As we’ve covered many times before, drug addiction treatment is a vast, yet strictly personal process. Every individual struggling with substance abuse disorders (SUDs) has different needs, different potential co-occurring disorders, and different underlying conditions. Thus, while journeys to recovery follow a robust, research-backed framework, treatments will often need to cater to these unique factors. At Bright Futures Treatment, our Boynton Beach rehabilitation center consistently upholds this principle – and the benefits of cognitive behavioral therapy in drug addiction treatment consistently show.
A key element of therapy personalization lies in cognitive behavioral therapy (CBT), whose evolution has allowed it to retain its value today. This type of therapy has found ample use in treatments for various SUDs over the years, from alcohol abuse to recreational drug abuse and more. To illustrate why that is, let us explore cognitive behavioral therapy in drug addiction treatment in due depth.
What is Cognitive Behavioral Therapy?
Starting with the fundamentals, let us first define CBT. As a type of psychotherapy, or psychological treatment, CBT is very often misunderstood. This may be fine in everyday discussions, but not in such contexts as this article’s.
In its most basic form, CBT is a type of talk therapy which focuses on psychological treatment. It seeks to benefit the individual psychologically and emotionally, by exploring and addressing behavioral patterns and how they manifest. It is thus non-invasive, non-medical, and extremely flexible. As we’ll outline in later sections, CBT has many forms, which follow different approaches and combine with different methods.
Should you need more specifics here, VeryWellMind offers the following definition of CBT:
“[CBT] is a type of psychotherapeutic treatment that helps people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior and emotions. [It] focuses on changing the automatic negative thoughts that can contribute to and worsen emotional difficulties, depression, and anxiety. These spontaneous negative thoughts have a detrimental influence on mood.
Through CBT, these thoughts are identified, challenged, and replaced with more objective, realistic thoughts.”
PositivePsychology also defines it as follows:
A brief history of cognitive behavioral therapy
With this in mind, cognitive behavioral therapy in drug addiction treatment is relatively new. The practice’s history did not primarily revolve around SUDs specifically until dual diagnosis principles paved the way for such applications.
Still, here we may cover the fundamentals of its rich history through specific key dates and developments.
- 1913; behaviorist John B. Watson laid the foundations for behavioral psychoanalysis.
- 1938; a treatment for youth enuresis (Bolla, Sartore, & Correale) saw an initial, albeit controversial at the time, application of behavior therapy (BT).
- 1950s; Albert Ellis began practicing Rational Emotive Behavior Therapy (REBT), seeking to help patients rationalize their worldviews.
- 1960s; considered the father of CBT by many, Dr. Aaron T. Beck carried out psychoanalytic experiments and began categorizing cognitive distortions. The AAC notes that “CBT originated when Beck’s perspective changed on mental health conditions from viewing depression and anxiety as mood disorders to viewing these conditions as cognitive disorders”. The work of Joseph Wolpe and Arnold Lazarus also helped CBT thrive during this time.
- 1970s; CBT continued to find new applications through trial-and-error, particularly as higher functioning patients started receiving treatment.
- 1991; Clark & Watson’s Tripartite Model emerged, offering a new lens through which future CBT treatments would improve further.
- 2000s; as empirical studies such as Gaudiano’s (2008) contested CBT literature, a new “third” wave of acceptance-based CBT emerged and continues to develop. It is this wave that largely informs the applications of cognitive behavioral therapy in drug addiction treatment today.
Across its evolution, CBT has consistently focused on the “cognitive triangle”, as DrugAbuse defines it:
If you would like a deeper dive into the history of CBT, PositivePsychology offers an excellent, thorough analysis of it.
Forms and Types of Cognitive Behavioral Therapy
With the above context in mind, then, we can now more easily explore the different types and subsets of CBT. While many variations exist today, and see different uses, the 4 primary ones include the following:
- Cognitive therapy; the “core” principle of CBT, cognitive therapy has evolved in strides since its inception by John B. Watson. Today, it focuses on identifying disruptive, inaccurate, and harmful thinking patterns and behaviors, addressing them to assist in recovery.
