Cognitive-behavioral therapy for addictions and substance abuse
Cognitive-behavioral therapy (CBT) for addictions and substance abuse is a structured form of psychotherapy that helps individuals identify and modify negative thoughts and behaviors linked to their addictive patterns. This therapeutic approach is grounded in the understanding that thoughts, emotions, and behaviors are interconnected. CBT encompasses various therapy types, including cognitive therapy and dialectical behavior therapy, and has been extensively researched, particularly in the context of addiction treatment.
In CBT, patients work with therapists to recognize triggers for substance use and develop coping strategies to prevent relapse. The therapy also emphasizes the importance of reframing negative thoughts—known as cognitive distortions—and replacing them with healthier perspectives. Group settings are often utilized, which can enhance effectiveness. Treatment typically involves defined goals, structured sessions, and may last between twelve to twenty-four weeks.
While CBT has demonstrated positive outcomes in addiction recovery, it requires skilled therapists and may be less effective for individuals with significant cognitive impairments or those unwilling to engage in the therapeutic process. Overall, CBT serves as a valuable tool for individuals seeking to overcome addiction by fostering self-awareness and encouraging the adoption of healthier behaviors.
Cognitive-behavioral therapy for addictions and substance abuse
- ALSO KNOWN AS: Relapse-prevention coping skills
- DEFINITION: Cognitive-behavioral therapy (CBT) is a form of psychotherapy in which a person works with a therapist to identify, challenge, and rethink any misperceptions or negative thoughts and their associated undesirable behaviors. The term cognitive-behavioral therapy applies not to one specific type of therapy but rather to a group of therapy types that share a similar approach. These therapy types include rational-emotive behavior therapy, rational behavior therapy, rational living therapy, cognitive therapy, and dialectical behavior therapy (DBT).
History and Development
Early work by researchers including Ivan Pavlov, John B. Watson, and B. F. Skinner was based on classical behavioral theory, which states that learning begins with an individual's interactions with the environment and that behaviors form from exposure to stimuli in the environment. In the 1960s theorist Aaron T. Beck emphasized the impact of each person’s thoughts and emotions on behavior, referring to therapy that addressed both thoughts and behaviors as cognitive-behavioral therapy (CBT).
General Uses
Cognitive-behavioral therapy has been used widely in the field of psychiatry for disorders including those of mood, thought, personality, and addiction. CBT can occur in either a one-to-one therapist-patient setting or in a group therapy setting.
In the area of addictions and substance abuse, research by G. Alan Marlatt and J. R. Gordon published in the 1980s incorporated CBT concepts into a specific strategy for preventing relapse of negative addictive behaviors. Experts note that CBT may be one of the most studied treatments for addiction, and research has confirmed that this approach, especially when used in a group setting, has a generally modest but positive effect in persons who have abuse or addiction diagnoses.
The use of CBT with either medication or other psychosocial approaches may provide an added benefit in some cases as compared with CBT alone. While CBT differs in many ways from popular twelve-step programs such as Alcoholics Anonymous and Narcotics Anonymous that are often used by people struggling with addictive behaviors, both CBT and twelve-step approaches encourage participants to pursue activities that are incompatible with the addictive behavior and to find ways to combat negative thinking.
Persons who participate in CBT to cope with an addiction or abuse problem work with the therapist to understand repeated patterns that promote ongoing substance abuse and addiction. Persons in therapy learn to identify factors that can trigger relapse of abusive or addictive behaviors and learn how to successfully refuse the substance or behavior of abuse.
CBT participants explore the consequences of continued substance abuse behaviors. Scrutiny of even seemingly small decisions that may affect thoughts, emotions, or behavior, as in the case of an alcoholic who may pass a favorite bar on the way to or from work, is strongly encouraged. CBT emphasizes the successful use of coping skills and the adoption of new activities that are completely unrelated to the addictive behavior.
An important aspect of CBT is identifying thoughts that support continued substance abuse or other addictive behaviors (often referred to as cognitive distortions) and learning to replace these thoughts with more beneficial ones. This process is called reframing. Patients engage in role play or rehearsal that is intended to help them cope with cravings for the addictive substance or behavior, or with high-risk situations, such as being invited to an occasion at which the substance of abuse will be available. Patients are often assigned homework, during which they can practice new thought patterns or skills learned during therapy sessions. Treatment goals are usually well defined in CBT, and sessions are structured, brief in duration, and often limited to twelve to twenty-four weeks.
Limitations
While experts have identified many benefits associated with CBT, one potential disadvantage of this approach is the need for specialized and fairly complex training of therapists so that they can use CBT techniques effectively with patients. CBT may have limited usefulness in patients who have higher levels of cognitive impairment or in those who are not prepared to undertake the work that is required for learning new thoughts and behaviors.
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