SPECIALIST THERAPY
Addiction Therapy in London & Online.
Many people who seek addiction therapy are not in crisis in any visible way. They may be holding down demanding jobs, maintaining relationships, and presenting well to the world. But privately, they are drinking more than they intended, returning to a behaviour they promised themselves they would stop, or finding that the thing they turn to for relief is quietly taking more than it gives.
If that sounds familiar, you are not alone, and you are not beyond help.
You do not need to wait for visible collapse. Private, clinically grounded addiction therapy can address both the compulsive behaviour and the underlying causes before the problem costs more than it already has.
Matthew Frener is a UKCP Registered Psychotherapist, BACP Senior Accredited Member, and Advanced Practitioner of Addiction Professionals with specialist expertise, offering private addiction therapy, counselling and psychotherapy from Fitzrovia, Central London, and online. His clinical background spans residential rehabilitation at Start2Stop in South Kensington and outpatient DBT work at Priory Hospital North London, giving him direct, sustained experience of addiction across a full range of presentations and severities.
This page sets out what addiction therapy involves, the types of addiction Matthew works with, and how sessions are structured.
Last updated: June 2026
What is Addiction Therapy?
Addiction therapy is a form of talking therapy that helps you understand and change your relationship with a substance or compulsive behaviour. It works on the principle that addiction develops for reasons, and that those reasons matter as much as the behaviour itself.
So the work runs on two tracks at once:
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The behaviour: patterns of use, triggers, consequences, and the cycle of relief and craving
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What sits beneath it: the trauma, shame, unmet needs or relational difficulties the behaviour has been managing
It asks what the substance or behaviour helps you feel, avoid or get through, and then builds other ways of meeting those needs, so the addiction is no longer doing a job nothing else can do. For many people it has been a way of coping with emotions that feel impossible to sit with; therapy gives those experiences somewhere else to go, and over time the substance loses the role it has been holding.
This is what separates therapy from symptom management. Working on the behaviour alone tends to produce short-term change followed by relapse. Working on both tracks is what makes lasting recovery possible.
Types of Addiction I work with
I work with a wide range of addictions and compulsive behaviours in adults. Many people begin while still in the middle of it.
Substance Addictions
Substance addictions involve a physical and psychological dependence on alcohol, drugs, or other chemical substances. They are often characterised by escalating use over time, unsuccessful attempts to cut down, and continued use despite clear harm to health, relationships, or professional life.
Some forms of physical dependence, particularly on alcohol, benzodiazepines or opioids, need a medically supervised detox before or alongside therapy, because stopping suddenly can be dangerous. Weekly outpatient psychotherapy is not a substitute for that. If you may need a detox, I will say so honestly and help you think through the right next step, including a referral where appropriate. Having worked in residential treatment, I am clear about where that line falls, and once you are medically stable, therapy is where the deeper, lasting work begins.
Alcohol Addiction
Alcohol is one of the most common presentations in private addiction therapy. Many clients describe a pattern that began as social drinking and gradually shifted: more units per occasion, drinking alone, using alcohol to manage anxiety or wind down after work, and finding that a day without a drink feels uncomfortable in ways that are difficult to explain.
Alcohol dependency exists on a spectrum. You do not need to be drinking in the morning or unable to function to benefit from therapy. If alcohol is taking up more mental space than you would like, or if your relationship with it feels out of your control, that is enough of a reason to seek support.
If you are physically dependent on alcohol, medical supervision may be required before stopping. I can help you understand the appropriate pathway and, where needed, coordinate with your GP or a medical team.
Drug Addiction
I work with clients presenting with dependency on a wide range of substances, including cocaine, ketamine, crystal meth, cannabis, MDMA, prescription medications (including benzodiazepines and opioids), and stimulants. I frequently work with poly-substance users, where more than one substance is involved, which frequently adds complexity to both the presentation and the recovery process.
Drug addiction in high-functioning adults often goes unnoticed for longer than it should. The professional who uses cocaine to sustain performance pressure, the person who relies on cannabis to sleep, the individual whose prescription medication use has quietly exceeded its intended parameters; these are common presentations that respond well to structured therapeutic work. Therapy offers a place to look honestly at what the substance provides, and at what life without it might actually be like.
