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Sometimes it’s hard to understand how people become addicted to drugs. In fact, we automatically associated these people as “addicts” who lack willpower. Addiction is considered a chronic relapsing disease caused by changes in the brain’s neurocircuitry.
Similar to other chronic illnesses, addiction is a highly treatable and curable disease, especially when combining addiction treatment medication with behavioral therapies. In this article, I’ll talk about how cognitive behavioral therapy can help you overcome addiction.
Behavioral therapy is an interpersonal treatment based on psychological principles. Specific therapies are individualized to patients with a psychiatric disorder, problem, or adverse condition. There are many types of behavioral therapies with varying methods and levels of support. Behavioral therapies are provided in individual or in-group settings.
These structured therapies help patients recognize the impact of their behaviors (i.e. dealing with stress or interpersonal relationships), on their substance use and ability to function in a safe and productive manner. They teach patients how to change their behaviors as a way to control their substance use disorders.
Clinicians should be initiating behavioral therapy for the following reasons:
- Treatment of a psychiatric disorder, with the goal of reducing symptoms and improving functioning.
- Changing maladaptive thoughts, behaviors, and relationships.
- Providing support when a difficult or a chronic problem impairs functioning.
- Enhancing a patient’s capacity to make behavioral changes (i.e. losing weight, quitting smoking, or increasing adherence to medical treatment).
- Increasing family cooperation with treatment.
Individual counseling is provided in structured sessions in order to reduce substance use and develop effective coping strategies and life skills. Group counseling is a standard component of substance use disorder treatments, however, should be used in conjunction with individual therapy.
Cognitive behavioral therapy
Cognitive and behavioral therapy (CBT) is an evidence-based treatment for psychiatric disorders including depression, generalized anxiety disorder, posttraumatic stress disorder, panic disorder, eating disorders, obsessive-compulsive disorder, as well as several medical conditions (i.e. addiction insomnia, smoking, low back pain).
CBT can be used individually or in combination as a program of interventions. CBT includes education, relaxation exercises, coping skills, stress management, and assertiveness training. Therapists help patients identify and correct maladaptive beliefs. CBT uses thought exercises or real experiences to facilitate symptom reduction and improved functioning. Learning occurs through decreased reactivity from repeated exposure to a stimulus.
Generally, substance use disorders develop as a result of maladaptive behavior patterns. CBT implements techniques to change these behaviors and improve managing skills by emphasizing the identification of dysfunctional thinking. CBT is a short-term solution that involves 12 to 24 weekly individual sessions.
Each session explores the positive and negative consequences of substance use and the use of self-monitoring as a strategy to recognize cravings that may lead to relapse. They also assist the individual in developing various coping strategies.
Types of cognitive behavioral therapy
Behavioral changes involve learning new behaviors and changing the old. Positive reinforcement for these changes can aid this process. Contingency management is a sub-component of CBT, which involves providing incentives to patients to support positive behavior change. This has been shown to be an effective modality in the treatment of substance use disorders (SUD).
With contingency management individuals typically receive a voucher that can be exchanged for food, recreational activities, or services when they perform the desired behavior (i.e. drug-free urine tests, participation in treatment activities, etc.).
Motivational interviewing is another component of CBT commonly used to encourage patients to change maladaptive behaviors, and to help patients resolve uncertainties they have about stopping their substance use. Derived from cognitive behavioral and readiness-to-change models, motivational interviewing seeks to help patients recognize and make changes to these behaviors, matching strategies to the patient’s stage of readiness to change. Key components of motivational interviewing include:
- Expressing empathy.
- Helping the patient identify discrepancies between problematic behaviors and personal values.
- Accepting the one’s resistance to change.
- Enhancing self-confidence in his or her capabilities.
Motivational interviewing has demonstrated positive outcomes such as decreasing SUD, decreasing dependency and improving treatment engagement in a wide range of populations. In conjunction with other behavioral interventions, motivational interviewing has been shown effective for SUD involving heroin, cocaine, and nicotine.
