What are cognitive-behavioral therapies for addictions and substance abuse?

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

CBT 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.

Bibliography

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Larimer, Mary E., Rebekka S. Palmer, and G. Alan Marlatt. “Relapse Prevention: An Overview of Marlatt’s Cognitive-Behavioral Model.” Alcohol Research and Health 23 (1999): 151–60. Print.

Magill, Molly, and Lara A. Ray. “Cognitive-Behavioral Treatment with Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials.” Journal of Studies on Alcohol and Drugs 70 (1999): 516–27. Print.

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Wright, Jesse, Michael
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