Sixteen studies did not report follow-up periods (20, 32, 33, 35, 38, 41–44, 46, 48, 57, 66, 67, 77, 81). Relation of the main included mindfulness-based interventions (MBIs) in the search literature and the type of related addiction. Mindfulness interventions were applied in a wide range of addictions both in SUDs and BAs (e.g., gambling disorder). The majority of these studies focused on heterogeneous substance use, followed by studies on cigarette smoking, alcohol, opioids, gambling disorder, stimulants, marijuana, combination of cocaine and alcohol, and combination of tobacco and alcohol.
- The therapist must be
prepared to move from topic to topic while always adhering to the major
theme–that how the client thinks determines how the client feels and acts,
including whether the client abuses substances. - In the largest trial to date, the added benefit of the combination was not observed, but review data suggest some benefit, and particularly for adding pharmacotherapy to CBT for alcohol use disorder.
- CBT is commonly used to treat depression, anxiety disorders, phobias, and other mental disorders, but it has also been shown to be valuable in treating alcoholism and drug addiction.
- Cognitive therapy techniques challenge the clients’ understanding of themselves
and their situation. - Finally, summary data on individual drugs beyond alcohol, later follow-up outcomes, and secondary measures of psychosocial functioning are quite sparse.
The model incorporates the stages of change proposed by Procahska, DiClement and Norcross (1992) and treatment principles are based on social-cognitive theories11,29,30. While there are a number
of different models of relapse (Donovan
and Chaney, 1985), the two best articulated within the
cognitive-behavioral model are those presented by Annis and Davis and
Marlatt and Gordon (Annis and Davis,
1988b; Marlatt and Gordon,
1985). Relapse prevention approaches rely heavily on functional
analyses, identification of high-risk relapse situations, and coping skills
training, but also incorporate additional features. These approaches attempt
to deal directly with a number of the cognitions involved in the relapse
process and focus on helping the individual gain a more positive
self-efficacy. A major component in cognitive-behavioral therapy is the development of
appropriate coping skills.
Effectiveness of CBT for Alcoholism and Addiction
Applications in the field are often based on Marlatt and Gordon’s (1985) model of relapse prevention, and there are several manuals available for use with alcohol (e.g., Epstein & McCrady, 2009; Kadden et al., 1992; Monti, Abrams, Kadden & Cooney, 1989) or other drug use disorders (e.g., Carroll, 1998). CBT for addictions has a well-established evidence base, but this literature continues to evolve (Carroll & Kiluk, 2017). 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.
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Cognitive-Behavioral Therapy (CBT) for Addiction and Substance Abuse
In addition, the patient could evaluate evidence from past holidays to compare the consequences and benefits of alcohol use in these settings. During assessment and early treatment sessions, case conceptualization requires consideration of the heterogeneity of substance use disorders. For example, the relative contribution of affective and social/environmental factors can vary widely across patients. A patient with co-occurring panic disorder and alcohol dependence may be experiencing cycles of withdrawal, alcohol use, and panic symptoms that serve as a barrier to both reduction of alcohol consumption and amelioration of panic symptoms. [56] Alternatively, patients without co-occurring psychological disorders may face different barriers and skills deficits, such as difficulty refusing offers for substances or a perceived need for substances in social situations. Attributional processes and emotional responses also play a role in an
individual’s decision to use (Marlatt and
Gordon, 1985).
In the absence of these skills, such problems are
viewed as threatening, stressful, and potentially unsolvable. Based on
the individual’s observation of both family members’ and peers’
responses to similar situations and from their own initial experimental
use of alcohol or drugs, the individual uses substances as a means of
trying to deal with these cbt interventions for substance abuse problems and the emotional reactions they
create. From this perspective, substance abuse is viewed as a learned
behavior having functional utility for the individual–the individual
uses substances in response to problematic situations as an attempt to
cope in the absence of more appropriate behavioral, cognitive, and
emotional coping skills.
What Is Cognitive Behavioral Therapy?
Clients in the contingent voucher
condition, compared to those who received vouchers on a noncontingent basis,
reported decreased craving for cocaine and significantly increased cocaine
abstinence. A more general positive treatment effect was also noted, with
clients in the contingent voucher condition also demonstrating an increased
abstinence from opiates. O’Brien and colleagues found that cocaine-dependent clients showed the
prototypical arousal and craving responses when first presented drug-related
cues that reminded them of their drug use (O’Brien et al., 1990).
- You can work with your therapist on the techniques that work for you and your unique situation.
- Finally, Negrei et al. (35) investigated if the combination of mindfulness techniques and a CBT group protocol diminished the level of depression and anxiety among a population with addictions.
- Both MET/CBT conditions included a CM component in which participants could earn up to $435 in gift cards if all urines were negative for cannabis.
- In addition,
cognitive therapy can help the client develop healthier ways of viewing both his
history of substance abuse and the meaning of a recent “slip” or relapse so that
it does not inevitably lead to more substance abuse.
Nevertheless, there is substantial
overlap in both the theory and practice of these two therapies. Clearly,
different clients will have different responses to these qualitatively different
approaches to modifying their thoughts and beliefs. Given the view that dysfunctional behavior, including substance abuse, is
determined in large part by faulty cognitions, the role of therapy is to modify
the negative or self-defeating automatic thought processes or perceptions that
seem to perpetuate the symptoms of emotional disorders. Clients can be taught to
notice these thoughts and to change them, but this is difficult at first.