their own words can fail them. An art therapist, it says, is trained in art and psychological theory and can help a person express themselves in ways beyond language and make sense of nonverbal cues and metaphors that arise during the creative process.

How it works in outline

Because the art-making takes place inside a psychotherapeutic relationship, it is therapy delivered through a creative medium and is not an art class. A rapid review by Adams and Stickley in the Nordic Journal of Arts, Culture and Health concluded that the creation of something, participating in a group and building a trusting therapeutic relationship appeared to matter more than the specific art form. That is a useful hint about mechanism, although the authors present it as a finding from a developing field, not a proven explanation.

What sessions can look like

According to AATA, an art therapist may encourage a person to try different media such as colored pencils, paint, clay and collage, and may also introduce nontraditional materials such as branches and leaves to widen creative expression. People may explore styles such as doodling, abstract design and contour drawing. The association stresses that you do not have to be good at art, and that the therapist chooses the type of art-making to fit the person's needs.

Adams and Stickley's review focused on group formats and covered arts activities of several kinds, including group art therapy with free drawing and self-portraits, as well as music, dance and movement, applied theatre and guided gallery visits.

What the research says

Two reviews are worth knowing.

• Megranahan and Lynskey, The Arts in Psychotherapy (2018). This systematic review looked for controlled trials of creative arts therapies for reducing substance misuse across eight databases. From 3,204 records, only five randomized trials met the criteria, and all five concerned music. The authors found no studies on visual art, drama, dance and movement therapy or arts in health. They described the quality of evidence as disappointingly low and could not reach conclusive results.
• Adams and Stickley, Nordic Journal of Arts, Culture and Health (2019). This rapid review selected 28 articles on group arts activities and arts therapies for people who use substances. It concluded that these activities have health and well-being benefits, while stating that the research is still emerging and mostly qualitative, and that larger studies with quantitative measures and follow-up are needed to learn whether benefits last.

Put together, the evidence suggests that people value arts-based work and that some report better wellbeing, but it does not establish that art therapy reduces drinking or drug use, prevents return to use, or outperforms other therapies. Music is the one creative arts approach with randomized trials, and those are covered in the music therapy page. AATA also cites research on art therapy for anxiety, depression and trauma in other groups, but those claims are not specific to substance use and should be read with that in mind.

Limits and who it may not suit

The main limit is the gap in evidence described above, so art therapy is best viewed as an add-on to treatment with a stronger evidence base, such as cognitive behavioral therapy or medication, not as a replacement for either. AATA's reasoning is that it may help most when words fall short, but no review identified who benefits most, so fit is a judgment for the person and a clinician. Someone who wants a structured skills program may prefer a different approach.

Creating art can bring up strong memories and feelings. For people with a history of trauma, the way a setting handles safety and pacing matters, and the page on trauma-informed care describes what to look for. Art therapy overlaps in spirit with narrative therapy, which also works with the stories people tell about their lives, and sits among the options in the overview of holistic and complementary approaches.

Questions to ask a clinician

• Is the art therapist credentialed (for example ATR or ATR-BC), and how do they coordinate with my main treatment?
• Are sessions individual or group, and how are they structured?
• What are the goals of art therapy for me, and how will we judge whether it is helping?
• If I find it uncomfortable or distressing, what happens next?