Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again

Rational-emotive therapy is often more challenging andconfrontative, with the therapist informing the client of the irrationality ofcertain types of beliefs that all people are prone to. Beck, on the other hand,believes that the cognitive therapist, using a supportive Socratic method,should enlist the client in carefully examining the accuracy of her beliefs.Thus, Beck places more importance on the client’s own discovery of faulty andunproductive thinking, while Ellis believes that the client should simply betold that these exist and what they are. Nevertheless, there is substantialoverlap in both the theory and practice of these two therapies. Clearly,different clients will have different responses to these qualitatively differentapproaches to modifying their thoughts and beliefs.

Efficacy of Cognitive Behavioral Therapy Combined with Another Psychosocial Treatment

Second, strategiesused to cope with nonspecific stress appear to be somewhat differentfrom those used to cope with temptation. These findings suggest thattreatment not only should rectify deficiencies in coping abilities, butthat it may be necessary to focus on skills to deal with both generalstress and substance-related temptation. Furthermore, it may benecessary to develop coping skills specific to several possiblesituations in which the client may use substances. In substance use-related situations, coping “refers towhat an individual does or thinks in a relapse crisis situation so as tohandle the risk for renewed substance use” (Moser and Annis, 1996, p. 1101).Cognitive-behavioral theory posits that substance users are deficient intheir ability to cope with interpersonal, social, emotional, andpersonal problems.

• One of the distinguishing features of CBT has been its relative durability of effects, with significant treatment effects persisting through a follow-up period, in some cases with individuals showing greater improvement after treatment ends (i.e., ‘sleeper effect’) (e.g., Carroll et al., 2000; Carroll et al., 1994b; Rawson et al., 2002).
• Although CBT is effective in treating mental disorders, CBT can be helpful for anyone looking to make a shift in the quality and health of their thinking or improve their mood.
• Below we review individual and group treatments including motivational interventions, contingency management strategies, and Relapse Prevention and related interventions with a focus on functional analysis.
• For example, in a large effectiveness trial of motivational enhancement therapy for Spanish-speaking patients seeking treatment for substance use, Carroll et al [50] found small advantages for this treatment relative to TAU only among those in the sample seeking treatment for alcohol problems.

Brief Interventions and Brief Therapies for Substance Abuse.

• There are some specific cognitive behavioral therapy techniques that are effective at all stages of change in recovery.
• In contingency management approaches, an active attempt is made to changethose environmental contingencies that can influence substance abusebehavior (Higgins et al., 1998).The goal is to decrease or stop substance use and to increase behaviors thatare incompatible with use.
• There are many challenges that may arise in the treatment of substance use disorders that can serve as barriers to successful treatment.
• Generally, the therapist takes a more active role in cognitivetherapy than in other types of therapy, depending on the stage of treatment,severity of the substance abuse, and degree of the client’s cognitivecapability.
• Both MET/CBT conditions included a CM component in which participants could earn up to $435 in gift cards if all urines were negative for cannabis.

There can be a wide range of thoughts like these, but all of them point to a smattering of automatic thoughts that may come up when faced with stressors, triggers, or cravings to use. Our team is available to guide you through the steps of assessing your insurance coverage for addiction treatment. Cognitive behavior therapy has existed for more than 50 years, and many pieces of research have been carried out about its use for various conditions. A key component of CBT for addiction is understanding how thoughts, emotions, and behaviors influence each other.

Integrating Exercise into SUD Recovery: Cognitive–Behavioral Strategies for Holistic Rehabilitation

Cognitive behavior therapy (CBT) is one of the most popular psychotherapy approaches for treating alcohol use disorder. This article will explain Cognitive behavioral therapy for addiction and specifically alcoholism, its effectiveness, and what to expect during a counseling session. This meta-analysis provides an up-to-date summary of treatment efficacy in Cognitive Behavioral Therapy (CBT) for alcohol or other drug use disorders. CBT is effective for these conditions with outcomes roughly 15–26% better than average outcomes in untreated, or minimally treated, controls. In conclusion, this meta-analysis shows CBT efficacy, in contrast to no or minimal treatment, was moderate and durable over follow-up. Consistent with a number of evidence-based addictions therapies, CBT effect sizes were small to non-significant in contrast to non-specific and specific therapies, respectively.

