CBT and DBT in Alcohol Addiction Treatment

About 14 million adults in the United States had an alcohol use disorder (AUD), also known as alcoholism, in 2019.1 With this medical condition, your ability to control your alcohol use is impaired. Even if you experience negative consequences resulting from drinking alcohol, you may be unable to stop drinking without professional help.1

Behavioral therapy is often recommended for treating substance use disorders, including alcoholism. The two most common types of behavioral therapy used for addiction treatment are cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT). The two are similar, but the modalities approach addiction treatment differently.2

In this article:

CBT and Alcohol Addiction Treatment

Cognitive-behavioral therapy (CBT) has a proven history of helping people with recovery from AUD.3 In fact, this form of behavioral therapy was developed to help prevent people from relapsing during their recovery from alcohol misuse.1 Later, CBT was adapted for other types of addiction and other mental health conditions.

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CBT’s founding principle is that behaviors that may hurt you—such as substance misuse—develop based on how you have learned to cope with stressors. That’s why the first step in CBT and addiction treatment is to identify the negative thoughts that lead into alcohol misuse behaviors.3

Once you have identified your thought patterns that lead to alcohol misuse, you and your therapist can work to change your automatic thought patterns and you responses to those negative thoughts or feelings. This process is called functional analysis and it helps you explore both the causes (i.e., your negative thoughts) and the outcomes of the resultant behaviors, such as binge drinking.3

When you’re working through functional analysis, your therapist may take you through a series of questions. This exercise will help you better understand how you feel just before you use alcohol, so you can better understand the connection between your thoughts and actions.

The questions may include:4

  • Where were you and what were you doing just before you used alcohol?
  • What were your feelings at that time?
  • After you used alcohol, did you experience any positive outcomes?
  • What negative consequences did you experience related to using alcohol?

Over time, exercises like these can help you remain in recovery because they help you identify and avoid triggering emotions, locations, or even individuals. You are then less likely to encounter triggers, and you can avoid your previous trigger response.3 For example, you may identify that you have previously used alcohol to distract yourself from overwhelming emotions, to distract yourself from traumatic associations with a location, or related to the social influence of a specific person.

With CBT, you’ll also focus on making specific changes to your behavior and you’ll get to practice those changes with your therapist before you have to test them in real life. After functional analysis, a CBT session for AUD recovery may include brainstorming sessions for coping techniques that serve you better than drinking. These may include:3

CBT is designed to help you work toward a goal—in this case, sustainable sobriety. Studies suggest that CBT yields positive recovery outcomes and may be used as a stand-alone AUD treatment or in combination with other forms of treatment.3

DBT and Alcohol Addiction Treatment

Dialectical-behavioral therapy (DBT) shares many similarities with CBT because it is a form of that behavioral therapy. What makes DBT for addiction unique is that, in addition to helping you change your behaviors, DBT also helps you accept difficult feelings and feel validation when you succeed at your goals.5

The word dialectical highlights the aim of DBT—to combine the opposites objectives of accepting your current situation and making necessary changes. When you choose to treat your alcoholism with DBT, you will engage in exercises that help you manage painful or intense emotions. Many individuals start misusing alcohol as a maladaptive coping mechanism to deal with challenging feelings or situations. In DBT, you will gain tools for coping with your feelings without turning to substance misuse.5

Many people who struggle with alcohol misuse are also living with depression or other mental health conditions. Studies suggest that up to 68% of people seeking help for alcohol misuse also have a diagnosis of major depression.6

Alcohol use can also worsen existing depression, creating a cycle of dependence on alcohol that may be difficult to break.6 DBT for addiction is particularly effective if you struggle with alcohol use and mental health concerns such as depression. That’s because this form of behavioral therapy can help you cope with tough emotions while you develop new ways to manage them.5

To reach that larger goal, DBT works through four smaller goals:5

  1. Regain control of your behavior
  2. Learn to regulate and engage with your feelings
  3. Build a healthy life and learn to solve simple conflicts and challenges with important life skills
  4. Build a full, connected future

