The Centre For Cognitive Behavioural Therapy

Alcohol / Drug Abuse

The nature of the industrialised western world with all it's concomitant demands on time and productivity, and the stresses and strains correlate with the profound rise in alcohol / drug abuse. One in every ten adults in the UK has a serious alcohol problem.

Alcohol/drugs affects every organ of the body and with chronic abuse can cause serious medical problems - damage to liver, pancreas, gastro-intestinal tract, cardiovascular system, immune system, nervous system and endocrine system. Alcohol is also linked to the leading cause of accidental death in the United Kingdom. Approximately 30% of suicides and half of all homicides are alcohol related.

What characteristics predispose individuals to alcohol & drug abuse?

Specific factors in an individual which give them a predisposition to alcohol/drug abuse are:

  • extreme sensitivity to unpleasant feelings
  • impulsiveness
  • low frustration tolerance
  • thrill/excitement seeking
  • low boredom threshold
  • hopelessness
  • lack of alternative sources of pleasure
  • depression/anxiety
  • anger control problems
  • social anxiety
  • personality disorder

Psychoactive substances are chemicals that affect the central nervous system and alter a person's thinking, moods, and behaviour.
The DSMIIIR - categorises psychoactive substances into ten classes:

    1. Alcohol
    2. Amphetamines
    3. Cannabis
    4. Cocaine
    5. Opiods
    6. Hallucinogens
    7. Inhalants
    8. Nicotine
    9. Sedatives
    10. Hypnotics

CBT for Alcohol/Drug Abuse

CBT therapeutic treatment for Alcohol/Drug dependence begins at the assessment session where the therapist looks at the initial sequence of events which led to the initial use of alcohol/drugs.

By understanding how individuals reliance on alcohol/drugs for pleasure and/or relief from emotional pain the therapist works to develop specific cognitive strategies to help reduce the intensity and demands of clients urges and create a stronger system of internal controls.

The CBT treatment rationale works with Alcoholics Anonymous in a complementary manner (12 step programme). The goals of treatment with CBT vary according to the clients individual needs, problems and previous history. Whereas AA views total abstinence as this treatment objective, CBT has found that clients prefer setting their own goals, and that way are more willing to achieve them.

The therapist helps clients to step back and assess how faulty thinking patterns impact on this emotional distress. By understanding the relationship between trigger situations which provide the stimulus for their addictive behaviours (work, stress, depression/loss, social anxiety, anger/resentment, low self esteem etc.) and the thoughts, beliefs and urges emotions which precede self medication through Alcohol/Drug abuse. Clients can work with self-defeating patterns and provide alternative ways of interpreting their life situations.

Stages of Treatment for Alcohol/Drug abuse

Used in conjunction with standard CBT treatment a five stage model developed by Prochaska and Di Climente deals with clients alcohol/drug ambivalence with regard to changing abusive alcohol/drug behaviours. They identify a wheel of five areas which clients move around in order to hold the gains which have been set as the goal for treatment.

These are:

Stage 1 - Pre-contemplative where clients are in denial of the extent of their personal drug/alcohol dependency.

Stage 2 - Contemplation where clients are willing to identify and examine problem behaviours but are unable to stop or lessen alcohol / drug dependency.

Stage 3 Preparation. Clients prepare for change but have not yet got a comprehensive plan on how to succeed.

Stage 4 Action. Clients demonstrate a decrease in Alcohol/Drug use based on the therapeutic intervention using belief change and symptom relief.

Stage 5 Maintenance. Clients hold their treatment gains over a period of months / years.

In practice with individualised CBT treatment plans for Alcohol/Drug dependence it is unexpected that clients will progress in a linear way through these stages of change through to the maintenance phase. It is more a two steps forward, one step back movement in which these gains can be maintained.


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