Alternative alcoholism TreatmentWhat 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 drinking.
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. 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'.
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.
A therapist , 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.
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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.
Managing Thoughts And Cravings For Use
Planning For Emergencies
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.
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.
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.
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Deborah Morrow, M.S. Addiction Psychology, is the director of treatment programs for The Alcoholism Guide website. In her practice, Deborah provides on-line coaching and support for those dependent on alcohol or who require other services such as relapse prevention or court mandated services. (Read More)