Cognitive-Behavioral Therapy (CBT)

Someone who suffers with addiction has a strong compulsion to engage in harmful behavior even though they know that it could have serious negative consequences. Using substances on a recurring basis actually causes changes in the brain that make it difficult for the affected individual to control their desire to use. The chemical changes in the brain may worsen any existing mental health conditions or trigger similar symptoms. Quality of life is significantly reduced as the person spends much of their time thinking about, obtaining and using the substance of choice.

A type of talk Therapy, cognitive behavioral therapy, often referred to as simply CBT and also has roots in Rational Emotive Behavioral Therapy (REBT) developed by psychologist Albert Ellis, aims to identify a person’s thoughts and feelings and how they can lead to unhealthy behavior choices. Since CBT helps the individual to develop healthier coping strategies for unrealistic thought patterns, it is often one of the first lines of treatment options for substance abuse whether through an inpatient or outpatient recovery program.

Understanding Cognitive-Behavioral Therapy (CBT)

CBT was created in the 1960s by a psychiatrist named Aaron Beck. He noticed that many of his patients with depression had negative thoughts that weren’t valid or based on reality, but the patients believed them to be true just the same. These thoughts influenced how they felt about themselves and the world around them and affected their behaviors in many situations as well. Since that time, CBT has been adapted to treating a wide range of mental health disorders and substance abuse.

The basic components of CBT

Because many behaviors are based on invalid thoughts and the feelings an individual has regarding those thoughts, CBT techniques is used to help that person to alter their thought patterns and learn new ways to cope with stressful situations.

1. Cognitive restructuring
The individual learns how to identify negative thoughts that have no proof or that aren’t valid and cause the person to feel badly about themself or that they can’t quit using harmful substances or stay quit. Instead, the individual is encouraged to examine these thoughts and replace them with more realistic ones.

2. Behavioral patterns
Negative thoughts and feelings of an individual cause a person to react or behave in a related manner. The goal of CBT is to replace the negative thought patterns and core beliefs that a person has about themself in the goal of encouraging more positive behaviors.

3. Skills training
As a part of learning new behaviors, cognitive-behavioral therapist helps the individual to learn new skills that can be used instead of the old behaviors where the person would turn to substances for comfort or to feel good, seeing a therapist you can communicate and work well with will help you get the most out of your therapy sessions. These new coping strategies can be learned and used to help the individual to avoid substance use and to prevent relapse when stressful situations arise.

The adaptability of CBT for various mental health disorders

One of the most intriguing factors of CBT is that it can be adapted as a treatment for multiple conditions, including substance abuse and many mental health disorders. Changing an individual’s core beliefs by replacing recurring negative thought patterns with more realistic ones allows a person to make better choices to increase overall well-being and improve quality of life.

CBT for Addiction Treatment: Core Concepts

While the general core concepts(according to American Psychological Association) of CBT remain the same, the technique can be altered slightly to focus on identifying the negative thoughts that could lead an individual to substance use or abuse.

Identifying and challenging addictive thought patterns

When treating any condition with CBT, it’s important to help the individual to identify recurring negative thoughts that have no factual support. The therapist can help the person to see why the thoughts may not be valid. When untrue thoughts are challenged, they can then be replaced with those that are more realistic and logical.

Continued use of drugs or alcohol often increases a person’s negative image they have of themself. Once the individual learns why they feel the way that they do, they’re better able to make more productive decisions and change their behavior in a way that’s more positive.

Developing coping strategies and skills for high-risk situations

A large part of the reason that substance users can’t quit is because they have learned that using drugs or alcohol helps them to cope with the negative perception they have of themself. CBT allows the person to find new behaviors that are more beneficial when negative thoughts arise instead of using substances.

Working with the therapist, the individual can learn to identify the specific thoughts or circumstances that have led to substance use in the past so that they can either turn those thoughts around and make better choices or to avoid those triggers and situations in the first place. For example, if going to a certain place or hanging out with a certain person causes negative feelings that lead to substance use, the individual may have to avoid those situations to avoid using.

Addressing co-occurring mental health disorders that contribute to addiction

Mental health conditions commonly co-occur with substance abuse. It’s believed that the recurring negative thought patterns that lead to the use of feel-good substances can also lead to conditions such as depression or anxiety disorders.

The use of alcohol and drugs can intensify the symptoms of these mental health conditions, and experiencing these mental health issues can trigger the desire for substances; it’s vital that any co-occurring disorders are identified and treated at the same time as the substance abuse to provide a more effective treatment outcome.

addiction therapy

Components of CBT in Addiction Treatment

Just like when using CBT to treat other conditions, the person will learn to identify the recurring automatic thoughts so that these can be changed to thoughts that are more accurate. Once the individual can learn to see faulty reasoning, they can work to change harmful behaviors to those that are more productive.

