Cognitive Behaviour Therapy for Alcoholism

Over the past few decades, cognitive behaviour therapy (CBT) has been extensively researched for use in the treatment of substance abuse and other mental disorders. But is CBT right for you or your loved one? Cognitive behaviour therapy for alcoholism can be quite effective when implemented correctly.

Alcoholism Defined: Alcohol Use Disorder

First things first, what is an alcohol use disorder (AUD)? There are different criteria for defining and diagnosing AUD. And these criteria have changed and developed over many years. You or a loved one may be suffering from alcoholism if one or more of the following criteria is met:

  • Physical dependence on alcohol (including withdrawal symptoms after consumption)
  • Trouble managing the amount of alcohol intake (includes binge drinking)
  • Preoccupation with alcohol or relying on it for certain times/events
  • Alcohol tolerance
  • An increased amount of alcohol use over time
  • Efforts to reduce alcohol use are ineffective
  • Interference with personal or professional life
  • Spends a significant amount of time trying to obtain, use, and/or recover from alcohol
  • Continued use despite harmful effects on the individual

These symptoms may present themselves as mild, moderate, or severe. Mild does not mean that the substance abuse should not be addressed. Alcoholism can lead to major health issues, physiologically, as well as emotional issues and interpersonal struggles.

It may still be difficult to really determine on your own if you or a loved one meets these criteria. It is not uncommon to ignore or excuse certain behaviours.

One way to help know if you might be struggling with alcohol-related substance abuse is if your drinking impacts or hinders any aspect of your life – whether that be personal responsibilities, interpersonal relationships, overall mood, etc.

If you think you or a loved one may be struggling with alcoholism, please consult a doctor or mental health professional as soon as possible.

What is Cognitive Behaviour Therapy?

The cognitive model is very straightforward and common-sense based, working with the relationship between cognitions, emotions, and behaviours. There are three main aspects highlighted with cognitive behaviour therapy:

  1. Automatic thoughts
  2. Cognitive distortions
  3. Underlying beliefs/schemas

The principles of CBT are based on the observations of dysfunctional automatic thoughts. Automatic thoughts are those that we first have in response to something. These thoughts may be mistaken, distorted, exaggerated, or unrealistic. These automatic thoughts can play a major role in the next item on the list – cognitive distortion.

Cognitive distortion occurs when an individual may have errors in logic in their belief systems. This is much more common in individuals suffering from mental disorders and/or struggles with substance abuse. Some of the most common cognitive distortions are:

  • Dichotomous thinking: seeing things as “black and white” with no “grey area”
  • Overgeneralisation: making broad generalisations from isolated events
  • Selective abstraction: focusing only on certain (often upsetting or negative) aspects while ignoring all other aspects
  • Disqualifying the positive: discounting positive experiences that conflict with negative personal beliefs
  • Mind reading: assuming others’ thoughts and intentions
  • Fortune-telling: predicting the outcome of events before they happen
  • Minimisation:  acknowledging positive characteristics and/or experiences but labelling them as insignificant
  • Catastrophising: focusing on the worst possible outcomes even if they are unlikely and labelling uncomfortable situations as unbearable or impossible
  • Emotional reasoning: making arguments and/or decisions based on feelings and emotions instead of objective reality
  • “Should statements”: concentrating on what “should” or “ought to” be instead of the actual situation at hand or having rigid and broad “rules” that are applied no matter the circumstances
  • Personalisation/blame/attribution: assuming complete and/or direct responsibility for negative outcomes (may be applied to the self with personalisation or to others with blame i.e. attribution errors)

All of these cognitive distortions that happen after automatic thoughts can lead to underlying belief systems or schemas. It is not uncommon for those suffering from substance abuse and addiction to engage in many or even most of these cognitive distortions.

This leads to many self-damaging underlying belief systems. However, the goal of CBT is to identify and change this vicious cycle for those suffering from substance abuse as a coping mechanism.

