Based onthe individual’s observation of both family members’ and peers’responses to similar situations and from their own initial experimentaluse of alcohol or drugs, the individual uses substances as a means oftrying to deal with these problems and the emotional reactions theycreate. From this perspective, substance abuse is viewed as a learnedbehavior having functional utility for the individual–the individualuses substances in response to problematic situations as an attempt tocope in the absence of more appropriate behavioral, cognitive, andemotional coping skills. Cognitive therapy can be useful in the treatment of substance abuse disorders inseveral ways.
Modularization and evaluation of effective components
The evaluation of CBT for SUDs in special populations such as those diagnosed with other Axis I disorders (i.e., dual diagnosis), pregnant women, and incarcerated individuals is beyond the scope of the current review, and thus the descriptions provided below focus on SUD treatment specifically. The meta-analytic evidence on CBT supports efficacy at short- and long-term follow-ups.13 In an early review (1999) of 26 studies by Irvin et al,14 the authors found CBT to be generally effective across a range of conditions, but effect sizes were roughly 5 times higher when CBT was combined with pharmacotherapy than when delivered as a stand-alone intervention. A major component in cognitive-behavioral therapy is the development ofappropriate coping skills. Deficits in coping skills among substance abusersmay be the result of a number of possible factors (Carroll, 1998). They may have never developed theseskills, possibly because the early onset of substance abuse impaired thedevelopment of age-sensitive skills. Previously developed coping skills mayhave been compromised by an increased reliance on substances use as aprimary means of coping.
Skills Training
Patients may want to know that the assessment and diagnosis they receive will guide the treatment offered. Patients hope, perhaps even expect, that this treatment has been studied carefully for safety and has been found to work with substance users with similar characteristics. Finally, patients wish to be confident that the cbt interventions for substance abuse person treating them has long track record of success with this intervention. Patients also may have evidence-based expectations, based on their previous history and experiences in the offices of health care practitioners. Patients may wish to hear about treatment alternatives and be partners in clinical decision making.
Cognitive behavioral therapy techniques
Should the client attribute her substance abuse tointernal, stable, and global characteristics (e.g., “I’m nothing but anaddict; there’s nothing that I can do to stop using”), then it is likelythat she will feel angry, depressed, hopeless, and helpless. These reactionsare less likely to occur and to be less pronounced for individuals who aremore firmly committed to the goal of abstinence or moderation and for thosewho have maintained such goals longer. If the individual does not have the necessaryrestorative coping skills to deal with them and to counteract the impact ofa negative attributional style, it is more likely that an initial slip willcontinue on as a full-blown relapse (Stephens et al., 1994).
- Patients attend therapy sessions with a CBT therapist, who can help you explore the connection between your thoughts, emotions, and subsequent actions.
- Objective To conduct a meta-analysis of the published literature on combined CBT and pharmacotherapy for adult alcohol use disorder (AUD) or other SUDs.
- Currently, there is not enough evidence base to support the effectiveness of 12-step programs as stand-alone interventions.
- The team at Oxford Treatment Center is available 24/7 to answer your questions about inpatient addiction treatment and outpatient drug and alcohol rehab in Mississippi.
In comparison to standard outpatient treatment, clients inthe CRA-plus-vouchers condition remained in treatment longer, had morecontinuous weeks of drug-free urine samples, and had greater amounts ofcocaine abstinence even at a 12-month followup. A similar pattern offindings has been obtained with methadone-maintained opiate addicts (Abbott et al., 1998). CBT for substance use disorders includes several distinct interventions, either combined or used in isolation, many of which can be administered in both individual and group formats. Specific behavioral and cognitive-behavioral interventions administered to individuals are reviewed below, followed by a review of family-based treatments.
It has been shown to reduce drug use, enhance treatment compliance, and improve family relationships [49,50]. Although the intervention generally is conducted with families, some evidence supports its utility with a single person [51]. No pharmacological agents are approved by the FDA for treating cocaine (or other similarly acting stimulants), cannabis (marijuana, hashish), or benzodiazepine use disorders. There have been many scientific advances in the past 5 years in the identification of multiple cannabinoid receptors, and research is underway to explore reciprocal pharmacological agents [36]. Much of the focus involves the dopaminergic system, dynorphinergic kappa opioid receptors, and dynorphin. Because people with these disorders often have co-occurring mood or anxiety disorders [37], many of these patients likely receive antidepressant or anxiolytic medications.
- Brief behavioral therapy might also involve the client’s spouse orsignificant others, who may attend several of the therapy sessions.
- 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.
- In the sections below we elaborate on how these possibilities may accelerate development of cognitive behavioral interventions in the next 30 years.
- Whilemany problem drinkers, for example, choose a moderation goal, acrosstime those with more severe problems shift to a goal of abstinence(Hodgins et al., 1997).Later sessions might also consider the introduction of cue exposuretraining or relapse prevention targeted at substance abuse above aparticular level.
- Although we consider our subgroup approach a strength, some effect size estimates were composed of a small number of primary studies, and this may result in underpowered analyses.
Cognitive-behavioral approaches to substance abuse disorders postulate thatlow levels of self-efficacy are related to substance use and an increasedlikelihood of relapse after having achieved abstinence (Annis and Davis, 1988b, 1989b; DiClemente and Fairhurst, 1995; Marlatt and Gordon, https://ecosoberhouse.com/ 1985). A modelof relapse that is based on the role of self-efficacy and coping is depictedin Figure 4-15. They also can be used episodically with clients who leaveand then return to treatment or during aftercare or continuing carefollowing a more intensive treatment episode.
Goals of Cognitive Behavioral Therapy
Despite the importance of combined pharmacological and behavioral interventions for AUD/SUD, few meta-analyses on this intervention approach have been performed. Typically, meta-analytic reviews in the AUD/SUD literature have been conducted on specific pharmacotherapies,9 groups of pharmacotherapies,10-12 or specific behavioral interventions, such as CBT. As a result, the evidence-informed guideline will relate only to the selection of a single, stand-alone therapy, whether pharmacological or behavioral, and not their combination. For example, in a review of 122 clinical trials of AUD pharmacotherapies delivered in outpatient settings,10 the authors could not conclude about the efficacy of pharmacotherapies when combined with a behavioral cointervention. Combined behavioral and pharmacological interventions are considered best practices for addiction. Cognitive behavioral therapy (CBT) is a first-line intervention, yet the superiority of CBT compared with other behavioral treatments when combined with pharmacotherapy remains unclear.