Cognitive Behavioral Therapy (CBT) for Addiction Treatment

The Basics of Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of psychotherapy that emphasizes the role of thoughts in shaping emotions and behaviors. It is based on the idea that one’s thoughts influence their feelings and actions. In essence, if clients can learn to identify and change negative or distorted thinking patterns, they can effectively change the way they feel and behave.

CBT is one of the most widely studied and effective forms of psychotherapy. Numerous research studies have shown that cognitive-behavioral therapy can be helpful in treating a range of mental health problems, including substance use disorders, depression, anxiety, eating disorders, and post-traumatic stress disorder.

This form of therapy can also be useful for emotional challenges that don’t involve a mental health diagnosis. Such challenges may include relationship conflicts, life transitions such as a new career or parenthood, the death of a loved one, physical symptoms of a chronic illness, or emotional trauma stemming from abuse.

While cognitive-behavioral therapy often focuses on solving specific problems, the skills learned during cognitive-behavioral therapy can help clients to better cope with challenges throughout their lives.

Cognitive-behavioral therapy is typically conducted in weekly sessions lasting 50-60 minutes, but some clients may need therapy on a twice-weekly basis. During sessions, clients work with their therapist to identify negative thoughts and behaviors, challenge these thoughts, and develop new coping strategies. While cognitive-behavioral therapy requires commitment and effort, it can be an incredibly effective way to make long-lasting changes in one’s mental health.

Cognitive Behavioral Therapy

Strategies Commonly Used in Cognitive-Behavioral Therapy

Cognitive-behavioral therapy emphasizes helping clients learn to take control of their mental health. The ultimate goal of cognitive-behavioral therapy is to give clients the tools and skills to be their own therapists.

This collaborative nature is a defining feature of cognitive-behavioral therapy. Progress happens both in sessions through exercises with the therapist and outside of sessions through independent “homework” exercises. The goal is to allow clients to build coping skills that they can carry throughout their lives to change distressing thought patterns and behaviors as new challenges arise.

In a cognitive-behavioral therapy session, the therapist focuses on current events and challenges in the client’s life rather than background information or past difficulties. While information about a client’s history is necessary for the therapist to gain the perspective needed to effectively treat their client, it is not emphasized in cognitive-behavioral therapy the way it is in some other treatment modalities.

Common techniques used in cognitive-behavioral therapy include education about the connection between thoughts, feelings, and behaviors; cognitive restructuring to identify and challenge distorted thinking; and exposure therapy to gradually confront feared situations. The method by which these strategies are applied will depend on each client’s unique needs.

Cognitive Restructuring Is a Primary Emphasis of Cognitive-Behavioral Therapy

Therapists may employ several strategies in cognitive-behavioral therapy to help clients change their thought patterns. For instance, a cognitive-behavioral therapy client may be challenged to recognize how their thinking may be distorted, how that is creating problems in their life, and how they can look at their thoughts from a more realistic perspective. Known as cognitive restructuring, this strategy lays the foundation for positive change for clients undergoing cognitive-behavioral therapy.

There are three core principles behind cognitive-behavioral therapy, and each places a significant emphasis on cognitive restructuring. According to the American Psychological Association:

• Mental health challenges are partially based on flawed ways of thinking.
• Mental health challenges are partially based on learned patterns of unproductive behavior.
• People with mental health challenges can develop better coping methods, which can result in fewer symptoms and a greater quality of life.

The goal of cognitive restructuring is to replace the client’s distorted thoughts with more realistic and positive ones. For example, someone who is struggling with anxiety might have the belief that they are always in danger. Through cognitive restructuring, they could challenge this belief by looking at evidence that contradicts it. They might then come to the conclusion that they are actually safe most of the time, which would help to reduce their symptoms of anxiety.

Is Cognitive-Behavioral Therapy an Effective Treatment for Substance Use Disorders?

Despite its relatively recent origins, cognitive-behavioral therapy has become one of the most popular approaches to treating a variety of mental health conditions, including anxiety, depression, and eating disorders. But what about substance use disorders?

Cognitive-Behavioral Therapy May Be Helpful in Treating Substance Use Disorders

A growing body of evidence suggests that cognitive-behavioral therapy may be an effective treatment for alcoholism and other forms of substance use disorders. Studies have found that cognitive-behavioral therapy can help to reduce drug cravings, improve treatment compliance, and reduce the risk of relapse.

In short, the available evidence suggests that cognitive-behavioral therapy can be a valuable tool in the treatment of substance use disorders. Cognitive-behavioral therapy is not an overnight cure, especially when the physical component of addiction comes into play, but it can be an effective tool in helping people to overcome substance use and live healthier, more fulfilling lives.

Potential Strategies Used in Cognitive-Behavioral Therapy for People Struggling With Substance Use

The goal of cognitive-behavioral therapy is to help people identify and change the negative thoughts and behaviors that are associated with their mental health struggles. In the case of substance use and addiction, this may involve helping the individual to identify and avoid triggers and develop healthy coping mechanisms when the urge to use kicks in.

