Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is a type of therapy where negative and unwanted thoughts are challenged. This is done in order to change behavioral patterns that are destructive. Cognitive Behavioral Therapy is used in a number of addiction treatment centers to work on both problem focused and action oriented behaviors with addicts.

The roots of CBT trace back to the early 1900s when psychotherapists were working on both cognitive therapies and behavioral therapies separately. John B. Watson and Rosalie Rayner’s studies of conditioning and behavior in the 1920s were some of the first studies into CBT.  There was also Alfred Adler’s study of “basic mistakes.” Adler influenced Albert Ellis who developed Rational Emotive Behavior Therapy in 1956, which came to be the first form of cognitive therapy.  There was a wide range of psychotherapists and doctors who worked on different non drug-based therapies, with what we now know as “Cognitive Behavioral Therapy” finally emerging in the 1970s.

Bernard P. Range and G. Alan Marlatt discuss Cognitive Behavioral Therapy from the perspective of those who deliver it, showing the true value of this therapy method:

“The basic techniques of cognitive therapy for alcohol-drug abuse demand, in the first place, strengthening of the therapeutic alliance through an empathic understanding of the client's problem, along with unconditional acceptance. Therapeutic relationship and conceptualization of cases play a major role. It is through them that a therapist can understand pain and fear behind the patient's hostility and resistance. It is crucial to explore the meaning and function of the patient's apparently oppositional and self-destructive actions, assessing their beliefs about the therapy, but it is also important to assess the therapist's own beliefs about the patient. Knowing how to use unpleasant feelings in collaboration in the therapeutic relationship as something useful and profitable for the therapeutic process is a much valuable skill.”

CBT as an Addiction Treatment Method

Cognitive Behavioral Therapy is essentially a treatment method that uses psychosocial intervention to come between the addict and his or her substance of choice.  It is based entirely off of empirical research, and as a therapy has been evolving since the 1970s when it was first created.  CBT has grown so much in popularity and proven efficacy that it is now the most widely used evidence-based practice for addressing and removing drug and alcohol addiction in recovering individuals.

CBT, while based in some very old ideas of psychotherapy, is actually a lot more scientific.  Rather than following the path of psychoanalysis where the therapist attempts to find unconscious meaning and stimulation in an individual, Cognitive Behavioral is problem-focused and action-oriented.  It is used to treat specific problems an individual is struggling with.  And, is used to aid the therapist and client in identifying specific problems related to addiction, clarifying them, and then assisting the client in finding and practicing effective strategies and tools for breaking down and eliminating the very symptoms of that addiction.

This is a very conscious, very hands-on approach to addiction recovery, with a lot of client-therapist back and forth, book study, question and answering, and information processing.  One author virtually applauded CBT, listing exuberantly the benefits of this treatment approach and what it can create:

“CBT is based on the belief that thought distortions and maladaptive behaviors play a role in the development and maintenance of psychological disorders, and that symptoms and associated distress can be reduced by teaching new information-processing skills and coping mechanisms.  When compared to psychotropic medications, review studies have found CBT-alone to be as effective for treating less severe forms of depression and anxiety, post-traumatic stress disorder (PTSD), tics, substance abuse (with the exception of opioid use disorder), eating disorders, and borderline personality disorder, and it is often recommended in combination with medications for treating other conditions, such as severe obsessive compulsive disorder (OCD) and major depressive disorder, opioid addiction, bipolar, and psychotic disorders. In addition, CBT is recommended as the first line of treatment for the majority of psychological disorders in children and adolescents, including aggression and conduct disorder.”

It gives participants real tools, real solutions, and real strategies for freeing themselves from the trappings of addiction for life.

Cognitive Behavioral Therapy; The Process

The process essentially involves six, major phases.  These are:

  • Assessment or psychological assessment of the individual’s mental and spiritual state.
  • Reconceptualization, or a gradual restructuring of the way an individual views substance abuse.
  • Skills acquisition through the attainment of real tools for saying no to drugs and alcohol.
  • Skills consolidation and application training for honing oneself for life after rehab.
  • Generalization and maintenance to create an understanding of one’s tools and coping strategies.
  • Post-treatment assessment follow-up to ensure that graduated clients are still following the CBT model.

These are typically the steps taken in a program, though the exact modus used tends to vary greatly from one program to the next.  Research of the CBT model and of clients who have experienced it indicates to us that the skills and the ideation that clients are able to get from it remain complete after treatment is finished.  Essentially, this is a recovery approach that sticks with people for life.  The central element of Cognitive Behavioral is to teach participants how to anticipate upcoming problems in life and how to enhance and increase the self-control of participants by educating them in positive coping strategies and methods for locating and addressing trigger mechanisms before they take over.

CBT will vary one to the next, but a main, driving force of these treatment methods will be to analytically explore the positive and negative effects of continued drug use and alcohol use.  They seeks to get clients to arrive for themselves at the conclusion that substance abuse is a highly toxic activity and one of which should be avoided.  They not only teach clients how to be mindful of stumbling blocks and trigger mechanisms, but it teaches clients how to effectively manage such negative traits, how to take a good personal self-inventory, and how to act in life so as to avoid relapse.

The National Institute on Drug Abuse has recognized it as being perhaps the greatest of therapies in treating substance abuse. According to NIDA:

“Cognitive-Behavioral Therapy (CBT) was developed as a method to prevent relapse when treating problem drinking, and later it was adapted for cocaine-addicted individuals. Cognitive-behavioral strategies are based on the theory that in the development of maladaptive behavioral patterns like substance abuse, learning processes play a critical role. Individuals in CBT learn to identify and correct problematic behaviors by applying a range of different skills that can be used to stop drug abuse and to address a range of other problems that often co-occur with it.”

