CBT has a good evidence base for many psychiatric and psychological conditions such as anxiety, depression and phobias. In recent years, it has been successfully applied in the field of addiction. Dependence on alcohol or substances is influenced by cognitions, thoughts and emotions. CBT helps in conceptualising addictive behaviours and adopting a framework for designing interventions that focus on better coping skills.
The CBT model recognises two types of learning:
- Learning by association (a.k.a. Pavlovian or classical conditioning)
- Learning by consequences (a.k.a. operant conditioning)
Learning by association involves triggers or stimuli to alcohol or drug use. Triggers may be external (e.g. environment, other drug users etc) or internal (e.g. thoughts, emotions, mood). These associations gradually strengthen as drug use is repeated.
Learning by consequences works on the principal of positive and negative reinforcement. If the person feels that drugs or alcohol make them feel more euphoric, relaxed or confident then they are likely to repeat that behaviour because they feel it was pleasurable (positive reinforcement). However, many drugs are taken to stave off unwanted symptoms such as depression, anxiety and withdrawal (negative reinforcement).
In terms of evidence, CBT appears to be most effective in treating stimulants like cocaine. CBT is goal oriented and problem focused. It is flexible and individualised to tailor the needs of patients. It can also be used in conjunction with other forms of treatment such as pharmacotherapy, addiction counselling and family therapy.