Equine therapy, also known as equine-assisted therapy (EAT), has a long history of being recognized for its healing properties in various cultures throughout time. This chapter focuses on the application of EAT for individuals with substance abuse disorders, with potentially positive effects on treatment retention and mental health. The therapy involves various activities with horses, including observing the herd, stable work, groundwork, mounted work, and driving. However, there is limited empirical evidence to support its effectiveness. Qualitative studies have highlighted the therapeutic benefits of EAT, including the development of trust, self-efficacy, and positive emotional affect, as well as being a break from traditional treatment. The Gaustad model of EAT, which focuses on attachment and relationships, is described. The therapy sessions typically last 12 weeks and include group sessions with check-ins, horse time, and check-outs. The chapter concludes by discussing future directions for EAT, including the need for standardized terminology and further exploration of the social well-being aspects of human-horse interaction.