Cognitive behavioral therapy for alcoholism is very effective. It is a form of treatment that focuses on beliefs and thinking.1 It’s these that determine how people feel and what they do. The National Association of Cognitive-Behavioral Therapists explains that CBT is based on the fact that thoughts cause feelings and behaviors. It’s not external things, like people, situations, and events. Thus, people can change the way they think in order to feel better and act differently. This is true even if their external situation does not change.2
Cognitive Behavioral Therapy for Alcoholism
Cognitive behavioral therapy for alcoholism generally deals with specific problems. It uses a collaborative goal-oriented approach. It is short-term, typically lasting 10 to 20 sessions. The average number of sessions is 16. The therapy moves quickly because clients are given weekly “homework” that bring about faster results.
There are several approaches to CBT. They include cognitive therapy, rational behavior therapy, and dialectic behavior therapy. Also rational living therapy, and rational emotive behavior therapy.
Despite their differences, CBT typically involves three steps.
- Identifying the problem.
- Identifying beliefs, thoughts and emotions related to the problem.
- Changing the negative or inaccurate beliefs, thoughts and emotions about the problem.3
Cognitive Behavioral Therapy for Alcoholism is Different
Cognitive-behavioral therapy for alcoholism differs from many other types of psychotherapies. That’s because sessions have a structure. The client doesn’t talk about whatever comes to mind.
At the beginning of the therapy, the client meets the therapist to describe specific problems. At that time they set goals. These problems and goals then become the basis for planning the content of sessions.
Typically, at the beginning of a session, the client and therapist will decide on the main topics. They will also discuss the previous session. At the end of the session, they will plan another “homework.”4
The homework in CBT for alcoholism might involve keeping a daily log of cravings to drink and what triggers them. Or it might focus on avoiding those triggers. It might be exercises to reduce cravings when they occur. The homework and the structure of the sessions make them very efficient.
The National Institute on Drug Abuse explains that
A central element of CBT is anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies. Specific techniques include exploring the positive and negative consequences of continued drug use, self-monitoring to recognize cravings early and identify situations that might put one at risk for use, and developing strategies for coping with cravings and avoiding those high-risk situations.5
Using CBT has an added advantage. The skills developed in cognitive behavioral therapy for alcoholism can easily also be applied to other problems in life.
The National Health Service of the U.K. gives a concrete description. It explains that cognitive behavioral therapy
“is a talking therapy that uses a problem-solving approach to alcohol dependence. CBT’s approach to alcohol dependence is to identify unhelpful and unrealistic thoughts and beliefs that may be contributing towards your alcohol dependence such as:
• ‘I can’t relax without alcohol.’
• ‘My friends would find me boring if I was sober.’
• ‘Just drinking one pint can’t hurt.’
Once such thoughts and beliefs are identified, you’ll be encouraged to base your behaviour on more realistic and helpful thoughts such as:
• ‘Lots of people have a good time without alcohol and I can be one of them.’
• ‘My friends like me for my personality, not for my drinking.’
• ‘I know I can’t stop drinking once I start.’
CBT also helps you to identify triggers that can cause you to drink such as:
• social anxiety
• being in ‘high-risk’ environments, such pubs, clubs and restaurants.
Your CBT therapist will teach you how to avoid certain triggers. And also how to cope with those that can’t be avoided.6
Effectiveness of CBT
The effectiveness of cognitive behavioral therapy for alcoholism has been extensively researched. It is one of the most effective therapies available. This is important because few programs for alcoholism have ever proved to be effective in any way.
It is important not to confuse CBT with cognitive behavioral education (CBE). Their names are very similar and their acronyms sound almost alike. Yet they’re very different in almost every important way. The most important difference is that the effectiveness of CBT has been well established by independent investigators. Their research is widely published in peer-reviewed books and articles. This is not true of cognitive behavioral education.
1. Often spelled cognitive-behavioral therapy. In most English-speaking countries it is spelled cognitive behavioural therapy or cognitive-behavioural therapy.
2. National Association of Cognitive-Behavioral Therapists. Cognitive Behavior Therapy.
3. Mayo Clinic. Cognitive behavior therapy.
4. Martin, B. In Depth: Cognitive Behavioral Therapy. PsychCentral.
5. NIDA. Cognitive-Behavioral Therapy.
6. Miller, W., et al. What works? A summary of alcohol treatment outcome research. Hester, R. and Miller, W. (Eds.), Handbook of Alcoholism Treatment Approaches. Boston: Allyn & Bacon. Pp. 13-63.
Readings: Cognitive Behavioral Therapy for Alcoholism
Carroll, K. and Onken, L. Behavioral therapies for drug abuse. Am J Psychiat, 2005, 168(8), 1452–1460.
Carroll, K., et al. Computer-assisted delivery of cognitive-behavioral therapy. Am J Psychiat, 2008, 165(7), 881–888.
Dutra, L., et al. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiat, 2008, 165, 179–187.
McHugh, R., et al. Cognitive-behavioral therapy for substance use disorders. Psychiat Clin N Am, 2010, 33(3), 511-525.
Magill, M. and Ray, L. Cognitive-behavioral treatment with adult alcohol and illicit drug users. J Stud Alc Drugs, 2009, 70(4), 516-527.