How Cognitive Behavioral Therapy CBT Can Treat Your Addiction

If you are interested in learning more about cognitive behavioral therapy for substance use disorders, help is available. One of the best predictors of success in recovery is staying connected to treatment for the appropriate amount of time. This means that, from the first step, it is important to follow a treatment plan which is customized to your needs. CBT is a widely effective treatment approach for many people and can help you challenge negative beliefs about yourself and start to create a new worldview.

  • The results of this study suggest that although CBI may reduce alcohol consumption, placebo pills and a meeting with a health care professional can have a stronger positive effect than CBI alone.
  • Abstract screening was performed by 2 raters in abstrkr.20 A bibliographic search of CBT reviews was also performed to identify any candidate studies not identified by the original search methods14,16,21-24 This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
  • Objective  To conduct a meta-analysis of the published literature on combined CBT and pharmacotherapy for adult alcohol use disorder (AUD) or other SUDs.
  • Marlatt and Gordon described a negative attributional process that can occurafter a slip (the first use of a substance after a period of abstinence) andthat may lead to continued use in a full-blown relapse (Marlatt and Gordon, 1985).
  • More than 53 randomized controlled trials on alcohol and drug abuse were examined to assess the outcomes of CBT treatment.
  • Bandura has hypothesized that expectations ofpersonal efficacy determine whether coping behavior will be initiated ornot, the amount of effort that will be expended in attempting to cope, andhow long a coping attempt will continue in the face of obstacles andaversive experiences (Bandura,1977).

DIAGNOSIS: Substance and Alcohol Use Disorders

Because of the brief nature of these interventions, they can be delivered opportunistically like when a patient presents in primary care, general hospital and so on, in both inpatient and outpatient settings by a range of specialist and generalist professionals who have been trained the use of these approaches. In this approach, there is an assumed distribution for the population effect size with both systematic and random sources of variability (Hedges & Vevea, 1998). Candidate variables were entered in participant (i.e., age, sex, race, primary drug, substance use severity), implementation, (i.e., treatment length, treatment delivery), and methodological (i.e., study risk-of-bias) blocks.

Primary Study Inclusion

  • As this paper has reviewed, many effective behavioral techniques for the treatment of substance use have been identified; however, use of such techniques is often scarce or non-existent in service provision settings.
  • For instance, clinically depressedpersons tend to blame themselves for adverse life events (internal), believethat the causes of negative situations will last indefinitely (stable), andovergeneralize the causes of discrete occurrences (global).
  • The principles of MI include expressing empathy through reflective listening, developing discrepancy between patients goals or values and their current behaviors, avoiding argument and direct confrontation, adjusting to client resistance and supporting self-efficacy and optimism.

This expanded, mediational model has been described as cognitivesocial learning or cognitive-behavioral theory. This theory postulates thatcognitive factors mediate all interactions between the individual, situationaldemands, and the person’s attempts to cope effectively. During cbt interventions for substance abuse the initial session, the therapist should note the most salientproblems identified by the client and intervene with them first. Thetherapist also should assess the client’s readiness to change and thendevelop initial behavioral goals in collaboration with the client.

What Is Cognitive Behavioral Therapy Used For?

Despite these findings, many trials have not found CBT to enhance coping or self-efficacy to a greater degree than comparison conditions, raining questions about the uniqueness of these mechanisms (Litt et al., 2008). Thus, consistent support for CBTs putative mechanisms of action remain elusive, as it does for many interventions (Emmelkamp et al., 2014). The third contrast in this meta-analysis assessed CBT as an add-on to usual care and pharmacotherapy compared with usual care and pharmacotherapy alone. First, there was substantial heterogeneity in the effect sizes obtained in these studies, suggesting unique study-specific factors could further explain outcome variability. This speculation is supported by the 2 influential studies observed in this subgroup.35,40 Moreover, moderator analyses by primary drug target showed variability in effect-size direction and magnitude with effects for cocaine and stimulant studies showing a range from moderate and negative35,41 to large and positive57,58 effects. This variability may be due, in part, to the lack of FDA-approved pharmacotherapy for cocaine/stimulant use disorder.73 In other words, FDA approval in this case was potentially confounded with the primary drug target.

