CBT is an alternative to the well-known 12-step self-help movement and other substance abuse therapy, which are based on Alcoholic Anonymous’s Twelve Steps. According to numerous studies, cognitive behavioral therapy is considerably more successful than 12-step groups like Alcoholics Anonymous. Furthermore, several types of research have revealed that 12-step-based treatment programs are harmful, with many of these treatment methods being less beneficial than being put on a waiting list for the care.
CBT therapy for addictions, unlike 12-step programs, has been thoroughly investigated and is based on human behavioral science. Cognitive-behavioral therapy differs from 12-step in that it does not imply that addiction is a lifelong illness. Instead, addictions are regarded as over-learned actions that provide important purposes. The goal of treatment is to learn new more effective behaviors to take the place of the addiction behaviors.
Cognitive Behavioral Therapy(CBT)
Cognitive-behavioral therapy (CBT) is a form of behavioral therapy that was developed to treat depression. Two important components of CBT include cognitive therapy and behavioral therapy, which are both regarded as the most effective psychological therapies. Cognitive-behavioral therapy focuses on changing distorted thinking and maladaptive beliefs and then learning how to view situations more realistically and adaptively.
Cognitive-behavior therapy and techniques:
Cognitive-behavioral therapists believe that addiction is a learned behavior and therefore it can be unlearned. Behavioral therapy combines therapeutic techniques across the areas of cognition and behavior to support the individuals in identifying and addressing distorted patterns of thought that often influence their. Cognitive behavior therapy is a problem therapy approach – the aim of which is to find healthy solutions to your current problems rather than focusing on the underlying reasons for your problem.
Cognitive-behavioral therapy techniques:
Cognitive-behavioral therapy tries to teach people how to identify and change unhealthy or ineffective ways of thinking. CBT can also be used for treating certain issues related to our behavior including drug abuse, depression, eating disorders & obesity, anxiety problems, phobias, and stress management. Cognitive-behavioral therapy techniques include:
- Identify negative thoughts
- Develops strategies for translating negative thinking into positive ways of thinking.
- Identify negative emotions and their triggers.
- Regain control over negative thoughts and behaviors.
- Learn to avoid or stop using coping methods that lead to problems such as drug abuse, including:
- Abstaining from drugs
- Avoiding high risk situations
Substance Abuse or Substance Use Disorders (SUDs)
A substance use issue is described as any type of problem connected to the use of a drug, including alcoholic beverages, illicit (street) drugs, or prescription/over-the-counter medication. That is, in order to fix this issue, you must first identify it. It may exist in nearly any area of life, including family, legal, or health.
Clinical elements of CBT for SUDs
Often substance use problems develop independence on a transaction between biological, social, and psychological causes. Evidence-based behavioral therapy treatment strategies or interventions mainly by helping people learn to cope with and reduce urges to use substances. By helping people better manage problematic thought patterns, difficult emotions, and urges to engage in unhelpful behaviors, CBT targets the underlying factors that maintain substance use disorders.
Efficacy of CBT for SUDs
This assessment of CBT for substance use disorders in special populations such as those with other Axis I Disorders (i.e. double diagnosis) pregnant women and incarcerated individuals is beyond the scope of current research. Cognitive-behavioral treatment includes many different interventions either in conjunction or isolated many may be given individually or in group form.
Here, specific behavioral and cognitive-behavioral interventions given to individuals are examined and then presented as family-based treatments. There was evidence for better effect sizes for contingency management approaches relative to relapse prevention or cognitive-behavioral treatment.
Alcohol Abuse
Behavioral therapies or cognitive behavioral therapy techniques can be valuable in alcohol or drug addiction treatment of alcohol abuse, and cognitive-behavioral therapy techniques have been found to be particularly useful in relapse prevention. The behavioral therapies that have been shown to be effective in the treatment of alcohol abuse are focused on either increasing abstinence or reducing problem drinking behavior.
Relapse Prevention Therapy (RP)
Relapse Prevention Therapy is a cognitive-behavioral approach that is designed to reduce the likelihood of future relapse. The focus of RP interventions is on learning skills to manage high-risk situations and cravings for substances. Skills taught in RP include: coping with cravings, avoiding unsafe situations, handling urges without engaging in substance use behaviors, and problem-solving difficulties associated with abstaining from substance use.
