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.
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Anton, R. F., Moak, D. H., Latham, P. K., Waid, R., Malcolm, R. J., Dias, J. K., & Roberts, J. S. (2001). Posttreatment results of combining naltrexone with cognitive-behavioral therapy for the treatment of alcoholism. Journal of Clinical Psycho-pharmacology, 21, 72–77.
Anton, R. F., Moak, D. H., Waid, R., Latham, P. K., Malcolm, R. J., & Dias, J. K. (1999). Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics: results of a placebo-controlled trial. American Journal of Psychiatry, 156, 1758–1764.
Baker, A., Boggs, T. G., & Lewin, T. J. (2001). Randomized controlled trial of brief cognitive-behavioral interventions among regular users of amphetamine. Addiction, 96, 1279–1287.
Beck, A. T., Freeman, A., Davis, D., & Associates. (2004). Cognitive therapy of personality disorders (2nd ed.). New York: Guilford.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Beck, A. T., Wright, F. D., Newman, C. F., & Liese, B. S. (1993). Cognitive therapy of substance abuse. New York: Guilford Press.
Beck, J. S. (2011). Cognitive behavior therapy: basics and beyond (2nd ed.). New York: Guilford Press.
Carroll, K. M., Nich, C., Ball, S. A., McCance, E., Frankforter, T. L., & Rounsaville, B. J. (2000). One-year follow-up of disulfiram and psychotherapy for cocaine-alcohol users: sustained effects of treatment. Addiction, 95, 1335–1349.
Carroll, K. M., Nich, C., Ball, S. A., McCance, E., & Rounsaville, B. J. (1998). Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction, 93, 713–727.
Carroll, K. M., Rounsaville, B. J., Nich, C., Gordon, L. T., Wirtz, P. W., & Gawin, F. H. (1994). One-year follow-up of psychotherapy and pharmacotherapy for cocaine dependence: delayed emergence of psychotherapy effects. Archives of General Psychiatry, 51, 989–997.
Crits-Christoph, P., Siqueland, L., Blaine, J., Frank, A., Luborsky, L., Onken, L. S., Muenz, L. R., Thase, M. E., Weiss, R. D., Gastfriend, D. R., Woody, G. E., Barber, J. P., Butler, S. F., Daley, D., Saloum, I., Bishop, S., Najavits, L. M., Lis, J., Mercer, D., Griffin, M. L., Moras, K., & Beck, A. T. (1999). Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Archives of General Psychiatry, 56, 493–502.
Deas, D., & Thomas, S. E. (2001). An overview of controlled studies of adolescent substance abuse treatment. American Journal on Addictions, 10, 178–189.
Epstein, D. H., Hawkins, W. E., Covi, L., Umbritch, A., & Preston, K. L. (2003). Cognitive-behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up. Psychology of Addictive Behaviors, 17, 73–82.
Evans, K., & Sullivan, M. J. (2001). Dual diagnosis: counseling the mentally ill substance abuser (2nd ed.). New York: Guilford Press.
Gilbert, P., & Leahy, R. L. (Eds.) (2007). The therapeutic relationship in the cognitive-behavioral psychotherapies. New York: Routledge/Taylor & Francis.
Kaminer, Y., & Waldron, H. B. (2006). Evidence-based cognitive-behavioral therapies for adolescent substance use disorders: applications and challenges. In H. A. Liddle & C. L. Rowe (Eds.), Adolescent substance abuse: research and clinical advances (pp. 396–419). New York, NY: Cambridge University Press.
Liese, B. S., Beck, A. T., & Seaton, K. (2002). The cognitive therapy addictions group. In D. W. Brook & H. I. Spitzer (Eds.), Group psychotherapy of substance abuse (pp. 37–57). New York: Haworth Medical Press.
Lydecker, K. P., Tate, S. R., Cummins, K. M., McQuaid, J., Granholm, E., & Brown, S. A. (2010). Clinical outcomes of an integrated treatment for depression and substance use disorders. Psychology of Addictive Behaviors, 24, 453–465.
Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. Journal of Studies on Alcohol and Drugs, 70, 516–527.
Maude-Griffin, P. M., Hohenstein, J. M., Humfleet, G. L., Reilly, P. M., Tusel, D. J., & Hall, S. M. (1998). Superior efficacy of cognitive-behavioral therapy for urban crack cocaine abusers: main and matching effects. Journal of Consulting and Clinical Psychology, 66, 832–837.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: preparing people for change (2nd ed.). New York: Guilford Press.
Mueser, K. T., Noordsy, D. L., Drake, R. E., & Fox, L. (2003). Integrated treatment for dual disorders: a guide to effective practice. New York: Guilford Press.
Newman, C. F. (2004). Substance abuse. In R. L. Leahy (Ed.), Contemporary cognitive therapy: theory, research, and practice (pp. 206–227). New York: Guilford.
Newman, C. F. (2008). Substance use disorders. In M. A. Whisman (Ed.), Adapting cognitive therapy for depression: managing complexity and comorbidity (pp. 233–254). New York: Guilford Press.
Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-solving therapy: a treatment manual. New York: Springer.
Nishith, P., Mueser, K. T., Srsic, C. S., & Beck, A. T. (1997). Differential response to cognitive therapy in parolees with primary and secondary substance use disorders. The Journal of Nervous and Mental Disease, 185, 763–766.
Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2011). Stages of change. Journal of Clinical Psychology, 67, 143–154.
Overholser, J. C. (1988). Clinical utility of the Socratic method. In C. Stout (Ed.), Annals of clinical research (pp. 1–7). Des Plaines, IL: Forest Institute.
Ramsey, S. E., Brown, R. A., Stuart, G. L., Burgess, E. S., & Miller, I. W. (2002). Cognitive variables in alcohol dependent patients with elevated depressive symptoms: changes and predictive utility as a function of treatment. Substance Abuse, 23, 171–182.
Rees, C. S., McEvoy, P., & Nathan, P. R. (2005). Relationship between homework completion and outcome in cognitive behaviour therapy. Cognitive Behaviour Therapy, 34, 242–247.
Tang, T. Z., Beberman, R., DeRubeis, R. J., & Pham, T. (2005). Cognitive changes, critical sessions, and sudden gains in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 73, 168–172.
Wells, E. A., Peterson, P. L., Gainey, R. R., Hawkins, J. D., & Catalano, R. F. (1994). Outpatient treatment for cocaine abuse: a controlled comparison of relapse prevention and Twelve-Step approaches. American Journal of Drug and Alcohol Abuse, 20, 1–17.
Wenzel, A., Liese, B. S., Beck, A. T., & Friedman-Wheeler, D. G. (2012). Group cognitive therapy of addictions. New York: Guilford Press.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: a practitioner’s guide. New York, NY: Guilford.
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Newman, C.F. Cognitive-Behavioral Therapy for Alcohol and Other Substance Use Disorders: the Beck Model in Action. J Cogn Ther 12, 307–326 (2019). https://doi.org/10.1007/s41811-019-00051-9
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DOI: https://doi.org/10.1007/s41811-019-00051-9