By the time Ronald got out of prison, he was 60 years old and willing to try anything to kick his opioid habit; even if that meant taking buprenorphine, which he had always figured was just another drug he’d get dependent on.

With little to lose after years in and out of detox and rehab facilities, Ronald gave buprenorphine a try to relieve his cravings and ease the symptoms of opioid withdrawal. What Ronald did not know is that he had another option to aid in his struggle with addiction. To his credit, he gave cognitive behavior therapy a shot as well.

Buprenorphine, combined with cognitive behavioral therapy, is considered the gold standard for treating opioid addiction. A year later, Ronald is clean, and he’s attending night school to earn his high school diploma. He feels free.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is a common form of psychotherapy that challenges the link between patterns of negative thoughts about oneself and society to change unwanted behavior patterns, such as addiction, or to treat mood disorders including depression.

Based on the principle that thoughts, feelings, and behaviors are interconnected, cognitive behavior therapy aims to reduce the potential for relapse by providing people in active addiction with the skills they need to identify behavior that triggers their abuse.

For example, people with alcohol addiction who want to stop drinking will learn to identify the triggers – thoughts, feelings, people, places, things – that make them crave a drink. Another trigger could be a party, where substance users might be influenced to take drugs to feel more relaxed among a crowd of unfamiliar people. CBT would address the coping strategies that substance users might use to avoid any of these problematic behaviors to prevent relapse and sustain abstinence.

Some of the techniques used in cognitive behavioral therapy include thinking through to the negative and positive outcomes of the continued use of alcohol and drugs or learning to recognize cravings before high-risk situations occur.

Specific strategies might involve:

  • Planning time to engage in an activity that is not alcohol- or drug-related;
  • Planning to avoid or leave an environment where drugs or alcohol are prevalent

CBT can be a beneficial tool ― either alone or in combination with other therapies ― in treating substance abuse. Like Ronald, many recovering substance users who combine CBT with medication, such as antidepressants, have remained sober long after detox and rehab.

What To Expect During Cognitive Behavioral Therapy

Cognitive behavioral therapy may be performed one-on-one or in groups with family members or others who have similar addictions and issues. In the early stages, students learn about their addiction and practice techniques, such as relaxation, coping, resilience, stress management, and assertiveness.

This might include developing a planned schedule of activities that present little or no exposure to drugs or alcohol. By recognizing and avoiding these high-risk situations, coping with behaviors associated with abusing substances becomes less difficult.

During CBT, substance abusers are encouraged to talk about their feelings to become more confident and comfortable with discussing their troubles.

Approaches are likely to include:

  • Identifying troubling situations including medical conditions, divorce, grief, anger or patterns of behavior leading to substance abuse
  • Sharing thoughts, emotions and beliefs about these problems
  • Interpreting the meaning of a situation, and the beliefs about oneself, other people and events, sometimes in a journal
  • Identifying negative or inaccurate thinking that may be contributing to the problem including physical, emotional and behavioral responses in different situations
  • Reshaping negative or inaccurate thinking into helpful thoughts and behavior patterns

Intervention Areas for Cognitive Behavioral Therapy

  • High-risk situations, such as people, places, things, and problematic moods
  • Dysfunctional beliefs about drugs, oneself, and about one’s “relationship” with drugs
  • Automatic thoughts that increase arousal and the intention to drink and/or do drugs
  • Physiological cravings and urges to use alcohol and other drugs
  • Beliefs that patients hold to “justify” their drug use
  • Rituals and general behavioral strategies linked to the use of substances.
  • Adverse psychological reactions to a relapse

Length of Cognitive Behavioral Therapy

CBT is generally considered short-term therapy that is divided into five to 20 sessions, depending on the personal needs of the individual in recovery and the therapist. Factors to consider include:

  • Substance(s) abused
  • Severity of addiction
  • Length of addiction
  • Progress
  • Stress levels
  • Support from family and friends

Risks Involved With Cognitive Behavioral Therapy

Cognitive behavioral therapy presents few risks, except for the discomfort or uneasiness associated with exploring painful feelings, emotions, and experiences. Recalling these thoughts can be physically draining. However, a skilled therapist will minimize any risks and help recovering substance users manage and conquer negative feelings and fears.

Confidentiality In Cognitive Behavioral Therapy

Except in very specific circumstances, conversations with a therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety or when required by state or federal law to report concerns to authorities.

These situations include:

  • Threatening to immediately or soon harm oneself
  • Threatening to imminently harm or take the life of another
  • Abusing a child or a vulnerable adult
  • Being unable to safely care for yourself

Results From Cognitive Behavioral Therapy

Cognitive behavioral therapy may not cure an addiction, but the treatment can provide the power to cope with situations in a healthy way and to feel better about oneself both presently and in the future. This type of therapy isn’t effective for everyone, but steps can be taken to get the most out of treatment and make the experience a success.

  • Approach therapy as a partnership with a therapist
  • Be open and honest about painful emotions
  • Stick to treatment plan schedules
  • Don’t expect instant results
  • Apply what’s learned in sessions to assigned homework
  • Advise your therapist if therapy isn’t helping

Why Should I Detox?

The best way to step away from an addiction and cleanse the body from alcohol and drugs is to begin detoxification, typically at a hospital or residential substance abuse facility. Depending on the health of the patient and the degree to which withdrawal symptoms have subsided, detox may be combined with holistic approaches to treatment, such as cognitive behavioral therapy to teach patients to identify negative emotions and potential triggers for abuse followed by coping strategies for handling these stressors.

What Is The Next Treatment Step?

Research tells us that addiction is a disease of both the brain and body. What steps you choose after detox to treat these afflicted areas will make or break your chances for sustained recovery. Patients dependent on drugs or alcohol who are most committed to recovery will continue treatment at a residential substance abuse facility where the unique issues and circumstances surrounding their addiction can be addressed.

During this stay, clients can take part in cognitive behavioral therapy and other approaches to treatment in group and one-on-one counseling, educational lectures, and workshops as part of a comprehensive recovery program.

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