Moderation Management (MM)
Moderation management is a cognitive-behavioral approach to reducing drinking that has been adapted for use with individuals who are in the early stages of change or who have a history of relapse. It shares many of the same principles as RP, but it does not assume abstinence as an end goal (e.g., it is contingent upon “drinking responsibly”). The MM program of addiction treatment helps individuals reduce their drinking by identifying occasions in which they are likely to drink and then developing strategies for avoiding problem drinking behaviors on these occasions.
Cognitive-Behavioral Coping Skills Therapy
This behavioral intervention teaches individuals skills that will help them cope with the urge to drink. Skills include: identifying the factors that lead a person to crave a drink, managing cravings in order to avoid relapse, and increasing healthy coping mechanisms when faced with high-risk situations.
Interventions for Pregnant Women
This section will focus on interventions designed specifically for use with pregnant women who are in outpatient treatment for a SUD, including CBT for pregnant women. Treatment can be initiated at any point during pregnancy.
Structure and organization of the interventions
CBT for Pregnant Women (CBTPW) consists of a manual-based cognitive-behavioral intervention designed to reduce substance use disorders in pregnant women, their partners, and couples living together. The CBTPW intervention includes an assessment phase, during which patients are asked to complete the TIPI questionnaire (a screening tool for substance use disorders) to assess their level of risk factors.
Alcohol Use Disorders (AUDs)
Uncontrolled drinking and the use of alcohol are common disorders that are associated with significant morbidity. The goal of treating alcohol use disorder (AUD) is to help people learn to drink in moderation whilst avoiding the occurrence of negative consequences related to excessive drinking. Some beneficial interventions include: self-help groups, educational programs aimed at increasing knowledge and de-stigmatizing alcohol problems; family members can also be involved in these group sessions.
Approaches to alcoholism treatment
Alcoholism treatment approaches are typically classified into three categories: philosophical, pharmacological, and treatment matching. Sensitivity to gender differences is crucial when developing an appropriate approach for treatment.
Treatment for Female Alcoholics
The purpose of the cognitive-behavioral approach is to discontinue the use of alcohol, whereas psycho-social approaches assist in dealing with issues that may have led to substance use disorders. The cognitive-behavioral approach consists of two components: a) learning coping strategies, and b) restructuring attitudes and behaviors. Psycho-social approaches emphasize the psychosocial problems or mental illness that have occurred in response to alcohol consumption.
Pregnant Women
Treatment should be tailored according to the stage of pregnancy, the severity of alcohol use disorder, and whether or not there is a co-occurring psychiatric condition. Pharmacotherapies that have been used to treat pregnant women with AUDs include disulfiram, naltrexone hydrochloride, acamprosate sodium, topiramate, and baclofen. A recent study evaluating the efficacy of acamprosate sodium in pregnant women with AUD found that the medication reduced alcohol consumption. Unfortunately, many women do not receive any form of treatment during pregnancy and thus abstain during this time.
Anxiety Disorders
Although it is possible for an individual to experience anxiety as a result of substance abuse, it is also common for an individual to abuse substances in order to reduce anxiety. During substance abuse treatment, for patients with anxiety disorders, it is necessary to treat both the substance use disorder and coexisting anxiety disorder if present.
Drug Abuse
Excessive use of drugs or drug abuse is defined as compulsive drug-taking despite the negative consequences of continued use. The reason for this behavior is complex and may have genetic, environmental, cognitive, affective, social, and neurobiological underpinnings. Because substance abusers are unable to resist urges to continue their drug-seeking behavior despite the severe adverse effects experienced, they are diagnosed with drug dependence.
The World Health Organization estimates that the United States is currently experiencing a significant epidemic of prescription drug abuse, which has claimed more lives than all other illicit drugs combined. Research also indicates that prescription drug abuse is replacing heroin as the number one substance of abuse in large cities across America. Unfortunately, many doctors are unaware that their initial prescriptions may lead to a patient’s addiction, and deny the connection between the prescription of these drugs and their subsequent misuse or abuse.
Medication can be used as a means of assisting with the withdrawal process from illicit substances. In most cases, medication-assisted therapy (MAT) is considered when opioid drug or alcohol use withdrawal is complicated by physical dependence on opioids. FDA-approved medications used in MAT are buprenorphine, methadone hydrochloride, and naltrexone.
Methadone maintenance treatment
Cognitive-behavioral approaches during methadone maintenance treatment (MMT) include cognitive-behavioral therapy (CBT), supportive psychotherapy, and twelve-step facilitation (TSF). CBT is designed to develop coping strategies by identifying the likely problems encountered during MMT. A major component of CBT is teaching patients skills that can be used to avoid relapse.