Although CBT for substance abuse is characterized by heterogeneous treatment elements—such as operant learning strategies, cognitive and motivational elements, and skills building interventions—across protocols several core elements emerge that focus on overcoming the powerfully reinforcing effects of psychoactive substances. Behavioral, cognitive, cbt interventions for substance abuse and cognitive-behavioral treatments all rely heavilyon an awareness of the antecedents and consequences of substance abuse. Inall of these therapeutic approaches, the client and therapist typicallybegin therapy by conducting a thorough functional analysis of substanceabuse behavior (Carroll, 1998;Monti et al., 1994; Rotgers, 1996).

CBT is also compatible with a number of other elements intreatment and recovery, ranging from involvement in self-help groups topharmacotherapy (Carroll, 1998). Although a therapist may guide the individual in a behavioral self-controlmodel, the substance abuser maintains primary responsibility for changinghis behavior. During the course of therapy, the client and therapist meet inbrief sessions to go over homework and ensure that the client is followingthrough.

Michael Bernstein

First, our results suggest that prescribing clinicians should favor CBT over usual clinical management to ensure optimal clinical outcomes for addiction, in the context of pharmacotherapy. This conclusion is based in our comparison of CBT plus pharmacotherapy vs usual care plus pharmacotherapy. Second, CBT is not superior to other evidence-based behavioral treatments for addiction, yet in the context of its superiority to usual care, our findings suggest that clinicians should favor an evidence-based behavioral therapy, CBT or otherwise, in conjunction with pharmacological treatment. Third, the add-on benefit of CBT compared with pharmacotherapy and usual care was not clearly supported and suggests that benefit of CBT as an adjunct requires further investigation.

Mechanisms of behavior change (MOBC) are person-level processes that exert a causal influence on a specific behavior change outcome. For CBT for AOD, the MOBC of interest are the specific indicators that are, based in theory, expected to transmit the effects of the intervention on its targeted outcomes. These include cognitive shifts in self-efficacy related to various risk scenarios https://ecosoberhouse.com/ (eg, negative affective states, positive affective states), enactment of coping skills relevant to the CBT approach (eg, quantity or quality of skills), changes to environmental contingencies (eg, quantity or quality of available social supports). If CBT is delivered in an integrated format, then additional MOBC relevant to the other intervention should be considered.

• CBT is commonly used to treat depression, anxiety disorders, phobias, and other mental disorders, but it has also been shown to be valuable in treating alcoholism and drug addiction.
• Although empirical support for these interventions is promising, it is most often garnered through efficacy studies in which the treatment is carried out under optimal conditions.
• Here, results suggested no unique benefit of adding CBT to pharmacotherapy compared with other evidence-based behavioral modalities.
• One study on the prevention of recurrent depression has shown that cognitive behavioral therapy can significantly lower the residual symptoms after successful antidepressant treatment.
• In contrast to the ample evidence regarding CBT’s efficacy, far less is known regarding the mechanisms of how it exerts its effects (Kazdin, 2007).

An alcohol-dependent client,for instance, may believe that he drank because he was weak (an internalattribution) or because he was surrounded by people encouraging him to havea beer (an external attribution). He may believe that his failure tomaintain abstinence shows that he is a weak person who can never succeed atanything (a global attribution) or that a drinking episode does notrepresent a general weakness, but was instead due to the specificcircumstances of the moment (a specific attribution). He may believe thatthe cause of his slip is something he cannot change (a stable attribution)or that the next time, he will catch himself and exert better copingresponses (an unstable attribution).