Cognitive-behavioral therapy (CBT) is a powerful tool in fighting addiction. It’s a form of psychotherapy, also referred to as “talk therapy.” It can be used to address the underlying causes of not just substance use disorder, but it can be used for various mental disorders like depression, anxiety, or phobias.
CBT doesn’t always amount to years in the therapist’s chair, either. It can be quite effective on a short-term schedule, ranging from a few weeks to a few months, to get results. In part that’s because CBT operates under the belief that the past may be important, but it’s more vital to develop tools to handle current problems and prepare the patient for long-term recovery.
Substance Use Disorders
A substance use disorder (SUD) is defined as a situation where an individual continues to use drugs and/or alcohol despite the negative consequences it levels on a person’s day-to-day life. That includes health, work, school, or family, as well as getting into dangerous situations or getting into trouble with the law.
For 2018, an estimated 20.3 million people in the United States ages 12 and older had a substance use disorder.
Causes vary, but genetics, environment, age of first use, and any underlying mental health conditions (trauma, bipolar disorder, etc.) can all affect the likelihood of drug or alcohol addiction.
Addiction can be very challenging to overcome, in part because drug and alcohol use, especially when started at a younger age, or through extended use, rewires the brain, affecting how it experiences rewards as well as the areas that govern impulse control.
That’s where medication-assisted treatment (MAT) can prove extremely helpful in recovery. It includes medications to help a person safely and comfortably navigate withdrawal. Medicines may also be prescribed to address underlying conditions like depression when needed. MAT also includes behavioral therapies — like CBT — and counseling. The goal is to mend both the more pressing issues like detoxification, which can be painful and sometimes dangerous while developing new coping mechanisms.
What is Cognitive Behavioral Therapy?
CBT addresses both the cognitive (how we think and feel) and the behavioral during treatment. CBT dwells less on the underlying causes, however, and focuses more on changing how we respond to negative patterns of thought, emotions, and behaviors. It can be very effective for treating SUDs when paired with medication-assisted therapy.
As the therapist helps the patient uncover what is fueling the dysfunctional behavior (whether it’s drug use, panic attacks, or whatever else it may be), they’ll also work on helping the patient see things from a different perspective as they work on healthier ways to respond.
It’s been shown to work on its own as well as paired with other treatment approaches. Evidence shows can be quite effective as part of the treatment regimen for alcohol and drug use disorders.
CBT focuses on how negative thoughts can lead to negative feelings and actions. The therapist will usually help the patient:
- Identify key problems or issues
- Become aware of unproductive thought patterns and their downsides
- Take negative thinking and mold it in ways to change feelings
- Learn and develop new behaviors
Changing old thinking patterns and replacing them with healthier responses is a key component in the relapse prevention part of addiction recovery.
A therapist might ask a number of questions to figure out what drives drinking or drug-taking behavior. They include examining the entire process: What a person was doing before using, what they were feeling and whether something occurred right before they used substances. They also will ask about the positive and negative consequences of the behavior.
There are several techniques used in CBT therapy. They include:
- Cognitive restructuring or reframing: Turning a negative thought into something positive.
- Guided discovery: This helps the patient examine and see things from different perspectives.
- Exposure therapy: Gradual exposure to a problematic or triggering stimulus, to build coping ability.
- Recording thoughts: This can include journaling or any other way to get in touch with one’s feelings.
- Activity scheduling and behavior activation: Simply deciding to do something can deflate some of the anxiety of decision-making. It also can set good habits.
- Behavioral experiments: For anxiety-provoking activities, the patient may be asked to predict the outcome. Later, they’ll discuss what really happened.
- Relaxation techniques: The patient will work on building skills, like deep breathing, to reduce stress.
- Role-playing: Acting out scenarios can help with problem-solving, gaining confidence, and improving communication.
CBT can be done in individual, family, or group therapy sessions. Practitioners include psychiatrists, psychologists, psychiatric nurse practitioners, social workers, marriage and family therapists, and other mental health professionals.
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Benefits of CBT
Some may find CBT to be uncomfortable at first, but in time it can help. A patient, by learning to reframe old thinking patterns and adopt newer and healthier ways to cope, can move on to a happier, more productive life.
The process works through the stages of change, getting the patient more comfortable with it, including:
- Pre-contemplation (denial, low motivation)
- Contemplation (considering change, but not acting on it)
- Preparation (intentions shift, and the patient begins to move in the direction of change, perhaps by booking an appointment)
- Action (steps are taken and efforts made to change)
- Maintenance (using what’s been learned to maintain sobriety and prevent relapse)
Scans of people undergoing CBT have shown some shifts in brain activity, showing that this form of treatment can make a difference.
It can make a valuable tool in relapse prevention through its teaching of coping and problem-solving skills. The patient may also learn to better deal with fears of not being able to the self-destructive patterns. Instead of fearing they’ll walk smack-dab into failure, CBT can help walk them more slowly and more surely toward recovery.
Lincoln Recovery strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.