A Guide to Using Cognitive Behavioral Therapy for Addiction Treatment

What Is Cognitive-Behavioral Therapy?

What is Cognitive Behavioral Therapy

Cognitive-behavioral therapy is a form of “talk therapy” that many therapists and rehabilitation experts use to help those addicted to drugs and alcohol overcome their addictions. Therapists use cognitive-behavioral therapy to help their clients get sober and then to prevent future incidences of relapse and return to abuse.

Other names for cognitive-behavioral therapy include:

  • Behavior therapy
  • Cognitive restructuring
  • Cognitive therapy
  • Exposure therapy
  • Rational emotive behavior therapy

While rehabilitation specialists use cognitive-behavioral therapy for addiction treatment, the approach is used across many types of problems and concerns. Examples include treatment for anger management, chronic pain, eating disorders, and obsessive-compulsive disorders.

Some of the basic tenets of cognitive-behavioral therapy are to help a person identify how their thinking influences their behavior and how to adopt healthier ways of thinking and behaviors that can help a person become and stay sober.

The History of Cognitive-Behavioral Therapy

Psychiatrist Aaron Beck is credited with inventing cognitive-behavioral therapy in the 1960s. Dr. Beck observed that patients expressed many feelings, yet also kept their thoughts to themselves and that these inner thoughts were often those that could keep them in a cycle of abuse, anxiety, and depression. Dr. Beck identified a link between thoughts and behaviors and used this concept to create the basis for cognitive-behavioral therapy as people know it today.

The foundations of cognitive-behavioral therapy are rooted in three main principles: classical conditioning, operant conditioning, and modeling.

Classical Conditioning

The principle of classical conditioning is that of association. A person will start to associate certain places, people, and activities (such as listening to certain types of music, watching certain movies, or even eating certain foods) with using drugs or alcohol. Even if the person isn’t using drugs anymore, hearing, smelling, or seeing certain things will remind them of drug use and may trigger a strong physical or mental craving.

Operant Conditioning

Operant conditioning is the principle where drug use consistently reinforces a person’s behavior. When a person has cravings for a substance and then uses the substance, they experience a sense of euphoria or energy and have reinforced the behavior. However, a person also experiences operant conditioning in a negative manner. Examples include going to jail or getting in trouble with the law for drug use. They may have also experienced negative feedback from their families, lost jobs, or experienced difficult drug withdrawal symptoms.

Modeling

Modeling is the third historical approach to therapy incorporated in cognitive-behavioral therapy. This involves using the behaviors of people who have successfully overcome a substance abuse addiction to help an individual remain sober.

How Does CBT Work?

How Does CBT Work

Cognitive-behavioral therapy involves educating a person about addiction and then helping them identify the behaviors and situations that led the person to where they are. A therapist will begin by conducting a functional analysis to understand the extent of a person’s drug abuse. This involves asking questions to gain an understanding of the extent of the drug abuse. There will be questions about how often a client uses drugs, who they use them with, where they use them, and how the drugs make the client feel. Each of these bits of information are important for a therapist to understand the thoughts a person has leading up to their drug use and the behaviors they act on that keep them using drugs or alcohol.

The approaches are usually split into two categories, cognitive and behavioral.

A person in cognitive-behavioral therapy is typically encouraged to identify low-risk and high-risk behaviors and a therapist encourages a person to engage in as many low-risk behaviors as possible while in turn minimizing high-risk behaviors. It also emphasizes the importance of re-framing a person’s thinking.
Instead of thinking, “I can’t believe I relapsed after I’ve been sober for a year, now I’ll never be able to quit,” a person in cognitive-behavioral therapy would think, “This is a setback, but I have been sober for a year, and I can do it again. I just need to re-focus on my sobriety.”

Misconceptions About CBT

Misconceptions About CBT

It takes a long time

A common misconception about cognitive-behavioral therapy is that it is an extended or lengthy therapy. Instead, the therapy is intended for short-term use, but long-term effects. According to PsychCentral, most people participate in cognitive-behavioral therapy for five to ten months in weekly sessions that are usually about fifty minutes in length. Completing even 12 sessions of cognitive-behavioral therapy has been shown to be as effective as taking medications after a two-year follow-up.

It’s the only therapy provided

Another misconception about cognitive-behavioral therapy is that it is the only therapy a doctor may use to treat a person in recovery. Treatments should always be individualized to a person’s unique experiences and history of drug or alcohol abuse. This may mean that a doctor will recommend cognitive-behavioral therapy along with taking medications aimed at keeping a person from relapsing. For example, a study found that alcoholics who participated in cognitive-behavioral therapy and took medications such as naltrexone or acamprasote experienced the best outcomes when quitting drinking. A therapist may also recommend cognitive-behavior techniques along with other psychiatric approaches. Rarely is cognitive-behavioral therapy the only treatment a person struggling with addiction may use to get clean.

