The Cognitive Behavioural Therapy Approach for Alcohol Addicts - Essay Example

The cognitive behavioural therapy approach for alcohol addicts BY YOU YOUR SCHOOL INFO HERE HERE Introduction Though there are many different approaches to treating alcohol problems in the clinical environment and in the therapeutic environment, one of the most prominent that is gaining ground is the cognitive behavioural therapy approach (CBT). The CBT treatment process consists of a rather short cycle in which the social worker and the patient suffering from addiction begin to build a foundational relationship that assists, first, in identifying the root and motivation behind the problems. These interventions consist of a functional analysis, skills training, identifying social characteristics that assist in driving addictive behaviours, and then reinforcing different coping skills to assist in combating the complex emotions behind alcohol consumption. Cognitive behavioural therapy has been shown to be effective with many different demographics, thus it is even more important as a therapy tool for those in society with limited resources that may not have proper access to more clinical treatments. CBT works to deconstruct certain lifestyle characteristics and then re-emphasize effective coping strategies as a means to cure the addictive personality. There are other models recognized as having reliability in treating alcohol problems, ranging from spiritual healing, the family model (when applicable), and didactic learning through role playing as part of a broader behavioural modification system with multiple phases. The rationale for alcohol consumption varies, thus not all approaches will be equally similar. Where most of these programs are similar to CBT is in the ability to provide a new cognitive path of self-awareness. CBT and its components The basis of cognitive behavioural therapy is that the individual suffering from addiction needs to come to understanding regarding their intrinsic motivations in order to alter their behaviours leading to alcoholism. The root of alcohol dependency is significantly different in certain cultures and family structures, therefore internal motivations for these addictive behaviours are driven by complex and unique motivations. Often, alcohol addiction is a form of escapism used as a tool to avoid unhappiness or issues with self-image and self-confidence. Magill (1998) identifies that people are inherently unhappy due to their irrational belief systems and the method by which they interpret events inaccurately. Cognitive behavioural therapy seeks to identify these internalized issues so that new strategies and behaviours can be developed to create a more productive citizen without the need for alcohol as an escape tool. The CBT approach consists of first conducting a functional analysis, in which the social worker and the patient, together, identify the different thoughts, emotions and lifestyle circumstances that exist which are driving alcohol dependency (Buddy 2008). Functional analysis is a form of needs analysis, which uncovers the root of self-confidence issues, self-image problems, or any other dysfunctional method of interpreting the surrounding world in order to understand issues of culture, lifestyle and cognitive development. Following this analysis is a period of skills training, in which specific coping skills are developed between the patient that are linked to the elements discovered through the functional analysis process. In this stage of CBT, the social worker “assists the individual to unlearn old habits and learn to develop healthier skills and habits” (Buddy 2008, 2). The goal in the cognitive behavioural process is to help the individual identify with their own intrinsic problems and then learn new and more positive methods to deal with complicated emotions of personality dysfunctions rather than relying on alcohol to curb these difficult emotions or responses. Alcoholism, in many demographic groups, is the product of what is referred to as operant conditioning, in which addictive behaviours become strengthened based on the received consequences following alcohol use. In some instances, a person consuming high volumes of alcohol regularly may experience heightened sexual arousal or euphoria (though temporary) and will therefore find positive reinforcement through the activity and ensure it is repeated for the purpose of experiencing these heightened emotions again (Kadden 2009). Operant conditioning can be quite powerful for the addicted personality, especially if most of the consequences surrounding the alcohol usage provide positive reinforcement. These emotional responses or stimuli can become well-engrained into personality and lifestyle function, making it difficult for the social worker to undo long-standing conditioning. Some addicts also are conditioned through classical conditioning, in which certain events become synonymous with the process of alcohol consumption. For example, long-term use of an addictive substance may be linked, at the cognitive level, with certain places such as bars and night clubs, certain individuals with whom alcohol is consumed, or even specific times of the day when certain emotional states are more powerful (NIDA 2009). When an individual finds that situations or events are paired with the alcohol process, it can have a replicating effect in terms of how cravings develop or how they view the very nature of their addictive behaviours. Again, this is difficult for the social worker to undo since it is engrained through a systematic linkage with positive events and people. As mentioned, the differences between why individuals consume alcohol are unique in most situations, requiring the social worker to take a more in-depth approach to interpersonal relationship-building so that trust can be established and allow the patient to explore their inner thoughts in a friendly and inviting environment. This usually occurs in the functional analysis period where these relationships are built with a variety of therapeutic tools used by the social worker. When implementing a CBT approach, there should be specific, timed steps that occur in the process of analysis and behavioural modification. Reilly & Shopshire (2002) offer that such efforts include relaxation interventions that get to the root of the emotions behind the alcohol addiction and as a form of emotional reassessment and response. Cognitive interventions include understanding the nature of irrational belief systems and the distorted appraisals that occur when the individual assesses their environment or lifestyle. Communications skills interventions also occur as part of this approach, allowing the individual to rethink their