Using Cognitive Behavioral Therapy (CBT) In Addiction Treatment
When used as part of an individualized treatment plan, cognitive behavioral therapy can help a person take control of their thoughts, empowering them to take control of their recovery.
Cognitive behavioral therapy helps a person remove self-sabotaging thoughts which fuel drug or alcohol abuse. More specifically, it focuses on the way a person’s thoughts influence their feelings and behaviors. By understanding how these elements are connected, a person is better equipped to think and act in a positive way that supports sobriety.
What a person thinks, how they feel and how they act has a massive impact on their life and health, especially during recovery. When these factors are grounded in positive habits they increase a person’s well-being and sober living skills. On the other hand, should these be dysfunctional, a person could experience harm to their life, health, and recovery.
As part of addiction treatment, cognitive behavioral therapy helps a person confront and cope with thought patterns and problems in their life which drive addictive behaviors.
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy is a combination of two therapeutic approaches, cognitive therapy, and behavioral therapy. As a psychotherapy, or “talk therapy,” the addicted individual and therapist build a therapeutic alliance that uses talking as a means to promote healing and the learning of healthy behaviors. Examples of psychotherapists who provide these services include psychiatrists, psychologists, licensed professional counselors and licensed social workers.
As opposed to psychoanalysis, which focuses heavily on the past, cognitive behavioral therapy is a problem-oriented strategy which helps a person look at dysfunctional patterns within their current life. Past events aren’t ignored, however, the focus is on helping a person identify and change current thoughts, emotional reactions, and behaviors which are damaging their life and recovery.
Role Of Cognitive Behavioral Therapy In Addiction Treatment
A mind changed by addiction can create an unhealthy environment of negative thoughts, changeable emotions, and compulsions for drug use. Together, these elements can color the way a person relates to their experiences and change the way they view their substance abuse. Paired with any pre-existing patterns of negativity or a mental illness, this imbalance can fuel drug abuse and lead a person to self-medicate.
It can be difficult to manage the challenging thoughts and emotions life brings when sober. For an addicted person, this can be crippling. Without help and guidance from a trained professional, it can be hard to manage these things in a healthy and productive way.
Negative thoughts and the damaging behaviors which result from them can act as a trigger for drug or alcohol abuse. Breaking this cycle through therapy helps a person succeed within treatment and build a solid foundation for recovery.
While certain outpatient programs may offer cognitive behavioral therapy, due to the intensive nature of the sessions this treatment may be better used in a residential inpatient drug rehab program.
Which Types Of Drug Addiction Does Cognitive Behavioral Therapy Treat?
While cognitive behavioral therapy may be used to treat addiction to numerous drugs of abuse, research shows that it’s more effective for certain forms of substance abuse than others. According to the National Institute on Drug Abuse, cognitive behavioral therapy is an evidence-based approach to drug addiction treatment for:
A research article supported these findings in part. The article’s authors analyzed the results of 34 randomized controlled trials, which totaled 2,340 patients treated by this therapy, to determine the benefits of CBT as a treatment for substance abuse.
The researchers found that the best treatment outcomes were associated with marijuana. After that, cocaine and opioids saw the best results. However, the smallest effects were witnessed in individuals who had poly-substance, or polydrug, dependence. This means that individuals who are struggling with addiction to more than one substance may benefit more fully from another form of therapy or a combination of treatments.
Cognitive behavioral therapy has been shown to produce long-lasting results when used to treat various types of addiction. For instance, the article also cited one study that “reported that 60% of patients in the CBT condition provided clean toxicology screens at 52-week follow-up.”
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Benefits Of Cognitive Behavioral Therapy
Every person living under the weight of addiction has unique circumstances which brought them there. Identifying and treating personal issues that prompt drug or alcohol abuse helps to reduce triggers and self-destructive behaviors.
Cognitive behavioral therapy has been shown to:
- help a person heal from trauma.
- build coping skills that reduce the impact of stress.
- help a person handle emotions in a healthier way.
- help a person resolve problems in their relationships.
- strengthen a person’s communication skills.
- help a person cope with grief or loss.
- help a person deal with a chronic medical illness.
- reduce or alleviate certain symptoms of mental illnesses.
- prevent a relapse of these symptoms.
- work as a treatment for a mental illness when medications cannot be used.
Left unaddressed, many of these issues may cause a person to use drugs or alcohol as a means of avoiding the pain or discomfort caused by these situations.
Length Of Cognitive Behavioral Therapy Treatment
One of the greatest benefits of cognitive behavioral therapy is its intensive approach and relatively short treatment time when compared to other therapies. Typically, a person may have weekly sessions for five to 20 weeks, totaling 10 to 20 sessions. The exact length of treatment and frequency of sessions may vary depending on an individual’s specific needs and treatment goals.
There are several factors which influence a person’s treatment plan. These include the:
- specific circumstances or disorder(s).
- level of symptoms a person experiences.
- length of time a person has been struggling.
- level of stress a person is facing.
- level of support a person has from family and friends.
The psychotherapist providing these treatments can help a person determine the right treatment plan for their needs. As treatment progresses, this plan may be changed to better accommodate a person’s recovery goals and current life circumstances.
