How Does Cognitive-behavioral Therapy Help With SUD?

Psychotherapy is one of the foundations of substance use disorder (SUD) treatment, along with medication-assisted therapy (MAT) and withdrawal management. While withdrawal management and MAT address the more immediate needs of SUD patients, psychotherapy is essential for helping maintain sobriety and improving the chances of long-term recovery.

Of all the available psychotherapy approaches used for SUD treatment, cognitive-behavioral therapy (CBT) is by far, the most widely used. If you or someone you know is about to receive treatment for a drug or alcohol use disorder, chances are CBT will be the first tool attending psychotherapists will reach for.

But given that several different psychotherapy approaches are available, why has CBT become so widespread in mainstream SUD treatment? What is it about CBT that makes it uniquely suited for this purpose? We’ll try to answer these and other questions below. If you’re in New England, get in touch with Boston Drug Treatment Centers for a full listing of certified drug rehabs in Boston that offer CBT and other psychotherapy approaches.

What is the premise of cognitive-behavioral therapy?

Cognitive-behavioral therapy assumes that individuals can control their emotions and actions by changing the way they think. In other words, negative thoughts are presumed to cause negative actions. By reframing these thoughts into something positive, better decisions and therefore better actions can be made.

While the classic Socratic method is the most common mode of implementation, CBT can be done in several ways. The main goal of most CBT approaches is to get recovering individuals off of self-defeating patterns of thinking, which should result in them being better able to manage cravings for their substance of choice.

What are the causes of negative thinking?

Negative thinking is a serious obstacle in overcoming SUD. Negative thoughts are self-reinforcing, causing people to develop a warped view of themselves and the outside world. Left unaddressed, these types of thoughts often sap at a person’s motivation to continue with treatment and recovery.

These thoughts can cause a person to be paranoid or to see nonexistent patterns. Even when there is proof of the opposite, individuals with negative thought patterns may believe themselves to be worthless or unloved and therefore continue to act self-destructively.

Continuous traumatic experiences can cause negative thought patterns. This is common in households and other environments where constant abuse is present. While individuals can be somewhat more resilient to single, one-off events, constantly experiencing small micro-aggressions and other kinds of abuse can strongly reinforce negative thinking.

These patterns can develop at any time in a person’s life. However, in many cases, negative thought patterns begin in childhood and adolescence. The reason for this is still not completely clear, but it may have to do with the brain still being in development in this period. Negative thought patterns are thus, possibly a kind of deep learning that could only be effectively addressed with therapy.

How can CBT help with SUD?

While it is not the only factor involved in SUD, negative thinking can do a lot to reinforce drug and alcohol use. Even if a person has already undergone a complete withdrawal from their substance of choice, the potential for relapse will always be present if the negative thoughts that cause the SUD remain unaddressed.

As mentioned earlier, a Socratic approach is most often used to implement CBT in an SUD treatment context. The attending therapist will first ask the patient about the patient’s beliefs concerning their substance misuse. They can then help the patient question their own beliefs and constructively reframe them. With regular sessions, the patient can then begin to see things more positively, which can improve their motivation to stay clean.

Limitations of CBT for SUD treatment

While CBT by itself could be used for milder forms of substance use disorder, moderate and severe SUD also needs to be treated through withdrawal management, MAT, or a combination of all these treatment approaches.

With worse forms of SUD, addressing negative thought patterns is not usually enough to safely get a patient through recovery. They may be facing potentially fatal withdrawal symptoms or a serious chance of relapse if they do not receive MAT or proper withdrawal management. This is especially relevant if the individual has an alcohol or opioid use disorder, as mismanagement of these conditions can lead to fatal withdrawal symptoms or an overdose upon relapse.

Standard CBT is also less useful for patients who have poor emotional regulation or are at risk of harming themselves or others. For these individuals, a specialized form of CBT called dialectical behavior therapy is usually recommended to help them better accept difficult situations and regulate their emotions. Once they are more stable, they may be treated with conventional CBT or some other psychiatric approach.

Learn if CBT is right for you

If you’re interested in CBT as part of SUD recovery or want to learn more about its other applications, you must see a qualified therapist before trying it for yourself. Seeing a mental health professional will help you better identify any potential blind spots in your self-assessment, which can lead to better results. They may also be able to recommend more appropriate approaches for your specific cases.

If you’re in New England, Boston Drug Treatment Centers can connect you with substance rehab programs and facilities that offer CBT and other psychotherapy approaches. Good luck, and be well!