- Multimodal therapy; a type some argue was born of Clark & Watson’s Tripartite Model, multimodal therapy identifies psychological intersectionality. Namely, it identifies 7 modalities as sources of psychological disorders; behavior, affect, sensation, imagery, cognition, interpersonal factors, and drug/biological considerations.
- Rational Emotive Behavior Therapy (REBT); rooted in Albert Ellis’s REBT, this type of CBT still seeks to rationalize irrational beliefs. Through active challenge, it seeks to make the patient aware of harmful thought patterns so they can change them.
- Dialectical Behavior Therapy (DBT); finally, DBT leans into dialectic therapy to best address cognitive disorders. As it does, it focuses on emotional regulation and mindfulness to best integrate with other therapeutic strategies.
Still, those are only the basics for text economy. For example, Deepanjali Deshmukh identifies a 5-area model instead of the traditional 7 in ResearchGate:
Such variations, as well as multiple subsets, can be found across treatment types and programs, each with its own goals – as we’ll cover later.
What Cognitive Behavioral Therapy is Not
Evidently, cognitive behavioral therapy in drug addiction treatment and other treatments remains an invaluable asset for therapists. However, there is still a decent amount of confusion on what CBT is not. So here we may briefly outline what CBT is not, and what it cannot do:
- Psychoanalysis; as AAC’s DrugAbuse notes, CBT is not psychoanalysis. Psychoanalysis is a “Freudian approach [which] aims to get at the bottom of subconscious determinants of your actions/behavior”. Although potentially useful in its own ways, psychoanalysis only partially overlaps with CBT in intended outcomes.
- Person-centered/ humanistic therapy; similarly, as DrugAbuse also notes, CBT is not “person-centered” in an academic sense. CBT involves active cognitive therapy, whereas “this approach involves a mostly-passive therapist that says little during sessions in an attempt to have you resolve your issues independently”.
- Universally accessible; while very flexible in its forms and applications, CBT is very structured. It requires cooperation, awareness, and willingness, which not all SUD cases offer. As VeryWellMind notes, “it is often best-suited for clients who are more comfortable with a structured and focused approach in which the therapist often takes an instructional role”.
- A substitute for medical assistance; finally, CBT can also not replace medication when needed, such as medically assisted treatment (MAT). It can synergize terrifically with pharmacological treatments, but not often replace them.
In brief, cognitive behavioral therapy in drug addiction treatment should not be mistaken for what it is not. It offers ample benefits as it stands, so it should not be misunderstood or overestimated in scope or application.
Benefits and Advantages of Cognitive Behavioral Therapy
To illustrate this, let us now outline some of the key benefits and advantages of CBT. In no particular order, the primary ones include the following:
- Cognitive awareness. As its explicit goal, CBT makes the patient aware of negative, harmful, and simply inaccurate thoughts and worldviews. In doing so it aligns with the 12 steps of Alcoholics Anonymous (AA) as regards acceptance prior to recovery. This characteristic allows it to integrate with other therapies as well, as AA’s 12 steps are the basis of many.
- Flexibility. Because of its expansive scope and principle variety, as we outlined above, CBT can flexibly address many different disorders. It thus offers an excellent tool toward therapy personalization, helping address each patient’s unique needs.
- Short-term effectiveness. In addition, CBT has been found to have positive effects relatively early during therapy. In the aforecited article, VeryWellMind finds that “improvements can be seen in five to 20 sessions”. Such short-term effectiveness can, understandably, accelerate other concurrent treatments as well.
- Affordability. As regards costs, too, CBT is far from costly – typically costing less than many other types of therapy. In the US, the Affordable Care Act’s Medicaid benefits now cover CBT as well, as we’ll see later.
- Remote viability. Finally, similar to other types of counseling and talk therapy, CBT has also demonstrated effectiveness even in remote settings. This also expands its potential applications to online therapies.
