Since its introduction in the 1960s, cognitive behavioral therapy, or CBT, has become one of the most popular therapeutic models in the field of drug treatment. Originally developed to address the challenges of depression, CBT is now used to help patients who suffer from many other disorders, including drug addiction, alcoholism, eating disorders, and more.
In substance abuse treatment, therapists and counselors successfully apply the principles of CBT to help recovering addicts learn healthy ways to deal with stressful situations and difficult emotions. Simply put, CBT is founded on the idea that changing the way people think and learn can correct the behaviors that keep them from leading happy, fulfilling lives.
Origins and principles
Dr. Aaron Beck, a psychiatrist at the University of Pennsylvania who specialized in the study and treatment of depression, was the first to develop the principles of CBT. In the 1960s, the field of mental health was dominated by the theories of psychoanalysis, which held that our thoughts, behaviors, and feelings arise from needs and urges buried deep in the subconscious. In order to correct dysfunctional behaviors, the psychoanalyst uses an intensive therapeutic process to delve into a patient’s memories and past experiences.
While studying the effectiveness of psychoanalysis, Beck found that in most cases, depression arose from the patient’s dysfunctional cognitive patterns rather than from conflicts in the subconscious. Depressed patients tended to be fixated on negative, automatic thoughts that played repeatedly in their minds, like songs on a broken recording. By helping patients learn to recognize those thoughts and replace them with more constructive beliefs, Beck found that he was able to help them feel better, function more effectively, and view the world in a more positive light.
CBT in addiction treatment
Why has CBT been so effective at treating such a wide range of psychiatric and medical health issues? CBT is based on the belief that the individual has the power to make positive changes in his or her life by actively working to modify destructive thoughts and behaviors. In substance abuse treatment, CBT empowers patients in the following ways:
- By giving them simple, effective tools for changing negative beliefs
- By strengthening their confidence and sense of self-determination
- By helping them visualize the future in a positive way
- By helping them develop stronger, more trusting relationships
- By teaching them practical ways to prevent relapse
- By helping them cultivate sober activities to replace substance abuse
CBT can be used in a variety of therapeutic settings, from individual counseling sessions to group therapy, family counseling, and relapse prevention classes. Because CBT focuses on acquiring practical coping skills, many patients see positive results very quickly in their day-to-day lives. For addicts who have lost the ability to care for themselves, hold down a job, or manage their finances, CBT can provide valuable tools for rebuilding their lives.
What makes CBT so effective?
CBT is one of the most widely studied psychosocial interventions for substance abuse treatment. Clinical studies have consistently shown that the coping strategies of CBT can increase a patient’s chances of achieving long-term recovery. A comparative analysis of 53 clinical studies published in the Journal of Studies on Alcohol and Drugs indicated that CBT was effective at treating a wide range of disorders, including alcoholism, drug abuse, nicotine addiction, eating disorders, and many other conditions.
Flexible and versatile, CBT be applied in different ways in substance abuse treatment. In individual counseling sessions, the therapist can use CBT to help the patient identify the automatic thoughts that keep him or her stuck in a cycle of addictive behavior. In group counseling, patients can actively practice their interpersonal skills and coping strategies with their peers. In relapse prevention training, patients learn how to identify their substance abuse triggers and recognize the early warning signs of a potential relapse.
The skills learned in CBT offer a practical way to break free from self-destructive thoughts and behaviors. For recovering addicts who have lost their sense of control over their own lives, the tools of CBT offer the hope of freedom from the cycle of addiction.
Changing destructive thought-patterns
- Addiction has a powerful effect on the brain, changing the way the addict perceives herself and her future. The automatic thoughts that run through an addict’s mind serve to feed the addiction:
- “Why shouldn’t I drink/use drugs? My life is worthless anyway.”
- “I’ve been addicted for years. I’ll never change.”
- “I’ve relapsed so many times; there’s obviously no hope for me.”
- “I’m no good to anyone. I might as well keep using until I die.”
- Most addicts aren’t consciously aware that they think this way, yet these destructive words play continuously in their minds. Through activities like talk therapy, journaling, or group discussions, patients can learn how to recognize these thoughts when they occur. Once they identify a negative thought, they learn to replace it with a more positive belief, such as:
- “I deserve a healthy, positive life. I’m a worthwhile person.”