Assessment and goal setting

The individual must be willing to change. Even though they’ll work with a therapist who can help to provide a more realistic viewpoint, it will be up to the person to put in the effort to make the necessary changes. During the initial assessment, the therapist will work with the individual to set realistic goals. Progress in reaching these goals can be seen through improved thought processes and subsequent behaviors.

Cognitive restructuring techniques

Because the negative thoughts that can lead to substance use are automatic, it’s important for the individual to learn to identify these thoughts as soon as they arise so that they can be stopped before the individual turns to drugs or alcohol for temporary relief.

1. Identifying cognitive distortions
Some activities in CBT that can be useful for an individual is keeping track of thoughts that frequently lead to substance use. This can be done through journaling or keeping thought records. The individual writes down the negative thought and then analyzes it, making a list of any evidence that can prove or disprove that the thought is accurate.

2. Challenging and replacing negative thoughts
By looking at the evidence and analyzing each negative thought objectively, CBT treatment this can help to prevent catastrophizing, mistaking feelings for facts, all-or-nothing thinking, over-generalizing, magnifying, minimizing and other negative thinking patterns that often lead to substance use.

Behavioral strategies

While the cognitive aspect of CBT focuses on thoughts, an individual’s behavior is expected to change as well. Identifying and replacing inaccurate thoughts will help with altering negative behaviors that occur as a result. Additionally, it’s very helpful for someone to learn more positive behaviors to replace the negative ones that they’re trying to avoid.

1. Exposure and response prevention
The therapist will work with the individual to determine which type of response will work best for that specific person. A negative memory or recurring thought will be examined multiple times to help the person identify the thoughts and feelings associated with that memory. The individual will then determine the best response on moving forward any time that memory or negative thought recurs. Over time, the memory will become less painful, allowing the person to move forward.

2. Contingency management
Although contingency management can be used alone, it’s frequently incorporated into CBT. The individual makes both short- and long-term behavioral goals and rewards each goal as it is met. As an example, a person may decide to reward themself with a new outfit or a spa day for reaching a sobriety goal, such avoiding substance use for a week. If the individual does not reach that goal, they don’t get the reward.

3. Relapse prevention planning
It’s important for the individual to prepare for potential thoughts and situations that create triggers. As a part of a relapse prevention plan, the person may learn new behaviors to engage in rather than turning to drugs or alcohol. When the negative thoughts occur, the individual will replace them with more realistic ones. Then, rather than using substances, they may decide to exercise, meditate or perform some other action.

While stopping the unwanted behavior of using alcohol or drugs is the main goal, it can be very helpful if the individual is able to replace the negative response of using with a more positive action to take its place.

The Effectiveness of CBT for Addiction Treatment

Whether used alone or in combination with other forms of treatment for addiction, CBT has been shown to be extremely effective in a short period of time.

Review of research studies and success rates

In the journal Psychiatric Clinics of North America, a review of multiple studies showed that CBT was effective at helping 60 percent of participating individuals to maintain sobriety after a one-year follow up. However, this treatment showed less promise with polysubstance use but can be more effective when combined with other treatments.

Additionally, a meta-analysis published in Cognitive Therapy and Research showed similarly encouraging results.

Comparison to other treatment modalities

CBT has been shown to be similarly effective at treating substance abuse as 12-step programs and medication-assisted treatments. An individual can continue to see positive results once CBT has stopped because everything learned during this therapy can be put into practice by the person on their own. 12-step programs and medication don’t always have this type of lasting impact.

However, when used in connection with 12-step programs or medications to treat co-occurring conditions, an individual is more likely to have a better outcome with CBT than by using one treatment on its own. By treating the person as a whole, the likelihood of recovery improves, and relapse is less likely to occur.

Factors influencing the effectiveness of CBT in addiction treatment

Although CBT has been shown to help an individual to overcome addiction, there are several important factors that can determine the effectiveness of this treatment:

  • Therapist competence and experience
  • Client motivation and commitment
  • Access to appropriate resources and support systems

Integrating CBT into Comprehensive Addiction Treatment Plans

Because CBT helps the individual to change the patterns of thinking that can lead to drug or alcohol use, it can provide a solid foundation when combined with other types of therapy. Along with individual therapy, the individual may also benefit from group or family counseling sessions.

As a part of a multidisciplinary approach, the person will work with the CBT therapist in addition to other providers as needed for their individual circumstances, such as a social worker, psychiatrist or family physician.

Key Takeaways

CBT helps an individual to identify and alter negative thought patterns that lead to harmful behaviors. By changing the way the person thinks, they can react differently and in a more positive manner to stop using substances and maintain sobriety.

While the individual treatment plan forms to onset of the recovery process, ongoing support can help to reduce the chance or relapse or help the individual to get back on track should a relapse occur.

If you’re trying to overcome dependence on drugs or alcohol, consider CBT as a valuable component of a comprehensive addiction treatment plan. To learn more or to get started on your recovery journey, contact us today.


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Reviewed for Medical & Clinical Accuracy by Long Island Treatment Center