That said, cognitive behavioral therapy in drug addiction treatment cannot substitute for psychotropic medication where it is needed. Where it can be employed, however, it has also shown remarkable potency toward recovery from SUDs.
Goals of Cognitive Behavioral Therapy
Finally, before delving into our main subject, here we may outline the exact goals of CBT. These are virtually universal, including for drug addiction treatment and SUB treatment, so doing so here will provide a solid foundation moving forward.
With equal brevity, the 3 primary goals of CBT are as follows:
- Mental recovery; by accepting, challenging, and ultimately changing harmful and untrue thnking patterns, patients should achieve mental health improvements.
- Self-reliance; through self-assessment and self-help tools, patients should acquire risk management tools and knowledge to remain self-reliant throughout rehabilitation and beyond.
- Communication improvements; after extensive introspection and talk therapy, patients should achieve better communication which further assists in maintaining substance abstinence.
Should we identify risk management as the core CBT goal, the 3 following steps compose its principal core:
- Recognize; the patient identifies everyday triggers that can lead to substance use or trigger depression.
- Avoid; the patient consciously removes themselves from these situations or prevents them from happening entirely.
- Cope; the patient uses their newfound tools to cope with negative emotions, cravings, and other signs of addiction.
Newmarket Therapy Centre consolidates these into the “3 C’s of CBT”:
Techniques of cognitive behavioral therapy
To achieve these goals, cognitive behavioral therapy in drug addiction treatment typically employs the following techniques in order:
- Problem identification. First, patients must begin with introspection. Acquiring the ability to identify negative thought patterns can be extremely challenging for some, but is the cornerstone of CBT.
- Practicing new skills. Then, beyond theoretical practice, patients need to practice relapse prevention and coping skills before applying them to real-world situations. With proper guidance, this continuous process rarely presents many challenges for most.
- Setting goals. Still with unrelenting guidance by one’s therapist, the patient then learns to both set and evaluate goals. These will include short-term goals, such as maintaining abstinence for another set period of time, and long-term goals, such as career advancements.
- Applying problem-solving skills. Alongside coping skills, patients should acquire problem-solving skills they can put into action. These will typically still revolve around tackling psychological and emotional challenges, such as momentary distress and longer periods of stress.
- Self-monitoring. Finally, patients should have developed sufficient self-awareness, willingness, and mental fortitude to continue to self-monitor after rehabilitation. This continuous process should include documenting symptoms, feelings, thoughts, and behaviors, and communicating them to one’s therapist. While also likely challenging, robust aftercare programs with enough open communication channels typically assist CBT in this regard.
Again, much like above, these techniques may need to differ to suit a patient’s individual needs. As robust as CBT’s framework is, personalization lies at its core.
Cognitive Behavioral Therapy in Drug Addiction Treatment
Within these contexts, then, CBT finds ample applications in drug addiction treatment. To explain this in due depth, here we may first cover its uses throughout different stages of addiction treatment.
#1 Inpatient programs
The initial phase of most treatments, inpatient programs call for clinical settings to ensure a safe and closely monitored environment. During such programs, patients will typically receive:
- Medically Assisted Treatment (MAT), if needed
- Medication management assistance
- Continuous monitoring by qualified clinicians and psychotherapists
- Counseling, typically through individualized therapy sessions
- Nutritional support and education, if needed
At this initial, crucial stage, CBT can see fundamental applications toward providing psychological support. As patients struggle with withdrawal symptoms, psychological and emotional support is often invaluable toward ensuring successful detoxification. Patients typically cannot develop coping skills at this stage, but continuous CBT applications in later stages can often begin here.
Notably, programs for inpatient rehab Boynton Beach treatment centers offer will also typically follow this model. As they do, they may bridge inpatient programs with outpatient ones through the Florida model, as we’ll cover next.
#2 Outpatient programs
Outpatient programs are where cognitive behavioral therapy in drug addiction treatment can truly begin to thrive. Now in residential settings, patients are much more capable of reaping the benefits of CBT.
