Cognitive Behavioral Therapy CBT for Addiction & Substance Abuse

The studies initially provided relatively high rewards (as high as $1,000) for sustained abstinence from substance use [47-49], but recently, effectiveness studies have focused on providing low-cost CM as a more feasible addition to traditional counseling programs. Petry and Martin [15] examined the addition of CM to standard community based treatment (methadone maintenance and monthly individual counseling) for cocaine and opioid dependent patients. CM in this study was delivered through a raffle format using a fixed ratio schedule in which drug-free urine samples afforded patients the opportunity to draw from a fish bowl for prizes valued between $1 and $100; patients in the CM condition achieved longer durations of abstinence through a 6-month follow up period relative to those who did not receive CM. Attributional processes and emotional responses also play a role in anindividual’s decision to use (Marlatt andGordon, 1985). 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.

• In the present study, estimates of effect were sizable only among the seven studies contrasting CBT with a minimal comparison.
• The patient can learn to recognize the circumstances that trigger drinking or drug use, remove themselves from the situation, and use CBT techniques to alleviate the thoughts and feelings that lead to abuse.
• Specifically, we will examine what might be considered “classical” or “traditional” applications based on Marlatt and Gordon’s17 seminal work but will also consider some integrative applications such as CBT in combination with MI, CM, and pharmacotherapy.
• The form of CBT used in NIAAA’s Project MATCH (Kadden et al., 1992) consisted of 12sessions, administered as individual therapy, meeting once per week.
• No combination was more effective than naltrexone or combined behavioral intervention (CBI) in the presence of medical management.

Cognitive-Behavioral Therapy for Substance Use Disorders

These techniques canbe conducted successfully in individual, group, and family settings, amongothers, to help clients change their substance abuse behaviors. The question of whether one has heard of CBT might be relatively straightforward to answer, but what defines CBT is more challenging. Given its ubiquity and longevity, CBT for addiction is increasingly becoming an umbrella term for interventions that include a range of cognitive and behavioral techniques (see Table 1). For the purposes of the present discussion, we define CBT for AOD as a class of interventions that are time-limited, targeted, and based on principles of both cognitive (ie, an emphasis on the role of thoughts in shaping emotions and behaviors) and behavioral (ie, an emphasis on the role of behaviors in shaping emotions and thoughts) therapies. There is typically a phase of personalized assessment characterized by techniques such as functional analysis.

Everything You Need to Know About Cognitive Behavioral Therapy for Addiction

From the two review studies considered and the subsequent 15 studies of mediators of CBT effects, coping skills, self-efficacy, and reduced craving show promise, but there is minimal evidence to suggest these processes are uniquely important to CBT and are more likely processes that are broadly relevant to AOD behavior change. Platforms for delivering addiction interventions via technology are diverse and multiplying rapidly. Overall, results from meta-analyses of such interventions are promising (Boumparis, Karyotaki, Schaub, Cuijpers, & Riper, in press; Carey et al., 2009; Riper et al., 2014; Rooke, Thorsteinsson, Karpin, Copeland, & Allsop, 2010; Tait, Spijkerman, & Riper, 2013), but methodological quality of studies within this young field is variable and often weak (Kiluk, Sugarman, et al., 2011). In the sections below we will cover only those which (1) are explicitly or predominantly cognitive-behavioral in focus (although several include components of MI and other interventions), (2) the primary targeted outcome is alcohol or drug use, and (3) the intervention is delivered online. We include an expanded description of a computer-based CBT program developed by our research group as a possible paradigm for how CBT evolve in the future.

• Annis and Davis use graduated homeworkassignments to help in this process (Annis and Davis, 1988b).
• Once the maladaptive thoughts are discovered in a person’s habitual, automaticthinking, it becomes possible to modify them by substituting rational, realisticideas for the distorted ones to create a happier and healthier life withoutsubstance abuse.

Cognitive Behavioral Therapy Techniques for Addiction

Each individual is approached asa unique case, albeit one to which broad principles can be applied. We provide an overview of Cognitive Behavioral Therapy (CBT) efficacy for adult alcohol or other drug use disorders (AOD) and consider some key variations in application as well as contextual (ie, moderators) or mechanistic (ie, mediators) factors related to intervention outcomes. Family therapy remains a “promising” intervention https://ecosoberhouse.com/ with polydrug users, family interventions, community reinforcement and CM approaches have been shown to be superior to drugs counseling and 12-step approaches. The Figure summarizes study inclusion for the present report on combined CBT and pharmacological interventions for adult AUD/SUD (PRISMA diagram). The protocol for this meta-analysis was not registered but was scientifically reviewed at the National Institutes of Health.

