For any substance or behavioural addiction, an understanding of the motivations behind the need to engage in the substance or behavioural addiction is essential for treatment to be successful. Cognitive behavioural therapy (CBT) is a treatment approach that helps to recognize a person’s behavioural patterns as well as their perceptions and cognitions about their addiction. Specifically, a person who has an alcohol addiction can use CBT as a treatment approach to help gather a more in-depth understanding of the individual’s thoughts and emotions in regards to their alcohol consumption. CBT treatment approaches for alcohol addiction can be implemented through internet-delivered CBT, skills training, and relapse prevention. Critically analysing the evidence on CBT treatment approaches by understanding what CBT is, how it is used for treatment, and how effective it is, leads to a better understanding of CBT and who would have a higher success rate when using this approach for treatment. Before considering if CBT is an appropriate method of treatment, it is important to evaluate what alcohol disorder is and the diagnostic criteria in which examines the nature of the condition. According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013), the definition of alcohol use disorder is a collection of physical, cognitive, and behavioural symptoms that may include but are not limited to elements such as withdrawal, cravings, and tolerance. The American Psychiatric Association (2013), continues by stating that individuals with alcohol use disorder continue with their consumption of alcohol despite the negative consequences it has on factors in the individual’s life such as their health and interpersonal relationships. According to Hadjistavropoulos, Mehta, Wilhelms, Keough, and Sundstrom (2019), alcohol causes harm to not only the individual that consumes the alcohol but also their community, as it is the third risk factor for disease throughout the world. Alcohol consumption has been associated with more than 60 somatic diseases such as cardiovascular disease, liver disease, and numerous cancers (Hadjistavropoulos et al. 2019). Brewer, Hani, and Davis (2013) explain that addictions have a substantial effect on an individual’s physical, mental, and economic health, as the economic tolls of alcoholism ranges as high as 6% of a country’s gross domestic product. This illustrates that alcohol use disorder affects a wide range of a person’s life (financial state), which puts a higher emphasis on finding an appropriate treatment approach to increase a person’s success rate. According to Kadden (1994), individuals rely on alcohol as their preferred choice of coping with problems or meeting personal needs, as positive experiences with alcohol consumption are repeated do to the effects of alcohol being fast and easy to achieve. CBT can be used to alter cognitive patterns, hopefully leading to maintained sobriety. Recognizing the most common antecedents (social, emotional, physiological, cognitive) for an individual is one of the main focuses of CBT, as it leads to the ability to disengage an individual’s connection with alcohol while teaching them different behaviours when responding to the antecedents (Kadden 1994). Another core element of CBT about substance use as stated by McHugh, Hearon, and Otto (2011), is aimed to diminish the reinforcing effects of alcohol consumption by increasing the contingency linked to not drinking, which is done by integrating reduction and abstinence skills that reward non-drinking activities.
The overall goals of CBT are the improvement of an individual’s general functioning, symptom reduction, and remission of the disorder (Hofmann, Asnaani, Vonk, Sawyer, and Angela, 2012). Hofmann et al. (2012), found that these goals can be accomplished through the individual being active when participating in a joint problem-solving process when challenging the validity of their maladaptive perceptions to modify their behavioural patterns. In short, CBT combines emotion-focused, cognitive, and behavioural techniques throughout the intervention process in hope that these strategies will help the individual cope with their substance use addiction. Knowing that CBT approaches for a substance use disorder can encompass a multiplicity of interventions that focus on different target behaviours is critical when deciding which treatment approach would have the highest success rate for a particular individual. When analysing CBT approaches for alcohol addiction, one example of a treatment that can be implemented is through internet-delivered CBT. Hadjistavropoulos et al. (2019) conducted a study where they incorporated material to evidenced-based CBT procedures for alcohol use disorders and delivered the intervention through the use of the internet. The CBT strategies were provided through modules and lessons and typically introduced relapse prevention to the individual (Hadjistavropoulos et al. 2019). Hadjistavropoulos et al. (2019) continue by explaining that internet cognitive behavioural therapy (ICBT) can be implemented with the guidance of a therapist (actively giving feedback, answering questions, discussing treatment content) or the intervention could be completely self-guided (guidance is only done by brief reminders being given to the client on what module to do next). Within Hadjistavropoulos et al. (2019) study, there were five main categories of modules: alcohol information (education of the effects of alcohol), preparing for change (motivational exercises for goal setting, stages of change), skills training (analysis of triggers, self-control, coping skills, social skills, problem-solving skills, relapse prevention), wellbeing (mindfulness, relaxation, exercise, nutrition), and lastly program components (drinking dairy, text/email prompts, blood-alcohol concentration). Individuals could gradually access the modules based on their readiness which was all determined by the therapist (Hadjistavropoulos et al. 2019).
