Cognitive-Behavioral Therapy for Alcohol Abuse - Coursework Example

Cognitive-Behavioral Therapy for Alcohol Abuse al affiliation Cognitive behavioral therapy (CBT) is currently widelypracticed as one of the methods of dealing with alcohol abuse and dependency. According to basic principles of this approach, a person’s well-being and happiness are predetermined by their thoughts and beliefs. Correspondingly, the task of cognitive behavioral therapist is to help their patient learn how to recognize and resist automatic thoughts which may otherwise trigger their desire to drink. Patients are often given homework assignments, which are supposed to improve their abilities to cope with everyday situations, control their own behavior and thoughts, and finally, change the way they think about alcohol. Patients are also supposed to acquire strategies of behavior in high-risk situations. Statistics show that other therapies are generally as effective as CBT, in case CBT used as a stand-alone approach. Nevertheless, its efficacy is much higher when this approach is accomplished by strategies and techniques, usually practiced in other therapies. In the paper there are several examples which show how elements of other therapies may be incorporated in CBT. Pharmacotherapies may intensify CBT as well. This area requires special attention and further exploration. Therapy outcome depends on a patient themselves, that is why individual approach is always required. To find a successful combination of elements from different therapies often means to raise effectiveness of the treatment. Key words: cognitive behavioral therapy, coping skills, thoughts and beliefs, strategies of behavior. Cognitive-Behavioral Therapy for Alcohol Abuse Statistics of the last decades show that alcohol abuse is currently turning into a mainstream trend, widely practiced by people of different ages and genders. In other words, alcohol abuse and dependence became one of the most urgent issues of modern society. Alcohol abuse may exert catastrophic consequences, both for the users themselves and for the society they belong to, that is why researchers within this area are vitally important. Among a number of practices for treating alcohol abuse and dependence, cognitive behavioral therapy (CBT) is known as one of the most widely recognized approaches. In case CBT is used as a stand-alone approach, its efficacy is equal to the one of other therapies, as researches show (Magil & Ray, 2009). When combined with other practices and recovery efforts, CBT is proven to be highly effective. Thus, the aim of the paper is to provide an overall picture of CBT and show that it is one of the most effective methods of dealing with alcohol dependence when accomplished by other strategies and techniques, though it is not as effective when used as stand-alone treatment. CBT is usually defined as a talking therapy which helps patients take responsibility for their own thought, feelings, and actions. Most problems a person faces root in misconception of their own self and people around. In other words, learning processes are believed to exert decisive influence when it comes to a persons well-being (Kadden, 2002). The role of outside stimuli, such as people and events around, are of minor importance. A person is often unable to change circumstances, but they always may try to change the way they think about them. Therefore, the way an individual feels and behaves may be changed as well, as cognitive behavioral therapists claim. Thus, thought processes are of primary importance, since they may lead to a number of mental health problems, accompanied by alcohol abuse. Poor self-esteem, for example, may result into alcoholism and depression. Therapist helps patients investigate their own thoughts and feelings in order to find the true reason of patient’s cravings to consume alcohol. To be aware of the prime cause often means to take the first step towards life without alcohol. At the same time, misunderstanding of the true reasons of alcohol abuse often leads to aggravation of the existing problems (Kadden, 2002). Therefore, the task of a therapist is to help their patients recognize and get rid of those automatic thoughts which make them feel a strong craving for alcohol. CBT seems to be one of the most effective forms of treatment of alcohol abuse since it attaches much importance to basic instincts of an individual. Among them there are survival and reproductive instincts. Therefore, all the individuals derive pleasure from activities and states, necessary for their survival and reproduction. These are food, sexual relationships, comfortable temperature, child rearing, and so on. Correspondingly, all the individuals avoid things which may hurt them or cause discomfort, such as pain, hunger, heat, freeze, etc. Consequently, every individual starts associating certain feelings and emotions with activities and situations when they may be experienced. When it comes to alcohol, however, it may be regarded an additional source of pleasure, in other words unnatural. As a result, natural sources of pleasure are no longer as required as before. In practice, people who are addicted to alcohol strive to receive this artificial pleasure, which is harmfully to their health and reproductive abilities. This pattern may be related to other forms of addiction, drug addiction first and foremost, and that is what therapists should straggle with. According to the principles of CBT, an abuser should be persuaded that short-run pleasure that alcohol may provide is quite insufficient in long-term perspective. In other