Cognitive relates to the way we think, learn, act, and relate to world around us, and cognitive therapies examine patterns of behaviors and thoughts that may be self-destructive while seeking ways to modify them.
Cognitive behavioral therapy, or CBT, is a type of psychotherapy commonly used in substance abuse and dependency treatment. Unlike traditional talk therapy methods, CBT requires active participation that is goal-oriented and problem-focused.
Prescription drug abuse
The Centers for Disease Control and Prevention (CDC) considers prescription drug abuse an epidemic in the United States, as 44 people die every day from a prescription opioid overdose. In many cases, benzodiazepines are also involved in prescription opioid overdose fatalities. While difficult to quantify success rates, one study published by Psychiatric Clinics of North America, estimated that CBT methods effectively maintained abstinence in drug abusers for 52 weeks in 60 percent of those reviewed.
Prescription drug abuse spans socioeconomic classes, race, gender, and age, and it often begins with a legitimate prescription from a doctor. There is a misguided and common misconception that since prescription drugs are prescribed by doctors, they must be safer that illicit drugs. In 2011, the Drug Abuse Warning Network (DAWN) reported that 1.2 million Americans sought emergency department (ED) treatment for an adverse reaction to the misuse or abuse of prescription medications.
Pharmaceuticals are generally safe when used as intended and directed, but anytime they are used for a nonmedical, or recreational purpose, it is considered abuse, which may have unintended and dangerous consequences.
Prescription drugs that are regularly abused fall into four main categories:
- Opioid pain relievers, including OxyContin, Vicodin, and Percocet
- Benzodiazepine sedatives or tranquilizers, such as Valium, Xanax, Klonopin, and Ativan
- Stimulant medications such as those for treating attention deficit hyperactivity disorder (ADHD) like Adderall and Ritalin
- Mood-stabilizing medications and antidepressants, including lithium, Celexa, and Lexapro
Abusers of these medications may take more than an intended dose at a time, take these drugs beyond their medical necessity, crush and snort them, or dissolve and inject them.
- While each of these drugs may have a different effect, all of them can create such a rush of euphoria, or “high,” that when abused over time, they can disrupt the natural reward and motivation pathways in the brain and central nervous system. By interfering with neurotransmitters responsible for feelings of pleasure, such as dopamine and serotonin, chronic drug abuse can lead to users developing a psychological and physical dependence on them. This dependence can then induce compulsive drug-seeking behavior, drug cravings, and the onset of uncomfortable withdrawal symptoms when the drug leaves the bloodstream. CBT is an effective method for treating prescription drug abuse, working to reverse some of the negative psychological effects.
Traditional cognitive behavioral therapy
Addiction is a complex disease with many potential underlying causes. The National Survey on Drug Use and Health(NSDUH) estimated that 6.5 million Americans aged 12 and older had abused prescription drugs in the month before the 2013 survey.
While abuse may not always lead to addiction, regular and repeated drug abuse does increase the risk of addiction.
Stress and the way we cope with trauma and negative emotions may also be related to substance abuse, and high levels of anxiety and stress are often considered precursors to addiction. Child abuse, neglect, and events leading to post-traumatic stress disorder (PTSD) all can disrupt our “fight or flight” feelings, and they may trigger a desire to numb the pain through substance abuse. Prescription drugs can temporarily suppress anxiety, fear, and other negative emotions, and drug abuse can create a maladaptive strategy for coping that can lead to a substance abuse dependency. The U.S. Department of Veterans Affairs reports that as many as two in 10 veterans suffer from both PTSD and a substance abuse disorder, for instance, while the Anxiety and Depression Association of America (ADAA) estimates that mood and anxiety disorders co-occur with substance abuse disorders around 20 percent of the time. CBT is an effective strategy for determining the underlying cause of addiction and what your personal triggers for substance abuse may be.
Once your stressors have been identified, therapists can employ CBT methods to teach new and healthy coping mechanisms by modifying your negative emotional responses. New life skills are taught with CBT, and sometimes homework outside of therapy sessions may be involved. By learning how to better handle stress and changing negative images of self, confidence and self-esteem can be lifted, and self-destructive behaviors, including substance abuse, are reduced.
Cognitive behavioral therapy has been scientifically proven to actually change some of the dysfunctional neural circuits in the brain related to fear and the handling of negative emotions, as published in the Journal of Neuropsychiatry and Clinical Neurosciences. By learning healthier ways to cope with stress and negative emotions, CBT reduces compulsions to self-medication through drug abuse. CBT is an evidence-based treatment model, meaning that scientific evidence is combined with professional experience and individual preferences in order to determine an optimal treatment plan. Many substance abuse treatment programs will combine therapy models to promote long-term recovery.
Motivational interviewing and contingency management
Motivational interventions, the most popular of which is likely motivational interviewing (MI), are patient-centered approaches to substance abuse and dependency that are non-confrontational and focus on empathy and understanding. Instead of demanding a cessation of substance abuse, MI is a gentler approach that through negotiation encourages positive behavior changes. MI, like traditional CBT methods, seeks to build up self-confidence and positive images of self while defining and modifying negative and self-destructive emotions and actions. MI strives to help substance abusers find the inner motivation to stop abusing drugs.
- Contingency management approaches use positive reinforcement in order to encourage abstinence from drugs. Every time a clean drug test is administered or other healthy lifestyle changes are instituted, prizes, vouchers, or cash are distributed. This approach has been proven effective in improving retention and abstinence rates, especially in those with opioid dependencies, the Psychology of Addictive Behaviors journal reports. By introducing constructive reinforcement that is not a drug, contingency management can positively influence inner motivations to make helpful and healthy choices, thus reducing drug abuse.
The community reinforcement approach utilizes similar methods in an effort to make sober living a more attractive option than substance abuse by providing positive changes to the social environment. Couple and family behavioral therapy identifies substance abuse as having negative effects on relationships, and the therapy improves interpersonal relationship functioning through education on substance abuse and positive reinforcement for drug-free behavior.
- Cognitive behavioral therapy and evidence-based treatment models are highly effective in preventing relapse and encouraging substance abusers to remain in treatment and achieve long-term recovery from addiction. Often therapies may be combined with pharmacological methods, especially during detox, in order to manage drug cravings and withdrawal symptoms.
Highly trained professionals at The Recovery Village will conduct a detailed and comprehensive assessment in order to determine the best possible treatment method for you or your loved one. Progress is evaluated regularly, and modifications may be made in an effort to promote a sustained and successful recovery. Contact an admissions coordinator today for more information.