- “I have the power and the skills to change my life if I want to.”
- “Relapse is a symptom of addiction, not a reflection of my personal strength.”
- “My life has purpose and meaning. I want to make it count.”
With patience and practice, destructive thoughts can be replaced with positive, self-affirming phrases. Just as negative thoughts can drive addicts deeper into destructive behavior, positive thoughts can reinforce their self-esteem and help them pull themselves out of the trap of addiction.
Modifying destructive behaviors
Lost in a fog of craving and compulsion, many addicts forget why they started using drugs in the first place. According to Current Psychiatry Reports, CBT is a powerful way to help patients identify the situational and emotional triggers that drive their substance abuse. Therapists may use written or oral exercises to guide patients toward an understanding of their own triggers. A therapist may ask you to think of all the situations where you feel compelled to use drugs, such as:
- Being around certain people: addicted friends, drug dealers, critical family members, or coworkers
- Experiencing difficult emotions: anger, jealousy, loneliness, boredom, or anxiety, fear
- Experiencing positive emotions: joy, happiness, pride, or excitement
- Reliving bad memories: conflicts, abuse, abandonment, violence, or trauma
- Going to certain places: bars, clubs, or parks where you used to buy drugs
According to the principles of CBT, it’s not the triggers that cause a relapse, but the way the recovering addict responds to these triggers. After learning how to identify these high-risk situations, recovering addicts can reduce the risk of relapse in the following ways:
- By talking themselves through the negative consequences of drug use (losing a job, losing custody of children, going to jail, etc.)
- By finding sober activities to replace drug use (playing a sport, listening to music, going to a movie, doing a home improvement project, etc.)
- By finding holistic ways to manage stress and cravings (meditation, yoga, acupuncture, massage, etc.)
- By communicating their needs to others (calling a friend or sponsor, going to a 12-step meeting, making an appointment with your therapist, etc.)
- By learning how to avoid drug users and refuse drugs (“I’ve had enough, thanks” or “I’m drug-free now, and I like it.”)
CBT helps recovering addicts strengthen their communication skills, so they can effectively ask for help, refuse drugs, and express their emotions. In drug treatment, these skills are honed and practiced in a variety of settings, from one-on-one therapy to support group meetings and family counseling sessions. As addicts learn how to deal successfully with stressful situations or emotions, they develop a sense of self-efficacy, or the belief that they can handle the challenges of life as well as its joys and triumphs.
CBT in the recovery process
Although CBT is a powerful component of drug treatment programs, therapy alone is usually not enough to help patients achieve their recovery goals. Combining CBT with other therapeutic treatments can produce even better outcomes than therapy alone. A study published in the Journal of Consulting and Clinical Psychology, for example, found that relapse prevention training based on the principles of CBT was most effective when combined with other approaches, like medication therapy. In drug treatment, CBT can be combined with pharmacotherapy for optimal results. Three of the medications approved for drug treatment include:
- Methadone (Methadose, Dolophine): an opioid drug that can relieve withdrawal symptoms and reduce cravings in patients struggling with addiction to opiates like heroin, oxycodone, hydrocodone, or morphine
- Buprenorphine (Suboxone, Subutex): a recently introduced opiate that can provide many of the benefits of methadone with a lower potential for abuse and addiction
- Naltrexone (Revia, Vivitrol, Depade): a medication that blocks the pleasurable effects of opiates and helps prevent cravings for alcohol or opiates. Naltrexone has also been used in the treatment of cocaine addiction.
In addition to medication therapy, CBT can be combined with other modalities, such as nutritional counseling, expressive therapies (art, music, or dance therapy), fitness training, experiential therapies, or holistic therapies (yoga, massage, or acupuncture). By combining therapeutic strategies, drug treatment programs give patients the very best chance at long-term success.
A comprehensive drug treatment program can incorporate the tools of CBT at every level of treatment, from detox through the aftercare phase. At The Recovery Village, we utilize evidence-based modalities like CBT to help our patients create healthy, meaningful lives. If you, or someone you love, are struggling with drug addiction, we can give you the tools you need to break free. Call our intake specialists at any time to learn more about our cutting-edge addiction treatment plans.