Bad thoughts lead to detrimental action. CBT, or cognitive behavioral therapy, aims to disrupt this causality. In essence, this approach teaches people how to change the way they think and respond to problems.
CBT is a form of psychotherapy that helps patients identify harmful thoughts and assess whether they accurately portray reality. If these thoughts are not accurate, CBT supports individuals in recognizing the way they are thinking and how to engage in redirection and reframing to support different thinking approaches.
“One of the biggest things CBT does is it challenges irrational beliefs,” California-based addiction specialist Dr. Alia Kaneaiakala told The Fix. “It challenges those types of thoughts that are borne out of fear or anxiety.”
This model has helped patients respond to a variety of conditions and disorders, from depressive and post-traumatic stress disorder (PTSD) to eating and obsessive-compulsive disorders.
In the realm of addiction, however, CBT aims to disrupt this very specific and well-worn causality: bad thoughts lead to the abuse of addictive substances.
According to the National Institute on Drug Abuse (NIDA), CBT helps people with addictions by allowing them to explore “the positive and negative consequences of continued drug use, self-monitoring to recognize cravings early and identify situations that might put one at risk for use, and developing strategies for coping with cravings and avoiding those high-risk situations.”
As it stands, CBT remains one of the most popular and widely employed treatment methodologies today. Yet its use, benefits, and role in addiction treatment are what we explore in this article.
The History of CBT
When psychiatrist Aaron T. Beck began helping people with depression identify and evaluate streams of spontaneous negative thoughts, he founded an approach in the 1960s that would revolutionize behavioral treatment.
Beck would notice that the patients he treated were engaged in negative internal dialogue. A PsychCentral article illustrated how one of those sessions might have gone:
“…in a therapy session the client might be thinking to herself: “He (the therapist) hasn’t said much today. I wonder if he’s annoyed with me?” These thoughts might make the client feel slightly anxious or perhaps annoyed. He or she could then respond to this thought with a further thought: “He’s probably tired, or perhaps I haven’t been talking about the most important things.” The second thought might change how the client was feeling.”
Dr. Beck discovered that by helping patients address these thoughts, they “were able to think more realistically. As a result, they felt better emotionally and were able to behave more functionally.”
According to the Beck Institute, a site that he co-founded, when those patients changed underlying beliefs about themselves, their environment, and other people, they realized a lasting change in their behavior and outlook.
Dr. Beck coined this approach “cognitive therapy.” This was how CBT or cognitive therapy was born.
Now, this approach is used to treat people with a wide variety of issues, especially those with substance abuse addictions. CBT is seen as “a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving.”
However, CBT has its fair share of critics. Yet it stands as a widely practiced methodology to treat people with substance addictions.
How CBT Tackles Addiction
CBT can be administered in several different formats, either in individual or group settings. The following approaches are most common for substance abuse addictions as outlined by this study that was published in the Psychiatric Clinics of North America:
- Motivational interventions: This approach addresses the motivational barriers that might be present that prevents someone from quitting drugs or alcohol.
- Relapse Prevention and other treatments: This approach teaches patients to take alternative responses to cues that would otherwise trigger them to abuse substances.
- Couples and Family Treatments: A tried-and-true approach that relies on the partner, family, and/or members of the community to help an addicted person achieve abstinence.
The Benefits of Treating Addiction With CBT
Ultimately, proponents of CBT for substance abuse disorders believe this method can be a hedge against relapse. In fact, the Beck Institute cites how addicted persons can benefit from CBT. Here are the findings:
- They learn to identify dysfunctional thought patterns (e.g., “permission-giving beliefs”) and develop effective responses in their thinking and writing.
- They learn how to delay and distract cravings by engaging in constructive activities such as journaling, going to meetings, and communicating with supporters. They also learn how to pursue other positive means in response to substance abuse cravings.
- They develop and practice verbal responses and approaches to be equipped to politely turn down offers of alcohol or drugs — the substances that invoked addiction within them in the first place.
- They also learn how to solve problems directly and effectively, instead of engaging in substance abuse in response to those issues.
- They become well-versed in the “pros and cons” of alcohol and drug use versus sobriety. With that, they can address distortions in thinking along the way.
- They learn to practice the behaviors and attitudes of self-respect. They also learn how to counteract undermining beliefs that lead to helplessness, hopelessness (e.g., “I’m a bad person anyway, so I might as well mess up my life by using.”), and eventual use.
- They learn to utilize healthy social and communal support by engaging in 12-step meetings, gathering with family and friends who support sobriety, and staying away from negative influences that undermine goals.
- They develop the determination to make healthy lifestyle changes that support sobriety and self-efficacy. This includes having a healthy daily routine, refraining from cursing and raging, engaging in hobbies, and participating in activities that promote spirituality and serenity (e.g., yoga).
How CBT Is Used With Other Treatments
CBT has been administered with other types of treatment such as medication, pharmacotherapy, and hypnotherapy.
For example, naltrexone and CBT have been used in combination to treat alcohol dependency. Cognitive behavioral therapy has also been used with contingency management, a popular substance abuse treatment method that emphasizes the reinforcement of desired behaviors and withholding of punishment of undesired behaviors.
CBT is viewed as an effective treatment method for people with substance abuse addictions. In professional addiction treatment, clients can get access to CBT and a variety of other therapeutic services, including:
- Addiction Education Classes
- Relapse prevention
- Co-occurring disorders treatment
- Behavioral therapy
- Individual therapy
- Family therapy
- Couples therapy
- Group therapy
- Life skills training