Behavioural Addictions
Behavioural addictions follow the same neurological and psychological patterns as substance addictions. They involve a compulsive cycle of anticipation, engagement, short-term relief, and consequences, driven by the same dopaminergic reward pathways. The absence of a substance does not make them less serious or less treatable.
I work with the following behavioural addictions:
Addiction | Common presentation |
|---|---|
Gambling | Sports betting, casino, online gambling; financial secrecy; chasing losses |
Pornography | Escalating use; impact on intimacy and sexual function; shame and concealment |
Sex and love addiction | Compulsive sexual behaviour; relationship patterns driven by avoidance or intensity |
Co-dependency | Compulsive caretaking or people-pleasing patterns in relationships |
Food and eating | Binge eating, restriction, or compulsive food rituals as emotional regulation |
Internet and gaming | Compulsive use of screens, social media, or games to the detriment of daily life |
Shopping and spending | Compulsive buying; financial consequences; use of spending to regulate mood |
Work addiction | Using productivity as avoidance; inability to rest; identity fused with output |
Why Behavioural Addictions Are Often Harder to Name
One of the challenges with behavioural addictions is that the behaviour itself is not inherently harmful. Everyone eats, works, has sex, uses the internet. The line between a habit and an addiction is not about the activity but about the relationship to it: whether it is driven by compulsion rather than choice, whether it is being used to manage an emotional state, and whether attempts to stop or reduce it have repeatedly failed.
Many clients arrive having spent years dismissing their own experience because they felt their problem was "not serious enough." In my experience, the shame attached to behavioural addictions is often more acute than that attached to substance use, precisely because they are less visible and less socially sanctioned as genuine struggles.
That shame is itself something therapy addresses directly. Naming what is happening, in a non-judgemental space, is often the first significant step toward change.
LGBTQ+ Clients and Chemsex Support
I work affirmatively with LGBTQ+ clients and have a clinical understanding of how shame, identity, minority stress, and sexual culture can intersect with addiction in ways that are distinct from the mainstream addiction narrative.
Chemsex and Sexualised Drug Use
Chemsex refers to the use of substances, typically mephedrone, GHB/GBL, crystal methamphetamine, or ketamine, in sexual contexts, most commonly among gay and bisexual men. It is one of the more complex presentations in addiction work, because the substances, the sexual behaviour, and the emotional drivers are often deeply entangled.
Clients seeking support around chemsex may be dealing with:
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Escalating drug use that began in sexual contexts and has spread beyond them
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Loss of the ability to have sex without substances
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Exposure to sexual risk, including HIV, STIs, or non-consensual experiences while under the influence
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Profound shame, secrecy, and difficulty speaking to mainstream services about what is actually happening
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Grief, loneliness, or disconnection that chemsex has been temporarily resolving
My approach to chemsex is non-judgemental and clinically grounded. The work is not about sexual behaviour itself, but about the relationship between substances, emotional regulation, intimacy, and identity. Clients do not need to arrive with perfect language for what is happening, or with a clear goal of stopping. The starting point is simply an honest conversation about where things are.
LGBTQ+ Identity, Minority Stress, and Addiction
For many LGBTQ+ clients, addiction is bound up with experiences that are not always visible to services or therapists unfamiliar with the community: internalised shame, the long-term effects of growing up in a homophobic or transphobic environment, the particular social cultures of LGBTQ+ spaces, and the way that substances or compulsive behaviours have functioned as coping mechanisms in contexts where other forms of support were unavailable.
I offer therapy that is explicitly affirming. Sexual orientation and gender identity are not treated as problems to be addressed, and the therapeutic space is one where clients can speak freely about their lives, relationships, and experiences without needing to explain or justify who they are.
How I work with addiction
Addiction is rarely the problem itself. It is usually a solution to a problem that has not yet found words.
