Cognitive-Behavioral Therapy for Addiction

We are humans. And as humans, we have to learn to do almost everything. Very little of what we know is inborn. A lot of how we think was learned from the people we grew up with: 

  • Our parents
  • Extended family
  • Teachers
  • Coaches
  • Our peers

Sometimes, the thought patterns we learned were good but at other times, not so good. Fortunately, if we identify thought patterns that are unnecessarily negative or nonproductive, we can learn new ways of thinking.

Cognitive-behavioral therapy (CBT) is one way to do that.  CBT is a technique of cognitive  restructuring in which we: 

  • Identify unproductive ways of thinking, 
  • Recognize that we’re thinking those thoughts, 
  • Actively stop those thoughts, 
  • Reject them, and 
  • Replace them with more productive ways of thinking.

What Is CBT?

Cognitive-behavioral therapy for substance abuse operates on the theory that thoughts, feelings, and behaviors are all linked. Identifying and changing the links between thoughts, feelings, and behaviors helps change unwanted factors such as being too sad (feelings) or substance abuse (behavior). CBT is an extremely common and effective therapy for many psychological disorders. Additionally, it’s a great choice for people suffering from addiction.

CBT is a directive therapy. That means that the therapist leads the process. The therapist teaches patients how to develop effective methods to cope with a range of issues, including:

  • Depression
  • Anxiety disorders
  • Panic disorders
  • Substance use disorders (SUD)

Burton Hutto, a psychiatrist and director of the Crisis Stabilization Inpatient Unit at the University of North Carolina School of Medicine states that “Cognitive behavioral therapy is based on the idea that the person is having difficulties because of faulty thinking and behaviors.” Through CBT, the negative thoughts are identified, challenged, and replaced with more realistic, objective thoughts.

What Happens in CBT for Addiction Treatment?

One important step in using CBT to reduce addictive behavior is recognizing the triggers of that behavior. For example, many people say they want to reduce their drinking, a typical unwanted behavior. So, what are the triggers that lead them to crave a drink?

  • Thoughts
  • Feelings
  • Situations
  • People

The trigger for one person might be wanting to be more outgoing at a party; another person’s trigger might be their exhaustion after a long workday. By going through CBT, most people can recognize patterns in their life that are directly tied to their addictive behaviors. When you identify those patterns, CBT therapists can help break the connection between a trigger and an addiction behavior through activities, homework, and lessons. 

An example might be if you discover that you tend to drink because it helps you relax when stressed, the therapist might teach you alternate ways to unwind. If you experience unhelpful thoughts surrounding your drinking (“I’ve been drinking for so many years. I’ll never be able to stop.”), the therapist will help you train your mind to think with a more productive approach.

Another feature of cognitive-behavioral therapy is that the skills you learn to manage your addiction can work for many problems. Nearly 20% of people with addictions also suffer from depression. By taking part in CBT you can reduce your addictive behaviors and get rid of the troublesome thoughts and feelings that are associated with depression. 

How Does CBT Work?

CBT helps you recognize and change negative thought patterns and behaviors that are wrecking your well-being. You may be convinced that you will contract coronavirus and die. This is not necessarily true, even if it is remotely possible. CBT helps you get a more realistic view of what’s going on and also helps you recognize and accept events that are beyond your control.

Therapy is focused and structured. You will make a plan with your therapist at the start of the sessions. Since there is a schedule on what you want to accomplish, it’s a shorter-term therapy and therapy that usually doesn’t last more than 6 months. Individuals learn coping methods and more practical and productive ways to react to distressing or anxiety-promoting situations or feelings. In addition, there is homework such as keeping track of thoughts, feelings, and situations, and then discussing them in the next therapy session.

The 5 Steps of CBT

  • Make a list.

This is simple. Get a piece of paper and divide it in half from top to bottom. Use the left side to write down “Old Thoughts”  or “Unproductive Thoughts,” and the right side for “Replacement Thoughts.”

  • Write down your unproductive or old thoughts.

Start writing down your unproductive thoughts that you find yourself having on a regular basis. It can be: 

  • Anxious or worried thoughts
  • Self-critical thoughts
  • Any thoughts that show a lack of self-confidence or are self-deprecating
  • Thoughts that hold you back
  • Thoughts that make you unhappy

Write them out in the way they sound when you say them to yourself.

  • Create Replacement Thoughts

On the right side of the paper, create a replacement thought for each unproductive thought you wrote down. When creating your replacement though there are a few ways to do this. 

  • You can just write the opposite of your negative thought
  • Ask yourself if it’s a lie, then what is the truth? 
  • Create a more accurate picture of your situation

Make sure that your replacement thought isn’t just you lying to yourself. This is about getting through a tough situation or emotional reaction by focusing on the positive and supporting your ability to change yourself.

  • Read the List Frequently

Read your list of replacement thoughts at least two times a day. After a while, you will begin to memorize the wording and content of them so that you can use them each day.