It’s the only treatment for substance abuse

The final misconception is that cognitive-behavioral therapy is the only available therapy to help a person overcome substance abuse. If a person has tried cognitive-behavioral therapy approaches in the past and found themselves unsuccessful, they may be discouraged that therapy does not work in substance abuse treatment. However, therapists can use a variety of approaches to help a person overcome their addiction. Examples of alternatives to cognitive-behavioral therapy include motivational interviewing or contingency management. According to the American Psychological Association, these therapies are also effective in treating substance abuse. However, they may not be as widely used as a cognitive-behavioral therapy. As a result, a person may need to talk to a doctor or specific rehabilitation facility to confirm that the facility offers the specific treatments.

Effectiveness of CBT

Effectiveness of CBT

Many therapists and rehabilitation experts regard cognitive-behavioral therapy as the superior therapy method. The support for the effectiveness of this therapy approach extends back decades to meta-analysis research studies that supported the use of cognitive-behavioral therapy in a variety of therapeutic approaches.

Meta-analyses are one of the most important forms of research in support of a particular therapy because researchers conduct a search for all available published data. They then review the data and can combine the effects on a larger scale. Some meta-analysis reports may have 15 or more studies that represent thousands of people are their outcomes.

CBT vs. Other Therapies

One of the more recent meta-analyses published comparing cognitive-behavioral therapy to other therapy types was published in the journal Clinical Psychology Review. The researchers examined 26 studies that compared cognitive-behavioral therapy approaches to other therapy types. The other types included expressive psychotherapy, insight therapy, experiential psychotherapy, Gestalt therapy, and transactional analysis. Of note, the patients’ diagnoses in the research studies were not always related to substance abuse. Some patients in the studies were undergoing therapy for conditions such as depression, anxiety, eating disorders, or personality disorders.

The study’s authors found that “CBT outperforms other forms of psychotherapy at post-treatment”. The authors found patients undergoing cognitive-behavioral therapy had fewer symptoms at six months and one year after the completion of their therapy compared to patients who didn’t. The study’s authors concluded that cognitive-behavioral therapy should be the first line of treatment for almost all patients. However, the authors did note there is limited research available regarding cognitive-behavioral therapy and substance abuse disorders specifically.

CBT for Addiction Treatment

Another study published in the journal “Psychiatric Clinics of North America” supports the use of cognitive-behavioral therapy for treating substance abuse disorders. Researchers of this study specifically conducted a meta-analysis related to cognitive-behavioral therapy and addiction. In one study the researchers reviewed, they found an estimated 60 percent of patients treated for cocaine addiction were clean after one year after undergoing cognitive-behavioral therapies.

Other organizations that specialize in mental health disorders and substance abuse also endorse the effectiveness of cognitive-behavioral therapy. An example is the National Alliance on Mental Illness (NAMI). According to NAMI, “Cognitive behavioral therapy has a considerable amount of scientific data supporting its use”. Because many therapists, psychologists, and scientists are trained in cognitive-behavioral therapies, the therapy type is usually widely found.

Cognitive-Behavioral Therapist Qualifications

Therapists who practice cognitive-behavioral therapy may view their role as a coach or guide for a person struggling with substance abuse. People who practice cognitive-behavioral therapy can come from a variety of educational backgrounds.

For example, a person may be a cognitive-behavioral technician or group facilitator. These are usually certification programs that a person must have a high school diploma in order to earn. There are other certifications available to those who have a bachelor’s degree.

Psychiatrists, who are medical doctors specializing in mental health and disorders, attend many years of post-graduate training to provide cognitive-behavioral therapies.

Each state can set different requirements for rehabilitation treatment and training. For example, 14 states do not currently require addiction counselors to have certifications to practice, according to the American Psychological Association. Only one state requires addiction counselors to have a master’s degree to provide addiction counseling services. Therefore, the training of a cognitive-behavioral therapist can vary widely from location to location.

Where Can I Find Cognitive-Behavioral Therapy?

Therapists use cognitive-behavioral therapy in both individual and group counseling sessions, including family therapy. Cognitive-behavioral therapy is a common component of many 12-step programs and therapeutic approaches. A person can find a specialist via the National Association of Cognitive-Behavioral Therapists website. However, cognitive-behavioral therapy is so widely used, it is likely most therapists will or can use cognitive-behavioral therapy interventions to help a person become and stay sober.

If a person is specifically interested in cognitive-behavioral therapy, they should talk to a potential therapist or drug treatment facility about the types of therapy available. The person can ask about the therapist’s philosophy and approach toward practice. This approach can help a person ensure they receive the therapy type they are most interested in.

Integrating Cognitive-Behavioral Therapy After Treatment

Integrating CBT After Treatment

The principles of cognitive-behavioral therapy focus on making behavioral changes that can help a person stay sober long-term. Examples of these behaviors a person can integrate to prevent relapse include:
Cognitive-behavioral therapy can be an effective approach in helping a client overcome their substance abuse history. Because cognitive-behavioral therapies also focus on relapse prevention, they have the power to ideally serve as a long-term solution for those struggling with drug and alcohol addiction.