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.

Problem focused strategies or emotional focused strategies are the two primary approaches used in cognitive therapies to create a shift in thinking which transforms the client’s perception of the problem. Problem focused strategies are useful in directing the client to identify a specific problem. The client is then assisted in identifying the responses that are typically used to reduce distress in the situation and to evaluate those responses for effectiveness. Alternative responses are then developed and examined from a cost-benefit perspective empowering the patient to make conscious choices about how he/she chooses to respond to stressful situations. This empowerment lends the patient a sense of control, as heretofore-unrecognized options become viable alternatives in managing distress.

Emotional focused strategies achieve the same end as the problem-focused strategies but from a different means. In this technique, the client’s perception of the distressful event is altered, thereby causing a subsequent change in level of perceived distress. By redefining the problem, the patient can hold the power to transform a crisis into an opportunity or challenge. This re-framing of the event can be accomplished by minimization, distancing, selective attention, and searching for positive value from a bad situation. Ultimately, the result is that the patient has an increased sense of control over the situation and therefore stress is reduced.

Common Ground

During the course of a lifetime, an individual obtains information from a wide range of sources. Early childhood is where a great deal of this information is obtained and deeply ingrained within the individual. In light of the multi-generational appearance of substance abuse, it appears likely that some of the information obtained from primary caretakers could be founded in the dynamics of substance abuse. Children raised in the home with a substance abuser will be exposed to the behaviors, values, and beliefs that have supported the addictive behaviors. As these learned addictive behaviors are incorporated into the cognitive processing of the child, they become virtually subconscious thoughts and leave the child with a distorted sense of normalcy concerning family function and a full repertoire for justifying his or her own substance abuse in the future. Those children raised in such environments may also become likely to develop behaviors that are enabling for other substance abusers. Cognitive based therapies applied to the substance abuser must address the issues of faulty beliefs and values, regardless of whether they are conscious or unconscious in nature.

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