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Treating Drug Addiction With Cognitive Behavioral Therapy

Dr. Richard Foster, LICDC-CS

Medically reviewed by

Dr. Richard Foster, LICDC-CS

March 13, 2019

Cognitive Behavioral Therapy (CBT) first emerged as a therapy for the treatment of drug and alcohol addiction in the 1960s and has been improved upon in the decades since. CBT recognizes that the treatment of addiction doesn’t relate specifically to the thoughts or feelings we have, but our actions in coping with those thoughts or feelings. It is a powerful and effective tool in the treatment of drug addiction and shows particular promise in the treatment of women battling addiction.

How Does Cognitive Behavioral Therapy Work?

Cognitive behavioral therapy works in the treatment of drug addiction by helping an individual recognize and address key negative thoughts and subsequent behaviors that fuel their drug addiction. People behave in response to their perception of their surroundings. In the unhealthy mind, or in a drug-addicted mind, this perception can be largely skewed. Cognitive behavioral therapy seeks to identify thought patterns or behaviors related to unhealthy perceptions and replace those unwanted behaviors (including drug use) with positive coping strategies or actions.

Cognitive behavioral therapy works in phases, first assessing the addiction and any mental health disorders, then working with an individual to reconceptualize their environment. Reconceptualization is a key component of CBT. It asks the individual to address their surroundings and any negative thought patterns or feelings associated with their surroundings and work on viewing this environment from a place of heightened awareness.

People often behave in a situation based on feelings and perceptions of their situation. Reconceptualization raises the awareness that not all thoughts and feelings are based on truths and that assessing which thoughts or feelings are based on reality and which are based on fears or past traumas can help a person reassess their surroundings toward more positive reactions and behaviors.

At this stage, an individual will be taught improved coping skills to replace former drug use, whenever stressful situations or drug triggers arise, and how to apply these skills. This process is followed up by a review, or follow-up assessment.

Benefits Of Cognitive Behavioral Therapy

There are many benefits to choosing cognitive behavioral therapy to treat drug addiction, including the length and overall impact of the program. In general, CBT lasts between 12 and 16 weeks, with weekly sessions, leaving time available for complementary treatment options, work, and school. Cognitive behavioral therapy is also relatively inexpensive and covered by most insurances.

Studies indicate CBT is an effective treatment form, and when used in conjunction with other complementary therapies, including pharmacological, residential, and even the 12-step model, reduces relapse rates considerably. One such study examined the outcomes of CBT used in conjunction with naltrexone therapy to reduce opioid dependency. Naltrexone is a prescription medication used to block the pleasurable effects of opioids, which helps to decrease the motivation to relapse. The study found that participants who received CBT in conjunction with naltrexone benefited from a long-term success rate of 62 percent compared to 40 percent in the non-CBT control group.

Cognitive behavioral therapy has been shown to be particularly effective for women, who tend to benefit more from empowerment models, than the traditional 12-step program. And because cognitive behavioral therapy is used to treat many of the co-occurring mental disorders that often accompany or precipitate addiction, it is an effective tool in dealing with both the mental and substance use disorder.

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Though drug cravings can appear to come out of nowhere and can vary with intensity, they usually relate to specific triggers, including locations, people, scents, sights, or reminders of past traumas. In addressing perception and helping the individual regain some awareness and control over those external, and even internal triggers, cognitive behavioral therapy can help reduce the frequency or intensity of drug cravings.

Cognitive behavioral therapy is particularly beneficial in addressing drug addiction in that it focuses on promoting positive action, where an individual before relied on a substance as a coping mechanism. Once a person is able to identify negative thought patterns or interactions in their lives that created greater vulnerability to drug use, they can then begin to recognize, for example, that when they get a drug craving, it is not likely to last more than 10 minutes. They can then make a conscious choice in that 10 minutes to constructively act and go out for a walk, find a quiet spot and practice mindful meditation, or journal their feelings, in place of turning to their drug of choice. Planning for a healthy coping strategy to replace one that has a damaging effect on the brain and body is one way to prevent further damage from relapse.

  • Short-term therapy
  • Evidence-based
  • Effective empowerment model for women
  • Effective in addressing co-occurring disorders
  • Reduces overall drug cravings
  • Reduces the impact of past traumas
  • Promotes positive action
  • Inexpensive and covered by most insurance

Cognitive Behavioral Therapy And Dual Diagnosis

Multiple studies have shown CBT to be an effective therapy in treating substance use disorder with a co-occurring mental disorder including anxiety and schizophrenia. These positive outcomes were increased with the complimentary use of motivational interviewing (MI), and, in some cases, pharmacological therapies.

One such study examining the effects of CBT on substance use disorder and depression, as a co-occurring mental disorder, found positive results even six months past the last session. Similar studies on co-occurring schizophrenia and substance use disorder indicate significant improvements for the long-term outcome where CBT is incorporated as part of a treatment plan. These studies also point to the cost advantage of including CBT in drug addiction treatment.

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