Through these goals, DBT goes beyond the behavior changes of CBT. It helps you focus on positive outcomes and can provide additional motivation to avoid relapsing when faced with cravings during recovery.5

Like CBT, you may choose DBT as your only treatment for alcoholism. But the therapy method is also effective when combined with other treatment options, including peer support groups such as Alcoholics Anonymous (AA), other forms of talk therapy, or medications that help prevent alcohol misuse.5

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CBT Versus DBT

Both CBT and DBT are forms of talk therapy, classified as behavioral therapies because they focus on changing your behavioral responses to triggering emotions and situations. Both CBT and DBT can help you with your recovery from alcoholism. And both forms of therapy can be effective forms of treatment on their own or in combination with other treatment options.

The two methods also have key differences. The main focus of CBT is reason and rationality. When you and your therapist explore CBT, you’ll work through your current assumptions about alcoholism using a critical eye, helping you differentiate between your beliefs and reality. In this way, you can overcome feelings of failure, inadequacy, or hopelessness by logically exploring the underlying triggers that make you feel that way.3

In contrast, DBT treatment stems from the principles of mindfulness. The guiding principle is that when you’re more aware of your present thoughts and feelings, it is easier to manage your emotions without resorting to external coping mechanisms.5

CBT treatment methods also differ from those used in DBT. With CBT, your therapist guides you to identify the connections between your thoughts, emotions, and actions. Over the course of your treatment, you’ll gain the ability to identify “problematic” thoughts, which could lead you to engage in “maladaptive” behaviors—actions that, like misusing alcohol, cause you harm but that you find difficult to avoid.3

Once you learned to identify those potentially damaging thoughts, you’ll receive guidance to redirect yourself away from them. That will help you avoid the destructive behaviors you once used as coping mechanisms. CBT treatment time varies based on individual needs. On average, studies show effective change is achieved after 11 sessions. Some people may need a longer treatment duration, although most CBT courses do not extend beyond 20 sessions.7

Instead of seeking to understand the source of your thoughts, DBT treatment helps you engage in—or “hold”—two opposites simultaneously: accepting the current state of your emotions and addiction alongside the potential for learning to manage your emotions to avoid reacting badly to triggers you may encounter. Whereas CBT is generally a solo treatment option, DBT can be effectively introduced to group therapy sessions, allowing several people to engage in mindful reactions to triggering incidents. Most DBT treatment plans include a weekly combination of individual and group therapy sessions.8

Are you seeking help for alcoholism but aren’t sure which treatment method is your best option? Call (phone) today to discuss treatment options with our addiction treatment specialists.

Resources

  1. National Institute on Alcohol Abuse and Alcoholism. (2021). Understanding Alcohol Use Disorder.
  2. National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition).
  3. McHugh, R.K., Hearon, B.A., & Otto, M.W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric Clinics of North America, 33(3), 511-525.
  4. Substance Abuse and Mental Health Services Administration (US). (1999). Treatment Improvement Protocol (TIP) Series, No. 34. Chapter 4—Brief Cognitive-Behavioral Therapy.
  5. Dimeff, L. A., & Linehan, M. M. (2008). Dialectical behavior therapy for substance abusers. Addiction Science and Clinical Practice, 4(2), 39-47.
  6. Kuria, M. W., Ndetei, D. M., Obot, I. S., Khasakhala, L. I., Bagaka, B. M., Mbugua, M. N., & Kamau, J. (2012). The Association between alcohol dependence and depression before and after treatment for alcohol dependence. ISRN Psychiatry, 2012, 482802.
  7. Hiltunen, A. J., Kocys, E., Perrin-Wallqvist, R. (2013). Effectiveness of cognitive-behavioral therapy: An evaluation of therapies provided by trainees at a university psychotherapy training center. Psych Journal, 2(2), 101-112.
  8. Chapman, A. L. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry(Edgemont), 3(9), 62-68.

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