Cognitive Behavioral Therapy and Substance Abuse Rehabilitation
Cognitive behavioral therapy (CBT) is a therapeutic approach that focuses upon how one thinks and behaves. This methodology is based upon the concept that our thoughts create our feelings and our behaviors. If we change the way we think, we can alter our feelings and our behaviors. Cognitive behavioral therapy seems to work more quickly than other forms of therapy for certain conditions including addictions treated in drug and alcohol rehab facilities. Once one alters the thinking process, every thing else quickly changes as well.
Cognitive behavioral therapy is a successful tool in treating anxiety, depression and substance abuse addiction in dual diagnosis treatment settings. It encompasses a number of different approaches; however, two of the more popular modalities are:
- Dialectic Behavior Therapy
- Rational Emotive Therapy
Patients with mood disorders, anxiety, substance abuse and schizophrenia combined with medication and CBT seem to have better outcomes than those patients without CBT. Throughout the therapeutic process, the psychotherapist will have the patient examine the validity of negative beliefs, thus challenging those beliefs. One of the founders of CBT, Aaron Beck, noticed that automatic thoughts tended to be negative and unrealistic. He concluded that these thoughts make one feel worse about themselves rather than better. One can understand this process by the statement: It is not the event that is important, but rather how I respond to the event that matters.
To that end, patients are often encouraged to log thoughts that come into their head. This allows patients to view any patterns of thinking and feeling that follow, and then seek alternative thoughts for such situations. The patient is taught rational self-counseling skills. Patients learn to identify cues and triggers associated with substance use.
(Sources: adapted from National Alliance on Mental Illness; Addiction Magazine)
According to a government report on CBT and cocaine addiction, CBT works because it is structured, goal oriented, flexible, individualized, and compatible with other substance abuse rehab modalities. CBT, according to the report, “can address several critical tasks that are essential to successful substance abuse treatment…” For example:
- Foster the motivation for abstinence.
- Teach coping skills.
- Change reinforcement contingencies (changing drug seeking behaviors and those behaviors associated with a drug addicted lifestyle).
- Foster management of painful affects.
- Improve interpersonal functioning and enhance social supports.
Strategies of CBT stress coping skills (avoiding dangerous situations, leaving difficult situations) change both the thoughts and the actions. The patient learns self control strategies that enable the patient to recognize the processes and habits that foster substance abuse. This approach to thinking, feeling and behavior adapts easily to both individual and group treatment. The change occurs as clients:
- Recognize the problem (what clues are there, worry, anger, depression).
- Identify the specific problem (solving the problem is easier once the specifics have been identified).
- Approaches to problem solving (brain storming a number of solutions without judgment before evaluating the options).
- Solution choice (consider the positive and negatives of the specific choice).
- Assess effectiveness of the solution (building problem solving skills from simple problems to complex).
(Source: adapted archives.drubabuse.gov/TXManuals/ CBT)
According to the United Nations Office on Drugs and Crime, CBT helps clients understand a variety of interconnected issues which bring into focus relapse prevention. CBT teaches clients:
- About substance abuse and addiction
- About triggers and cravings
- Cognitive skills (thought stopping , urge surfing)
- Relapse prevention
Once a person alters his or her thinking about a situation, the feelings generated from the thinking will also change as will the behaviors that will occur as a result of the thoughts and feelings. When one learns to think in a calm, positive, goal focused manner, he or she feels better about self and then behaves in healthy and positive ways. With practice, the addict will be empowered to recognize when the process has taken a negative slant and stop it before a relapse occurs.
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