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” assignments that bring about faster results.
There are several approaches to cognitive behavioral therapy. They include cognitive therapy, rational behavior therapy, dialectic behavior therapy, 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 is Different
Cognitive-behavioral therapy differs from many other types of psychotherapies because sessions have a structure, rather than the person talking freely about whatever comes to mind. At the beginning of the therapy, the client meets the therapist to describe specific problems and to set goals they want to work towards….These problems and goals then become the basis for planning the content of sessions and discussing how to deal with them. Typically, at the beginning of a session, the client and therapist will jointly decide on the main topics they want to work on this week. They will also allow time for discussing the conclusions from the previous session. And they will look at the progress made with the homework the client set for him- or herself last time. At the end of the session, they will plan another assignment to do outside the sessions.4
The homework in cognitive behavioral therapy for alcoholism might involve keeping a daily log of cravings to drink and what triggers them. Later assignments might focus on avoiding those triggers. Or they might be exercises to reduce cravings when they occur. The homework and the structure of the sessions make them 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, explaining 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 how to cope effectively with those that are unavoidable.”6
Effectiveness of Cognitive Behavioral Therapy for Alcoholism
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 cognitive behavioral therapy (CBT) with cognitive behavioral education (CBE). Although their names are very similar and their acronyms sound almost alike, they are very different in almost every important way. The most important difference is that the effectiveness of cognitive behavioral therapy has been well established by independent investigators. Their research is widely published in peer-reviewed books and other publications. This is not true of cognitive behavioral education.
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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.
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, 2003. Pp. 13-63.