A trauma-informed, relational approach to addiction
Addiction is rarely the problem itself. It is usually a solution to a problem that has not yet found words, the alcohol that makes social situations bearable, the pornography that fills the space left by loneliness, the gambling that offers the only real sense of aliveness, the cocaine that makes a high-pressure career feel survivable. Each is doing something for the person using it, and understanding what that is does not excuse the behaviour; it is the most direct route to changing it.
So my understanding starts beneath the behaviour, with what it has been managing: unprocessed trauma, attachment wounds, chronic stress, or shame that has never had anywhere to be spoken. Rather than treating addiction as a failure of character or a habit to be drilled out, I work to understand what it has been doing for you and what it has been protecting you from. Willpower is rarely the missing ingredient; the work is about building enough internal steadiness that the substance or behaviour is no longer needed in the same way.
What drives addiction
The roots differ from person to person, but a few recur:
Trauma
Childhood adverse experiences, relational trauma, or adult traumatic events that have not been fully processed
Anxiety and emotional dysregulation
Using substances or behaviours to manage overwhelming internal states that feel uncontrollable
Depression and low self-worth
Self-medicating as a response to persistent low mood or a deep, often pre-verbal sense of inadequacy
Loneliness and relational disconnection
A behaviour that stands in for intimacy, connection, or the experience of being truly known
Identity and meaning
Compulsive behaviour that fills a void created by work pressure, loss of purpose, or not knowing who one is outside of performance
Minority stress
For LGBTQ+ clients, the cumulative psychological impact of stigma, discrimination, and internalised shame
An integrative relational approach to addiction
I work relationally and integratively, drawing on a range of therapeutic approaches depending on what each client brings:
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Psychodynamic therapy: exploring early experiences, attachment patterns, and the unconscious drivers of addictive behaviour
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Internal Family Systems (IFS): understanding the different parts of you, including the part that uses; rather than fighting that part, IFS gets curious about what it is trying to do for you, and finds ways to meet that need without the harm
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Dialectical Behaviour Therapy (DBT): practical, in-the-moment skills for managing overwhelming emotion and urges
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Cognitive and behavioural approaches: identifying and interrupting the thought patterns and situational triggers that maintain the addiction cycle
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Relational therapy: examining how your self-worth and your relationships have become entangled with the compulsive behaviour
No single therapy works for every person. My integrative training lets me adapt the work to what is actually needed, rather than fitting you into a predetermined framework. You can read more about how I work on my About page.
Stabilisation comes first
Before any deeper work begins, the priority is stability. There is no value in opening up trauma or painful history while daily life still feels unmanageable, that tends to overwhelm rather than help. So the early work focuses on building the skills and resources to manage day to day: steadying routines, finding ways to handle difficult emotions and urges, and establishing enough safety, internally and in your circumstances, to make deeper exploration bearable. Only once that footing is in place do we turn to the underlying material. This pacing is not a delay; it is what makes the rest of the work possible.
DBT is one of the main ways I help build that footing. It was created for people living with intense emotional dysregulation, and its core skills, distress tolerance, emotional regulation, mindfulness, and interpersonal effectiveness, translate directly into addiction work, lowering the internal pressure that reaches for the substance.
Abstinence, harm reduction and your own goals
Recovery does not look the same for everyone. For some people abstinence is the right aim; for others it is reducing or fundamentally changing their relationship with the behaviour, an approach often described as harm reduction, one that is chosen rather than compelled. I work with both, and I will not ask you to commit to abstinence before we begin. What matters is that your life expands rather than contracts, and that the addiction no longer holds the same power over your daily functioning and your sense of who you are.
Just as I do not work to a single therapeutic model, I do not work to a single recovery programme. Twelve-step recovery helps many people, and I have worked in settings founded on it, but it is one route among several. Together we define what change means for you, and the therapy follows that.
Relapse and relapse prevention
Relapse is a normal part of many people's recovery. A setback rarely means the work has failed or that you are back at the start; more often it carries information about what still needs attention. The useful question is what it reveals, and what can be built from knowing it.
