What is CBT for Substance Abuse?

Cognitive Behavioral Therapy (CBT) is a short-term, focused approach to helping cocaine-dependent individuals become abstinent from cocaine and other problematic substance abuse.

Like other Cognitive Behavioral approaches, CBT assumes that learning processes play an important role in the development and maintenance of substance abuse and dependence.

In other words, by watching people use substances, being repeatedly reinforced or rewarded for the substance abuse and by the properties of the substance itself, and using the substance in a wide range of situations; substance-dependent individuals have, in many ways, learned to become substance dependent.

Cognitive-Behavioral Treatment (CBT) for substance abuse posits that the same learning processes involved in the acquisition of substance-using behavior can be used to help individuals reduce their drug use and become abstinent.

CBT is a didactic approach, where patients are given specific, structured training in a range of coping skills. CBT has two critical components:

The first critical component is through functional analysis of the role that the substances play in the individual’s life. Functional analysis is simply an exploration of substance abuse with respect to its antecedents and consequences.

The second critical component in CBT is skills training. In CBT a substantial part of each session is devoted to learning and practicing coping skills.

In fact, CBT can be thought of as an individualized training program that helps substance abusers unlearn old habits associated with substance abuse and relearn more healthy skills.

Another important feature of CBT is that it addresses several critical tasks that are essential to successful substance abuse treatment:

  • Fostering the motivation for abstinence
  • Teaching coping skills
  • Changing reinforcement contingencies
  • Fostering management of painful effects
  • Improving interpersonal functioning and enhancing social supports

The CBT Manual Substance Abuse:

This manual focuses specifically on Cognitive Behavioral Therapy (CBT) for cocaine abuse. It is intended to provide practical strategies for therapists working with this population. CBT is a didactic, short-term, skills-based approach.

The manual describes the rationale for CBT for drug abuse:

  • with session-by-session guidelines for key types of CBT interventions including functional analysis of drug use
  • coping with craving
  • managing thoughts about drug use
  • treatment for depression and anxiety
  • refusal skills
  • seemingly irrelevant decisions
  • problem-solving skills
  • planning for emergencies and
  • HIV risk reduction strategies

There are various techniques of CBT that are used for substance abuse people. I am mentioning one of them (Contingency Management).

Contingency Management for Substance Abuse

Contingency Management (CM) treatment of CBT which is broadly used for substance abuse is an intervention that provides tangible rewards to patients for reaching concrete behavioral outcomes.

For example, vouchers exchangeable for retail goods or services or the chances to win prizes of varying magnitudes (usually $1-$100 in value) are provided to patients who submit drug-free urine specimens or attend treatment regularly.

Here, the purpose of substance abuse treatment is bringing change to the patient’s behavior. Change is achieved by decreasing undesired behaviors and increasing desired behaviors.

Aspects of CM treatment include:
  • using rewards and punishers in shaping behaviors
  • understanding the importance of contingencies
  • selecting appropriate behaviors to modify
  • identifying reinforces to use
  • designing monitoring and reward schedules

The goals of CM are to decrease drug-seeking and drug-taking behavior and to increase time spent on activities with non-drug using social supports and drug abstinence behaviors.

For treatment to be successful, patients not only stop using substance use but also take part actively in treatment, work toward lifestyle changes such as getting work, moving to a secure atmosphere, and socializing according to social rules and regulations.

Contingency management techniques, sometimes called motivational incentives, are an effective and powerful way to enhance behavior change and stopping substance abuse.


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