Cognitive Behavioural Therapy in Addiction Treatment

Cognitive behavioural therapy, more commonly known as CBT, has been used for many years to treat a range of issues including depression, anxiety, bipolar disorder, schizophrenia, and addiction. It is a common therapy used around the world by many practitioners and hundreds of studies have demonstrated its effectiveness in helping people overcome a range of mental health issues.

What is Cognitive Behavioural Therapy?

Cognitive behavioural therapy is a treatment that combines cognitive therapy – which examines the way you think, and behaviour therapy – which examines the way you behave. (1). It allows you to see the relationship between how you perceive certain events or ideas in your mind, and how you experience those events or ideas.

For example, if you are invited to watch a movie and spend the entire day believing that you won’t enjoy the movie, the chances are that you won’t enjoy the movie.

Cognitive behavioural therapy focuses on trying to change negative thoughts and actions into positive ones.

How does Cognitive Behavioural Therapy work?

Cognitive behavioural therapy works by combining therapy aimed at changing your thoughts, perceptions, emotions and understanding, with therapy that aims to change the way you act towards certain situations. It engages your senses and changes your outlook.

It teaches you that negative emotions and actions are not rational or logical (2) and explores why the person undergoing therapy may take comfort in such negative emotions.

Addiction is a prime example of an issue that can be helped with Cognitive Behavioural Therapy. While an addict may understand that what they are doing is not healthy, they may not be able to stop the cycle of using alcohol or drugs to numb their pain, and consequently feeling shame and regret. Knowing the root cause of the problem is often the only way to know how to solve the problem.

Cognitive Behavioural Therapy to treat addiction

Automatic negative thoughts are closely linked to anxiety and depression. Many people who suffer from anxiety and depression often turn to drugs or alcohol to cope. This means that there is a link between automatic negative thoughts and addiction.

When a person is dealing with crippling self-doubt and internalised feelings of inadequacy, they can often turn to alcohol or drugs to self-medicate as they feel that this is the only way to deal with these negative feelings.

A specially trained therapist can help an addict identify their impulsive negative thoughts and talk them through where they may have originated.

Once an addict understands the root cause of their negativity, they can begin to pinpoint when they may be about to spiral, which in turn allows them to better control their substance abuse and overcome their addiction.

CBT helps patients overcome their addiction by

  1. Providing tools and knowledge to identify triggers
  2. Teaching self-help methods to stabilise moods
  3. Help dismiss the automatic negative thoughts
  4. Teach effective communication skills

After an addict has learned to identify their triggers and has tackled these triggers head-on, they can begin to swap their negative behaviours and emotions with positive ones. This, in turn, leads them to replace their addictions to drugs and/or alcohol with something healthier like jogging, painting, writing or even listening to music or a podcast.

Cognitive Behavioural Therapy techniques

Cognitive behavioural therapists use a range of techniques to help their patients overcome addiction. They may use one or more of these techniques in addition to talk therapy, and each client will have their therapy tailored to suit their specific needs.

Some examples of techniques your CBT therapist may use include:

1. Behavioural Experiments

Behavioural experiments use both negative and positive thoughts to see which approach is more effective in changing behaviour.

Example: “If I punish myself for abusing drugs or alcohol, I’ll do it less” vs “if I am kind to myself after abusing drugs and alcohol, I’ll do it less.”

Your therapist will work with you to find which of these approaches is better suited to your needs.

2. Thought Records

Addicts tend to have automatic negative thoughts which can be difficult to overcome. Learning to recognise these negative thoughts is important to help with overcoming addiction. Thought records allow you to examine your automatic negative thoughts by writing them down and finding objective evidence to support them. By doing this, you can learn that many of these negative thoughts are unwarranted.

Example: “I made a mistake at work and everyone thinks I’m bad at my job. I need to drink to feel better” could become “I made a mistake at work, but that is ok because everyone makes mistakes. I will learn from this and move on.”

It can also be helpful to look back through your thought records on bad days.

3. Activity Schedules

Many people turn to drugs or alcohol to break the monotony of daily life. For recovering addicts, it is important to stay occupied and active so as not to fall back into unhealthy habits.

Keeping a weekly schedule of positive, healthy habits can keep your mind focused and help to keep you on track in your recovery. It doesn’t have to be anything strenuous, either.

Example: “I’ve had a long and difficult day, I need alcohol to unwind” could become “I’ve had a long and difficult day, I’m going to unwind by finding a new podcast to listen to while I rest”.

Other positive activities could include walking, gardening, or crafting. Talk with your therapist about what interests you and together you can make an activity schedule that suits you.

4. Negative Image Exposure

This is a more difficult form of therapy for many addicts as it forces them to revisit painful memories over and over again. They talk to their therapist about every aspect of that painful memory and describe in great detail every sight, sound, and smell.

By revisiting this memory frequently, the pain and anxiety it causes it reduced over time, allowing the person to overcome the pain from their past.

Example: A woman with a difficult childhood has been using drugs to avoid thinking about her past as it is too painful. Repeated exposure to those memories will begin to cause her less pain, which in turn will require less self-medication from her. (3)

How Cognitive Behavioural Therapy differs from other therapies

Cognitive behavioural therapy is more engaging than traditional therapy methods. Rather than simply listen to their patients, CBT therapists work with their patients to tailor a treatment plan to each individual’s specific needs.

Many rehabilitation programs include CBT in conjunction with other therapies as it allows people to learn immediate coping techniques and equips them with the knowledge they need to help themselves long after therapy has finished.

The basis of cognitive behavioural therapy is a rapid treatment which focuses on taking immediate action to tackle the issue.

Cognitive behavioural therapy can be taken in a one-on-one counselling session, but is equally effective in a group counselling environment, making it a very adaptable form of therapy.

It is believed that people need an average of 16 sessions for CBT to have lasting effects. (4)

Relapse Prevention

Cognitive Behavioural Therapy was originally developed as a relapse prevention method (5) for alcohol and cocaine-related addictions. Relapse is less likely after CBT as it teaches the recovering addict ways to identify and control their triggers, as well as coping techniques when faced with these triggers.

It also teaches the person how to cope with their cravings if they ever find themselves in a high-risk situation.

By replacing automatic negative thoughts with a more positive or realistic approach, the addict can learn to adapt to situations that might involve being around the substance they were once reliant on.

Research shows that the cognitive-behavioural approaches taught in this therapy remain with the patient long after therapy has completed.

References

[1] https://www.mind.org.uk/information-support/drugs-and-treatments/cognitive-behavioural-therapy-cbt/about-cbt/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/

[3] https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/cognitive-behavioral-therapy

[4] https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/cognitive-behavioral-therapy

[5] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127598

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/