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Cognitive Behavioral Therapy for Addiction

The problem of substance abuse has been around for thousands of years. Ancient texts, such as found in the Bible, illustrate the dangers of chasing after alcohol and the foolish decisions made while under the influence. Ancient tribes in South America depended heavily on the motivation derived from the coca leaf and the psychoactive effects. Early America was beset by a scourge of opium addiction, and methamphetamines fueled the soldiers of WWII.

Even as the types of addictive substances change and the cultural acceptance of the use of substances varies, treatment approaches for relief from the enslavement of substance addiction have historically changed and evolved. One of the most recent and robust approaches for substance abuse treatment to have emerged during the past century is Cognitive Behavioral Therapy. Originally designed as an effective and short-term treatment for mood disorders such as anxiety and depression, its usefulness in treating substance use disorders has been similarly verified.

Cognitive Behavioral Theory in a Nutshell

Cognitive Behavioral Therapy, or CBT, was developed during the 1960s. A prominent psychologist determined that there was a link between the thoughts and beliefs that are held by an individual and that individual’s eventual actions. If one were to adjust the thoughts and beliefs to reflect a more positive and productive worldview, then the self-defeating behaviors would decrease. It is our own interpretations of the world that determine our thoughts, and it is our thoughts that determine our actions. CBT seeks to treat and adjust the underlying beliefs that manifest into undesirable behaviors.

Key Elements of CBT

One of the most useful features of CBT treatment is its simplicity. Concepts underlying the CBT focus are clearly defined, and responsibility for progress is evenly distributed between therapist and client. The role of the CBT therapist is to assist the client in discovering which beliefs exist, which thoughts are associated with such beliefs, and which behaviors are engaged in as a result of holding onto these beliefs. 

As getting to the root of our deepest beliefs can take some time, a CBT therapist will often begin by asking a client to simply identify the types of behaviors that are experienced during the day and will ask that client what thoughts were going on at such moments. Together, the therapist and the client will work backward to uncover the core beliefs that drive our thoughts and behaviors. This detective work occurs simultaneously with active adjustments made to our daily routines.

Automatic thoughts are another key feature of CBT and are sometimes referred to as unconscious thoughts. In essence, these are the types of ideas that we form in our minds without thinking twice about them. If our core beliefs have been crafted in a way that makes the world appear as a scary and unsafe place, for instance, our automatic thoughts are likely to be geared toward protecting ourselves. As a result of our thoughts being centered on self-protection, our subsequent behaviors are likely to be applied toward defense. Identifying these automatic thoughts and directing them elsewhere can result in new, more adaptive, responses becoming the norm.

CBT relies on the idea that our brains are flexible when it comes to establishing new patterns and habits. Recent scientific studies support this concept, as it has been found that our brains develop new neural pathways throughout our lifetimes. Neurons create the pathways through which information travels in the brain. With consistent practice, we can train information to follow a different neural pathway from the one that we utilized, before. A CBT therapist will assign exercises and homework that will assist you in developing these new pathways in thinking and response while at home, and will review the outcomes of your practice with you during sessions.

Structure of CBT for Addiction Treatment

While the original model of CBT was designed to follow a very strict pattern of sessions and progression, addiction-focused CBT approaches can vary. Treatment providers may utilize it as a stand-alone treatment or may decide to integrate elements of CBT into other treatment modalities. Whichever structure is employed, the application of CBT in substance addiction treatment has a very good track record for fostering recovery.

As much of substance abuse treatment relies on the positive aspect of group support, CBT elements may be presented in a group setting. A group may be challenged to identify common situations that precede temptation to use drugs or alcohol. With the help of the CBT group leader, differing thoughts and responses to such scenarios can be explored, and assigned homework will consist of practicing those new responses over the next week. Some time will be devoted, during the next group session, to discussing the practicality and success rate of applying the new coping techniques.

Psychoeducation is another important part of recovery using CBT. Before we can actively work on changing a thought pattern, we need to be aware that it even exists. Once we are made aware of a pattern, we need to be equipped with the tools necessary to change it for the better. CBT therapists will often begin the treatment process by providing information about the elements of CBT and will integrate worksheets and handouts throughout the treatment. These worksheets will be designed to educate about the origin of our thoughts and to provide ideas for applying more effective coping strategies when the temptation to use substances is high.

CBT for Co-occurring Disorders

One of the perks of utilizing CBT in an addiction recovery program is that the approach can simultaneously be used to reduce symptoms of other mental health disorders. Mood disorders – such as depression, anxiety, and PTSD – respond very well to CBT treatment. Many people who struggle with addiction are also seeking relief from these types of mental health disorders, and some have even developed an addiction problem due to a misguided attempt to relieve the suffering wrought by these types of issues. Applying CBT in such co-occurring cases can result in the ability to adjust core beliefs in a way that frees you from both addiction and mood disorders.