reducing addiction: CBT

• CBT


  around 16 sessions over a 12-week period - establishes a relationship between therapist and client and educates client about the process of what CBT entails including setting an agenda (planning for sessions) and negotiating treatment goals

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  there are two critical components to CBT: functional analysis, skills training
• functional analysis


  understanding of the function of a behaviour - its causes (cognitive biases) and its consequences (financial/personal losses) - conducted at the beginning of CBT and throughout - it works to

  1. identify possible high-risk situations (e.g., at a wedding where alcohol is present), and
  2. establish thought patterns during these high-risk situations
• skills training


  learning to replace current thinking/coping strategies with more helpful alternatives
• skills training: cognitive restructuring


  confronting/addressing faulty beliefs that may operate unconsciously - disputing a gambler's distorted/biased view of chance through use of statistics and probability

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  originally the client and therapist can work on this together, but over time the client may learn how to do it independently
• skills training: specific skills training

  functional analysis may find that the client lacks specific skills to help them cope in specific situations e.g., prone to feeling angry -> lack anger management skills -> resort to addictive substance/behaviour to cope with overwhelming emotion (e.g., drinking)

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  CBT can use anger management training to help the client learn skills to cope with anger e.g., breathing exercises/learning to remove oneself from a high-risk situation
• skills training: social skills training

  functional analysis may reveal that the client lacks social skills that allow them to cope in specific social situations e.g., a recovering alcoholic being offered a drink at a wedding and not refusing due to fear of fuss or embarrassment

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  CBT and social skills training can help the client learn to calmly refuse a drink and cope with the social situation e.g., using eye contact and a firm refusal
• ao3 - research support

  Petry (2006) - rates of gambling in those with an addiction decreased far significantly when they underwent GA meetings and an individual CBT programme than just GA meetings - face-to-face CBT provided the most effective results, suggesting some therapeutic benefit in the client-therapist relationship

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  participants randomly allocated with no significant difference in the extent of their gambling at the start of the procedure - findings provide strong and reliable evidence that CBT is effective in treating gambling addiction
• ao3 - poor treatment adherence

  drop out rates in CBT treatment groups 5x higher than other forms of therapy - this may be because it is expensive, demanding and requires significant engagement and motivation - even when the most high-risk users continued in treatment, they take it less seriously and complete fewer assignments/attend fewer sessions

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  clients often initially seek CBT due to a life crisis caused by their addiction - once this is resolved, they often give up therapy - this reduces full understanding the effectiveness of CBT to reducing addiction
• ao3 - relapse prevention


  for clients who remain in therapy, CBT appears to be especially effective at preventing relapse (most experiences of addiction include chronic relapse)

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  a major strength of CBT is how it incorporates the likelihood of relapse into treatment - viewing it as an opportunity for further cognitive restructuring and learning rather than a failure
• ao3 - short-term/long-term gain

  research reviewing 11 studies comparing CBT for gambling addiction showed medium to large beneficial effects in reducing gambling behaviour for up to 3 months after treatment - but after 9 months there are little significant differences in outcome between those who underwent CBT and control groups - ineffective in reducing gambling addiction

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  researchers also concluded that the studies they reviewed were of such poor methodological quality that they probably overestimate the efficacy of treatment with CBT
• ao3 - alternatives


  drug therapy and behavioural interventions may be more preferable due to being less demanding - although drug therapy has issues in that it does not treat the cause of the addiction, only the symptoms -> an interactionist approach with drug therapy to reduce addiction and CBT to address root causes would be most effective

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  but CBT doesn't actually treat root causes - believes addiction is due to cognitive dysfunction - this focus on cognition ignores the influence of wider problems e.g., socio-economic situations, family context, current stresses