The Matrix Model
The Matrix Model is a multi-component CBT consisting primarily of evidence-based practices such as relapse prevention, family therapy, group therapy, drug education, and self-help. Group sessions occur 3 times per week for 16 weeks, which combines CBT, family education, social support, individual counseling, and urine drug testing.
Family behavior therapy
Family behavior therapy (FBT) is a therapeutic approach used in for SUD that focuses on developing skills and setting behavioral goals over the course of 20 sessions. Activities of daily living, including violence prevention and HIV/AIDS prevention, are the main focus of FBT.
Research has demonstrated the effectiveness of SUD therapies engaging the spouse or family in reducing substance use or misuse while addressing other issues (i.e. communication, neglect, conflict, and partner violence).
A key feature of FBT is a “daily sobriety contract” between a patient and their spouse, where the patient states their intent not to maintain sobriety, and the spouse supports the patient’s efforts to remain abstinent. Additionally, FBT teaches communication and non-substance-associated positive activities for couples.
Other behavioral therapies
Twelve-Step Facilitation (TSF)
Twelve-Step Facilitation (TSF), delivered in 12 weekly sessions prepares patients to understand, accept, and become engaged in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). TSF interventions have been shown to be effective in a variety of ways, which include stand-alone interventions and integrated with other treatments.
TSF encourage AA or NA participation via group counseling. However, TSF is different from generic group counseling because it involves a set of sequential sessions focused on three key ideas:
- Acceptance – Realizing their substance abuse is a disorder, and that life has become unmanageable because of their abuse. Willpower will not overcome the problem. Abstinence is the best alternative.
- Surrender – Accepting the support structure of other recovering individuals or recovery activities.
- Active involvement in a 12-step program.
Psychodynamic therapy relies on developing patient insight and is based upon childhood experiences, unresolved conflicts, and previous relationships that influence an individual’s current situation. Adult relationships are the byproduct of unconscious patterns that begin in childhood. Psychodynamic psychotherapy uncovers unconscious patterns of interpersonal relationships, conflicts, and desires with the goal of improved functioning.
Interpersonal therapy (IPT) focuses on interpersonal difficulties leading to psychological problems. This form of therapy focuses on the individual’s interpersonal life in four problem areas: grief over loss, interpersonal disputes, role transitions, and interpersonal skill deficits. IPT is an evidence-based treatment primarily used for psychiatric conditions, such as depression and eating disorders.
Supportive psychotherapy widely used to help individuals cope with illness, deal with a crisis, and maintain optimism. Most models emphasize communication of interest and empathy; supportive therapy may also include guidance on available services, advice, respect, praise, and/or encouragement.
Recovery support services
Recovery support services (RSS) are provided by both SUD treatment programs and community organizations to engage and support patients in treatment and provide ongoing support after treatment to prevent relapse.
With the growing adoption of electronic health records (EHRs), patients and their provider can easily access and share treatment records in order to improve care. Emerging technologies such as telehealth and telemedicine using smartphones, the Internet, video-conferencing, and streaming media can deliver and provide health information or education, and monitor the effects of treatment as it pertains to addiction.
SUD is a preventable and treatable disease that affects behavior and brain function.
Treatment should be adapted to fit one’s drug use patterns, social problems, and
comorbidities. These programs incorporate families, communities, and social networks
to reduce drug use and relapse, and successfully manage withdrawal.
Do you have questions or comments on Cognitive Behavioral Therapy and addiction? Share them in the comments below!
Author bio: Dr. Joshua M. Gleason is a clinical research fellow at Harvard Medical School where he leads teams of healthcare professionals and scientists, overseeing clinical trials. Dr.Gleason obtained a Doctor of Medicine from Ross University School of Medicine and holds a Masters of Science in Molecular and Cell Biology and a Master of Health Science in Biomedical Science. Before joining Addictions.com as a medical reviewer and writer, he collaborated with the Department of Emergency Medicine at UMass Memorial Medical Center to collect and analyze substance abuse-related overdose and death to identify problematic areas better and evaluate prevention efforts. He continues to educate the public by raising awareness about substance misuse and abuse empowering patients to make safe choices.