emotional intelligence and consider new methods of approaching dealings with others in their environment rather than through alcohol escapism. This is accomplished successfully, however, only after the social worker has a working model of the inner thought and behaviour processes within the addict after the functional analysis portion of therapy has reached the end of its stage life cycle. Why CBT for disadvantaged or isolated citizenry? The main advantage of CBT approaches for those in society without access to more clinical and expensive therapy is that these sessions can be completed in a brief period of time. Burnett (2008) identifies that successful cognitive behavioural therapy is usually achieved in only six to twenty sessions with the social worker. Depending on the competency of the social worker, a collaborative environment for open discussion can be built early on in the relationship so that self-disclosure, role playing, stress management and coping strategies can begin to be considered (Burnett). For those without the ability to procure more clinical methods of handling their addictive problems, CBT represents a low-cost and functional method to sustain a healthier lifestyle without heavy and concentrated reliance on alcohol products. There are certain realities associated with society and the class in which the addict resides that drive these behaviours in the first place. For example, Payne, DeVol & Smith (2001) identify that there are long-standing, engrained rules of class living that remain with the individual throughout their lifetime even if they evolve from lower class status to a higher position in society. These rules often drive the individual thought process, method of social interaction, and cognitive strategies (Payne et al). For the social worker, it is necessary to understand these long-standing value and thinking systems that occur as a product of their social and economic classes. For example, it is rather common for people in lower class, poverty-stricken environments to have very distorted perceptions of social relationships, with a great deal of trust missing in their social relationships. These must be uncovered and assessed in the functional analysis stage of CBT in order to identify with these engrained cultural premises. There is also a broad social stigma associated with alcoholism that drives social isolation and works to compromise the mental health of addicts (White 2008). Society plays a major factor in how the individual assesses their unique addictive personality, perhaps denying that there is a problem in the first place so as to avoid negative social assessment from peers and the broader society. When denial is in place and firmly planted, therapeutic sessions in CBT may require longer patient/social worker interventions to identify these sociological elements and help the patient shed their defence mechanisms. This is quite valuable for the impoverished citizen that is already facing social stigmas related to finance and class status, thus they require an open and empathetic social worker to help them identify the root of issues related to self-esteem and self-confidence that might be driving alcohol reliance. Essentially, the role of the social worker in CBT processes is to deconstruct their experiences systematically. Deconstructionists believe that reality is unknowable and cannot necessarily be tested against any sociological or psychological model (Leahy 2008). However, a CBT social worker with a deconstructionist perspective takes a more optimistic viewpoint, believing that patient schemas can be tested against reality and gives a sense of autonomy in the patient as a “structural empiricist” to understand their role in society, lifestyle and as a functioning self-motivated individual (Leahy 2008, p.2). Essentially, the goal is to empower the individual to reassess their emotional intelligence and become more fully functional members of society through new communications strategies and self-assessment tools unique to their class or social status. It is elements of the individual’s lifestyle or ethnic culture, as well, that must be considered throughout the entire CBT process. “Since personal traits and sociocultural factors have great impact on the therapeutic outcome and social adaptation after treatment, cultural characteristics must be reflected in therapy options” (Im, Hoo, Kim & Kim 2007, p.184). Cultural dimensions include the level of power distance found in the lifestyle of the patient, such as workplace dynamics, or even the level of masculinity versus femininity found in their social culture that drives certain gender-oriented expectations. It could be, for example, that the addict has more masculine traits, but is a female patient, thus they do not function well with members of their social group and are left isolated with reliance on alcohol. The CBT approach identifies all of these characteristics to help the individual understand their own human value as compared to social stigmas or cultural expectations. The key, it seems, in the cognitive behavioural approach is to build a better sense of self-identity and self-confidence by gaining new knowledge about the world in which the patient lives and thrives. Again, this makes this a quality treatment option because of its short duration and the interpersonal approach taken by the social worker that reinforces human value, something which might be lacking by older citizens or low income groups without an adequate relationship or family support network. Is CBT effective for alcoholics? Individuals who seek therapy often require validation from the social worker in order to come to grips with their addictive problems and personality. It is common for certain social groups to have a distorted view on what is considered satisfactory validation, insisting that the social worker does not have proper empathy for their condition. For example, the patient may imply that the social worker does not fully understand how the addict feels, having an idiosyncratic rule for validation such as stating “unless you feel as bad as I do, you don’t care about me” (Leahy 2008, p.771). The patient requiring validation from the social worker, however distorting the perceptions of empathy, can often be dismissive to social worker efforts. The patient must come to understand, through functional analysis, that their methods by which they validate themselves against others are inaccurate which may be causing many of their socio-cultural problems or inability to function effectively without reliance on alcohol. This, again, entails an approach to building better emotional intelligence so that the individual ceases distorting their validation efforts and building