For clarity, outpatient programs typically come in the following 3 types:
- Intensive Outpatient programs (IOPs); the most intensive type of outpatient programs, as the name suggests, IOPs entail strict supervision. Patients do relocate to residential settings, but continue to receive intensive care and therapy to help ensure a successful rehabilitation.
- Florida model programs; a hybrid between inpatient programs and IOPs, the Florida model also allows for residential relocations. However, it also offers Day/Night inpatient treatment options, should a patient need them.
- Outpatient Programs (OPs); finally, the typical outpatient program type is simply OP, which tones down the offerings of IOPs. OPs are typically reserved for patients who show great success toward rehabilitation, and thus require less strict supervision.
Typically, almost any IOP Palm Beach treatment providers offer comes with some form of CBT. This is simply because most types of outpatient programs still deal with highly functional, post-detox patients who can embrace it. At this stage, patients participate in rigorous group therapy and individualized therapy sessions, which offer ample room for CBT.
#3 Aftercare programs
The final stage of addiction treatment, the typical aftercare program primarily focuses on relapse prevention, emotional support, and personal growth. Here, cognitive behavioral therapy in drug addiction treatment can shift its goals from developing initial coping skills to achieving long-term, self-sustained recovery.
Aftercare programs do differ quite significantly across treatment providers. However, they typically include an alumni program which can facilitate:
- Open communication channels; arguably the primary goal of such programs, open communication channels seek to offer post-rehab support. These can include social media groups, chat application groups, phone lines, and others. In all cases, communication is paramount – and in our context, a key component of CBT’s self-monitoring practice.
- Opportunities for socialization; another common goal of aftercare programs lies in socialization, as SUDs thrive on isolation and depression. To achieve this goal, aftercare programs will typically offer regular outings, where past and present patients can meet and socialize. This kind of CBT-minded peer support has often been found to substantially assist in reducing the chance of relapse.
- Continued support group therapy; finally, aftercare programs will in most cases include attending group meetings, which is where rehabilitated individuals can truly practice, hone, and maintain their self-reliance skills acquired through CBT.
In brief, inpatient programs lay the foundations for CBT through an introduction while in clinical settings. Then, IOPs and OPs leverage CBT to its full extent, offering patients the support and personal growth they need. Finally, aftercare is where the individual can truly put their skills to the test and ward off relapse, cementing success.
Applications of Cognitive Behavioral Therapy in Drug Addiction Treatment
While the above should cover the fundamentals, now we may delve deeper into how exactly CBT finds its many applications. For the sake of text economy we’ll keep this section brief, while still outlining the essential information you may need.
Combined with other therapies
First, CBT finds near-inherent synergies with other types of therapies used in drug addiction treatment. To illustrate this, consider the following:
- Dual diagnosis. Initially, dual diagnosis helps identify co-occurring mental disorders. In doing so, it helps therapists and patients cooperate toward identifying and addressing underlying addiction causes. Indeed, mental health issues do overlap with addiction somewhat, and one can fuel the other. In this context, CBT provides an excellent therapeutic tool toward a successful recovery.
- Trauma therapy. Similarly, trauma therapy also explores underlying causes of SUDs in past trauma and seeks to address them. Fortunately, and in large part by design, trauma therapy intersects with CBT somewhat. Using techniques of both in combination can substantially improve recovery rates, as well as help prevent relapse.
- Holistic treatments. Another frequent characteristic of SUD treatment, holistic therapy also leans heavily into the patient’s mental wellbeing. Typically applied in IOPs and beyond, holistic therapy offers fertile ground for psychological introspections and self-improvement. In this context, CBT principles can apply to psychotherapy of multiple types, serving the same ultimate goal.
