COGNITIVE BEHAVIORAL THERAPY
CBTs for the treatment of substance use disorders are based on social learning theories regarding the acquisition and maintenance of the disorder. These therapies target two processes conceptualized as underlying substance abuse: 1) dysfunctional thoughts, such as the belief that the use of substances is completely uncontrollable, and 2) maladaptive behaviors, such as acceptance of offers to use drugs. Early versions of this approach were derived from cognitive therapy for depression and anxiety by Beck and Emery and placed primary emphasis on identifying and modifying dysfunctional thinking patterns. Other adaptations of this approach have broadened the focus of therapy to help the patient master an individualized set of coping strategies as an effective alternative to substance use. Typical cognitive strategies include fostering the patient's resolve to stop using substances by exploring positive and negative consequences of continued use, recognizing seemingly irrelevant decisions that could culminate in high-risk situations, and identifying and confronting thoughts about substance use. Behavioral strategies are based on a functional analysis of substance use (i.e, understanding substance use in relation to its antecedents and consequences) and include the development of strategies for coping with craving, preparing for emergencies, and coping with relapse to substance use.
SOCIAL SKILLS TRAINING, an element of CBT, recognizes that alcohol and drug dependence commonly results in the interruption of normal developmental acquisition of social skills as well as the deterioration of previously learned social skills because of the interference of drug-seeking and drug-using behaviors. Social skills training targets an individual's capacity for 1) effective and meaningful communication, 2) listening, 3) being able to imagine someone else's feelings and thoughts to inform one's own behavioral interactions, 4) being able to monitor and modify one's own nonverbal communications, 5) being able to adapt to circumstances to maintain relationships, and 6) being assertive. This strategy has been successfully used as an adjunct to a more comprehensive treatment plan and can be delivered in a wide variety of outpatient treatment settings. It may be particularly useful in certain dually diagnosed populations, such as patients with schizophrenia and adolescents at risk for beginning substance abuse.
RELAPSE PREVENTION is a treatment approach in which CBT techniques are used to help patients develop greater self-control to avoid relapse. Specific relapse prevention strategies
include discussing the patient's ambivalence about the substance use disorder, identifying
emotional and environmental triggers of craving and substance use, developing and reviewing specific coping strategies to deal with internal or external stressors, exploring the decision chain leading to reinitiation of substance use, learning from brief episodes of relapse (slips) about triggers leading to relapse, and developing effective techniques for early intervention. In more recent clinical trials, techniques drawn from cognitive therapy and relapse prevention have been combined with the aims of initiating abstinence and preventing relapse.
Cognitive Behavioral Therapy (CBT) and cognitive therapy is one of the most widespread and standard forms of treatment provided by Los Angeles and Orange County intensive outpatient and residential addiction treatment programs.
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