How Can We Apply CBT to Addiction Treatment?

Studies were included if they targeted adult populations (age ≥ 18) meeting criteria for an alcohol or other drug use disorder (DSM III-R through V; American Psychiatric Association, 1987; 1994; 2000; 2013) or problematic use (e.g., Saunders et al., 1993). The treatment must have been identified as either Cognitive Behavioral or Relapse Prevention, although some studies were included based on a description of key CBT elements such as functional analysis, avoidance of high risk situations, and/or coping skills training (see Supplemental Table 1 for details). Studies of CBT delivered in either individual or group format were included, but we excluded studies of CBT delivered as an integrative therapy combined with another psychosocial (e.g., COMBINE Cognitive Behavioral Intervention, Mindfulness-Based Relapse Prevention) or pharmacological intervention.

Cognitive Behavior Therapy Versus Other Therapies

• It is critical that CBT not be considered as a static intervention, but rather one that constantly evolves and is refined through the Stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions.
• Patients can apply the practical skills and coping strategies they learn during these sessions to everyday life.
• Overall, these interventions have demonstrated efficacy in controlled trials and may be combined with each other or with pharmacotherapy to provide more robust outcomes.
• Symptoms of substance abuse reflect the external consequences of problematic use such as failure to fulfill role obligations, legal problems, physically hazardous use, and interpersonal difficulty resulting from use.
• Figure4-18lists a number of features thought to beunique to cognitive-behavioral interventions.

Cognitive behavioral therapy (CBT) approaches have among the highest level of empirical support for the treatment of drug and alcohol use disorders. As Psychology of Addictive Behaviors marks its 30th anniversary, we review the evolution of CBT for the addictions through the lens of the Stage Model of Behavioral Therapies Development. The large evidence base from Stage II randomized clinical trials indicates a modest effect size with evidence of relatively durable effects, but limited diffusion in clinical practice, as is the case for most empirically validated approaches for mental health and addictive disorders. 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. Moreover, returning to Stage 1 to reconnect clinical applications of CBT to recent developments in cognitive science and neuroscience holds great promise for accelerating understanding of mechanisms of action. It is critical that CBT not be considered as a static intervention, but rather one that constantly evolves and is refined through the Stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions.

Primary Study Outcome Variables

Follow-up rates were also low (5.6% of the randomized sample were reached for 6-month follow-up assessment); making it difficult to make inferences regarding the efficacy of the program. The studies reviewed above highlight both the promise of technology-based interventions as well as their significant limitations, which include highly variable rates of retention and adherence and poor rates of follow-up, particularly for studies collected entirely on-line (Kiluk et al., 2010). Several studies have used use wait-list controls, hence limiting the inferences that can be drawn regarding the efficacy of the intervention evaluated.

• The client gradually exposes herself toincreasingly difficult situations with greater relapse risk but does sowithout using.
• Cognitive-behavioral therapy teaches different skills to better manage our thoughts and behaviors.
• When it comes to addiction, CBT can help you take steps to reframe your situation to avoid triggers.

What Is Cognitive Behavioral Therapy Used For?

Tables 1 and 2 describe each study with respect to key design characteristics and effect sizes and are separated by posttreatment and follow-up outcomes, respectively. For outcomes of interest, biological assay/frequency measures and quantity measures are considered primary, and when available both are reported in Tables 1 and 2. Finally, the sample was distributed in roughly equal thirds with respect to the types of conditions to which combined CBT and pharmacotherapy was compared; narrative results and Tables 1 and 2 are organized by these clinically informative subgroups, and given the distinctiveness of these comparator conditions, no overall pooled effect size is reported. The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or non-specific control. Consistent with findings on other evidence-based therapies, CBT did not show superior efficacy in contrast to another specific modality. Research has shown that CBT can be an effective treatment for substance use disorders, both on its own and in combination with other treatment strategies.

How Does Cognitive Behavioral Therapy for Addiction Work?

Robust evidence suggests the efficacy of classical/traditional CBT compared to minimal and usual care control conditions. CBT combined with another evidence-based treatment such as Motivational Interviewing, Contingency Management, or pharmacotherapy is also efficacious compared to minimal and usual care control conditions, but no form of CBT consistently demonstrates efficacy compared to other empirically-supported modalities. CBT and integrative forms of CBT have potential for flexible application https://ecosoberhouse.com/ such as use in a digital format. Data on mechanisms of action, however, are quite limited and this is despite preliminary evidence that shows that CBT effect sizes on mechanistic outcomes (ie, secondary measures of psychosocial adjustment) are moderate and typically larger than those for AOD use. Cognitive Behavioral Therapy (CBT) is a leading behavioral approach for intervention with alcohol or other drug use disorders (Substance Abuse and Mental Health Services Administration, 2014).

Cognitive restructuring

CBT uses a variety of coping skills to help you recognize and restructure unhealthy thought and behavioral patterns.5,13 During your initial assessment for alcohol use disorder, your therapist will help you to identify underlying triggers and unhealthy coping skills that are connected to your alcohol use. Similar limitations occurred in a Swiss study of an 8-module internet-based program encompassing CBT and cbt interventions for substance abuse MI called Snow Control for individuals reporting cocaine use at least 3 times in the past 30 days (Schaub, Sullivan, Haug, & Stark, 2012). Participants were randomly assigned to the Snow Control program or an 8-session online psychoeducation control. Treatment engagement was very low, with only 18/96 (19%) allocated to the Snow Control program accessing a module and only 8 of the 100 allocated to control.

What Is Cognitive Behavioral Therapy?

• A key component of CBT for addiction is understanding how thoughts, emotions, and behaviors influence each other.
• CRA has been described as a promising but underutilized treatment for alcoholabuse (McCrady, 1991).
• Providers should take advantage of the widerange of behavioral therapy techniques that are available.
• Negative consequences expectedfrom cocaine include global negative effects, anxiety, depression, andparanoia (Jaffe and Kilbey, 1994;Schafer and Brown, 1991).