  • Notice and Replace

While you go through your day, notice when you think one of your unproductive thoughts and stop yourself. Reject the old thought and speak the replacement thought. The trick to cognitive restructuring is consistency.

Different Types of Cognitive-Behavioral Therapy

CBT for addiction includes a range of techniques and approaches that focus on emotions, thoughts, and behaviors. These can go from structured psychotherapies to self-help data. There are several specific types of therapeutic approaches that involve CBT including:

  • Dialectical Behavior Therapy (DBT)

DBT is a modified type of CBT. The main goals are to teach people to live in the moment, learn healthy ways to:

  • Cope with stress
  • Regulate emotions
  • Improve relationships.

One important benefit of DBT is the increase in mindfulness skills. Mindfulness helps you focus on the present and pay attention to what’s happening inside your thoughts, feelings, sensations, and impulses. Likewise, you use your senses to become aware of what you hear, smell, see and touch without being judgmental.

Mindfulness skills help you focus on healthy coping skills when you are experiencing emotional pain. It can also help you remain calm and avoid indulging in negative thought patterns and impulsive behavior. Distress tolerance skills help you learn to accept yourself and your situation and help you get ready for strong emotions and empowers you to deal with them.

  • Rational Emotive Behavior Therapy (REBT)

REBT helps you recognize irrational beliefs like self-defeating feelings and thoughts and how to actively challenge them. REBT involves: 

  • Identifying irrational beliefs
  • Challenging these beliefs
  • Learning to recognize and change the associated thought patterns

Although each type of cognitive-behavioral therapy uses a different approach, they all work to look at the underlying thought patterns that add to the person’s psychological distress.

  • Mindfulness-Based Cognitive Therapy (MBCT)

This type of CBT combines CBT with meditation and helps build a non-judgmental present-oriented attitude which is known as mindfulness.

Techniques of CBT

CBT is about more than identifying thought patterns; it is focused on using a wide range of strategies to help people overcome these thoughts. The treatment techniques used most are:

  • Cognitive Restructuring

This includes tracking your thoughts in difficult situations, identifying the distortion in your thinking, and testing out whether your thoughts are accurate.

  • Exposure

This technique helps you gradually approach what you fear. By being exposed gradually, you can master your feared situations.

  • Activity Scheduling

This helps people increase positive behaviors they should be doing more. Scheduling these behaviors increases the chance that they’ll get done.

  • Practicing New Skills

It’s important to practice skills that can then be used in real situations. You might start practicing coping skills and rehearsing ways to deal with situations that could trigger a relapse. Many people’s problems come from not having the necessary skills to achieve their goals.

  • Goal Setting

During CBT, your therapist can help you with goal-setting skills and focus on the process as much as the results.

  • Problem-solving

Problem-solving skills can help you see and solve problems that come from stressors in your life. It helps reduce the effects of psychological and physical illness.

What Does the Evidence Show About CBT for Addiction?

There have been many studies conducted to test the effectiveness of CBT for addiction treatment. One analysis showed that CBT had a statistically significant effect after looking at 53 controlled trials for alcohol and drug users. In addition, CBT has proved to have long-term positive results. A study with cocaine users in methadone treatment found that 60% of CBT patients were still clean at a 52-week follow-up exam. 

Even though CBT has an excellent track record, with many studies demonstrating its effectiveness in treating depression, anxiety, and other conditions, including addiction, there are other options. It is common to use a medication in combination with CBT. In reality, therapists are likely to “mix and match” skills from several psychotherapy approaches depending on your individual needs. 

In the end, CBT is effective at teaching better coping skills which helps people reduce their substance use. It also has lasting benefits after formal treatment ends and can protect you against relapses. The CBT methods that became popular at the end of the 20th century are now being further refined and supplemented by a “third-wave” of behavior therapy. This wave focuses on mindfulness, acceptance, and being “in the moment.”

North Jersey Rehabs Can Help You Reach Your Goals

If you are struggling with an addiction, you already know you need help. You can’t successfully recover from addiction on your own, and you probably shouldn’t try it. Depending on your addiction, its severity, and duration, it could be life-threatening to just quit cold turkey. Many substances cause intense, dangerous withdrawal symptoms when you quit. 

North Jersey Rehabs can offer you a detox center where you will have medical supervision to help you go through withdrawal safely. This will prepare you for treatment. We have four levels of care so you enter the program that is best for you.  And you can continue on your treatment journey in the lower levels, even including a sober living residence. In addition, our therapists are licensed professionals experienced in CBT and other forms of therapeutic treatment. 

We have nine locations in New Jersey, so you can find one easily. Contact us and we’ll talk about what you want in a treatment center and how we can meet your needs. You can’t reach the road to recovery if you don’t take the first step.

References:

https://www.aarp.org/health/conditions-treatments/info-2020/find-m

https://groffandassociates.com/2017/10/12/5-easy-steps-to-changing-your-thinking-

https://www.talkspace.com/blog/types-of-cbt/