words, it is necessary to show abusers the pleasure they may lose from not having family, friends, health, money, home, and social status. Simultaneously, patient should be provided with an opportunity to regain natural sources of pleasure, such as family, child rearing, career, health improvement, and so on. Patients are supposed to believe that they are able to achieve their personal aims if they make efforts. Confidence of their own capacity to achieve goals often helps patient cope with depression and discomfort when adapting to living situations (Kadden et al, 1992). Setting and achieving goals help patients build self-confidence, improve self-esteem and quality of life. As a result, the patient’s mood and general mental state may be improved in a natural way. This may show patients that they do not need alcohol or any other stimulants in order to feel comfortable. Among the variety of other techniques it is worthy to mention ‘target chart’, drawn on a piece of paper. It begins with survival and reproductive instincts, and then it is continued with basic needs, such as food, water, comfort temperature, pain avoidance, sex, maternal drive, and so on. Basic needs are afterwards transferred into complex summary of associations – health, home-fire, financial strength, family, friends, career, social position, education, etc. On the chart it is also pointed out how alcohol abuse and addiction may impede the achievement of these goals. As a result, long-term pleasure of life is decreasing. This chart is supposed to be placed in the plain view of a patient – it may sometimes be a strong factor of motivation. Atmosphere of mutual trust and respect between therapist and client are very important for the course of therapy. Although the main goal is to cope with alcohol dependency, a lot of different topics are discussed. Therapist is supposed to recognize skills their patient lacks in order to maintain a sober lifestyle. The aim of each session is to help patient learn new skills which would help them in various real-life situation (Carroll & Onken, 2009). Sessions last approximately one hour, sometimes 45 minutes. Their quantity is always established individually. As a rule, there are 12-18 sessions. Thus, the key principle of CBT is to help patient acquire self-control and develop effective strategies of coping with provocative situations. There is a number of specific techniques which may be applied for this purpose. One of them was mentioned above – therapist emphasizes negative consequences which prolonged alcohol abuse may exert. Secondly, patients are taught to monitor themselves in order to be able to recognize cravings for alcohol the moment they appear, as well as situations which may put a person at risk of use. In other words, patients are supposed to elaborated strategies which would help them cope with cravings and avoid high-risk situations. Thus, CBT practices structured teaching approach. Patients are often given homework assignments with rather strict instructions. The main idea is to change the way people think about alcohol drinking. It is worthy to provide a couple of examples of assignments patients are often offered. Among the most widely-practiced ones there is a request to describe the history of their own drinking experiences. Patients are also supposed to point out situations which they think to be risky. After this, therapist may help patients cope with circumstances which evoke their desire to drink. One more example – patients are often engaged into certain activities which are supposed to replace alcohol. Sport activities is a perfect alternative in this case. There is a number of therapy programs which enlist patients into sport teams. Results are often successful. On the one hand, team sport is always a good opportunity to acquire and reinforce coping skills, as well as to establish relationships of mutual support. On the other hand, hobby may become a reliable way to deal with depression, and therefore, with cravings for alcohol. Cognitive behavioral approach is especially advantageous since the skills an individual manages to learn remain after the therapy course is finished, as researches show (Kadden et al, 1992). What is more, effects of CBT are even more powerful when the therapy is strengthened by medications and techniques from other forms of behavioral approaches. The therapy, in particular, has been shown to be effective when combined with opioid antagonists (naltrexone, for instance) (Magil & Ray, 2009). According to results of investigations, conducted by the National Institute on Drug Abuse, CBT is one the most effective ways of treating alcohol dependence (NIDA, 2005). CBT is also proven to be the best way for treating substance use disorders when combined with pharmaceutical treatments. Researchers have randomly conducted more than 25 trials among alcohol-dependent people, as well as among users of tobacco, marijuana, cocaine, and opiates. Results show that CBT in many cases is much more effective than other methods of treatment, though quite often other therapies turn to be as much effective as CBT is. As a rule, response to the treatment depends on a patient themselves. Combinations with other recovery efforts, as the studies show, produce the best results (NIDA, 2005). Thus, it is possible to make a conclusion that CBT cannot be called a remedy when referred to as a stand-alone method of treatment. It is sometimes more effective than other approaches, but not always. Nevertheless, there are certain circumstances when CBT is likely to be superior to other approaches. Its effectiveness