CBT for Alcohol and Drug Problems:
A 12-Step Alternative
Cognitive Behavioral Therapy (CBT) for addictions is an alternative to the popular 12-step self-help movement and other substance abuse treatment. Studies have shown CBT to be significantly more effective than 12-step groups like Alcoholics Anonymous. Furthermore, numerous studies have shown 12-step-based treatment programs to be harmful, with many of these treatment approaches being less effective than being on a waitlist for the treatment. Unlike 12-step groups, CBT interventions for addictions have been thoroughly researched and are based in the science of human behavior. Also, unlike 12-step, CBT treatment does not support the idea that addiction is a lifelong disease. Instead, addictions are viewed as over-learned behaviors that serve important functions. The goal of treatment is learning new, more effective behaviors to take the place of the addiction behaviors.
A substance use problem is defined as any kind of problem related to the use of a substance, including alcohol, illicit (street) drugs, or prescription/over-the-counter medication. The problem can be in any area of life, such as family, legal, or health. Often, substance use problems develop in dependence on a transaction between biological, social, and psychological causes. Evidence-based CBT treatment intervenes mainly by helping people learn to cope with and reduce urges to use substances. By helping people better manage problematic thought patterns, difficult emotions, and urges to engage in unhelpful behaviors, CBT targets the underlying factors that maintain substance use.
CBT for alcohol and drug problems may include:
Mindfulness Training: Mindfulness, or the ability to connect to the present moment, and mindfulness therapies have been found to be very beneficial in the treatment of addictions. Mindfulness training can help people learn to tolerate unpleasant emotions and sensations that would ordinarily trigger them to use. Mindfulness can also help people identify urges and tolerate them without acting on them, a skill very important for someone with a history of drug or alcohol use problems.
Stimulus Control: Stimulus control refers to our tendency to behave one way in the presence of one stimulus and a different way when with a different stimulus. With addictions, stimulus control strategies involve assessing what sorts of situations, thoughts, and feelings trigger strong urges to relapse and removing them. For instance, watching a particular TV show may seem innocuous, but if it is consistently paired with drinking, it is likely to be a trigger. Many people think the way to stop using is to just stop engaging in the consumption of a substance. In reality, it is more important to eliminate potential triggers as much as possible because they are what lead to whether one uses or not.
Self-monitoring: Most people either dramatically underestimate or overestimate behaviors they would like to change. Self-monitoring involves tracking the behavior over time to 1) get an accurate sense of the frequency of the behavior and 2) identify patterns that may be important in altering the behavior. Self-monitoring with substance use involves not only tracking whether or not one has used, but the frequency and intensity of urges to use. When urges increase, it becomes clear the individual needs to apply more cognitive-behavioral interventions.
Functional Analysis: When people have strong urges or use, it is usually helpful to analyze in detail all the factors that combined to result in the behavior. Rather than oversimplify the problem by identifying one cause, functional analysis can help identify all of the causes and conditions, thus providing many more potential solutions the next time a similar situation arises.
Impulse Tolerance Training: An important skill in addiction work is learning to tolerate impulses to use rather than giving in to them. By applying mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills, even if someone has a very strong urge to use, they can work with it without relapsing.
Emotion Regulation Training: Drugs and alcohol have a way of numbing painful emotions, which can be pleasant in the short term but does not allow one to learn effective coping with emotions in the long term. By learning concrete emotion regulation strategies, it is possible to learn to cope with and even decrease painful emotions without relying on substances.
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