In practice, relapse prevention works on three fronts. The first is mapping your high-risk situations and triggers: the emotional states, environments, relationships, and times of day that exert a stronger pull, with enough precision that they can be anticipated rather than encountered unprepared. This is a careful exploration of the emotional landscape around the addiction, not a mechanical checklist.
The second is building coping strategies you can reach for under real distress: real-time skills such as urge surfing, playing the tape forward, and TIPP, the fast-acting techniques DBT uses in moments of acute distress, alongside more personal strategies that fit your actual life. And if a relapse does happen, we meet it with curiosity rather than recrimination, what led up to it, what the feeling was, what you told yourself, so that it becomes part of the work. Approached this way, a lapse often accelerates recovery rather than derailing it.
Underneath much of this sits shame. Shame is a powerful driver of continued addictive behaviour: the secrecy it demands, the self-loathing it feeds, and the way it forecloses asking for help all keep the cycle turning. A large part of this work is loosening shame's grip, something that grows less out of technique than out of the experience of being fully known and not judged in the therapeutic relationship itself.
Private addiction therapy vs Rehab: what is the difference?
Both can help, and many people use them together. The difference is setting and intensity.
Private addiction therapy (outpatient) | Residential rehab | |
|---|---|---|
Setting | Weekly sessions, in person or online | Live-in, residential |
Duration | Open-ended, paced by you | Usually a fixed block of weeks |
Fits around life | Yes: work, family, routine continue | No: you step away from daily life |
Best for | Ongoing, in-depth relational work | Acute crisis, detox, intensive stabilisation |
Many people choose outpatient private addiction therapy as a first step, or use it to hold and extend the work after a residential stay.
Matthew Frener's experience with addiction
Why addiction experience matters
Not every therapist has worked extensively with addiction, and the dynamics involved: ambivalence, relapse, shame, the link between addiction and trauma, are easier to work with when your therapist recognises them as part of the territory rather than as obstacles.
Clinical experience across residential, hospital and private settings
My grounding in addiction runs across three settings.
My clinical career began at Start2Stop in South Kensington, one of London's leading residential and outpatient addiction programmes, where over nearly three years I worked with people recovering from alcohol, drug and behavioural addictions, individual and group work, risk assessment, and close collaboration within a multidisciplinary clinical team. That gave me direct experience of addiction at its most acute, and of what recovery actually asks of a person day to day, alongside work and relationships rather than apart from them. I have also worked as a DBT practitioner at Priory Hospital North London, one of the UK's most established private psychiatric hospitals, with complex presentations where addiction sits alongside emotional dysregulation and other co-occurring conditions. And in my private practice in Fitzrovia, I offer the sustained, in-depth relational work that lasting change depends on.
Working across residential, hospital, and private settings means I have encountered the full range of addiction presentations, not only those that arrive in a consulting room. I am not easily surprised, and I bring real clinical depth to work that is too often minimised or misunderstood. It also means I understand addiction from more than one vantage point, including from closer than the consulting chair.
Qualifications and professional accreditation
I am a UKCP Registered Psychotherapist (reg. 2011186201), a BACP Senior Accredited Member (411260), an NCPS Senior Accredited Registrant (NCS24-06133), and an Advanced Practitioner of Addiction Professionals (2584), the UK professional body for addiction practitioners. I hold an MSc in Integrative Psychotherapy and trained as a DBT practitioner.
You can read more about my background, training and approach on my About page.
Fees for Addiction Therapy & Getting Started
Fees for sessions range from £100-£120 per 50 minutes. I currently accept AXA, Aviva, WPA, Cigna, and Vitality insurance.
Sessions take place in person at my consulting room in Fitzrovia, Central London, or online via secure video. For full details on fees, payment, cancellation, location, and how to get started, visit the Practical Information page.
FURTHER READING
From the journal
Frequently asked questions
READY TO TAKE THE NEXT STEP?
If you are reading this page, something has already shifted. You are considering the possibility that the way things are does not have to be the way things stay.
That is not a small thing.
A free introductory call with me takes 15 to 30 minutes and carries no obligation. It is a chance to talk, ask questions, and get a sense of whether this is the right fit. Sessions are available in person in Fitzrovia, Central London, and online across the UK.