- Group sessions. Finally, group therapy sessions arguably offer the best applications of cognitive behavioral therapy in drug addiction treatment. In fact, group therapy will often explicitly include CBT models right from the start. Group sessions focus on psychoeducation, life skill acquisition, and emotional support, among others, leveraging group dynamics to do so. CBT overlaps with these goals and techniques substantially, and can fuel 12-step recovery groups, emotional management sessions, and a wealth of other self-improvement activities.
While only rudimentary examples, those should best illustrate how well therapy providers can weave CBT into established therapy models. These too, as highlighted above, can follow the patient’s journey to recovery across each stage in appropriate forms.
Combined with therapeutic activities
Second, CBT can also significantly overlap with other therapeutic activities. This is a quite expansive term and therapy group, so here we may divide it into 2 main subsets.
First, across all stages of addiction treatment, individual therapeutic activities that help the patient heal are encouraged. These depend on what the patient can bring to each treatment center, but will often include diary-keeping, journaling, and similar activities. These activities can directly assist CBT, by encouraging the patient to self-monitor and communicate their progress.
Then, typically in OP settings, patients will often engage in group therapeutic activities that strengthen social skills. These will vary, but often include outings, barbeques, team sports, art therapy, and similar activities. Where earlier ones can help cultivate CBT, these offer an excellent setting where the patient can practice and thrive socially.
Granted, exact combinations with CBT principles and practices will indeed vary considerably. Still, there is both ample ground and enough incentives to do so, as the benefits are substantial.
Is Cognitive Behavioral Therapy in Drug Addiction Treatment Effective?
On that note, let us conclude with some much-needed reassurance. CBT may sound foreign, largely theoretical, and perhaps too idealistic. To the average person it may sound like jargon with little use and questionable potential benefits at best. This is perfectly understandable – but rest assured it’s far from the case.
Cognitive behavioral therapy in underlying, co-occurring mental health disorders
First, consider how Center for Personal Growth identifies CBT as the “gold standard” for mental health disorder treatment:
This factor alone should help illustrate the efficacy of CBT for drug addiction treatment as well. The dual diagnosis principle finds considerable overlap between the two, including in relapse probability, so CBT offers fundamental benefits from the very first stages of treatment to the last.
Cognitive behavioral therapy in drug addiction treatment and SUDs
But even without this element in mind, ample research has documented CBT’s demonstrable effectiveness toward SUD treatment. In our context, benefits of cognitive behavioral therapy in drug addiction treatment in particular have been proven time and again.
Take R. Kathryn McHugh, Bridget A. Hearon, and Michael W. Otto, for example, whose research published in NIH finds that:
“[CBT] for substance use disorders has demonstrated efficacy as both a monotherapy and as part of combination treatment strategies. […]Evidence from numerous large scale trials and quantitative reviews supports the efficacy of CBT for alcohol and drug use disorders. […]Evidence also supports the durability of treatment effects over time.”
To demonstrate this point further, they later also note that:
“Studies evaluating the relative efficacy of different cognitive-behavioral approaches for SUDs have yielded equivocal results with regard to the relative benefits of these approaches for drug use outcomes. […] However, results of effect size analysis across treatment trials provide support for the most robust treatment effects for contingency management for drug use.”
They do recognize the remaining challenges with CBT, of course, as it is an evolving field – as we outlined above. Still, their findings leave little room for doubt; CBT evidently works, and it can indeed help ensure a successful recovery from drug addiction.
Cognitive Behavioral therapy is A Game Changer
To summarize, cognitive behavioral therapy in drug addiction treatment can help patients cope with withdrawal symptoms, understand their deeper psychological challenges, and adjust their mindsets to facilitate recovery.
This non-invasive type of talk therapy can complement an array of established treatment practices across all rehabilitation stages. It can inform trauma therapy, fuel holistic therapies and introspection, and augment emotional support practices. Across its different forms, it offers patients an array of tools they can use to achieve self-reliance and personal growth.
While by no means a standalone miracle treatment, CBT presents new opportunities to personalize treatments and help ensure success. At Bright Futures Treatment, CBT has been an invaluable asset toward fulfilling our mission, and an integral part of our treatment services.