Overall, Hadjistavropoulos et al. (2019) found that ICBT is an efficient form of CBT as it can overcome potential barriers like rural living situations as it is conveniently accessible for the individual, as well as how it addresses the concern of stigma for an individual who wants manage their issues in the most private manner possible. To some of the CBT elements that were discussed above, skills training is one of the many intervention concepts used when addressing alcohol use disorder. Kadden (1994) believes that coping skills training addresses an individual’s behavioural discrepancies, consequences of drinking, and their responses to antecedents when analysing their alcohol addiction. Even though an individual can rarely express exactly what is causing them to drink, Kadden explains that they can identify environmental or personal events that drinking follows through a structural assessment or clinical interview. Knowing this information clarifies the role drinking plays in an individual’s life, which then guides the intervention efforts for changing their behaviour through intrapersonal or interpersonal skills (Kadden, 1994).
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According to Kadden (1994), events such as thoughts of alcohol and cravings can be altered by the individual learning intrapersonal skills such as listing activities they could participate in to distract themselves until craving past, or challenging their thoughts of alcohol by reviewing the risks alcohol has on their life. Coping skills such as problem-solving, decision making, stress management training, systematic desensitization, and cognitive strategies can all be effective for the individual as it gives them the ability to cope and anticipate the consequences of their behaviours (Kadden, 1994). Interpersonal skills as stated by Kadden (1994), can be evaluated by a functional analysis as it identifies an individual’s problematic behaviours when interacting with others. For alcohol use disorder, individuals have to learn to resist forms of peer pressure from the people around them and learn how to communicate their emotions through conversations and body language by being assertive and refusing requests to drink (Kadden, 1994). Interpersonal skills also involve the individual learning how to handle negative emotions such as criticism, to decrease the ability of relapse brought on by these emotions (Kadden, 1994). Also, skills training involving intrapersonal and interpersonal skills are beneficial for an individual to apply to their everyday life when trying to prevent the chance of relapse within their substance use addiction. Another element of CBT that is beneficial for a treatment approach to alcohol use disorder is relapse prevention. According to Kadden (1994), relapse prevention is similar to the treatment approach of skills training as it engages in many of the same methods. However, in contrast to skills training, relapse prevention focuses more closely on analyzing the relapse process by ensuring that the intervention can identify behaviours that need to be strengthened to maintain long-term sobriety (Kadden 1994).
McHugh et al. (2011) explain the importance of identifying high-risk situations such as friends or environments that an individual will more likely be susceptible to engage in alcohol use. Relapse prevention interventions look to modify an individual’s lifestyle by providing them training within decision making and self-control, which will hopefully lead them to make more appropriate choices to avoid high-risk situations (Kadden 1994). Although CBT treatment approaches for substance use disorders differ depending on the substance that an individual is addicted to, research has shown positive results within CBT treatment approaches for alcohol use disorder. According to McHugh et al. (2011), CBT in general implements interventions that use learning-based approaches to target motivational and cognitive barriers as well as maladaptive behavioural patterns. In more specific terms, other considerations support the use of CBT in the early stages of an individual’s recovery process from alcohol use disorder, due to the individual experiencing cognitive impairments (Kadden 1994). Kadden found that due to these impairments, most research suggests that individuals would benefit from a more structured treatment approach such as CBT, as it reviews new skills – while breaking down learning new behaviours into small achievable tasks. However, due to no single treatment approach being found as effective for all alcohol use disorders, an increase in inpatient treatment matching is receiving more attention as a form of improving treatment effectiveness (Kadden 1994). By critically analysing the evidence on different approaches of CBT through internet-delivered CBT, skills training, and relapse prevention, a better understanding of the treatment is accomplished. In return this information allows for a higher success rate for the individual as the treatment can be tailored solely to their needs. For an individual with alcohol addiction, CBT is an effective form of treatment as it helps to develop in-depth perceptions of the individual’s thoughts and emotions that relate to their substance use behaviours. In conclusion, it is crucial to find the motivations of why an individual engages in any substance or behavioural addiction to provide them with the most appropriate treatment approach.
References
- National Center for Biotechnology Information: Cognitive-Behavioral Therapy for Substance Use Disorders
- Anxiety and Depression Association of America: Substance Abuse
- Verywell Mind: Dialectical Behavior Therapy for Addictions
- PubMed: Cognitive Behavioral Therapy for Substance Use Disorders
- National Center for Biotechnology Information: Cognitive Behavioral Therapy (CBT) for Substance Use Disorders
