How Equine Therapy Works in Drug & Alcohol Addiction Recovery

Written by Gerard Bullen

Editor: Editorial Team

Medically Reviewer: Editorial Team

Last updated: March 12, 2022

Equine Therapy (also known as Equine-Assisted Therapy) involves the use of horses as a therapeutic tool in the treatment of mental health disorders and behavioral conditions, such as substance addiction, anxiety disorders, and post-traumatic stress disorder (PTSD).

The use of equines in behavioral therapy (from horses to ponies and donkeys) has grown tremendously within the U.S. over the last couple of decades, but the origins of using domesticated or tamed animals as a therapeutic tool can be traced far back in history.

Equine therapy is used today in the U.S. as part of many treatment programs for both substance addiction and mental health disorders, and a form of equine therapy is widely used here at SpringBoard Recovery as part of our full and holistic approach to recovery from drug and alcohol use disorders.

Furthermore, all forms of equine therapy are considered part of the wide range of animal-assisted therapies (AAT) used in the treatment of substance addiction and mental health disorders.

Apart from equines, AAT utilizes other intelligent and sentient animals, such as dogs and dolphins, and has been successfully used in the care and treatment of patients with cancer and other serious medical conditions, in addition to the other disorders previously mentioned.

Horse Therapy for Addiction Recovery

What Is Equine Therapy?

Equine therapy, as a general term, relates to any therapeutic process where horses are involved. However, they are different, more specific variations on the same theme:

  • Equine-assisted psychotherapy (EAP), which places the focus of the therapy on the emotional health of the patient and their family
  • Equine-assisted learning (EAL), which focuses on teaching and enabling patients to manage their behavior and emotions by understanding a horse’s responses, and
  • Equine-assisted therapy (EAT), which refers to other forms of therapy where horses are used, such as occupational therapy

Equine-assisted psychotherapy involves patients engaging in activities such as feeding, grooming, and leading a horse – while being supervised by a professionally qualified mental health professional.

The main objective of using equine-assisted psychotherapy is to enable patients to develop essential personal traits, such as emotional regulation, improve their level of self-confidence, and enhance their sense of responsibility.

Mature horses are large, powerful animals, and can weigh between 900 and 2,000 pounds or more. Creating a bond with such an animal also helps recovering addicts build vital trust and communication skills.

Furthermore, all forms of equine-assisted therapy are growing in popularity and usage due to their “experiential” nature and approach, which has been shown to be highly beneficial for those with behavioral issues.

History of Horse Therapy for Mental Health

The History of Using Horses in Behavioral Therapy

Since the times of Ancient Greece, thousands of years ago, horses have played their part in the process of therapy. The Greek physician Hippocrates, known today as the “Father of Medicine,” wrote about the therapeutic potential of horseback riding.

In the U.S., the experience of horse riding became popular as a therapeutic tool during the 1950s and 1960s. In 1969, the North American Riding for Handicapped Association was formed, which later became the Professional Association of Therapeutic Horsemanship International (PATH).

As a nonprofit organization, PATH now promotes equine-assisted services (EAS) for individuals with special needs all over the world. Additionally, PATH is the credentialing organization for accrediting centers and certifying instructors and equine specialists.

What is Equine Therapy

What is Equine-Assisted Psychotherapy (EAP) Used For?

Equine-assisted psychotherapy (EAP) can be used with a variety of age groups, including children, teenagers, and families, and in a variety of therapeutic settings too.

EAP offers a very different experience for the patient, compared to the standard, more traditional counseling process most people associate with talk therapy.

It brings people outside and into the fresh air, offering a different, more natural landscape in which to learn about and process the emotional challenges they face.

EAP is used as a complementary therapeutic service to be used in partnership with more traditional treatment.

As part of our completely holistic approach to drug and alcohol addiction treatment, equine-assisted psychotherapy (EAP) has been successfully used by SpringBoard Recovery for a number of years.

Here are the most common medical disorders and conditions that can benefit from the use of EAP:

1. Substance Use Disorders (Drug & Alcohol Addiction)

Drug and alcohol addiction continues to present a major public health crisis in the U.S., and the number of fatal drug overdoses seen across the nation since the coronavirus pandemic began continues to reach record levels, and are still rising.

The Extent of Substance Addiction in the U.S.

