Behavioral Therapies In Drug And Alcohol Addiction: A Complete Guide

Drug and alcohol addiction, or substance use disorder (SUD), is a condition characterized by a person’s inability to control drug and alcohol use.

When you become addicted, you can’t resist the urge to take drugs and drink alcohol despite knowing the harm it may cause. 

In most cases, addiction begins with experimental use in social situations. For example, if you’re peers are drug users, how can you say no when they offer you some? For many, it becomes more recurrent until they can no longer control it. 

The risk of drug and alcohol addiction may vary depending on the substance used. Some drugs are more potent and may trigger addiction faster than others. These include cocaine, marijuana, opioid painkillers, nicotine, stimulants, and methamphetamine.

Today, there are many ways to treat drug and alcohol addiction. Behavioral therapy is one of them, which aims to help individuals identify and change their self-inflicting and unhealthy behaviors. It posits that learned behaviors can be altered for the better. 

If you seek behavioral therapy to combat your addiction, visit or other rehab facilities to start the treatment. Mental health professionals (e.g., psychiatrists and psychologists) will guide you toward sobriety.

Below are the different types of behavioral therapy experts may recommend for you to overcome your addiction.

1. Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy well-recognized for treating addiction and other mental health conditions, such as depression and anxiety. The principle behind CBT indicates that addiction is based on negative behaviors and self-destructive thinking patterns.

CBT is defined as a combination of cognitive therapy and behavioral therapy. It identifies maladaptive thought patterns, behavior, and emotional response and replaces them with more desirable ones.

The main goal of CBT is to help individuals determine and change unhealthy thinking patterns that may negatively affect their moods, emotions, and behaviors. During the therapy, such thinking is identified and substituted with healthier thoughts.

Here are the techniques used in CBT:

  • Negative Thought Identification: This is the process of knowing the feelings, situations, and thoughts that contribute to unhealthy behaviors. However, it’s often challenging, especially for individuals who can’t examine themselves.
  • Practicing Coping Skills: In CBT, individuals are taught skills they can use in real life. For example, people with SUD can practice techniques and strategies to help them deal with situations that may trigger a relapse.
  • Setting Goals: This is an important step in overcoming addiction, helping you improve your life and health. During a CBT session, a mental health expert can help you identify your goals and classify them, whether short- or long-term.
  • Solving Problems: This technique will teach you how to solve conflicts caused by life stressors. This can also help you minimize the negative impact of physical and psychological illnesses.
  • Self-Monitoring: This technique involves keeping track of behaviors, experiences, and symptoms and discussing them with a mental health expert. With this, experts can identify the best treatment for your condition.
  • Therapeutic Role-Playing: This technique is often used to treat phobias, but it can also be used to combat addiction. It allows individuals to practice skills that may help them overcome relapse and substance cravings.

Other techniques utilized in CBT include journaling, mental distractions, and relaxation.

2. Contingency Management 

Contingency management (CM) is a behavioral therapy that rewards individuals for every positive change they make in their lives.

CM is based on operant conditioning—a principle that incentivizes individuals for their healthy behaviors. Incentives can be a movie pass, raffle-draw prizes, discount coupons, free meal vouchers, etc. However, no rewards will be given if there’s no improvement in behavior.

Behavioral Therapies In Drug And Alcohol Addiction

So, what are the possible behaviors that can be rewarded based on the principles of CM? 

  • Attending treatment schedules without missing a single one
  • Attending support groups, such as Narcotics Anonymous (NA) and Alcoholics Anonymous (AA)
  • Testing negative in drug tests
  • Consistently avoiding drug and alcohol use
  • Engaging in activities that promote recovery
  • Taking medications at the right time and the right dosage

CM also comes in different variations and interventions, such as abstinence CM, attendance CM, and voucher-based reinforcement.

  • Abstinence CM: In this intervention, individuals must provide drug tests to their therapist. If the results of their tests are negative, they’ll be eligible for incentives, such as prize slips in different denominations.
  • Attendance CM: The main goal of this intervention is to encourage individuals to complete their attendance for therapy sessions. This technique can help increase an individual’s overall sense of accomplishment.
  • Voucher-Based Reinforcement: As the name implies, this intervention focuses on providing vouchers to individuals once they achieve a target behavior. They may receive a voucher for every negative test result they provide, which can be exchanged for goods.

Another CM intervention is prize-based CM. It’s similar to voucher-based reinforcement. But instead of vouchers, it offers individuals opportunities to win cash prizes. Cash prizes may range from USD$1 to USD$100.

3. Rational Emotive Behavior Therapy

Rational emotive behavior therapy (REBT) is a type of CBT that focuses on helping individuals manage thoughts and emotions in a more realistic and healthier way.

Identifying irrational beliefs is also a goal of REBT. Irrational beliefs are negative responses to stressful life events and situations, resulting in more problems. 

The main principle of REBT can be explained by the ABC model. ABC stands for:

  • A: Activating event—a situation happening around you
  • B: Belief—your thoughts about a particular situation (activating event)
  • C: Consequence—your response to a particular belief

The ABC model will help you recognize the irrational beliefs that can cause psychological disturbances. Usually, these are perceived as ‘absolutes,’ such as ‘I can’t,’ ‘I won’t,’ or ‘I shall.’ Here are some examples of common irrational beliefs:

  • You must feel overly upset over other people’s failures in life.
  • You must be successful and always on top of everything so that people may find you valuable.
  • You will only be happy if you avoid all the challenges in life.
  • You will never be able to control your happiness. It will always be dependent on external factors.

Once you’ve identified your irrational beliefs, it’s time to replace them with healthier ones. Note that this can be overwhelming at some point, and it’s alright to make a mistake and feel discomfort about your assessment of yourself.