a better sense of self-identity and, in a sense, less narcissism when comparing social worker attitude with their own distorted concepts and perceptions. In this type of therapeutic environment, individuals with distorted validation concepts may drop out of the programme or require elongated interventions to handle the problem. CBT theorizes that the relationship between drinking behaviours and the quality of relationships are reciprocal and highly correlated. Alcohol abuse “serves as a chronic stressor and has a deleterious effect on relationship functioning” (Vedel, Emmelkamp & Schippers 2008, p.281). This is why cognitive behavioural therapy has been shown to be effective with certain individuals as the very basis of the therapy approach is to identify how behaviours and communications style impact others in their lifestyle environment. It can be used to assess problems within the marriage that were not necessarily transparent to the addict or explain problems occurring with anger management that are masked through alcohol dependency. The individual, through an open and collaborative environment, must uncover through social worker actions and interventions the linkages between addictive behaviours and social problems occurring in their functional relationships. This can be done through role playing exercises, with the patient taking the role of the spouse or workplace colleague (as two examples) so that the individual understands the emotional stress and toll that his or her actions create for those in their social environment. Trevisan (2008) identifies that cognitive behavioural therapy has been quite effective with older citizens facing alcohol addiction. In a group format, sessions involving 414 at-risk alcohol users were studied and after the CBT process had reached its conclusion, 75 percent of the participants maintained their developed drinking goals and did not return to steady drinking (Trevisan). It was the process of feedback and what is referred to in this case study as psychoeducation that helped older adults identify with the causes of their addictive problems and identify better coping strategies to be more fully functional without reliance on alcohol escapism or the positive reinforcement it provides temporarily. The main goal of CBT processes are to help the individual change their methodology about how they view themselves in their personal lives, the nature of their substance abuse, and learn new and more positive methods to cope with difficult scenarios. The approaches to treatment differ on a case-by-case basis, based on certain class factors or socio-cultural dynamics, however the evidence seems to suggest it is highly effective and would be a viable treatment option for people suffering with alcoholism. Alternative Models Wilber’s Spectrum of Development model explores elements of Christian mysticism, yoga, and represents what is referred to as a transpersonal consciousness in order to develop a more productive alcohol ambition. It implies foundational concepts from Freudian philosophy in terms of identifying with the id and superego, with borderline boundaries separating self-consciousness from transcendental knowledge (Nixon, 2001). Through a multi-stage process, new foundations are built related to spiritual enlightenment and success in combating existential issues. This is a departure from ordinary treatment, however it explores the broader dynamics of self-understanding that, much like CBT, alters negative cognitive processes to assist in reconsidering certain behavioural patterns. The family model is also used commonly in social work, that is a four stage process linking family goals and values with self-understandings. It begins with a diagnosis process in which the individual recognizes that alcohol has become central to family structure and functioning and removing it from the family completely. Positive thought patterns are created with healthier behaviors in the family structure that lead to an intended reorganization of priorities and structural boundaries (Cornille & Hicks, 2010). The primary element of this program directly related to CBT is the ability to change perceptions regarding environment by altering cognitive mapping techniques in the individual. CBT is the more preferred program, as it implies a relationship between social worker and the individual where other systems are focused primarily on the individual and understanding inherent motivations. Behavioural therapy underscores the importance of emotional intelligence and assists in finding a balance at the perceptive level rather than through psychoanalytical processes or those reliant on group involvement. Conclusion The cognitive behavioural therapy approach works systematically to change attitudes and behaviours that might be a product of long-standing socio-cultural principles or simply a distorted sense of self. It uses various tactics such as role playing, relaxation exercises, relationship-building, emotional intelligence creation, and positive communications so that the individual can function without the alcohol as a lifestyle crutch. It works to breakdown the cycle of negative behaviours through identifying with intrinsic thought processes that drive an individual to drink heavily and consistently. By spotlighting how these behaviours impact others, along with the damage caused to self-identity, an individual is driven to rethink their behaviours and adopt more positive approaches to coping. The nature of this system has found significant positive results in many different demographic groups and should be considered a viable alternative to clinical treatment for those without access to high quality or high cost treatment options in society. References Buddy, T. (2008). [internet] Cognitive behaviour therapy for addiction. [accessed 11.11.2010] [available at http://alcoholism.about.com/od/relapse/a/cbt.htm] Burnett, C. (2008). [internet] Ask the expert: Cognitive behavioural therapy. UNC School of Medicine [accessed 11.10.2010] [available at http://www.med.unc.edu/medicine/fgidc/collateral/cbt.pdf] Im, S., Yoo, E., Kim, J. & Kim, G. (2007). Adapting a cognitive behavioural program in treating alcohol dependence in South Korea, Perspectives in Psychiatric Care. 43, 4, pp.183-193. Kadden, R.M. (2009). [internet] Cognitive-behavior therapy for substance dependence: coping skills training. University of Connecticut School of Medicine. 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[internet] Long-term strategies to reduce the stigma attached to addiction, treatment and recovery within the city of Philadelphia. [accessed 11.10.2010] [available at http://www.facesandvoicesofrecovery.org/pdf/White/StigmaMedicationTreatment.pdf] Read More