Alternative Alcoholism Treatment C.B.T.
Medically Reviewed By Nicole Arzt | Last Edited : February 06 2021| 4 Sources
What is cognitive behavioral therapy and is it an effective stand-alone treatment for alcoholism?
Cognitive behavioral therapy is perhaps the best-known and most-practiced of the behavioral therapies.
It is already used in the treatment regimens, both explicitly and
implicitly, of many alcoholism treatment centers, and is also utilized
by support groups set up to support those looking for help with their
Both treatment centers and support groups use CBT alongside other therapies/medications and counseling. What we want to examine on this page, however, is the possibility of using only cognitive behavioral therapy, that is, as an alternative alcoholism treatment.
Does CBT have the potential to be a stand-alone alternative alcoholism treatment or does it need to be used as part of a treatment regimen to be effective?
What Is Cognitive Behavioral Therapy?
Cognitive behavioral therapy tries to understand how an individual's learning has occurred. This therapy focuses on the connection between thoughts, feelings, and behaviors.
Our behavior is learned, we are not born to behave in a certain way. Put simply, some of the behavior we learn is 'good' and other behavior is 'bad' or 'maladaptive'
. Once you identify the thoughts driving a specific behavior, you can learn to challenge those thoughts.
A therapist using CBT will, firstly, attempt to help you understand the reasons for your 'bad' behavior and why you developed such a negative response to certain 'triggers'.
The second, and arguably more important goal of CBT, is to identify and learn better responses, or coping strategies, for the triggers.
An Example Of CBT in action
You, for example, may suffer from stress. In order to unwind after a bad day you have a drink which relaxes you. You learn that alcohol relieves stress. Over time you become dependent on this drink to relax, before long you are having two, three, a bottle. Your wife complains you are drinking too much, the relationship suffers. Hangovers become common and you get into trouble at work ultimately being made redundant. This causes more friction with your wife and so on.
, using your testimony, will help you identify the reasons for your drinking; you learned that alcohol relieved stress, and every time you drank to ease the stress, the idea that drink relieved stress was reinforced. However, over time drink no longer fulfilled this function, in fact it created more stress. Despite this you continued with the behavior becuase of the 'maladaptive learning process'
Having identified the reason for the behavior you and the therapist would then identify coping skills that could be utilized to deal with stress in the future. Skills that didn't involve drinking.
This is a rather simplistic example, but I think it illustrates how cognitive behavioral therapy can work.
Coping Skills For Alcoholics
As pointed out above, one important role of CBT, is to identify and practice coping skills
that can replace undesirable behavior. In the case of alcoholics this undesirable behavior is using drink as a response to triggers.
Monti,P.M., Abrams,D.B., Kadden, R.M., & Cooney, N.L.
in their manual, Treating Alcohol Dependence: A Coping Skills Training Guide
list 14 coping skills areas
. Alcoholics are usually deficient in a number of these and as a result have been using alcohol as a coping strategy (Please note that this list of areas is not exhaustive).
These 14 coping skills can be split into two categories, namely intra-personal and interpersonal. The former are those that involve the alcoholic alone, and the latter where at least one other person is involved.
- Intra-personal Skills
- Managing Thoughts And Cravings For Use
- Anger Management
- Negative Thinking
- Pleasant Thinking
- Relaxation Skills
- Decision Making
- Planning For Emergencies
- Interpersonal skills
- Drink Refusal
- Refusing Requests
- Handling Criticism
- Intimate Relationships
- Enhancing Social Support Network
- General Social skills
The therapist will, with the client, identify the coping skills that need to be worked on and then through various methods, including role-play will practice them. The alcoholic will ultimately gain 'fluency' in these coping skills by learning them through a process of reinforcement.
The idea is that in the future, when the recovering alcoholic is out in the real world, they will automatically reach for a coping skill rather than a drink
, when a particular trigger situation occurs.
CBT also focuses on other important skills, such as:
- Relaxation training (deep breathing, mindfulness)
- Pleasant activity scheduling
- Social skills
- Positive affirmations
- Challenging self-fulfilling prophecies
To reinforce and strengthen these skills, many therapists assign homework in between sessions. For example, you might be instructed to practice using a new coping skill every evening for one week. Or, your therapist might encourage you to track your emotions and thoughts to gain insight into specific patterns.
How Effective Is CBT As An Alternative Alcoholism Treatment?
CBT seems, then, to offer an alternative alcoholism treatment, one that does not require belief in a higher power but a belief in the individual's ability to change behavior through the adoption of coping skills. If you believe in a higher power, CBT can work along with any spiritual beliefs.
But what do the statistics say as to its effectiveness as a stand-alone treatment:
Richard Longabaugh and Jon Morgentsen
(1998) looked at 39 studies that compared Cognitive Behavioral Therapy with other alcoholism treatments.
11 of these studies looked at the effectiveness of CBT compared with other stand-alone approaches (the measure of effectiveness was the amount of patients who managed to stay sober for a year after the treatment regimen). 10 of the comparisons revealed no significant difference between the approaches. In short, CBT is no better or worse than other treatments for alcoholism.
Do these results mean CBT is not a good alternative alcoholism treatment? On the contrary, it means that those who find it difficult to accept 12-step treatment have a viable and equally effective alternative
. One that focuses on the power of the individual to change, not on a higher power.
Even better news
is that Longabaugh and Morgentsen also looked at studies that examined the effectiveness of alcoholism treatment programs (using many different approaches) that had CBT as a component. Their conclusions were that these treatment programs were far more effective than others that didn't use CBT.
Today, many practitioners and treatment facilities teach CBT in both group and individual therapy. It’s known as an evidence-based care model, which means research continues to back its effectiveness.
Lead Writer/Reviewer : Kayla Loibl
Licensed Medical Health Professional
I am a Mental Health Counselor who is licensed in both New York (LMHC) and North Carolina (LCMHC). I have been working in the Mental Health field since 2015. I have worked in a residential setting, an outpatient program and an inpatient addictions program. I began working in Long Island, NY and then in Guelph, Ontario after moving to Canada. Read More
Cognitive-Behavioral Therapy for Substance Use Disorders provided by the US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/.
Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine) provided by the National Institute on Drug Abuse: https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/cognitive-behavioral-therapy.
Alcohol Abuse Provided by the Association for Behavioral and Cognitive Therapies: https://www.abct.org/Information/?m=mInformation&fa=fs_alcohol.
Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults with Alcohol or Substance Use Disorders provided by Jama Network: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767358.
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