Here are three key concepts REBT wants you to follow:

  • You deserve to be accepted regardless of what you achieved and what mistakes you made in life.
  • Other people also deserve to be accepted, even if their mood and behavior are something you hate a lot.
  • You will experience a lot of negative things in life because life isn’t designed to be always positive.

Some techniques your therapist may use to target your emotional responses include guided imagery, journaling, and meditation.

4. Dialectic Behavioral Therapy

Dialectic behavioral therapy (DBT) is another form of CBT. It aims to teach individuals how to stay in touch with the present, regulate their behavior and emotions, strengthen their relationships with others, and formulate a healthy way to combat stress.

DBT was initially developed to treat personality disorders, particularly borderline personality disorder (BPD). However, as time passed, it has been used to treat other conditions, including addiction and other self-destructive behavior.

DBT has four treatment stages:

  • Stage 1 – Assessment: All your extreme and self-inflicting behaviors will be discussed in this stage. These may include self-harm or suicidal thoughts.
  • Stage 2 – Address Issues: This stage addresses concerns that may negatively affect an individual’s quality of life. These may include regulating emotions, interpersonal ability, and tolerating distress.
  • Stage 3 – Focus On Self: This stage concentrates on issues that may affect one’s self-confidence and relationships with others (interpersonal).
  • Stage 4 – Get The Most Out Of Life: This stage involves a treatment that encourages individuals to experience life to the fullest. It includes finding happiness, building stronger bonds, and pursuing dreams.  

Here are the DBT techniques your therapist may use:

  • Mindfulness: DBT aims to develop mindfulness skills, encouraging you to focus on what’s around and inside you (e.g., current emotions, perceptions, impulses, etc.). It also helps you focus on coping skills that may help you overcome addiction.
  • Distress Tolerance: This technique allows you to accept who you are and where you are now. It also involves related techniques, such as self-soothing and thinking of the consequences of failure to address distress.
  • Emotion Regulation: This technique allows you to manage and control intense negative feelings effectively. Also, it’ll help you identify and change unhealthy emotions and create more positive experiences.

Through DBT, you’ll be able to accept yourself and your circumstances, identify and change unhealthy thought patterns, replace beliefs with more realistic ones, and learn new skills.

5. Twelve-Step Programs

Twelve-step programs support groups that help individuals overcome drug and alcohol addiction—sometimes dual-diagnosis conditions. It was created by AA to recover from alcohol addiction.

The main concept of 12-step programs is to achieve and maintain sobriety by helping one another. And that healing alone isn’t enough unless individuals suffering from addiction submit to a higher omnipotent being.

This omnipotent being doesn’t have to be God, especially if you’re not a Christian. It could be the universe, the support group community, or other higher being depending on your spirituality and religion (e.g., Allah for followers of Islam).

So, what are these 12 steps? 

  • Step 1: Admit that you’re powerless over addiction.
  • Step 2: Believe that there’s a higher power that can help you.
  • Step 3: Surrender all your control to the higher power.
  • Step 4: Establish and optimize your personal inventory.
  • Step 5: Admit to yourself, someone, and the higher power all your mistakes.
  • Step 6: Prepare yourself to be corrected by the higher power.
  • Step 7: Ask the higher power to get rid of all your flaws and imperfections.
  • Step 8: Create a list of all the mistakes you’ve made towards other people and prepare yourself to ask for apologies.
  • Step 9: Reach out to those who have been hurt by your wrongdoings. Stop if you think that talking to them would hurt them more. It means they’re not yet ready for you.
  • Step 10: Continue your personal inventory and admit your mistakes.
  • Step 11: Seek spiritual connection and enlightenment with the higher power through meditation and prayer.
  • Step 12: Carry the message of the 12-step program and offer it as help to those who are in need of it.

Aside from AA, various support groups—with the same goal of fighting addiction—have created their own versions of the 12-step program. These are NA, Gamblers Anonymous (GA), and Heroin Anonymous (HA).

6. Motivational Interviewing

Motivational interviewing (MI) is designed to help individuals be motivated to change their unhealthy behavioral patterns. This approach is effective for individuals with conflicting desires about making behavioral changes.

When it comes to addiction, individuals often have mixed feelings. For example, you want to change your behavior but are not yet ready to do it. MI can address such contradictory ideas by motivating them to change for the better version of themselves.

Here are the four principles behind motivational interviewing:

  • Expressing Empathy: Individuals with addiction are often reluctant to seek treatment because of the fear of being judged. However, therapists aim to understand their situation instead of judging them based on their client’s point of view. This is called empathy.
  • Developing Discrepancy: This principle is based on the idea that individuals become motivated when they see where they are now. The therapist’s role is to help them define their core values and goals. This encourages individuals to change.
  • Rolling With Resistance: This principle encourages therapists to help them understand themselves instead of opposing or challenging individuals with addiction. This can be done by offering different versions of particular events, increasing their motivation to change.
  • Supporting Self-Efficacy: This principle encourages therapists to support an individual’s self-efficacy (the confidence to achieve a target behavior). They guide their clients throughout the process, encourage them, and acknowledge every positive change.

Final Words

Drug and alcohol addiction can be treated by undergoing behavioral therapy sessions. Behavioral therapy includes cognitive behavioral therapy, contingency management, rational emotive behavior therapy, dialectic behavioral therapy, 12-step programs, and motivational interviewing.

These aim to help individuals with addiction identify behaviors learned and change them. If you or a loved one has SUD, talk to a mental health professional as soon as possible. They’ll help you find the right therapy and treatment for your condition.

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