Treating Cocaine addiction and cocaine dependence
Cognitive-behavioral therapy is the most effective approach in the treatment of acute cocaine intoxication. This is because it focuses on reducing the immediate negative effects associated with drug abuse. It is also beneficial for preventing future occurrences, although relapse rates are high.
Cognitive-behavioral therapy is also effective in treating cocaine dependence. The focus of cognitive-behavioral approaches is on attaining abstinence; however, most patients with acute cocaine intoxication will experience an episode of relapse even after achieving short-term abstinence. Longer-term therapies are necessary to treat addiction and prevent further relapses.
Efficacy of CBT for Drug Use Disorders
The efficacy of CBT for drug or alcohol use disorders has not yet been empirically examined, although it is used frequently in outpatient programs. The main advantage of CBT is that it is a brief, inexpensive intervention that can be integrated into other substance abuse treatment modalities.
Exposure therapy
The use of exposure therapy has been demonstrated to treat posttraumatic stress disorder (PTSD) and anxiety disorders. It works by exposing the patient to the source of their anxiety, which is often a traumatic event. The practitioner should do this in a way that does not cause more distress for the patient.
The evidence shows that exposure therapy has fewer effects on its own than when it is combined with cognitive-behavioral therapy or medications. This suggests that combining multiple treatments can have strong benefits to patients suffering from anxiety disorders and treating alcohol use habits.
Food addiction
The similarities between substance abuse and obesity have led to the notion that food can also be addictive. People who are obese often describe their eating habits in similar ways as people experience with drug use, thus leading researchers to develop weight loss programs based on behavioral approaches that mirror those used for treating substance abusers. This has led to the development of a program combining cognitive-behavioral therapy with a food plan. This has been effective in promoting weight loss for people who have obesity problems .
Alcohol abstinence and relapse prevention
Cognitive-behavioral therapy is recommended as the treatment of choice for alcohol abstinence and relapse prevention by the American Psychological Association. It provides useful strategies that can be used to avoid relapse, while also increasing motivation for abstinence.
Tobacco addiction
Cognitive-behavioral therapy is effective in treating tobacco dependence by increasing the rate at which people quit smoking (for instance, by doubling their success rate). However, this therapy may not be suitable for all smokers because it encourages them to abstain rather than reduce their intake.
Motivational enhancement therapy is designed to improve the patient’s readiness for change by highlighting the pros of quitting smoking and the cons of continuing. It is not an effective treatment on its own but can be useful in combination with CBT.
Efficacy of CBT for Personality Disorders
Cognitive-behavioral therapy has been examined as a way to treat personality disorders, particularly borderline and antisocial personality disorder (ASPD). It involves the modification and restructuring of problematic attitudes that may be causing or contributing to symptoms related to ASPD.
Borderline personality disorder (BPD)
After examining the two main components of cognitive-behavioral therapy, emotional regulation, and distress tolerance, researchers have found that it may be beneficial for patients with BPD. These are both skills necessary for creating stability in one’s life. For instance, the ability to suppress or avoid strong emotions may be too difficult for people who suffer from BPD, and thus it may be wise to focus on other aspects of cognitive-behavioral therapy.
Antisocial personality disorder (ASPD)
Patients with ASPD benefit from learning how to identify and label their emotions, as well as learning how to manage their urges and desires in a way that does not involve acting impulsively. This can be difficult to learn, but this type of therapy is a good option for those with ASPD.
Cognitive-behavioral therapy has been proven to reduce the risk of future use among patients diagnosed with BPD who have addiction problems. This therapy is helpful because the BPD symptoms themselves, such as impulsivity and instability, may increase the risk of addiction.
Cognitive-behavioral therapy for ADHD has been found to significantly reduce hyperactivity and inattentiveness in children with ADHD. Since these two factors are often what cause negative attention from peers during childhood, cognitive behavioral therapy can be extremely useful in preventing possible bullying behavior later on.
Maladaptive Behavior
Maladaptive behavioral patterns can have a very negative effect on social relationships. It may be helpful to use cognitive-behavioral therapy to help improve these patterns so that people can feel more comfortable doing things they used to enjoy, such as attending parties or visiting the library. A study of self-help interventions for loneliness found that those who used cognitive behavioral therapy reported that their loneliness decreased when compared to the control group.