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Individuals dependent on sedatives and tranquilizers orheroin/opiates reported that negative physical states and interpersonalconflict were the most important risk factors. Again, it is the individual’sappraisal of such situations, in terms of its threat to maintainingabstinence relative to their available coping abilities, that determines thesituational risk for the individual (Myers et al., 1996). The community reinforcement approach (CRA) was developed as a treatment foralcohol abuse disorders (Azrin,1976; Hunt and Azrin,1973). After a period during which it appears to have been littleused, it has received increased interest as a behavioral approach tosubstance abuse (Higgins et al.,1998; Meyers and Smith,1995; Smith and Meyers,1995). CRA is a broad-spectrum approach based on the principles ofoperant learning, the goal of which is to increase the likelihood ofcontinued abstinence from alcohol or drugs by reorganizing the client’senvironment.

Patients on opioid agonist maintenance therapies

[56] Alternatively, patients without co-occurring psychological disorders may face different barriers and skills deficits, such as difficulty refusing offers for substances or a perceived need for substances in social situations. Cognitive behavior therapy is a more hands-on approach compared to other less engaging psychotherapy techniques, which may take years to have a meaningful impact. Cognitive behavior therapy is a goal-oriented, problem-focused, actionable, adaptable treatment.

• While it is beyond the scope of this work, an important question for future research is – how or why this phenomenon continues to occur?
• Strategies for coping with negative affect, such as using social supports, engaging in pleasurable activities, and exercise can be introduced and rehearsed in the session.
• The functional analysis should also focus on thenumber, range, and effectiveness of the individual’s coping skills.
• Given the importance of experimental contrast type in estimating effect-size magnitude in clinical trials,25,26 we used this design factor as a primary subgroup variable.

Finally, summary data on individual drugs beyond alcohol, later follow-up outcomes, and secondary measures of psychosocial functioning are quite sparse. The largest treatment trial to date, Project MATCH[49] had 1726 subjects with alcohol use disorders who were randomly allocated to MET, CBT or TSF. The main outcome measures were the percentage of days/month that the client did not drink and the number of drinks they had in each drinking session. The results showed an increase in abstinence days from 20-30% to 80-90% and decrease in drinks per drinking day from to 1-4. Although, a main aim of this project was to see which clients benefited from which therapy, such client “matches” did not emerge. It was hypothesized that more important than “matching” treatments to clients is the relationship between therapist and client.

• Technology may provide a means for CBT interventions to circumvent the ‘implementation cliff’ in Stages 3–5 by offering a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations.
• As personal efficacy decreases, theanticipated positive effects of substance abuse increase and become moresalient (Brown et al., 1998).Under such conditions, the individual is likely to use (Moser and Annis, 1996).
• It should be noted that this review will for the most part concentrate on “classical CBT” rather than its many variants, including behavioral couples training, adaptations for specific comorbid conditions (such as mood management interventions), or combined approaches (such as the Community Reinforcement Approach).
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• Evidence has only begun to emerge to support this for cannabis and amphetamine use, with effectiveness for other illicit drugs yet to be tested.[13] People who misuse cannabis or stimulants, and are not in formal drug treatment, appear to respond well to BIs both in terms of increased abstinence levels and reduced drug use.
• However, in contrast to drug treatment, less evidence isavailable concerning the effectiveness of such contingency managementapproaches in the treatment of alcohol problems (Higgins et al., 1998).

The authors summarized the selection of potential mediators as related to self-efficacy, copings skills, craving/affect regulation/stress, and other (eg, social measures as well as more generalist constructs such as the therapeutic alliance). The mediation studies were additionally cbt interventions for substance abuse grouped by whether the independent variable was a between (ie, CBT versus another treatment) or within (ie, a CBT-related process) condition indicator. Problematic drug and alcohol users report problems in various areas including health, psychological and social problems.

Cognitive Behavioral Therapy for Co-Occurring Disorders