Despite naming the article for today “Cognitive Behavior Therapy for Addiction”, this is not an attempt at an all-encompassing description of CBT used to treat substance use disorder. I simply wanted people to understand what I was talking about. The field of substance use disorder treatment is in a strange place with Cognitive Behavior Therapy. There are countless places on the internet that make claims like “CBT is widely and successfully used to treat addiction”. Importantly, the widest clinical evidence that I could find was for Cognitive Behavior Therapy as an adjunct treatment for addiction. In other words, CBT used in addition to another treatment. Of course, in cases like that it would be hard to measure exactly how much of an effect different courses of treatment might have had when they are used together. I also found many very small studies that showed strong results for CBT. A small study amongst veterans seemed to indicate that CBT was very helpful for the group who underwent a 20-session CBT treatment protocol. At the end of that study, the authors called for more clinical research to be done to try and show the effectiveness of CBT for treating people with alcoholism and drug addiction. Despite many similar calls for more study, there are many sources that claim that CBT is simply one of the most proven treatments for addiction. My early reading of the research was that Cognitive Behavior Therapy might simply be one of the most promising possible treatments for addiction, with more research needed, but I wanted to investigate those questions today.
What is CBT
CBT was formally developed in the 1960s, and now serves as a blanket term for many treatment approaches developed from the early work of Dr. Aaron Beck. CBT is a “psycho-social intervention”. CBT approaches always concentrate on the way thoughts, and distortions of rational thinking, are affecting a patient. Connections between thoughts, feelings, and actions are important in CBT, and people in recovery will understand that connections between thoughts feelings and actions are paramount to understanding substance abuse and recovery also. CBT, when used to treat addiction, would seek to increase awareness of how feelings, thoughts, and actions are fueling drug and alcohol use. Some original ailments that were targeted by proponents of CBT were anxiety disorders and PTSD. There is much more clinical research and analysis of CBT for treating anxiety, compared to the somewhat newer concept of treating addiction with CBT. So why the great gulf in actual information on efficacy between the early uses of CBT and newer uses like treating addiction? It is not entirely clear. While it seems to be easy to find willing subjects for CBT research for things like PTSD, large scale studies of CBT for alcoholism and drug addiction treatment are mostly non-existent. The have been large-scale surveys by Cochrane and others, going back over 20 years, that seem to show that CBT is helpful when treating both alcoholism and drug-addiction, but newer studies have been recommending more research in this area for several years without many people taking up that challenge.
Why CBT for Addiction
One reason for the interest in studying CBT further for substance use disorder treatment may simply be how perfectly the tenets of CBT seem to fit into modern concepts of addiction treatment. The concept of “Maladaptive thoughts” lies at the center of CBT, and it seems like the same concepts are valuable when trying to overcome problem drinking and drug-use. Take three common maladaptive thought patterns that are studied within CBT. Minimizing, Denial, and Catastrophizing. Denial and minimizing have long been understood as primary obstacles to overcome on the road to seeking treatment for substance use disorder. Catastrophizing also, is a central concept in recovery. We talk about taking things “one day at a time”, which is precisely to avoid taking on too much and getting ahead of ourselves. In relapse prevention, we seek the advice of sponsors and experts, because too often the addicted mind will over-react, and every little thing is a catastrophe that might send us back out to drink or use again. Both CBT and 12-step principles are designed for the purposes of straightening out wayward thought processes that worsened during years of substance abuse. If CBT could be even better at teaching those lessens than 12-step programs and other treatments as usual, I too am in favor of further clinical research on the subject. It is important, however, that people understand that much more work is needed, because almost every study I found on CBT and addiction stated that in no uncertain terms.
By T.A. Cannon
Perry, Amanda E.; Martyn-St James, Marrissa; Burns, Lucy; Hewitt, Catherine; Glanville, Julie M.; Aboaja, Anne; Thakkar, Pratish; Santosh Kumar, Keshava Murthy; Pearson, Caroline; Wright, Kath (13 December 2019). “Interventions for female drug-using offenders”. The Cochrane Database of Systematic Reviews. 2019 (12): CD010910. doi:10.1002/14651858.CD010910.pub3. ISSN 1469-493X. PMC 6910124. PMID 31834635.
“What Is Cognitive Behavioral Therapy? Expert Dr. Mendonsa Explains”. Sprout Health Group. 21 October 2019. Retrieved 15 November 2019.