  • Before focusing more specifically on the cognitive-behavioral model, this chapterexamines the behavioral and cognitive theories and therapies that serve as thefoundations of and have contributed significantly to the cognitive-behavioralapproach to substance abuse treatment.
  • The population focus is adults with a diagnosed alcohol or other drug use disorder, as well as adults with substance use that may place them a risk for related consequences.
  • A goal of CRA is to make these alternative interpersonal and social sourcesof reinforcement available when the person is sober or drug-free, but tomake them unavailable if the person drinks or uses.

Functional Analysis

  • However, for some patients they may provide an adjunctive benefit in maintaining changes brought about by other drug and alcohol treatments, a finding that needs more replication.
  • A number of the behavioraltechniques described here are also used by therapists usingcognitive-behavioral therapy.
  • CM in this study was delivered through a raffle format using a fixed ratio schedule in which drug-free urine samples afforded patients the opportunity to draw from a fish bowl for prizes valued between $1 and $100; patients in the CM condition achieved longer durations of abstinence through a 6-month follow up period relative to those who did not receive CM.
  • Specifically, our primary goal was to derive valid, random effects estimates characterized by effect modifiers.
  • Most often, behavioral contracts and contingency management procedures areembedded in a more comprehensive treatment program.

Cognitiverestructuring is the general term given to the process of changing theclient’s thought patterns. Figure 4-10shows a number of distorted addictive thoughts and more rational alternativesthat the therapist might help develop and practice over the course of cognitiverestructuring. A goal of CRA is to make these alternative interpersonal and social sourcesof reinforcement available when the person is sober or drug-free, but tomake them unavailable if the person drinks or uses.

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Effectiveness of CBT for Alcoholism and Addiction

As personal efficacy decreases, theanticipated positive effects of substance abuse increase and become moresalient (Brown et al., 1998).Under such conditions, the individual is likely to use (Moser and Annis, 1996). The cognitive-behavioral model assumes that substance abusers are deficientin coping skills, choose not to use those they have, or are inhibited fromdoing so (Monti et al., 1994,1995). It also assumes thatover the course of time, substance abusers develop a particular set ofeffect expectancies based on their observations of peers and significantothers abusing substances to try to cope with difficult situations andthrough their own experiences of the positive effects of substances. Theyhave come to believe that substances have positive benefits that are moreimmediate and prominent than their negative consequences.

CBT therapy is a flexible low-risk therapy and has a good reputation for being effective in substance abuse recovery. Periods without therapy sessions allow clients time to practice the newskills of identifying and challenging unproductive thinking on their own.However, it is easy to fall back into old, automatic ways of thinking thatmay require a return to therapy. The therapist can productively build onwhat was learned in previous sessions, help the client see how she slippedinto old patterns, and further reinforce the process of catching oneself inthe process of thinking negative automatic thoughts.

Cognitive-Behavioral Therapy (CBT) for Addiction and Substance Abuse

cbt interventions for substance abuse

In the sections below we elaborate on how these possibilities may accelerate development of cognitive behavioral interventions in the next 30 years. Cognitive behavioral therapy (CBT) for substance use disorders has demonstrated efficacy as both a monotherapy and as part of combination treatment strategies. This article provides a review of the evidence supporting the use of CBT, clinical elements of its application, novel treatment strategies for improving treatment response, and dissemination efforts.

Clinical Trials

A focus is placed on clarifyingexpectations that each partner has about the behavior of the other. Forthose with a problem with alcohol, medication (e.g., disulfiram [Antabuse])monitored by the spouse may be used. The client also receives training inproblemsolving and in ways to refuse requests to drink or use drugs. Because substance abuse behavior is learned, it can be changed byteaching the client more adaptive, alternative behaviors aimed at achieving thesame rewards. Figure 4-3provides anoverview of some of the advantages of behavioral theories of substance abuse anddependence and their treatment. Three and six-month follow-up indicated significant reductions in drinking outcomes, but no significant differences between conditions (PDA at 3 months follow up was 73.3 for OA+SR compared with 71.2 for SR only).

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