What are the problems/criticisms in using CBT in addictive therapy?
Current research shows that CBT is very useful in treating clients with depression and/or anxiety. I believe that CBT would be equally successful in the treatment of addictions outside of drug and alcohol, such as gambling, over eating and especially pornography/sex. I have been assigned a research project where I have to demonstrate that CBT is not a good fit for addiction counseling. So, odd as it may sound, I would certainly appreciate some advice or recommended sources as to why CBT would not work with this type of counseling.
CBT involves the client processing reasons to make better decisions, to discover the reasons surrounding the addiction, and to understand the medical implications of this disorder. This process assumes the client is able to go through this process, which is a large assumption. You would have to have access to medical documentation (including neurological reports) which could be used to determine if the client is cognitively impaired and the degree of impairment.
I don't see that there is a problem per- sae with using CTB. Cognitive types of therapy can be quite the useful adjunct to JUST substance abuse/psycho- educations, and traditional dependency therapies--including medicinal therapies. I very much prefer to use an eclectic approach to treat ANY types of dependencies, including challenging thought process', because it helps to get to the surface core of triggers, and thinking that leads to behaviors, that lead to using once again
I agree CBT is likely to be effective for at least some addictive behaviors but if I was given the task of looking for evidence that it might not be effective my first port of call would be to look for research on Functional MRI and addictions, expecting that some of the brain areas involved may not be so amenable to cognitive work. Good luck with your challenge.
This is my personal experience working with women in group sessions within a residential substance abuse treatment center, and my personal opinion. I believe CBT is very effective for depression, and I believe most clients new in rehab could meet criteria for either depression or could be feeling depressive, whether organic or situational etiology. I use some CBT in a women's group for self-esteem...most effective with cognitive distortions and negative self-talk. However, in my workplace, clients come and go quickly which prevents some continuity in my once weekly 1-hour group sessions. My experience has been that the lack of continuity/consistency, and having less than an hour per session, presents a bit of challenge with using CBT in group sessions. The clients do seem to take well to using CBT for cognitive distortions in depression when it is kept very simple with just a few worksheets--have had good success when I keep it simplified in that each session is its own and does not bridge from/to other sessions. As far as CBT for addictions in general. Integrated therapies for depression in substance abuse often use motivational interviewing (especially in beginning stages of change) and CBT to help change thought patterns that take them back into (or keep them in) their addictive behaviors.. You can check out these articles: http://www.ncbi.nlm.nih.gov/pubmed/24304463 and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680631/ I am currently trying out a course of mindfulness-based cognitive therapy for depression with a client in residential addictions treatment.
Greater Manchester West Mental Health NHS Foundation Trust
Hi like Stacey, my experience of working with drug alcohol and mental health problems is that they do all tend to go together. The stages of change model suggests to me that we should use interventions that best suit where the person is at. CBTs and they are a number of them, are largely action focussed interventions. Unfortuntely even if people say they are ready for change they have not always resolved their ambivalance around this. This applies as much to anxiety and depression as it does to susbtance misuse.
So an action focussed intervention may not be all they require and they therefore drop out. The use of Motivational intervieiwing either as a prelude to other therapeutic approaches or used an integrative structure for CBT allows for a more person centered and flexible approach. In practice peoples motivation for change does change over time. An approach that addresses building motivation, can help in initiating change and in maintaining it.
Rowan University, Treatment Research Institute, & University of Pennsylvania
There is a good meta-analysis that was reported in 2009 by Xavier Castells et al. in The American Journal of Drug and Alcohol Abuse, volume 35, pp. 339–349. It shows that CBT is effective in the treatment of cocaine use disorders among opiate addicted patients. It is more effective, however, when combined with abstinence-based incentives. (See Fig 3, p 343) It is also effective in the treatment of other substance use disorders (e.g., marijuana), when combined with abstinence-based incentives. More studies should show up if you do a literature search.
I agree with all the above with the short answer being that CBT alone may not be appropriate or effective due to the variations among client presentations, ie. dual diagnoses. Since you are talking about behavioral dysfunctions and, generally speaking, medical imaging and neurological examinations are not available for most treatment centers, the amount of reliance on CBT would be based on the availability of psychosocialmedical support in diagnoses and treatment available.
Just to reiterate; CBT alone has not shown the success as compared to integrative approaches.
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