Cognitive-Behavioral Therapy for Alcohol and Other Substance Use Disorders: the Beck Model in Action

Abstract

The Beckian model of cognitive-behavioral therapy (CBT) for alcohol and other substance use disorders is highly consistent with generic CBT in terms of its structure, emphasis on the therapeutic relationship and case conceptualization, and focusing on teaching patients psychological self-monitoring and self-change skills. The model is distinctive because it zeroes in on the substance use issue per se by identifying and managing high-risk situations, modifying maladaptive automatic thoughts and beliefs (about substances, cravings, “permission-giving,” etc.), learning ways to resist acting on cravings and urges, interfering with substance-related behavioral patterns, limiting the damage from lapses, and learning adaptive life habits. CBT practitioners are more effective with this population when they respond with empathic understanding, even when the patients are ambivalent about being in treatment, are at a lower “stage of change,” and therefore are not fully collaborative and/or are not optimally forthcoming or sincere in their self-report. The CBT method of guided discovery is highly congruent with the methods of motivational interviewing, and CBT can be compatible and complementary with 12-step facilitation and pharmacotherapy. The outcome research on CBT for alcohol and other substance use disorders is not as extensive as that for other disorders, and the data (while promising) indicate that more work needs to be done in terms of preventing early termination and maintaining improvement for the long term. A number of studies suggest that CBT is at its best when helping patients manage their alcohol and/or substance use problems in the context of also providing effective treatment for their comorbid depression.