CBT for Addiction
It’s not easy to admit that you have a substance abuse 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 abuse 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 abuse, 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 abuse recovery. Cognitive behavioral therapy addresses the causes and teaches new coping skills to face a life without substance abuse 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 abuse.
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 Abuse 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 abuse 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 abuse continues.
- Teach coping skills. Many people with substance abuse 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 abuse is a way of life. It permeates everything the people with substance abuse 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 abuse, 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 abuse, 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 abuse 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.
Elements of Effective Cognitive Behavioral Therapy
Cognitive behavioral therapy will vary with each patient-therapist relationship, but elements that should always be a part of effective cognitive behavioral therapy include:
- Goals. At the beginning of treatment, therapist and patient should jointly discuss and decide what result they are working towards. This should be as specific as possible, but may be fine-tuned as therapy progresses.
- Agenda. As goals define the overall arc of therapy, an agenda sets the parameters for each therapy session, again jointly agreed on by the therapist and patient.
- Trust. For any therapy to work, the patient and therapist must work together. The patient always should be honest with the therapist, but also confident that the therapist is qualified. Before therapy begins, establish that the therapist is qualified and licensed in cognitive behavioral therapy.
- Homework. Rather than assuming the patient will remember everything that happened in therapy, especially the cognitive exercises designed to change their thoughts, feelings, and behaviors, it is normal for the therapist to set homework or “action tasks” to reinforce the lessons. Flashcards may be supplied and used to emphasize key points. Followup on homework should be a part of every session’s agenda.
- Feedback. Because it is a collaborative process, it’s important for the therapist to know if the patient felt it was fruitful and successful. The therapist should ask at the end of each session. If one therapist-patient relationship isn’t working out, the patient shouldn’t be afraid to seek a new therapist.
What Happens After Cognitive Behavioral Therapy?
While active cognitive behavioral therapy as described above doesn’t continue indefinitely, neither does it completely end abruptly. Aftercare is a standard part of any substance abuse treatment, and should, at minimum, include medical and psychological checkups and support groups to help prevent a relapse. With cognitive behavioral therapy, relapse prevention is built into the DNA.
What is Relapse Prevention?
Roughly half of all substance abuse rehab patients will experience a relapse at some point. That sounds bad, but it is about the same rate as relapse from similarly chronic conditions such as diabetes, hypertension and asthma. It needn’t be fatal, and recovery is still possible. Don’t quit quitting.
Relapse prevention is a form of cognitive behavioral therapy designed to prevent or minimize when a patient in recovery from substance abuse starts abusing alcohol or drugs again.If the patient in recovery does resume using, it shouldn’t be viewed as failure necessarily. Recovery and relapse are part of the same transitional process, and one stumble is not fatal.
Relapse Prevention in Cognitive Behavioral Therapy
Relapse prevention therapy includes teaching patients how to:
- Avoid or cope with “high-risk situations” that could lead to relapses. Strategies include behavioral (leaving a high-risk situation) and cognitive (positive thoughts and self-talk).
- Change their lifestyle to avoid their substance abuse triggers.
- Engage in more healthy activities more often. Maybe resume pre-SUD activities.
- Expect minor lapses and how to prevent them from becoming major relapses.
Dual Diagnosis, CBT, and Addiction
One reason for substance abuse relapse is an incomplete diagnosis of the problem. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2014 National Survey on Drug Use and Health (NSDUH), 40 percent of people with substance use disorder — eight million — also had a mental illness. Worse, dual diagnosis often goes undiagnosed.
The reasons why dual diagnoses occur aren’t always clear. The National Institute on Drug Abuse (NIDA) concluded that “people addicted to drugs are roughly twice as likely to suffer from mood and anxiety disorders, with the reverse also true.”
What Causes a Dual Diagnosis?
The causes of a dual diagnosis may include:
- People with mental illness may attempt to self-medicate their problem with alcohol or drugs.
- Substance abuse may have caused, triggered or exacerbated the mental illness.
- Both conditions may share a common risk factor, genetic or environmental.
Whatever the reason, cognitive behavioral therapy is used to treat mental illnesses as well as substance abuse, and its therapists are trained to look for such comorbidities.
Using Cognitive Behavioral Therapy to Battle Addiction at Willow Springs Recovery
When looking for a substance abuse treatment program for you or a loved one, make sure they offer cognitive behavioral therapy and other science or evidence-based treatments. That shouldn’t be difficult because cognitive behavioral therapy is used everywhere. The consensus of the research and clinical practice is that cognitive behavioral therapy — disorders, severe mental sometimes in conjunction with other treatments — works for substance abuse, depression, anxiety disorders, severe mental illnesses and other comorbidities.
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