Equine-assisted therapy for substance use: what is known

Equine-assisted therapy brings horses into a treatment program, usually as an extra alongside standard care rather than as a stand-alone treatment. The National Center for Complementary and Integrative Health (NCCIH) calls a non-mainstream approach used together with conventional medicine "complementary", and that is how equine programs are positioned in the research. People who take part often describe it as engaging and memorable. Whether it improves outcomes such as staying in treatment or reducing substance use is a separate question, and the answer from the research so far is that nobody can say yet.

What equine-assisted therapy is

A 2022 scoping review in the journal Substance Abuse Treatment, Prevention, and Policy uses "equine-assisted services" as a unifying term for any service in which professionals incorporate horses to benefit people. Under that umbrella sit several named forms, including equine-assisted psychotherapy, equine-facilitated psychotherapy, equine-assisted learning and horse-assisted therapy. A scoping review gathers and summarizes the existing literature on a topic, which makes it useful for showing how much evidence exists.

How it works in outline

The programs described in the review are planned as part of overall substance use treatment, with goals agreed between the participant and the therapist. Examples of goals include setting boundaries, building trust, managing emotions, and reducing anxiety or aggression. The review does not establish how contact with horses might produce change, and the programs it covers differ in length, activities and staffing.

What sessions can look like

The review lists activities from the included programs. They include observing herd behavior, grooming, stable work, groundwork such as catching and leading a horse around an arena or an obstacle course, and, in some programs, mounted work, vaulting and carriage driving. One six-week program ran for 1.5 hours a week, led by an addiction counselor together with an equine specialist and horse trainer. A Norwegian program ran twice a week for six weeks in 90-minute sessions, delivered by therapists who were also qualified riding instructors. A 20-week learning program used only ground activities and no riding.

A randomized trial from Oslo University Hospital describes the same pattern: 12 sessions of 90 minutes over six weeks, small groups of up to four participants, planned with the therapist around agreed goals, and led by psychotherapists specializing in equine-facilitated psychotherapy.

What the research says

The scoping review searched four databases. Of 188 titles, six studies met its criteria and three more came from other sources, giving nine in total. Every one of the nine involved adolescents or young adults. Among the studies that reported a location, five were from Norway, two from Canada and one from the United States.

• Quantitative findings: the data suggested a possible positive effect on staying in and completing treatment, and on participants' mental health, but the studies were small.
• Qualitative findings: participants described bonding with the horses, welcoming the break from traditional treatment, and feeling more self-efficacy, positive emotion and motivation for treatment.
• Overall conclusion: because of methodological limits and too few studies, the effectiveness of equine-assisted services as an add-on to treatment is described as inconclusive, and the authors say more research is needed before broad adoption is supported.

The randomized trial, by Gatti and colleagues in 2020, is a good example of why the review is cautious. It was designed to test an earlier encouraging finding. Fifty patients in residential treatment were randomly allocated, but only 37 could finally be included. Treatment completion was 44 percent in the horse-assisted group and 32 percent in the usual-care group, and average time in treatment was 98.7 days versus 107.4 days. The researchers found no statistically significant association between the intervention and treatment outcome, and they note that the shrinking sample made a false-negative result more likely. Their own conclusion was that the completion difference encourages further study in a larger sample.

Limits, safety and who it may not suit

The review lists several limits: most studies were small, unpublished results may be missing, the evidence comes from a few countries, and all participants were young. Findings may not carry over to older adults. It also records that experiences were not uniformly positive. One participant felt the horse sessions had little to do with their motivation, two did not look forward to sessions because of a fear of horses and a dislike of being outdoors, and others complained about the facility.

Horse work involves large animals, outdoor settings and physical activity. The review does not discuss injuries or other adverse events, so this page cannot give safety figures. Anyone considering a program can ask who handles the horses, what training the staff hold, and how the site manages risk, and can mention any physical limits or fears beforehand. People with a trauma history may find the topic of trauma-informed care relevant when judging whether a setting feels safe.

Other activity-based options with their own evidence are covered in art therapy, music therapy and the wider page on holistic and complementary approaches. Anyone starting from the beginning may find what happens when you ask for help a more useful first step than choosing an add-on.

Questions to ask a clinician

• Is this offered as an add-on to my main treatment, and how would it fit with my plan?
• Who leads the sessions, and what are their qualifications in both therapy and horse handling?
• What safety procedures are in place, and what if I am nervous around horses?
• What is known about whether this works for people like me, and what are the alternatives?