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How Cognitive Behavioral Therapy (CBT) Breaks the Cycle of Addiction

Cognitive Behavioral Therapy, or CBT, has been posited by numerous studies(1) and mental health facilities(2) as an effective form of treatment for disorders ranging from substance dependency, anxiety, and depression to post-traumatic stress (PTSD). CBT has been shown to be effective both as a primary treatment, alone or in conjunction with medication, and in cases where medication has failed to yield satisfactory results. CBT treatment is regarded by many mental health professionals and organizations, including (3) the World Health Organization and National Institute of Mental Health, as the “gold standard” of psychotherapy.

CBT usually consists of a weekly one-on-one session with a therapist over a period of six to 12 weeks. The therapy focuses on addressing present negative thoughts and feelings, and, with the help of a therapist, enables patients to develop practical coping mechanisms to identify and then reframe the thoughts in order to generate a healthier, more positive outlook. Once the CBT skills are learned, they can be practiced outside the therapeutic relationship, and should be incorporated in daily routines. “Using CBT lets us work on the unhealthy thought patterns that lead us to substance dependency and other mental health issues, among other behaviors – we are killing two birds with one stone,” says associate marriage and family therapist Jessica Fieldman.

CBT sessions can take a number of different forms and employ different tools, depending on the patient’s particular needs. While talk therapy is the most common way for individuals to begin CBT, there are other formats that may provide similar tools and results to that application, including group therapy, videos, books, computer software and web sites. The growth in popularity of CBT can be attributed in part to its reduced time commitment, compared to other modalities. In fact, CBT treatment can be completed in as few as five to 20 sessions. But CBT also offers a variety of other benefits, including ones that can be of immense value to patients struggling with addition.

CBT presents the patient with real-world skills that can be applied directly to the internal responses – thoughts, emotions, physical reactions, and dependency-related behavior, including high-risk behavior, cravings and urges, “permission-giving beliefs” and adverse psychological reactions to a relapse or slip (3A) – that are making them feel unable to progress in their lives. “Once a person recognizes that the thoughts they have are creating negative consequences, CBT becomes an effective mechanism in transforming these negative feelings and thoughts,” says Angela M. Rukule, M.S.Ed. M.F.T. and clinical therapist at Inneractions. “A negative mindset can change into a different way of thinking, offering opportunity for change. Instead of jumping to conclusions, the client can be offered a less anxiety-producing way to evaluate a situation fully. Removing the need to catastrophize each situation allows the client to approach difficult problems with more openness and far less panic.”

Additionally, CBT has been very effective when employed in conjunction with medication, or when prescription treatment alone has not yielded positive results. A study(4) conducted by researchers from the Family Institute at Northwestern University found that recovery rates for patients with recurrent and severe depressions who received both CBT and medication were substantially higher (81%) than for those who only received medication. The former patients also reported experiencing fewer serious side effects.

In a number of different studies, CBT has yielded impressive results in both for young people(5) and for adults of all ages. Children as young as six years of age have responded positively, with an approximate 70-80% response rate, and even those as young as two or three can benefit from the approach with parental support and gradual exposure. Elderly patients have also shown consistently positive response(6) to CBT treatment for depression and late-life anxiety.

Are there scenarios for which CBT may not be effective? The answer lies more (7) with the patient employing the treatment than with the treatment itself. CBT requires patients to explore the issues that create discomfort – the stressors, the external situations that create negative reactions. For those unwilling to commit to all that CBT may entail – from the necessary number of sessions to outside writing assignments – CBT may only yield limited results.

But for those ready to make a positive change in their outlook and behavior, CBT may provide the skills and tools to effect significant improvement. “When we become more aware of our thoughts and beliefs, we are able to challenge their reality and substance,” says Loree Cohen, M.S. L.C.S.W. and Clinical Director of Inneractions. “We can attack our faulty thoughts and beliefs by using a variety of techniques that are specifically designed to increase awareness. I use it as a therapeutic technique, but do so in my personal life as well. I would venture to say that I do it automatically. It’s like a daily check-in.”
Paul Gaita is a writer based in Los Angeles. He has contributed to, the Los Angeles Times and LA Weekly, The and many other publications and web sites.