always depends on a specific treatment phase. For instance, cognitive behavioral approach is often used as aftercare therapy (Longabaugh, & Morgenstern, 1999). Aftercare phase presupposes a huge variety of situations patient faces in everyday life, which could not be encountered during more intensive sessions of primary treatment. A person is supposed to be taught how to handle high-risk situations, and that is what actually cognitive behavioral therapists teach their patients to do. This assumptions, however, is not always true as well. Researchers find it difficult to identify mechanisms CBT works through (Longabaugh, & Morgenstern, 1999). For this reason this is still unclear which of the two following situations is more provocative. On the one hand, a person may feel unhappy, which may finally lead to their drinking. On the other hand, a person may be offered a drink by a friend (Longabaugh, & Morgenstern, 1999). Therefore, this issue requires further investigation. As it was mentioned, however, it is possible to increase effectiveness of CBT by accomplishing it with elements and techniques generally practiced in other approaches. For example, motivational interviewing. The main idea of this strategy is to increase a person’s motivation to change (Brown & Miller 1993). Every person is assumed to be motivated for positive changes. Thus, alcohol-dependent people, as it is supposed, are always motivated to get rid of their addiction. CBT is what may help them develop necessary coping skills, that is why its strategies may be used in motivational interviewing approach. On the contrary, some other patients already possess appropriate skills, but lack motivation. In this case, techniques of motivational interviewing may be incorporated in CBT (Longabaugh, & Morgenstern, 1999). Many representatives of other therapeutic approaches criticize CBT for underestimating the role of environment and people around. There is a research showing that the effectiveness of CBT could be sufficiently increased if environmental factors were incorporated (Longabaugh, & Morgenstern, 1999). It is necessary to mention two methods of dealing with addiction, behavioral marital therapy and community reinforcement approach. One of the main ideas of these two approaches is similar to the one in CBT – they point out possible consequences in case patient takes a drink. At the same time, effectiveness of the therapy is considered to be dependent on the quality of relationships with people, significant to the patient (Longabaugh, & Morgenstern, 1999). Therefore, as it is stated in the research, ‘The incorporation of environmental factors into cognitive-behavioral coping-skills training also may increase therapeutic control over the reinforcing factors that can help a patient maintain an alcohol-free lifestyle’ (Longabaugh, & Morgenstern, 1999). In general, the role of other people should not be underestimated. The sufficient ones may often exert predetermining influence in patient’s life. On the other hand, mutual support between patients is often really effective, and thus, it should not be neglected. Participation in self-help support groups may often reinforce effects of CBT. Thus, statistics show that efficacy of CBT may be sufficiently increased by incorporating techniques and strategies from other approaches. Correspondingly, there is a question which requires special attention and further investigations. It is necessary to find out particular ways of incorporating elements of other approaches into CBT, as well as vice versa. At the same time, it is necessary to improve the existing ones. Pharmacotherapies should not be forgotten as well. Finally, it is necessary to remember that each patient has their own individuality, which means that it is impossible to find a sovereign remedy. CBT is one of the most effective methods of dealing with alcohol dependence in percentage correlation only. In some cases, however, it may turn to be absolutely uneffective. In a conclusion it is necessary to say that every patient requires individual approach. This should be the first and foremost principle of any treatment. References Brown, J.M., and Miller, W.R. (1993). Impact of motivational interviewing on participation in residential alcoholism treatment. Psychology of Addictive Behaviors 7:211–218. Carroll, K.M., and Onken, L.S. (2005). Behavioral therapies for drug abuse. The American Journal of Psychiatry 168(8):1452–1460. Kadden, R.M. (2002). Cognitive-Behavior Therapy for Substance Dependence: Coping Skills Training. University of Connecticut School of Medicine. Farmington. Kadden, R.M., Carroll, K., Donovan, D., Cooney, N., Monti, P., Abrams, D., Litt, M. & Hester, R. (Eds.) (1992). Cognitive-Behavioral Coping Skills Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. Volume 4, Project MATCH Monograph Series. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. (DHHS Publication No. (ADM)92-1895). Longabaugh, R. & Morgenstern, J. (1999). Cognitive-behavioral coping-skills therapy for alcohol dependence: Current status and future directions. Alcohol Research and Health, 23, 78-85. Magil, M., and Lara A. Ray (2009). Cognitive-Behavioral Treatment With Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials. J. Stud. Alcohol Drugs. 2009 Jul; 70(4): 516–527. National Association of Cognitive-Behavioral Therapists (2006). What Is Cognitive Behavior Therapy?, Retrieved from http://www.nacbt.org/whatiscbt.htm National Institute on Drug Abuse (2005). Cognitive-Behavioral Therapy: An Overview. Retrieved from http://archives.drugabuse.gov/TXManuals/CBT/CBT3.html Read More