Here are some of the key strategies that cognitive-behavioral therapists may use to treat clients struggling with substance use disorders:

• Identifying triggers: One of the first steps in cognitive-behavioral therapy for substance use disorders is to identify the activities, people, places, or situations that trigger cravings for drugs or alcohol. Once these triggers are identified, clients can collaborate with their therapists to develop plans for avoiding them.
• Challenging negative beliefs: Many individuals with substance use disorders have negative beliefs about themselves and the world around them. These beliefs may be a driving force behind their use of substances. Cognitive-behavioral therapy can help clients to challenge these negative beliefs and develop a more positive outlook on life, which targets the substance use at its source.
• Building coping skills: Substance use disorders and addictions often begin as an unhealthy way to cope with stress and other difficult emotions. Cognitive-behavioral therapy helps clients to develop healthy coping skills to replace the habit of turning to drugs or alcohol. These skills can be essential for preventing relapse in the future.

Why Cognitive-Behavioral Therapy Can Be Particularly Beneficial for the Treatment of Substance Use Disorders

To understand why cognitive-behavioral therapy can be such a powerful tool in treating substance use disorders, it’s essential to understand exactly what a substance use disorder is. A substance use disorder (SUD) is defined as a problematic pattern of using alcohol or drugs that can lead to significant impairment or distress. It is characterized by difficulties in controlling use, persistent use despite negative consequences, and problems in different areas of life such as work, school, and relationships.

SUDs can range from mild to severe, and they often develop gradually as a person continues to use substances. There are many different factors that can contribute to the development of a SUD, including genetics, family history, environment, and psychological factors.

Let’s take a closer look at the latter two factors: environment and psychology. Numerous internal and external factors in an individual’s life can heighten their risk of substance misuse. These include:

• High-risk situations, including people, places, things, and negative mood states
• Flawed beliefs about oneself, substances, and how one relates to substances
• Uncontrollable thoughts that heighten one’s interest and intention to use substances
• Physical desires, cravings, and urges to use substances
• “Permission-giving beliefs” that clients leverage to justify their substance use to themselves and others
• Rituals related to the use of substances
• Negative psychological responses to relapse, which begin a vicious cycle

While the reasons behind substance use disorders vary greatly between individuals, these factors share an emphasis on the cyclic relationship between thoughts and behaviors. Cognitive-behavioral therapy addresses this relationship by focusing on the long-term maintenance of positive coping strategies.

Here is an overview of the skills that people struggling with substance use disorders may benefit from learning in cognitive-behavioral therapy:

• Identifying dysfunctional thought patterns such as “permission-giving beliefs” and coming up with healthy responses
• Delaying and distracting themselves when cravings arise through the use of constructive activities
• Becoming well-versed in the benefits of being sober and learning how to address distorted thoughts that may come up in the process
• Solving problems by direct, effective, and healthy means instead of drowning out one’s problems through unhealthy behaviors like substance use
• Developing a collection of assertive comments to decline offers of drugs or alcohol from others
• Finding a network of positive social support and avoiding individuals and groups that would make it more challenging to retain a healthy lifestyle.

The exact skills that a cognitive-behavioral therapist will employ when treating a person with a substance use disorder will depend on numerous factors. This highlights one of the strongest benefits of cognitive-behavioral therapy: It is a versatile treatment modality that allows therapists to take a unique approach for each individual being treated.

Cognitive-Behavioral Therapy Is Just One Piece of the Puzzle in Treating Substance Use Disorders

A substance use disorder is a serious medical condition that requires treatment by trained professionals. While there is no one-size-fits-all approach to treatment, cognitive-behavioral therapy is one of several principles that are generally accepted as effective.

However, cognitive-behavioral therapy alone is usually not enough to treat substance use disorders. Instead, it serves as a critical piece of a multifaceted network of treatment modalities administered by rehabilitation facilities, support groups, and individual counseling services.

The first step in recovery is usually admitting that there is a problem and seeking help. This can be a difficult task, as many people with substance use disorders are in denial about their condition. Once someone has decided to seek help, they will likely undergo detoxification and withdrawal, which can be both physically and mentally challenging. Afterward, they will need to work on developing new coping skills and strategies for dealing with triggers and cravings. This is where cognitive-behavioral therapy comes into play.

Seek Help If You or a Loved One Is Struggling With Substance Use

Recovery from a substance use disorder is a lifelong process that requires consistent maintenance, but with treatment, it is possible to achieve sobriety and live a fulfilling, meaningful life.

It is important to seek help if you think you or someone you know may be struggling with substance use. Those struggling with addiction may be reluctant to seek help, viewing it as a sign of weakness. However, the reality is that addiction is a disease, and like other diseases, it requires treatment. It’s never too late to seek help for substance use, and doing so could be the best decision you ever make.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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