According to the latest figures from the National Survey of Drug Use & Health (NSDUH) 2020, and published by the Substance Abuse & Mental Health Services Administration (SAMHSA), there were 40.3 million people* (aged 12 or older) – or 14.5% – with a substance use disorder (SUD) during the past year.

This includes:

  • 28.3 million with alcohol use disorder (AUD)
  • 18.4 million with an illicit drug use disorder, and
  • 6.5 million with combined alcohol and illicit drug use disorders

*Note: This is the first surveyed year when the criteria used for a SUD diagnosis was taken from the more recent 5th. edition of the Diagnostic and Statistical Manual of Mental Disorders (known as DSM-5).

Additionally, an estimated 17.0 million adults (aged 18 or older) – or 6.7% – had a mental illness co-occurring with a SUD – this is known medically as a co-occurring disorder or dual diagnosis

Furthermore, 5.7 million adults – or 2.2% – had a co-occurring serious mental illness (SMI) and  SD during 2020.

Equine Therapy for Mental Health Disorders

Substance Addiction Treatment & Equine-Assisted Psychotherapy (EAP)

The use of equine-assisted psychotherapy in the treatment of drug and alcohol addiction treatment offers a unique approach to achieving the ultimate goal of rehab – enabling people to live sober and healthy lives

Many of those suffering from SUD have issues with the dynamics of a healthy relationship, such as those relationships with their family or with their partner.

EAP teaches these patients to learn how to trust, deal and work with their vulnerability, and how to effectively communicate through their various interactions with the horse.

This enables them to not only experience a new level of confidence and a sense of safety but to also learn the value of building healthy relationships with those around them.

2. Mental Health Disorders

Mental health within the U.S. population has become a significant and serious issue following the start of the coronavirus pandemic, and many medical experts believe it will constitute a national public health crisis in the coming years, with growing rates of both depression and anxiety.

Equine-assisted therapies have proven to be very effective in helping to manage several mental health disorders and conditions, including:

  • Anxiety disorders, including
    • Generalized anxiety disorder (GAD)
    • Panic disorder, and
    • Social anxiety disorder
  • Post-traumatic stress disorder (PTSD), and
  • Attention-deficit / hyperactivity disorder (ADHD)

Photo of a stressed looking woman

The Declining State of Mental Health in the U.S.

Again, referencing the latest figures from the National Survey of Drug Use & Health (NSDUH) 2020:

  • 4.1 million adolescents (aged 12 to 17) – or 17.0% – experienced a major depressive episode (MDE) in the past year, and
  • 644,000 adolescents – or 2.7% – had a co-occuring disorder, as in a co-occurring MDE and SUD
  • 52.9 million adults (aged 18 or older) – or 21% – experienced any mental illness (AMI), and  
  • 14.2 million adults – or 5.6% – experienced serious mental illness (SMI) during 2020

Anxiety Disorder Treatment & Equine-Assisted Psychotherapy (EAP)

Although most people will experience serious anxiety at several key points in their lives, there are times when the level of anxiety being experienced is too great and beyond their control, and actually meets the clinical diagnostic criteria for an anxiety-related disorder.

Anxiety-related disorders and conditions where EAP has proven effective include (but aren’t limited to):

  • Generalized anxiety disorder
  • Panic disorder
  • Social anxiety disorder, and 
  • Other anxiety-based disorders and conditions, such as:
    • Separation anxiety
    • Selective mutism
    • Agoraphobia, and 
    • Specific phobias

Many people who struggle with high levels of anxiety are in a state of constant concern about both their past and their fears for the future.

Working with a horse during an EAP supervised session creates an opportunity for clients to “stay present and focused on the task at hand,” according to television anxiety expert Dr. Robin Zasio.

Because horses are naturally fine-tuned to be alert towards behavior and emotion, they are quick to sense heightened danger and respond accordingly. Clients with an anxiety-related disorder can directly relate to this shared ability to sense similar cues of potential and respond quickly, too.

It is through their interactions with the horse that the client learns skills to control their own behavior and emotions and to respond to change in a calmer, more measured way, EAP in the treatment of anxiety also helps clients to practice their vulnerability in a safe environment. 

Throughout the process of caring for the horse, clients are gently forced to try new tasks and take on new challenges. They are then encouraged to process their experiences with the horse, such as their fears about the situation, any specific insights, their discoveries, or other special moments.