Cognitive Behavioral Therapy Pros and Cons

For a quick study of CBT, and for a truly workable, “CBT at a glance” it is important to consider the pros and cons of this practice.  One clinic in the United Kingdom that actually specializes in the utilization of CBT wrote extensively about the pros and cons of this treatment method, and their opening statement has been included below:

“Research has shown that cognitive behavioural therapy (CBT) can be as effective as medication in treating Anxiety & Depression problems.  There is always a risk that bad feelings you associate with your problem will return, but with your CBT skills it should be easier for you to control them. This is why it is important to continue practising your CBT skills even after you are feeling better and your sessions have finished.”

The advantages of CBT as an overall treatment method are easy enough to see:

  • It can easily be as effective or more effective as medication in treating some mental health difficulties (of which addiction is the primary).  CBT is especially helpful in cases where medication alone has not worked.  It finally gives struggling addicts a method for tackling addiction that is totally holistic and which does not need medical supplementation like most treatment methods do.
  • Cognitive Behavioral is a very action-based recovery system.  The intention of this therapy is to give clients effective and stabilizing recovery tools that they can apply throughout life to ensure that sobriety is actually tangible and reliable.  CBT focuses on re-training and re-organizing thoughts and altering unhealthy behaviors, in order to make changes to how one feels on a day to day basis.
  • It provides tools that expand above and beyond addiction recovery and into all realms and avenues of life.  Skills that participants learn in CBT are very useful, very practical and very helpful strategies that can then be incorporated into everyday life and livingness.  CBT Therapy can help people in their marriages, in finance, at work, with the kids, with the parents, with one’s education, etc. It stands to help participants to cope better with future stresses and difficulties as they appear, even after the treatment itself has finished and one no longer sees any pull or urge towards substances.
  • CBT is secular, and can be worked on by individuals of all ethnicities, demographics, religions, creeds, backgrounds, income levels, occupations, ages, etc.  This is a universally applicable treatment method that is instantly relatable for all addicts across the globe.

There are not many disadvantages of Cognitive Behavioral Therapy.  It is either going to work for an individual or it is not going to work.  One could suppose that that factor in and of itself is a disadvantage, the fact that this treatment method is not universally workable for all who take part in it, but if that is a disadvantage to it, then that is a disadvantage to all treatment methods.  Here are some disadvantages that may present themselves to participants of the CBT approach:

  • To truly benefit from CBT and to get all that one can get from it, one needs to commit themselves to the process fully.  While some treatment methods are known to be somewhat workable even without “addict willingness” and does not work unless clients truly want to effect change upon themselves.
  • Due to the structured nature of it, the requirements it extends upon its participants, and the level of involvement that clients who take such courses must participate in, CBT may not be suitable for people who suffer from more complex mental health needs, learning handicaps, or communication difficulties.  For them, other therapies will likely be more efficacious.
  • As it can involve a very sincere and impassioned confronting of one’s emotions and anxieties, one may experience periods within the therapy where they are more anxious or emotionally uncomfortable than they were when they entered into treatment.  While many authorities on the subject support the idea that recovering addicts must experience the “real grit” of recovery to come out winning on the other side, that doesn’t change the fact that CBT Therapy can be uncomfortable for some people and can cause some people to walk away from treatment because CBT Therapy was, “Too much for them.”  It is a tough therapy yes, effective, but tough.

Finding Abstinence Through Cognitive Behavioral Therapy

Fatima Shad Kaneez, Kejing Zhu, Liming Tie, and Nurul Bahriah Haji Osman composed a lengthy study and research project of the value of CBT Therapy as a global recovery therapy for use in far more than just addiction treatment.  They published their findings in Research Gate under the heading, “Is Cognitive Behavioral Therapy an Intervention for Possible Internet Addiction Disorder?”  They had seen that it was perhaps the most successful substance abuse treatment therapy of the last century, and wanted to see if it could be used to address other behavioral addictions, such as internet addictions and gambling addiction.  Their opening statement lauds CBT with the true virtue befitting this very effective counseling technique:

“CBT is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors, and cognitive processes. CBT is based on Beck’s theory that thoughts determine feelings and behavior.  It has been used to treat depression, mood, anxiety, alcohol and other substance abuse, and borderline personality disorders as well as bulimia and sexual dysfunctions. Modified CBT is the most commonly used intervention for IAD (Internet Addiction Disorder) and is also proved to be effective.”

They are not the only outsiders to the addiction treatment community who have seen the value of Cognitive Behavioral Therapy in many different lights The U.S. National Library of Medicine of the National Institutes of Health writes praise about CBT Therapy as well.  According to their writings on the subject:

“A plethora of studies have examined the efficacy and effectiveness of cognitive-behavioral therapy (CBT) for adult anxiety disorders. In recent years, several meta-analyses have been conducted to quantitatively review the evidence of CBT for anxiety disorders, each using different inclusion criteria for studies, such as use of control conditions or type of study environment. This review aims to summarize and to discuss the current state of the evidence regarding CBT treatment for panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Overall, CBT demonstrates both efficacy in randomized controlled trials and effectiveness in naturalistic settings in the treatment of adult anxiety disorders.”

We can clearly see that CBT is quantitatively an incredibly valuable therapy for addressing even the most difficult of addiction struggles in people, no matter how bad things may have gotten for them.