Cognitive Theory and Therapy in Substance Abuse Treatment

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Significant cognitive theories are discussed that tend to play a major role in substance abuse treatments. Their common concepts are extracted and synthesized for the purpose of relating it to the relevant research about how they are applied to the development and treatment of addictive behavior.

Cognitive therapy is largely based on the work of Aaron T. Beck’s treatment for depression (Beck, 1976; Beck, Rush, Shaw, & Emery, 1979; Beck, Wright, Newman, & Liese, 1993). It has been shown to be an effective form of intervention when dealing with anxiety disorders, panic disorders (Beck, Emery, & Greenberg, 1985), eating disorders, substance abuse, and dissociative disorders. A highly flexible modality, cognitive therapy has been proven successful when used in both short and long term interventions and with a variety of patients: adults, adolescents, children, couples, and groups. To be effective, cognitive forms of therapy require that the patient be active in the process, able to work with an educational type format, and willing to make changes.

Central to the therapeutic modalities associated with cognitive therapy (i.e., rational-emotive therapy, cognitive behavioral therapy, and transactional analysis) is the concept that thoughts affect feelings. This construct implies that it is the emotional tones and expectations that one learns to associate with specific events that create problems rather than the events themselves that cause distress. Therefore, the goals of such therapies consist of assisting the client in identifying maladaptive thinking that result in emotional distress. Similar to behavioristic and humanistic therapies, cognitive therapies tend to be oriented in the present rather than the past. Current patterns of thought that result in current discomfort are focused on during therapy. For these therapies to be effective, the client must be motivated and capable of working from an educational perspective.

As its name implies, the primary concern is with the cognitive abilities and skills of the client. The cognitive therapies are directed towards identifying and correcting maladaptive thinking patterns that result in self-defeating or self-destructive behaviors and feelings. The goal of therapy is to assist the client in mastering skills used to identify problems, evaluating his/her perspectives concerning the problems, and providing a more balanced perspective that is conducive to more productive behaviors. This is accomplished by approaching problem solving in a systematic manner composed of steps that the client perceives as being manageable. Cognitive therapy is usually directed towards enhancing the coping capabilities of the patient.

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