What To Expect At Cognitive Behavioral Therapy Sessions
During a CBT session, the therapist will guide a person towards identifying and overcoming destructive and negative thoughts which could undermine their pursuit of sobriety. Cognitive behavioral therapy can take place in an individual, group or family setting, all of which can be helpful during addiction treatment.
At the first session, the therapist will explain the therapeutic process, answer any questions and evaluate the issues a person needs to work on. In the sessions that follow, the therapist will help the person work on clearly defined issues and goals which focus on them. To support these goals, a person may have “homework.” This may include practicing coping strategies and keeping track of any problematic thought patterns which arise.
In order for the therapist to recognize what a person needs to work on, the individual in treatment needs to open up about their struggles. This includes talking about the thoughts and feelings which revolve around them.
While it can be initially hard for a person to open up and feel vulnerable, the more honest a person is with themselves and their therapist, the greater their capacity for success.
To encourage this openness and promote healing, CBT has several goals, including:
- identifying the issues or circumstances which are connected to addiction.
- developing an awareness of negative thoughts, feelings, and behaviors which contribute to the addiction.
- identifying negative ways of thinking or false beliefs that make addictive behaviors worse.
- evaluating why these thoughts occur and how they can be reshaped or eliminated in a positive way.
During therapy, a person will learn a variety of life skills and recovery techniques that can help them upkeep their sobriety, such as:
- coping skills
- relaxation skills
- stress management skills
There are no known major side effects or dangers from cognitive behavioral therapy, however, it is natural for a person to feel some measure of anxiety or discomfort when they first acknowledge difficult issues or emotions they’re working to overcome. As therapy continues, these feelings should decrease and leave a person more grounded and able to successfully live a drug-free life.
Cognitive Behavioral Therapy In Use With Other Therapies
Cognitive behavioral therapy has shown great success in treating addiction when used alone or as part of a treatment plan that utilizes other therapies. Most commonly though, in rehab programs, CBT will be supported by a variety of other therapies which are tailored to a person’s unique needs. During addiction treatment, these therapies may include alternative therapies, other research-based behavioral therapies and/or medications (pharmacotherapies).
Ongoing research suggests that cognitive behavioral therapy may in many cases be more effective when used with other therapies, most notably contingency management (CM) (or similar methods) and motivational interviewing (MI).
Additionally, dialectical behavior therapy, a specialized form of CBT, is an evidence-based psychotherapy that uses traditional elements of CBT in partnership with other targeted approaches to treat addiction. Dialectical behavior therapy teaches mindfulness, acceptance and distress tolerance, all skills which can be vastly beneficial during recovery.
Typically, a combined approach better helps a person remove harmful influences, behaviors and thought patterns which encourage addictive behavior and act as triggers for relapse. Using multiple therapeutic methods helps a person develop coping and relapse prevention skills tailored to the life circumstances they’ll likely face after treatment.
Any time therapy is used, the exact form and combination of treatments should be guided by a person’s individualized treatment plan. In many cases, the behavioral therapies used during addiction treatment are influenced by other concerns in a person’s life, such as a dual diagnosis.
Role Of Cognitive Behavioral Therapy In Dual Diagnosis Treatment
In addition to substance abuse, cognitive behavioral therapy is a research-based treatment for numerous mental and physical health problems, many of which frequently occur with addiction.
Just as negative thoughts feed addictive behaviors, they also worsen the symptoms of certain mental illnesses. If these mental illnesses aren’t addressed and treated they can worsen the addiction or trigger relapse. When a person has both a mental health and substance use disorder it’s termed a co-occurring disorder or dual diagnosis.
Mental illness and addiction are often closely connected. In many cases, one causes or aggravates the other. If only one disorder is treated, the other can act as a trigger. For instance, if a person drinks alcohol to numb the sense of despondency caused by depression, the untreated depression could cause them to break sobriety and drink again.
Cognitive behavioral therapy can help a person nurture their mental and emotional health. By learning to think in a more positive way, a person is more apt to have balanced emotions and make healthier choices. In turn, these changes support recovery and continued abstinence. Even more, CBT has been shown to alter brain activity, leading experts to believe that it improves overall brain functioning.
Examples of mental health disorders which have shown success when treated with CBT:
- anxiety disorders
- bipolar disorder
- eating disorders (e.g. anorexia, bulimia and binge-eating disorder)
- obsessive-compulsive disorders
- post-traumatic stress disorder (PTSD)
- sexual disorders
- sleep disorders
Further, CBT has been shown to reduce symptoms relating to chronic pain. This can be particularly helpful for people who first began drug abuse as a way to self-treat pain. Opioid painkiller abuse frequently begins this way.
For these individuals, alternative forms of pain management are important parts of building sobriety and a strong recovery. By relieving some measure of these symptoms, the trigger (pain) is reduced, decreasing the temptation for self-medication and drug abuse.
Maintaining sobriety is a difficult journey, and while long-term success can be built on therapies such as this, positive outcomes are enhanced by a solid support network, including alumni aftercare services.
U.S. National Library of Medicine — Cognitive-Behavioral Therapy for Substance Use Disorders
Mayo Clinic — Cognitive Behavioral Therapy
National Alliance on Mental Illness — Psychotherapy
National Institute on Drug Abuse — Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine)