Essay On Cognitive Behavior Therapy & Treatment of Alcoholism

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Cognitive Behavior Therapy and Treatment of Alcoholism

Cognitive behavioral therapy is widely known in the treatment of depression, phobias and anxiety disorders. In the recent past, this therapy has become indispensable in treating alcoholism and other forms of drug addiction (Cooper, 2012). Cognitive-behavioral coping skills is an approach that focuses on helping the alcoholics to abstain from the abuse by using the same approach that led to the dependence in the initial stages. Cognitive Behavioral Therapy assumes that certain personal characteristics are generated internally from the thoughts and not external stimuli such as events and situations (Epstein & McCrady, 2009). In addition, people may not change their circumstances but instead change their thinking process about the same. As a form of psychotherapy, it tries to understand the process that contribute to individual learning. Some of the behavior learned by human beings can either be good or maladaptive (Epstein & McCrady, 2009). The therapist helps the addicts in understanding why alcoholism is maladaptive and the reason that contributed to certain triggers.

Arguably, the most important goal in this psychotherapy is identifying the best responses and coping strategies to certain behaviors. For instance, an individual may suffer from stress after a difficult day. As a way of unwinding, he takes a drink of two to three vodka martinis as a relief from stress. In the long run, the individual understands that alcoholic drinks relieves stress. Overtime, the individual, develops dependence on alcohol (Epstein & McCrady, 2009). Everybody in the family start complaining about such behaviors thus ruining the relationship between the members. Finally, the individual becomes less effective at work with the friction with the employer leading to loss of job (Maltzman, 2008). Using this testimony, the therapist will try to identify the leading factors that made the individual start drinking. Each time an individual drinks, the idea is further reinforced. Identifying the predisposing factor that contributed to drinking, the therapist can suggest the coping skills that are effective in dealing with stress (Maltzman, 2008). Cognitive behavior therapy offers effective and sustainable means of dealing with the adopted behavior of alcoholism.

The viewpoint of Cognitive Behavior Theory is that alcohol and drug dependence are acquired through experience. When alcohol provides certain desired results such as reduced tension and good feelings under repeated occasions, it may be viewed as the best option to achieve such results (Maltzman, 2008). This occurs in the absence of other ways of meeting such demands. A psychotherapist employing Cognitive Behavioral Therapy uses two primary tasks. Firstly, the therapist identifies the specific need met using alcohol and secondly provide alternative approaches for meeting such needs (Marsch & Dallery, 2012). Different viewpoints emanate from this general perspective. ‘Behavioral’ approach places emphasis on the observable antecedents and their consequences to alcoholism without referring to the cognitions that can be known through personal testimony. ‘Cognitive-behavioral’ approach include the cognitions, emotions and thoughts that precipitate to the acquired behavior. Cognitive-behavioral make use of the behavioral methods such as repeated practice and other reinforcements that modify the emotional processes (O'Farrell & Fals-Stewart, 2013).

Cognitive-Behavioral Therapy conceptualizes drinking problems and designs the appropriate interventions that develop adequate coping skills. These conceptual models are strictly behavioral, contingency management approaches and community reinforcement. Cognitive Behavioral Therapy make use of two learning processes: learning by association and consequential learning (O'Farrell & Fals-Stewart, 2013). In the learning by association approach, certain stimuli considered neutral can trigger alcohol use and abuse.

This is, as a result, of repeated reinforcement between such stimuli and alcohol abuses. Such triggers can be external to the individual such as peer pressure or internal such as emotions and thought processes. Association between these stimuli and alcohol develop when they occur repeatedly in proximity. Strengthening of such associations make the abuser become subject to the cravings and triggers of alcohol abuse (Rupp, Kemmler, Kurz, Hinterhuber & Fleischhacker, 2012). Using the learning by consequences model, drinking behavior is reinforced from the achieved results following the use. For instance, if an individual feels euphoric or sexually aroused, the act of ingesting alcohol becomes an adopted behavior (O'Farrell & Fals-Stewart, 2013). In this case, alcohol use has helped in achieving positive reinforcement. On the other hand, when the substance reduces anxiety, tension or depression, the likelihood of future use increases a process known as negative reinforcement (the unpleasant experience is terminated).

From the two model approaches, treatment using the Cognitive Behavioral Approaches are possible (Maltzman, 2008). Cue exposure approach helps in identifying the trigger events which become salient to the individual. In this treatment approach, individuals are exposed to their potent triggers without following them by alcohol abuse. The treatment approach enables the user reduce the craving to alcohol seeking behavior (Maltzman, 2008). This approach reduces the severity of the relapse to substance use. This approach is at its experimental stage with no clinical guidelines at the present.
Coping skills approach does not aim at reducing the severity of the triggers. Rather it seeks for the alternative responses to deal with the situation instead of finding solace in drinking.

In the presence of sufficient alternative coping skills, the addict can apply them when the trigger situation presents, rather than resorting to drinking (Epstein & McCrady, 2009). A related approach, Relapse Prevention, provides a systematic way of assessing consequences of drinking and using them to influence an individual in abhorring from the drinking behavior. In addition, it devises interventions that will help in reducing the probability of future relapse (Cooper, 2012). Other approaches used in Cognitive Behavioral Therapy, focuses on the consequences rather than the antecedents for drinking. These approaches are contingency management and community reinforcement approach.

