An estimated 16 million individuals in the United States have an alcohol use disorder (AUD), colloquially referred to as alcoholism. These 15.1 million adults, ages 18 and older, and 623,000 adolescents between the ages of 12 and 17, put themselves at risk of serious health problems, including blackouts, falls, car accidents, alcohol poisoning, liver damage, and some cancers. Abusing alcohol is very harmful, so finding a rehabilitation program that can help with medically supervised detox and evidence-based talk therapy is crucial to overcoming AUD.
One of the most popular, and successful, therapeutic approaches to treating AUD is Cognitive Behavioral Therapy. This approach to psychotherapy can work in both individual and group sessions. It has been applied to substance use disorders like alcohol addiction, as well as to co-occurring addiction and mental health problems.
What Is Cognitive Behavioral Therapy, and How Does It Treat Addiction?
Cognitive Behavioral Therapy (CBT) was developed as an approach to treating problem drinking, so it has long been shown to be successful in helping those with alcohol use disorders and alcohol dependence overcome these struggles. The underlying theory in this approach is that maladaptive behaviors like substance abuse come from the individual’s learned beliefs and coping mechanisms. Experiences earlier in life can lead to soothing behaviors or negative thoughts, and identifying these is the first step in changing them. The therapist will then work with their client to change behavioral responses to negative thoughts or emotions, which helps to reduce the risk of relapse.
During treatment for a condition like AUD, for example, a therapist may help their client confront the struggle with alcohol by considering the negative impact on relationships, physical health, and career if the person continues to drink too much. Then, the therapist will guide the individual through managing discomfort like cravings for alcohol and choosing healthier behaviors instead.
Because the focus of CBT is on specific behavioral changes, and practicing these changes before applying them to a real-world scenario, people who work with CBT during alcohol and drug rehabilitation typically maintain these skills after treatment has been completed. As CBT is goal-oriented, too, most people attend sessions for a short time. Generally, it’s about 12-16 sessions in all, although the person may attend more if they feel they need to change other behaviors, or they need ongoing support to keep working on change.
When applied in combination with other treatment approaches, including support groups, complementary medicine, and medication-assisted therapies, CBT works well for most people. As an approach to psychotherapy, it can be adapted to a wide range of clients, including those with co-occurring mental health struggles.
During CBT treatment, the therapist will guide their client through:
- Planning time to engage in non-drug-consuming behavior
- Leaving a situation in which there is drug abuse or consumption
- Learning about their external and internal triggers, like places or emotions that lead to cravings or compulsive behaviors
This form of therapy can develop behavioral changes like:
- Creating a planned schedule of low-risk activities
- Recognizing high-risk situations that could lead to substance abuse and avoiding them
- Coping with a wider range of problems associated with substance abuse
- Understanding what relapse is and learning methods to avoid this condition
The three foundational approaches to learning and conditioning in CBT are:
- Classical conditioning: When particular events or objects are paired, the presence of one can force the recall or craving for the other. For example, planning a party may induce a craving for alcohol because of an association between drinking and socializing. Understanding and avoiding cues for substance abuse is an important early step in the recovery process.
- Operant conditioning: Once the triggers for cravings or compulsive behaviors are found, developing strategies to avoid these triggers and manage emotional response can change behaviors. For example, if a person is triggered to crave alcohol by a specific place, they can leave and take a walk through a nearby park instead. The walk should release some endorphins and dopamine, improving mood. Positive reinforcement, such as praise, for avoiding relapse into alcohol abuse can also reinforce these behaviors through elevated mood and self-esteem. Punishment, such as incarceration, is a negative reinforcement tool.
- Modeling: Following the example of another person who has successfully overcome alcohol abuse can help the person understand the process of recovery, so they can copy that behavior. In Alcoholics Anonymous (AA), a person must find a sponsor – someone who has gone through the program successfully – to guide them through the 12 Steps. This is a form of modeling. This approach also works well for adolescents who are used to modeling social behaviors of adults.
Populations That Benefit from CBT Approaches to Alcohol Abuse
The Veterans Administration (VA) found that veterans who attended CBT sessions to overcome AUD reported that they better managed cravings and urges to consume alcohol; they felt more skilled at problem-solving; and they were more committed to changing behaviors and maintaining these changes.
Like other CBT sessions, VA hospitals providing substance abuse treatment will typically schedule therapy sessions about once per week, for one hour, with 12 sessions recommended. Each session includes a review of any lapses into abusing alcohol or drugs since the previous session; a summary of the previous session; reviewing completed homework, including its effectiveness or ineffectiveness; and determining new homework for the next week.
Although more men than women, in general, struggle with alcohol abuse, CBT appears to work particularly well for women working to overcome AUD. In a 12-week, female-specific study, both group and individual CBT sessions were found to be equally effective in overcoming alcohol abuse. Participants reported feeling better about their lives, their ability to manage stress, and satisfaction with their health.
Again, Cognitive Behavioral Therapy has been shown to be effective for most demographics. As a result, it is a widely used therapy in alcoholism recovery.