Rational Emotive Behavior Therapy for Addiction Treatment

Albert Ellis developed rational emotive behavior therapy in 1955. This form of psychotherapy is both cognitive and behavioral, and in treatment, it aims to assist people with identifying and correcting irrational thoughts and beliefs. Ellis believed that dysfunctional thoughts, emotions, and behaviors were intertwined and that in order to overcome pathological emotions and behaviors, people needed to replace their dysfunctional thoughts and behaviors with those that were more effective. 1

In rational emotional behavior therapy for addiction treatment, people must replace their irrational beliefs that are connected to addiction with more functional, healthy thoughts and emotions that foster sobriety. Ellis would argue that because behavior and thoughts are intertwined, addiction recovery is impossible without addressing irrational thoughts. Researchers have conducted studies to test the theories that Ellis offered, and the results have been promising, suggesting that rational emotive behavior therapy is a strong treatment option for addiction.

Rational Emotive Behavior Therapy for Recovery from Alcoholism

Using the framework Ellis developed, researchers have implemented a rational recovery program for people suffering from alcoholism and conducted a study to determine effectiveness. The rational recovery program utilized the rational emotive approach and offered an alternative to the spiritually-based Alcoholics Anonymous program. It was delivered in a group format, and it discussed “the beast,” which represents the impulsive thoughts that lead a person to drink.

Study results, which the authors published in a 1993 edition of The American Journal of Drug and Alcohol Abuse, showed that among participants who had been participating in the rational recovery program for at least three months, 73 percent of them were sober from alcohol during the previous month. Furthermore, the program was equally effective at promoting abstinence for people who had historically used cocaine heavily, suggesting it could also be useful for treating drug use. Finally, a majority of the participants in the study identified with the rational emotive approach, expressing that they thought it was critical to be aware of the impact of “the beast” and its dysfunctional voice. 2 This study provides evidence that rational emotive behavior therapy can be effective for individuals suffering from addiction, primarily to alcohol.

Rational Emotive Behavior Therapy helps Co-Occurring Depression

Additional research has shown that this form of treatment can be useful when combined with specific techniques for treating addiction. In a 2014 study conducted for an annual International Conference and Exhibition on Addiction Research & Therapy, researchers from the University of Mysore in India evaluated the effects of a combination therapy involving both motivational interviewing and rational emotive behavior therapy and compared this form of treatment to standard treatment. Study participants had co-occurring depression and engaged in dangerous abuse of alcohol or drugs, and results indicated that depression and functioning improved in the short-term with motivational interviewing and rational emotive behavior therapy.

The study authors found that rational emotive behavior therapy was more effective than standard treatment was for treating amphetamine abuse. The authors concluded that rational emotive behavior therapy is especially suited for use in substance abuse support groups, and it could promote the development of coping skills, such as drug refusal and managing stressors, among individuals struggling with addiction. 3

Evidence of Rational Emotive Behavior Therapy Benefits in Cases of Addiction

Beyond studies specifically examining the benefits of interventions that utilize rational emotive approaches for treating addiction, other research has shown that rational emotive behavior therapy aligns with the specific needs of individuals who suffer from addiction. A 1998 study in the Journal of Rational-Emotive and Cognitive-Behavior Therapy analyzed the contributions of multiple factors to alcohol problems among students enrolled in college.

Study authors, affiliated with Arizona State University, found that irrational beliefs were linked to alcohol problems among the college students, and they created an “irrational coping scale” that helped to explain alcohol problems. 4Rational emotive behavior therapy, with its focus on changing irrational beliefs and replacing them with more functional thought patterns, could be useful, as it could eliminate the irrational thoughts and dysfunctional coping strategies that individuals with alcohol problems demonstrated in this study.

Research on Challenging Irrational Beliefs 

Irrational beliefs have demonstrated a link to alcohol problems, and treatment targeted at challenging these beliefs has proven itself useful for patients undergoing medication-assisted treatment for addiction. In 2017, researchers from Iran conducted a study for publication in the International Journal of High Risk Behaviors and Addiction.

These researchers evaluated the effectiveness of a therapy designed to challenge irrational beliefs in patients receiving medication for drug addiction. Study results indicated that the therapy was significantly effective for decreasing irrational beliefs, including those associated with perfectionism, approval-seeking, and holding high expectations for oneself. 5 Based upon the results of this study, challenging irrational beliefs, which is the center of rational emotive behavior therapy, is helpful for individuals who suffer from addiction.

Substance Use Disorder Treatment Guidelines 

The research has shown that irrational beliefs are linked to addiction and should be a target of treatment, and the Substance Abuse and Mental Health Services Administration (SAMHSA) has provided a guideline of irrational beliefs that individuals with addiction may hold, and how treatment, such as rational emotive behavior therapy, can help to reframe these beliefs in a more positive manner.

Irrational Beliefs

For example, SAMHSA has reported that a person struggling from addiction might hold the belief that he or she cannot relax without drugs, but a more functional belief, that the client could develop during treatment, is that he or she wants to use drugs to relax, but that doesn’t mean it is necessary for the client to act on that desire. Another irrational belief could be that they only feel comfortable under the influence of drugs, but during treatment, the client could come to the realization that it might be difficult to feel comfortable while sober, but it is possible, as many people feel comfortable without drugs. Finally, people might continue to use drugs and alcohol because they believe that individuals who are sober are not happy, but during treatment, the therapist can challenge them to find evidence to support this feeling, with the hope they will realize they have no such evidence. 6 During treatment that utilizes a rational emotive approach, clients who struggle with addiction can learn to replace these irrational beliefs that create addiction with healthier, more functional thoughts that make recovery possible.

Replacing Irrational Beliefs

With its focus on challenging irrational beliefs, rational emotive behavior therapy is an effective tool for individuals suffering from addiction to drugs and alcohol. As research with those suffering from alcohol problems has demonstrated, irrational beliefs are strongly linked to addiction. Research has shown that therapy can help decrease irrational beliefs and reduce substance use, which suggests that the core tenets of the rational emotive approach are appropriate for use with individuals with substance use problems.

Studies specifically analyzing the effects of rational emotive behavior therapy have shown that it has benefits for individuals abusing multiple substances, including alcohol, cocaine, and amphetamines. The rational emotive approach seems to be helpful because of its emphasis on altering irrational thought patterns that contribute to addiction.