Horse helping with mental health

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) can develop in both adults and adolescents following a harrowing and traumatic event. It is characterized by the person experiencing increased arousal and reactivity to what’s happening around them on a constant basis, disturbing memories and nightmares, and symptoms of avoidance.

In the U.S., according to the Anxiety and Depression Association of America (AADA), it is estimated that 7.7 million people aged 18 or older struggle with PTSD.

The most common reasons for the development of PTSD are if someone has been sexually assaulted, or if they have served in the U.S. armed forces and experienced military combat.

EAP has proven to be of particular therapeutic assistance to military veterans with PTSD, and its use in the U.S. among this specific demographic continues to increase.

Tess Hassett, a qualified instructor at the Northern Virginia Therapeutic Riding Program, stated, 

A lot of [veterans with PTSD] have said that after what they’ve been through with their PTSD and depression, they never thought they’d be able to bond with someone again and feel that personal connection. But with their horse, they’re feeling that connection. They’re able to take that into the rest of their lives and into their relationships.”

Attention-Deficit / Hyperactivity Disorder (ADHD)

Attention-deficit / hyperactivity disorder (ADHD) is another disorder where EAP can be beneficial. It particularly appeals to both adults and teens with ADHD because it offers an active, fun, hands-on experience.

During an EAP session, the individual with ADHD is joined by a trained equine therapist and the therapy focuses on elements such as presence, attention, mindfulness, boundaries, social cues, among others.

PTSD Equine Therapy

3. Co-Occurring Disorder (Dual Diagnosis)

Equine-assisted psychotherapy (EAP) lends itself perfectly to the simultaneous professional treatment of co-occurring disorders (also known as dual diagnosis), which is the concurrent presence of both a substance use disorder (SUD) with a mental health disorder.

Unfortunately, the co-occurrence of a substance addiction alongside a mental health disorder is fairly common in the U.S. among those who abuse drugs and/or alcohol.

In fact, it is estimated that around 30% of people with SUD also have a mental disorder of some description, and, for particular diagnoses, the rate rises to over 50%.

The factors behind this are often complex, and can include:

  • People with a mental health disorder, eg. depression or anxiety, are more likely to “self-medicate” with alcohol or drugs to escape the way they constantly feel
  • Alcohol and drugs can trigger an underlying predisposition for mental health disorders to emerge, and
  • Substance use disorder can make the symptoms of a mental health disorder more pronounced, as well as to cause entirely new symptoms to emerge

To put it simply, mental health disorders can make you far more susceptible to substance use, and those addictive substances can make the mental health disorder considerably worse.

4. Children and Teenagers & Equine-Assisted Therapy (EAT)

Equine-assisted therapies (EAT), including the psychotherapeutic form, have proven to be as successful and as positive an experience for children and teenagers as it is with their adult counterpart.

As with adults, children can also experience personal and challenging disorders and issues, such as trauma, anxiety, depression, PTSD, and more.

Equine therapy offers adolescents a therapeutic environment that feels less threatening and more inviting than the traditional “talk therapy” office-type setting.

Children can find it particularly difficult to open up and process painful emotions and experiences, and this is where EAT has consistently proven to be highly beneficial. 

Among all age groups, equine-assisted psychotherapy (EAP) can help to improve:

  • Assertiveness

  • Confidence

  • Impulse control

  • Social skills

  • Empathy

  • Problem-solving

  • Trust in others

  • Trust in self

  • Developing/maintaining relationships

  • Emotional awareness

The Proven Therapeutic Benefits of Equine Therapy

Scientific research into the benefits and effectiveness of equine therapy is a fairly recent occurrence, and one of the initial research studies was conducted by Kay Trotter, Ph.D., a licensed professional counselor.

In her comparative study, published in the Journal of Creativity in Mental Health, Trotter found that introducing horses to the therapeutic process showed significantly increased positive behaviors while, at the same time, reducing negative behaviors.

It has since been shown that clients can experience a number of specific benefits from equine-assisted psychotherapy (EAP), such as:

  • Increased self-esteem
  • Increased self-respect
  • Improved adjustment to routines and guidelines
  • Improved focus
  • Less stressful friendships
  • Reduction in aggression

What Makes Equine Therapy Effective?