Professional treatment advice or counseling on alcohol or drug abuse may be conducted in an outpatient clinic, a therapist’s office, or within the patient’s home. It may involve both individual and group counseling sessions depending on the severity of addiction and other disorders that are associated with it.
Some other treatment strategies may include support groups, self-help, and 12 Step programs for both drug abusers and their loved ones. These groups can be found in many settings including churches, the workplace, schools, or even online chat rooms.
It is important to note that CBT interventions can be effective without professional help or with minimal assistance from a mental health professional. Clinical psychopharmacology involves the use of prescription medications to target specific symptoms of addiction and other disorders. It is used in conjunction with professional therapy and CBT interventions, but these drugs alone can help people heal from addiction or help prevent relapse. Substance abuse treatment is a therapeutic process that involves many components, and this includes pharmacological, psychological, social, and spiritual interventions.
Cognitive restructuring and cognitive behavioral therapy is a method used in substance abuse and addiction clinical settings. It helps people learn to recognize, identify, and label the feelings and thoughts that trigger urges and desires for cocaine, alcohol, or other drugs of abuse. CBT helps teach stimulus control strategies to deal with these triggers so that cravings do not lead to relapse.
The clinical trials have shown that cognitive-behavioral therapy is effective for reducing the frequency of cocaine use, as well as the severity of cocaine cravings. Cognitive distortions that lead to cocaine craving have been targeted in CBT interventions. These studies found that cognitive-behavioral therapy is not only effective in promoting abstinence from drug use, but it may also reduce the risk of future relapse.
Psychosocial intervention is any type of supportive therapy or behavioral treatment. This may involve attending self-help meetings, participating in support groups, or simply having a person the addict trusts, to talk regularly. The mental health services administration (MHSA) has outlined these psychosocial interventions into four main categories which are listed as Family-based treatment, social support, psychoeducational programs, and interpersonal therapy.
Reference
National Institute on Drug Abuse has stated that cognitive-behavioral therapy is one of the most effective treatments for addiction. The National Center on Addiction and Substance Abuse has released a study that shows that 90% of people treated with cognitive behavioral therapy were able to remain sober for at least three years.
Illicit drug users who used cognitive-behavioral therapy were twice as likely to be successful in their attempts at abstinence. CBT is also effective for those suffering from dual diagnoses (addiction and mental health disorders). Cognitive-behavioral therapists have suggested that cognitive-behavioral therapy has been found to increase abstinence rates, decrease relapse rates, and improve overall treatment outcomes.
A limited body of effectiveness research was conducted looking at these treatments without rigorous control of efficacy trials. A randomized controlled trial study of 228 cocaine users showed that those who received cognitive-behavioral therapy work were more likely to remain drug-free for three years than u even after the end of treatment.
Another study was conducted with outpatient methadone-maintained opiate addicts who received either CBT treatment or Motivational Interviewing (a form of brief counseling). Those in the cognitive-behavioral group, on the other hand, go on to direct clients toward alternative treatments after completing the six-month curriculum or no therapy at all. Substance misuse has been associated with an array of negative consequences.
Research suggests that CBT treatment may be effective in decreasing cocaine use in 40% or more of patients typically who are resistant to other types of therapy.
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How can CBT be used to treat addiction?
Cognitive-behavioral therapies focus on helping people change the thoughts and behaviors that may contribute to their drug abuse. One type of cognitive-behavioral therapy is called cognitive restructuring, which helps people identify and challenge the thoughts that lead them to drug abuse. This type of therapy can help people develop healthier ways of thinking about themselves and their drug use, which can lead to changes in behavior.
Is CBT effective for substance use disorders?
There is a limited body of evidence that suggests that CBT may be an effective treatment for substance use disorders. A randomized controlled trial study of 228 cocaine users showed that those who received cognitive-behavioral therapy were more likely to remain drug-free for three years than those who did not receive therapy.
How does CBT prevent relapse?
Cognitive-behavioral therapy helps people develop healthy coping skills and strategies to deal with stressful situations. These skills can help people resist the urge to use drugs. CBT also helps people identify and avoid situations that may lead to drug abuse.
What type of therapy is AA?
Alcoholics Anonymous is a mutual-aid group that follows the 12-step program. This type of therapy does not use cognitive-behavioral techniques but relies on peer support to help people recover from addiction.
What is the difference between CBT and AA?
Cognitive-behavioral therapy focuses on helping people change the thoughts and behaviors that may contribute to their drug abuse. Alcoholics Anonymous does not use cognitive-behavioral techniques but relies on peer support to help people recover from addiction.