Deficit of coping skills for both the antecedents and consequences of drinking have been blamed for maintenance of the addictive behavior (Marsch & Dallery, 2012). Under this realization, there is considerable effort devoted at coping skills training among the alcohol users. Coping skills training among the abusers serves as a practical utility which aims at reducing the risk and curtailing the addictive behavior. General reviews done in the past have shown CBT to be the most effective interventions for alcohol treatment if not the best. As already mentioned, CBT uses heterogeneous approach in a bid of improving the treatment response. There are cognitive and motivational elements in the treatment effort as well as skill building interventions. Alcoholism is maladaptive, and it forms strong association with distress among other trigger factors (Marsch & Dallery, 2012). There are both individual and group treatment under the umbrella of CBT.

Motivation interventions are used in the treatment of the individual as well as a group of alcohol addicts. Motivation enhancement techniques have find relevance in addressing the motivational barriers (O'Farrell & Fals-Stewart, 2013). The therapist can employ motivational interviewing, an approach that targets the ambivalence towards behavioral change relative to alcohol abuse. Subsequent application of motivation to the individual is applied. Motivation intervention model can either be stand-alone approach or a combination of other treatment strategies. In most cases, MI is given to the individual although the group format can also be used (O'Farrell & Fals-Stewart, 2013).

Contingency management finds basis on the operational learning theory that employs the use of non-drug reinforcement, for example, gifts following abstinence from alcohol use and abuse (Rupp, Kemmler, Kurz, Hinterhuber & Fleischhacker, 2012). Efficacy of CM has been reported for substances such as alcohol and other drugs. This approach helps the in saving money while at the same time inducing abstinence. The procedure can either be stable or escalating reinforcement schedules, a situation where the reinforce value increases with the duration of abstinence. The major challenge to this approach is the availability of the funds to provide reinforces within the clinical settings (Rupp, Kemmler, Kurz, Hinterhuber & Fleischhacker, 2012). In the recent past, job-based reinforcements have been introduced as the main alternative to the giving of funds. Furthermore, the contingency management have been incorporated among the couples through the utilization of reinforces available in their disposal as an aid in reducing alcohol abuse (Cooper, 2012).

Although alcohol abuse affects the individual directly, the disorder has ties with the social environment of the abuser. Several approaches within Cognitive Behavioral Therapy have been developed. Community Reinforcement Approach is similar to the CM and focuses on the contingencies within the environment of the abuser. This involves the inclusion of non-alcohol related activities in the daily schedule of the abuser (Cooper, 2012). The main aim in this approach is making the sober behavior have more rewards than resolving to substance abuse.

Efficacy of this approach find support from various meta-analyses with the use of the model demonstrated among other drug dependent populations such as cocaine users. Behavioral Couple Therapy realizes the existence of the relationship between alcohol abuse and problems facing the couple. The nature of the problem is defined from the difficult relationship that leads to dependence on alcohol as a coping strategy (Epstein & McCrady, 2009). The focus of this approach, therefore, is improving the functioning of the relationship while helping the partner to find alternative coping skills. Interventions under this approach include application of reinforcement for instance, recognizing positive behaviors (Epstein & McCrady, 2009). Others in the list are, contingent on drug free days, scheduling pleasurable non-drug programs and reward sustenance.


Combining Treatment Strategies have found applicability in the recent past. In such situation CBT is used together with pharmacotherapy (Marsch & Dallery, 2012). There are equivocal outcomes with studies showing that a combination of naltrexone and CBT has great outcomes. Coping Skills Training is the best in terms of psychological dependence. The use of alcohol to cope with certain problems in the life of the abuse places it under the escapist tendencies (Epstein & McCrady, 2009). Psychological dependence on alcohol in such situations lead to addiction with the person having no other choice but to drink. Deficit in the coping skills forms the main obstacle to full recovery from chemical dependence (Maltzman, 2008).

Cognitive Behavioral Therapy offers a heterogeneous approach in dealing with dependence on alcohol. Provision of appropriate coping skills is of great importance in the modification of the psychological dependence on alcohol. Functional analysis helps in identifying the antecedent that lead to alcohol abuse (Maltzman, 2008). Therapist in the respective rehabilitation centers may use less structured clinical interview identifying situations under which drinking occurs. Cognitive Behavioral Therapy is vital in analyzing the typical patterns of use and the antecedent situations. Associated consequences of alcohol abuse are identified with the abuser asked to provide a future situation which may make it difficult to refrain from drug abuse (O'Farrell & Fals-Stewart, 2013). By understanding the trigger situations to alcohol abuse, Cognitive Behavioral Therapy offers the best solution and intervention to alcoholism.


Cooper, L. (2012). Combined Motivational Interviewing and Cognitive--Behavioral Therapy with Older Adult Drug and Alcohol Abusers. Health \& Social Work, 37(3), 173--179.
Epstein, E., & McCrady, B. (2009). A cognitive-behavioral treatment program for overcoming alcohol problems (1st ed.). Oxford: Oxford University Press.
Maltzman, I. (2008). Alcoholism: Its Treatments and Mistreatments (1st ed.). Hackensack, N.J.: World Scientific.
Marsch, L., & Dallery, J. (2012). Advances in the psychosocial treatment of addiction: the role of technology in the delivery of evidence-based psychosocial treatment. The Psychiatric Clinics Of North America,35(2), 481.
O'Farrell, T., & Fals-Stewart, W. (2013). Behavioral couples therapy for alcoholism and drug abuse (1st ed.). New York: Guilford Press.
Rupp, C., Kemmler, G., Kurz, M., Hinterhuber, H., & Fleischhacker, W. (2012). Cognitive remediation therapy during treatment for alcohol dependence. Journal Of Studies On Alcohol And Drugs, 73(4), 625.