Conditioning and Learning With CBT

There are three main components of learning or conditioning with cognitive behaviour therapy for alcoholism. Understanding these basic psychological principles are very beneficial to the recovering alcoholic. Therapists will work on these fundamental components with clients during CBT:

This involves the pairing of two events or stimuli when one evokes recall or craving for the other. For someone with alcohol dependence, this can be something like feeling the dire need for an alcoholic beverage when attending a social event or dining out. Understanding and avoiding these classical conditioning triggers is an important first step in recovery.
In its most basic form, operant conditioning involves learning by employing rewards and/or punishments. There is an association made between behaviours and consequences. For someone in recovery, this may be something like self-rewards for sobriety. It can be something like replacing a stressful triggering event with something pleasant like taking a walk outside, listening to your favourite music, or engaging in some other kind of healthy reward.
Modelling is simply following the example of someone else or mimicking their behaviour responses to environmental stimuli. An example of this in alcohol abuse recovery would be like an AA sponsor. Utilising resources like Alcoholics Anonymous while undergoing cognitive behaviour therapy for alcoholism can help to increase success rates in individuals.

Combining all three of these basic psychological principles can help the individual to recognise, avoid, and cope with life’s daily triggers and stressors that have led to alcohol use in the past.

This has been shown to effectively help those struggling with substance abuse with alcohol. These are the three most basic skills for managing these triggers:

  • Recognise: Identifying events, circumstances, or even self-defeating feelings and beliefs that lead to alcohol use and abuse (could include social events, triggering environments, or even internal triggers like a reaction to stress or anxiety)
  • Avoid: Avoiding these trigger situations by removing one’s self from these places, events, or moods
  • Cope: Utilising the tools and techniques learned through CBT therapy to alleviate/address harmful thoughts and emotions that lead to alcohol use and abuse

What are the Benefits of Cognitive Behaviour Therapy for Alcoholism?

The basic principle of using cognitive behaviour therapy for alcoholism is that substance abuse and other related behaviours stem from learned beliefs and improper coping skills.

The basic goals of CBT in the treatment of substance abuse are to:

  • Identify these thoughts and their subsequent behaviours
  • Change these thoughts and beliefs to help create healthy coping behaviours

While there is much more to it than that, those are the basics of CBT. When you look at it from its most basic elements, it can feel less overwhelming.

There are so many benefits of utilising CBT techniques in achieving sobriety including:

  • Identifying automatic thoughts and personal beliefs that may lead to alcohol use
  • Helping to end false and destructive beliefs/insecurities
  • Enacting self-help tools to improve thought patterns and emotional state
  • Improving communication skills
  • Replacing cognitive distortions with healthy critical thinking patterns
  • Finding healthy coping mechanisms to replace maladaptive behaviours

CBT has also been found to be effective in therapy for other mental disorders including:

  • Attention deficit disorder (ADD)
  • Anxiety
  • Bipolar disorder
  • Depression
  • Eating disorders
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)

How Effective is CBT for Alcoholism?

Cognitive behaviour therapy for alcoholism is known to be quite effective, especially when combined with other appropriate treatment/counselling techniques.

It is important to not confuse CBT with cognitive behaviour education (CBE). It is also important to make sure that the therapist enacting this treatment is well educated and trained on this method of therapy.

Research has shown statistical significance with the use of cognitive behaviour therapy for alcoholism. However, it should be noted that these rates have shown some drop between the period of six to nine months into treatment.

Success rates drop even more after one year. This may highlight the need for continued counselling and guidance from a mental health professional, even if less frequent than the initial intervention.

In some cases, more often with comorbid mental disorders, an individual may require a medical assessment and even medications. This is one reason it is so important to talk with a mental health professional or doctor about yourself or your loved one.

Licensed counsellors and even some psychologists are not able to prescribe medications but often work alongside physicians and psychiatrists who may prescribe medication when necessary.

In Conclusion

CBT can be a healthy and effective treatment method for those in recovery. Again, it can not be stressed enough to speak with a licenced medical or mental health professional if you think you or a loved one could benefit from cognitive behaviour therapy for alcoholism.

It’s never too late to start and get life back on track with sobriety, health, and happiness.

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To discover your road to recovery, call us today on 0800 111 41 08