Cognitive Behavioral Therapy (CBT) was developed as a way to implement cognitive and behavioral changes to identify and correct problematic behaviors. Typical goals of CBT are to be able to anticipate, and identify, behavioral and cognitive problems, increasing clients self control by developing effective coping strategies, and educate the client on maladaptive thinking and behaviors and promote positive change.
Understanding Cognitive Behavioral Therapy
Techniques are utilized to exploring positive and negative consequences of problematic behaviors such as the negative consequences of continued drug use. Self-monitoring is also utilized in CBT to recognize cravings early, and identifying trigger situations that might increase the addicts risk for use, and developing positive strategies for coping with urges and triggers, as well as managing high-risk situations. Research indicates that the cognitive and behavioral skills learned through CBT continue long after the completion of treatment [2].
A meta-analytic review of CBT with drug abuse and dependence, which reviewed 34 randomized controlled trials, including 2,340 patients who were treated in substance abuse facilities, found that 60% of patients who received CBT treatment showed clean toxicology screens at the 52 week follow up [1].
Use of CBT For Alcoholism Treatment
CBT in recovery from alcoholism includes various interventions, which can be used individually or in group settings, especially in substance abuse recovery programs. Typically CBT is used in conjunction with family based treatments. Cognitive Behavioral Therapy is typically conducted for 12-16 weeks with sessions lasting 45-90 minutes in duration. This type of therapy is considered brief, short-term and intended to produce initial abstinence and stabilization.
One of the interventions is Motivational Interventions. This is where the provider address the motivational barriers (or treatment interfering behaviors) to change and recovery. It targets clients ambivalence toward behavior change in regards to substance abuse and recovery.motivation to overcome substance abuse by helping the person to live in the now and focusing on how they want to live.
This therapy involves structured conversations, which help clients increase CBT skills and tools. When the addict is in engaging their addiction, unhealthy, high-risk behaviors can be all consuming. Homework assignments and constant attention to the therapy process of learning sober behaviors are integral to CBT and Motivational Interventions [2,3,5].
Variants of CBT Treatment
Contingency Management is another variant of CBT effectiveness. This technique is grounded in operant learning theory and uses non-drug reinforcers to promote continued abstinence from alcohol. Using this method professionals can provide tangible incentives to encourage clients to stay sober.
Rewards might include offering cash, clinical privileges, employment, or restaurant vouchers for each clean drug test. Studies have found that carefully structured contingency management programs can help those in recovery stay sober [1,5].
Relapse Prevention is a third variant of CBT treatment. This therapy focuses on the identification and prevention of high-risk situations the addict might encounter. This could be a favorite drinking establishment, or friends who use.
This therapy includes challenge the client’s expectation of their perceived positive effects of alcohol will have coupled with psychoeducation to help the client make an educated choice in a high risk situation [1].
Cognitive Behavioral Therapy includes learning and unlearning behaviors within the addiction. CBT is an all-immersive program that works on changing belief systems and behaviorally working to change responses to triggers both internally and externally.
These behavioral therapies and treatments can be particularly effective when coupled with pharmaceutical treatments to help reduce the effects of withdrawal. According to Dr Stacy Sigmon with the University of Vermont, medicine can be an immediate reward for those in recovery. Pharmaceutical treatment can help the client get a few weeks of sobriety and take the ‘edge off’ of the initial recovery processes [5].
Integrating CBT in Alcoholism Treatment
In CBT and alcoholism, the focus is on specific, attainable goals. Each session has a specific objective. The goal is to help the individual formulate a goal and a way to obtain that goal with healthy tools and skills. CBT also works on educating the individual on life skills to create their own toolbelt for success.
Rational thinking is also a part of this process where thoughts and actions are based on real, functional ideas, and to question what is happening in the person’s environment to make appropriate and rational decisions. This is extremely useful in triggering situations where oftentimes during the addiction, the addict was acting on highly emotional states, rather than rationality [3].
Effectiveness of CBT in Recovery from Alcoholism focuses on studying the thought patterns to help introspection of self, both negative and positive, the world, and future planning. Individuals involved in CBT will learn to identify cognitive distortions which cloud a person’s world view. Some distortions include all or nothing thinking where the person sees situation or event in either ‘black or white.’
Overgeneralization or viewing a recent event as negative or a never-ending pattern of defeat. Mental filter is when a person only thinks about the negatives. Disqualifying the positive where only believing that ‘positives don’t count’ because of another force. Jumping to Conclusions where individuals tend to ‘mind read’ or assume something will happen or has happened and it is true, whether or not it is. Within CBT the belief is that changing your thoughts will lead to more positive thinking and improved emotions which in turn change behaviors [4],
Effectiveness of CBT in Recovery From Alcoholism includes various components which utilize cognitive and behavioral changes, incentives and rewards, motivational drives, as well as beliefs for future recovery. CBT provides a support network for the recovering alcoholic to help navigate through triggering situations.
CBT helps the individual with positive thinking which can in turn foster increased levels of self confidence and hope. CBT aids the individual in withstanding peer pressure and recognizing stressors, CBT is also cost effective and can be done both inpatient and on an outpatient basis which can also aid in keeping to more normalized activities of daily living and routine. In conclusion, CBT can benefit the recovering addict significantly as it address the emotions and thoughts of destructive addiction.
Community Discussion – Share Your Thoughts Here!
What have your found in CBT therapy work to be most helpful in your recovery process?
About the Author: Libby Lyons, MSW, LCSW, CEDS, is a Certified Eating Disorder Specialist (CEDS) who works with individuals and families in the area of eating disorders. Mrs. Lyons works in the metropolitan St. Louis area and has been practicing in the field for 11 years. Libby is also trained in Family Based Therapy (FBT) to work with children-young adults to treat eating disorders. Mrs. Lyons has prior experience working with the United States Air Force, Saint Louis University, Operating Officer of a Private Practice, and currently works with both Saint Louis Behavioral Medicine Institute within their Eating Disorders Program and Fontbonne University
References:
[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/
[2]: https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral
[3]: http://www.dualdiagnosis.org/treatment-therapies-for-dual-diagnosis-patients/cognitive-behavioral-therapy/
[4]: http://drugabuse.com/library/cognitive-behavioral-therapy/
[5]: https://www.apa.org/monitor/2013/06/addiction.aspx
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.
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Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on December 26, 2016
Published on AddictionHope.com