It’s not easy to admit that you have a substance use disorder problem because there’s so much stigma and conflicting information out there. Some people still think alcoholism and drug addiction are moral failings, although the vast majority of physicians, psychologists and empirical data disagree. What’s needed is not moral condemnation, but scientific treatment. One of the best is cognitive behavioral therapy, or CBT. Cognitive behavioral therapy for addiction treatment is a natural fit, and for good reason.
Addiction: Causes and Treatment
Some people object when addiction is described as a disease, associating diseases with infections such as measles and influenza, but there are many kinds of diseases and medical conditions. Former US Surgeon General Vivek Murthy wrote that “addiction is a chronic neurological disorder … not a character flaw” that “we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer,” as well as hypertension and asthma.
Biology seems to be a part of it (some people are born with a greater risk for addiction), but there is a mental or behavioral component, too. If you never use a drug, you’ll never know if you are addicted or not; once triggered, however—by illicit drug use or a prescribed painkiller following an injury—it can be harder to say no. Treating such substance use disorder requires many tools, from medically supervised detox—with or without medication-assisted treatment (MAT) drugs such as methadone and Suboxone—to support groups and aftercare.
If there was a cure for substance use disorder, then detox and MAT might be enough, but there isn’t and they aren’t. They only address the symptoms: dependency and withdrawal. A daunting aspect of addiction is the widely held belief that there is no cure. Recovery is not one-and-done. Most people require more help to stay straight throughout their life. There are many incidents of someone quitting drugs or alcohol for years before a fatal relapse.
Cognitive behavioral therapy is one of the most important and useful tools in substance use disorder recovery. Cognitive behavioral therapy addresses the causes and teaches new coping skills to face a life without substance use disorder one day at a time.
What is Cognitive Behavioral Therapy?
Cognitive behavioral therapy is an umbrella term for a group of related evidence-based therapies using both cognitive—the way we think and feel based on what and how we perceive—and behavioral psychology principles. At its most basic, cognitive behavioral therapy postulates that psychological problems such as addiction are caused, in part, by bad behaviors we were taught or learned. Such behaviors can be unlearned and new, healthier behaviors taught.
Unlike traditional psychoanalysis—which seeks to understand the underlying causes of behaviors—cognitive behavioral therapy focuses on changing the ways we respond to negative emotions, behaviors, and thoughts. Alone or in combination with MAT, it is often used to treat substance use disorder.
Cognitive behavioral therapy also is one of the most structured and briefest forms of psychotherapy. Patients aren’t expected to see their therapist for the rest of their lives. After a limited number of sessions (usually 20 or fewer), they should have learned new ways of thinking and dealing with their problems without alcohol or drugs and to have become their own therapists.
Cognitive Behavioral Therapy for Addiction
The Substance Use Disorder and Mental Health Services Administration (SAMHSA) breaks cognitive behavioral therapy down to two critical components:
- Functional Analysis. Learning to identify people, places, situations that might trigger the addictive impulse and avoiding or handling them without drugs or alcohol.
- Skills Training. How to unlearn unhealthy substance use disorder habits and learn new, healthier ways to behave, including a social support system, better interpersonal relations, and dealing with negative emotions such as depression and anger.
How Cognitive Behavioral Therapy Treats Addiction
Cognitive behavioral therapy can be used to treat many mental disorders. With regards to substance use disorder, it attempts to:
- Develop abstinence motivation. Using cognitive behavioral therapy techniques, the therapist helps patients realize how much they have to lose if their substance use disorder continues.
- Teach coping skills. Many people with substance use disorder problems started by using alcohol and drugs to cope with unpleasant realities. Cognitive behavioral therapy helps them learn better ways to cope.
- Create new habits. Substance use disorder is a way of life. It permeates everything the people with substance use disorder do and where they go. To avoid triggers, the cognitive behavioral therapy therapist helps them find new, positive activities and hangouts.
- Handle negative emotions. Drugs and alcohol numb pain, but they also numb non-drug or alcohol-related pleasures. Cognitive behavioral therapy teaches patients how to deal with the bad so they can experience the good, too.
- Improve social relationships. No man (or woman) is an island. Too much isolation can trigger substance use disorder, too. Cognitive behavioral therapy teaches the skills to build healthy relationships and social support networks.
What Happens in Cognitive Behavioral Therapy?
Cognitive behavioral therapy is psychotherapy or “talk” therapy. Through discussion, the therapist teaches the patient how to think about and respond to “stressful life situations” such as substance use disorder, its cues, and triggers. Cognitive behavioral therapy requires trained personnel. Fortunately, they aren’t hard to find because cognitive behavioral therapy is one of only two therapies in which all psychiatry residents are required to be trained. It’s that useful in many treatments. The best place to find cognitive behavioral therapy is with a therapist, either privately or, better yet, at a substance use disorder recovery facility where it is easier to incorporate other therapies. Cognitive behavioral therapy often works better in conjunction with MAT. Although cognitive behavioral therapy is highly structured, it is flexible enough to allow the introduction of elements from other therapies and approaches peculiar to a particular therapist-patient relationship, including medications.