What is Cognitive Behavioral Therapy for Addiction?

BT is designed to help a patient become more self-aware and manage their own thoughts in a healthy way.
BT is designed to help a patient become more self-aware and manage their own thoughts in a healthy way.

Treatment centers and clinicians are increasingly tapping CBT techniques to help shift patients’ negative thinking

By Jason Langendorf

January 28, 2021

CBT—or cognitive behavioral therapy—is increasingly tapped for addiction treatment. But what is it?

Let’s go back more than 50 years, when a young psychiatrist at the University of Pennsylvania developed a theory and a therapeutic approach that strayed from much of his work in psychoanalysis up to that point. Aaron Beck found that many of his patients were stuck in a cycle of recurring and negative thoughts that influenced their actions and emotions, ultimately leading to a sort of symptomatic confirmation bias and more negative thoughts.

Beck’s mission—to help his patients change those negative thoughts—is believed to mark the origin of cognitive behavioral therapy (yes: CBT). Although the focus of his work at the time was on patients with depression, his research has led to a model and a movement that have influenced countless forms of psychotherapy, including that for addiction.

What Is Cognitive Behavioral Therapy?

At its core, CBT is a collaborative therapy in which a therapist and patient explore the patient’s negative thought patterns, identify unhealthy “automatic thoughts” (which are driven by emotion and often distorted) and work to build a framework the patient can use to arrive at more positive thoughts that lead to more productive actions. Put simply, CBT is designed to help a patient become more self-aware and manage their own thoughts in a healthy way.

The approach behind cognitive behavioral therapy is a departure from the psychoanalysis Beck had been taught in school. Rather than trying to deconstruct and “fix” a patient’s past—childhood trauma, toxic relationships, painful memories—CBT focuses more on the present. Thought patterns are often established early in life and then become relatively fixed. Beck believed in helping a patient recognize negative thought patterns and understand that they are often irrational and self-defeating.

Put simply, CBT is designed to help a patient become more self-aware and manage their own thoughts in a healthy way.”

A CBT therapist could then help the patient better navigate those thoughts, leading to more positive actions in the future. Loads of clinical trials over the years have proven him right.

Why Is Cognitive Behavioral Therapy Useful for Addiction?

The American Society of Addiction Medicine (ASAM) defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

Because the compulsiveness of a person with an addiction often mirrors the compulsive thoughts of many patients with depression—and, indeed, the two conditions are often co-occurring—it’s little wonder that cognitive behavioral therapy has come to be used to help treat patients with disorders across the addiction spectrum, from alcohol to the internet.

That said, it takes time and commitment for CBT to work. It’s not an instant-fix solution for addiction, cautions Cory Newman, Ph.D., director of the Center for Cognitive Therapy and a professor of psychology at the University of Pennsylvania’s Perelman School of Medicine. “When people habitually misuse a psychoactive chemical—whether it is alcohol, marijuana, benzodiazepines, stimulants, opioids, hallucinogens, or any other—they typically receive significant, immediate positive reinforcement (e.g., a sense of ‘high’) as well as powerful, immediate negative reinforcement (e.g., relief from negative emotions and/or withdrawal symptoms),” Newman wrote in a guest blog for the Beck Institute for Cognitive Behavioral Therapy.

“Even when people are motivated to change, these experiences are formidable opponents to healthier, more stable, more meaningful sources of gratification, such as the pride one feels in having the ability to say ‘no’ to urges, the satisfaction of having spent a productive day, and the trust of caring others, including therapists,” he wrote. “Thus, effective treatment is at once an uphill climb.”

Still, the efficacy of cognitive behavioral therapy in the treatment of addiction and relapse prevention is proven, and CBT has had similarly encouraging results when combined with pharmacotherapy.

How Cognitive Behavioral Therapy Works

Cognitive behavioral therapy is different from many other forms of psychotherapy because of its interactive and collaborative nature. In a CBT session, a therapist and patient work through the patient’s problems together. It’s a goal-oriented practice of “collaborative empiricism” (a term coined by Beck) that is meant to lead to a patient building a framework of understanding and positive coping skills they can apply to their life.

These sessions can be conducted one-on-one or in a group. They are generally intended to follow a finite timeline (usually about 20 sessions of 50 minutes each, conducted within the span of a year). Typically, a therapist would initially gauge a patient’s feelings about the future and depression symptoms using the Beck Hopelessness Scale and Beck Depression Inventory, a series of yes-or-no and multiple-choice survey questions. Then, during sessions, the therapist and patient would discuss the patient’s experiences, thought patterns and emotions, and how each influences the others. A patient might be assigned “homework,” such as writing in a journal or exercising specific CBT-based strategies.

CBT is based on the premise that our thought patterns can be our own worst enemies. For many of us, they predict bad outcomes and project negativity—often without good reason—and leave an individual fearing the worst.

CBT is designed to retrain the brain, especially useful for people with addictions, and help a patient to become more self-aware and face their fears.

By anticipating negative thoughts and learning appropriate coping skills to deal with them in the moment, CBT offers a strategy for changing unproductive patterns and helping a person avoid creating or exacerbating problems in their life.

To learn more about CBT or find a therapist, check out the Beck Institute for Cognitive Therapy and the Association of Behavioral and Cognitive Therapies.

Photo: Marco Testi