All forms of equine therapy incorporate certain qualities, vital to its overall effectiveness, that are difficult to replicate in standard “talk therapy” and counseling sessions. These include

  • Non-Judgmental & Unbiased: As hard as therapists may try to provide a safe space for clients to explore and understand emotional and painful experiences, it can be difficult for clients to be completely open. Building therapeutic rapport with the client – critical for successful therapy – can take time. The presence of the horse, completely unbiased and non-judgmental, offers a sense of calm, as they only will react to the client’s current behavior and emotions.
  • Feedback & Mirroring: Horses are keen observers and are highly sensitive to movement and emotion. In fact, they will often mirror the client’s behavior or emotions, which creates a vital connection between the horse and the individual.
  • Managing Vulnerability: Clients often feel vulnerable when opening up about emotional challenges and past experiences. The horse provides a valuable reference point for the client, making it feel easier for clients to process their experiences.
  • Springboard Recovery logo

    SpringBoard Recovery & Equine Therapy

    SpringBoard Recovery and its use of equine therapy in treating co-occurring disorders was the subject of a week of television programming for “Arizona Midday,” presented by host Destry Jetton.

    SpringBoard Recovery gave a comprehensive and enlightening interview on the television program around the subject of mental health.

    Broadcast on Arizona Midday as 4 separate episodes, the interview covered a wide range of mental health topics, such as the then-forthcoming National Mental Health Awareness Month, and the nature and symptoms of PTSD.

    The interview took place at Hunkapi Farms, the 10-acre home of Hunkapi Equine Therapy – one of SpringBoard Recovery’s substance addiction and mental health therapies for disorders such as PTSD. 

    Hunkapi Equine Therapy offers a number of programs, all with the same aim of using the bond between horse and human as a catalyst for positive growth in the lives of participants.

    Hunkapi, their name derived from an old Lakota Native American tribal word which means “We are all related,” accepts clients with a wide range of diagnoses.

    External Sources:

  • U.S. National Library of Medicine. Equine-Assisted Therapies Using Horses as Healers: A Concept Analysis. January 2020. Available at NLM.NIH.gov.
  • Professional Association of Therapeutic Horsemanship International (PATH). Homepage. 2022. Available at PATHIntl.org.
  • Professional Association of Therapeutic Horsemanship International (PATH). What are Equine-Assisted Services? 2022. Available at PATHIntl.org.
  •  Substance Abuse & Mental Health Services Administration (SAMHSA). National Survey of Drug Use & Health (NSDUH) 2020. 2022. Available at SAMHSA.gov.
  • Google Books. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). 2022. Available at Books.Google.com.
  • National Alliance on Mental Illness (NAMI). Mental Health by the Numbers. March 2021. Available at NAMI.org.
  • U.S. National Library of Medicine. Generalized Anxiety Disorder. 2022. Available at MedicinePlus.gov.
  • IMDb. Dr. Robin Zasio. 2022. Available at IMDb.com.
  • Anxiety and Depression Association of America (AADA). Facts & Statistics. 2022. Available at ADAA.org.
  • Oxford University Press. Equine Assisted Therapy for Patients with Post Traumatic Stress Disorder: A Case Series Study. October 2019. Available at Academic.OUP.com.
  • Taylor & Francis Online. A Comparative Study of the Efficacy of Group Equine Assisted Counseling With At-Risk Children and Adolescents. October 2008. Available at TandFOnline.com.
  • 12 News. Arizona Midday. 2022. Available at 12News.com.
  • Mental Health America. National Mental Health Awareness Month. May 2021. Available at MHANational.org.
  • Hunkapi. Homepage. 2022. Available at Hunkapi.org.

  • Author: Gerard Bullen
    January 14, 2022

    Gerard has been writing exclusively for the U.S. substance addiction treatment industry for many years, providing a range of medically-reviewed work, including white papers, long-form, and short-form content articles, and blog posts for accredited addiction treatment centers. A member of the American Medical Writers Association, Gerard’s specific focus is substance addiction (an area that has impacted Gerard’s personal life in several ways), and he is particularly drawn to the topics of professional, evidence-based treatment, new and alternative therapies, and enabling readers to find their own sustainable, long-term recovery. Gerard lives and works in Maryland, U.S., he’s happily married, and a proud father. His interests include hiking with the family, reading fiction (from the classics to virtually all of the current NYT bestseller list), American and British film classics, and his beloved dogs, Toby and Coco, both rescued from the local pound.

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