Cognitive Behavioral Therapy (CBT) In Addiction Treatment: How Does It Work?

Pick almost any life struggle or mental health problem, and chances are there's research suggesting that cognitive behavioral therapy can help you with it. Addiction is no exception — but make no mistake. As a chronic brain disease often characterized by periods of remission and relapse, a disease that turns out to be progressive in too many cases, addiction isn't an easy beast to do battle with. It takes more than willpower. You also need help.

What is cognitive behavioral therapy?

Cognitive behavioral therapy helps you gain clear insights into the thought patterns and attitudes you have been carrying with you, sometimes without even realizing you had them. That is the "cognitive" part. Some of those thoughts and attitudes will be serving you well and are going to be based in reality — but others aren't.

Your thoughts are partly in charge of your behavior, but your behavior also governs your thoughts. A depressed person whose depression makes them socially isolate will feel even more depressed, for instance. In the case of addiction, your guilt about drinking, doing drugs, gambling, or whatever your addiction is, may be one of the very things that pulls you back in to go back for more. The "behavioral" part of CBT tackles your actions and helps you get settled into new habits. 

Cognitive-behavioral therapy is a practically-minded therapy that's excellent for people who want to solve problems they have right now, without necessarily getting into your whole life story. While it is usually a short-term therapy, involving something like eight to 12 sessions, there's no rule that you have to stop attending if the therapy is still helping you. 

CBT is something like "pulling yourself up by the bootstraps". Yes, you bet that you'll have help. Your therapist will be right there, equipping you with tools, like relaxation techniques, coping strategies, and insights. But you'll also have homework to do, and for CBT to work, you must be fully committed to the goal — in this case remission from addiction — and put in a lot of hard mental work. That starts with staying away from the substance or behavior you were addicted to, and making it to sessions, but it doesn't end there.

How has CBT been adapted to help addicts?

A variety of techniques has emerged specifically to help addicts and recovering addicts:

• Motivational intervention, which helps addicts identify obstacles towards sobriety or remission — and hopefully remove them. 
• Contingency management, in which addicts receive rewards for staying off their substance or away from their behavioral addictions. The chips people get in Alcoholics Anonymous would be one example. This approach is more effective for some addictions, like alcohol, cocaine, and opioids. 
• Relapse prevention helps addicts in remission recognize the triggers that make them want to use or engage in their behavioral addiction. It then teaches the addict to develop strategies to either stay away from the trigger, or to replace the urge to use with something else. Relapse prevention can also help you realize that the benefits of going back to your addiction in no way outweigh the negative consequences.

Your therapist will work with you to determine what approaches are best suited to your needs, starting with your first session, during which you discuss your problems and your goals.

How effective is cognitive behavioral therapy for addiction?

One study found that 60 percent of substance addicts had clean toxicology reports a year after starting treatment. However, research has also acknowledged that the addicts who participate in studies with high success rates often do so in the best possible treatment conditions. 

Cognitive behavioral therapy is not a cure-all. The risk of relapse is real and, depending on exactly what addiction you're looking at, often really quite high. Cognitive behavioral therapy can help addicts stay clean, sober, or in remission, but it's by no means guaranteed to work. If you or someone you care about is seeking treatment for addiction, know that CBT doesn't have to be a stand-alone treatment. In the case of alcoholism, for instance, treatment with the drug naltrexone may play another important role. So can peer-support groups, and other kinds of psychotherapy. In some cases, inpatient rehab will be required.