Abstract
This research paper investigates the effectiveness of cognitive-behavioral therapy (CBT) in reducing relapse rates undergoing treatment for drug addiction: a complex condition influenced by a variety of genetic, environmental, and psychological factors and is marked by cycles of use, withdrawal, and relapse. Among these three cycles, relapse is perhaps the greatest challenge in addiction recovery and addressing it is critical to improving treatment outcomes. CBT, a structured therapeutic approach aimed at altering dysfunctional (negative) thinking, helps individuals recognize and reframe negative thoughts related to drug use while equipping them with coping strategies to manage triggers which might lead to relapse. While CBT does significantly reduce relapse rates amongst individuals in its scope of effect, individuals who were not suitable for CBT often relapsed. This review synthesizes findings from 19 studies ranging from clinical trials to meta-analysis and reviews to assess the efficacy of CBT in reducing relapse rates among individuals suffering from drug addiction.
Introduction
Drug addiction is a complex condition driven by a combination of genetic, environmental, and psychological factors1. It typically begins with voluntary drug use but, over time, leads to brain changes that lead to the individual becoming dependent on substances (National Institute on Drug Abuse, 2018). The cycle of addiction is often marked by phases of use, withdrawal, and relapse, which is a challenge to break from (US Department of Health and Human Services, 2016). Relapse, defined as the return to drug use after a period of abstinence, is particularly challenging2. The top risk factors for relapse include exposure to drug-related cues, stress, and social situations involving drug use (Leifeste et. al, 2023). Targeting relapse is vital in addiction treatment. If relapse is not targeted in drug treatment, it can undermine recovery efforts and lead to overdose, and further psychological harm2.
One intervention used in treatment for drug addiction is cognitive-behavioral therapy (CBT). CBT is a structured approach of therapy that focuses on the connection between thoughts, emotions, and behaviors3. The form of therapy is theorized to be effective in reducing relapse rates because it targets the underlying behavioral patterns and triggers which lead to substance use. By helping individuals identify and challenge cognitive distortions – such as denial and rationalization – CBT reduces the sense of security individuals feel when justifying their drug abuse. Additionally, CBT enhances coping mechanisms by teaching individuals alternative ways to manage stress and employs various techniques such as cognitive restructuring, behavioral experiments, and skills training to do so4. CBT has been used to treat addiction since the 1970s, initially developed to address drinking problems (now considered a type of substance disorder) but later expanded to other forms of substance abuse. The historical development of CBT in addiction treatment shows its effectiveness in helping individuals identify and change the thoughts and behaviors that lead to substance use.
Key components of CBT in addiction treatment include coping skills, addressing cognitive distortions related to drug use, and relapse prevention strategies5. Individuals who suffer from drug addiction turn to substances rather than healthier coping skills to unburden themselves from the emotional trauma that they have received4. The goal of CBT is to increase coping skills or behavioral flexibility and make individuals less reliant on the substance3.
Individuals who suffer from drug addiction, experience cognitive distortions such as denial, rationalization, and minimization, which serve to justify their drug use, reduce feelings of guilt, and avoid confronting negative consequences of their behavior (a more conventional term: “avoiding reality”)6. Despite the extensive research supporting the efficacy of CBT in treating alcohol and drug use disorders (Magill et al., 2023), its specific impact on relapse rates among drug addicts remains a critical area of investigation.
Reasons why drug treatments does not target relapse as an outcome include the inconsistent definitions of relapse, challenges with participants being fully truthful about when they have relapsed, and loss to follow-up when participants drop out of studies7. Understanding the role of CBT in reducing relapse rates can provide valuable insights for enhancing therapeutic strategies and improving patient outcomes.
This research paper synthesizes data from 19 randomized controlled trials, encompassing – study arms, to evaluate the efficacy of CBT in decreasing relapse rates among individuals with alcohol or drug use disorders. By examining the effects of CBT against minimal treatment, nonspecific therapy, and specific therapy at various follow-up intervals, this study aims to clarify the conditions under which CBT is most beneficial in preventing relapse. The findings of this analysis will contribute to the ongoing discussion on optimizing addiction treatment protocols and highlight the potential of CBT in promoting sustained recovery.
Problem Statement: Despite its effectiveness in addiction treatment, the specific impact of CBT on relapse prevention remains widely unexplored and unclear. Many treatment options fail to directly address relapse due to inconsistent definitions, study dropouts, and behavioral challenges amongst patients.
Method
Search Strategy
The search was conducted on July 17, 2024, using the databases PubMed (for its vast biomedical literature) and Google Scholar (for its interdisciplinary reach). The search strategy entered was: “(CBT) AND (DRUG ADDICTION) AND (RELAPSE RATES) NOT (DEPRESSIVE DISORDERS)” since these digressing search terms were leading to clinical trials appearing that were completely unrelated to the subject matter. The initial search yielded 378 papers. We restricted the results to papers published from 2010 to present, which yielded 86 papers.
From this point, abstracts were manually screened based on topic relevance. Papers were included based on their focus on CBT and relapse in drug addiction. After manually screening the abstracts, we were left with 19 papers for analysis.
The findings were grouped thematically, focusing on the efficacy of CBT in reducing relapse rates, comparison of CBT with other treatments in reducing relapse rates, and specific mechanisms by which CBT reduces relapse in individuals with drug addiction.
Results
Efficacy of CBT in Reducing Relapse Rates
A review of recent studies suggests that CBT is effective in reducing relapse rates among individuals treated for drug addiction4.
Several studies have stated that an individual who goes through CBT and regularly attends therapeutic sessions will be significantly less likely to relapse as opposed to individuals undergoing other forms of treatment4
Clinical Trials and Case Studies
One study showed that individuals who participated in a CBT program had significantly lower relapse rates after six months compared to those in a control group8. Case studies also highlight the success of CBT programs that incorporate techniques such as mindfulness and coping skills training. These programs often emphasize the importance of patient engagement and tailoring CBT strategies to individual needs.
Mechanisms by Which CBT Combats Relapse
CBT combats relapse by addressing the cognitive and behavioral triggers that lead to drug use3. One of the key mechanisms is cognitive restructuring, which helps individuals identify and challenge the thoughts that lead to cravings.
CBT also aids in nullifying triggers by teaching coping strategies, such as avoiding high-risk situations and managing stress3. When an individual’s primary trigger for drinking might be stress – especially when she faces high-pressure situations at work – CBT can aid her in learning to identify her stress and cope in a healthier manner.
Discussion
In summary, the literature suggests that CBT is an effective intervention for reducing relapse rates among individuals in treatment for drug addiction. The findings indicate that CBT not only helps individuals abstain from drug use but also equips them with the tools to maintain long-term recovery.
However, the effectiveness of CBT on relapse rates may vary depending on individual patient factors (such as length of addiction, patient’s history, etc.). The effectiveness of CBT on relapse rates also depends on the context under which individuals use substances. For example, the length of which the addiction has persisted for, the amount of substance used. Generally, people who have been using substances for a longer period, or individuals using a greater number of substances may face a more challenging path to recovery through CBT due to entrenched patterns of behavior and a more ingrained dependence cycle.
Limitations of this literature review include potential biases in the selected studies (several studies catered towards exclusively one race). Despite these limitations, this review contributes to the understanding of how CBT can be used to address the persistent issue of relapse in drug addiction treatment. Further areas of research include addressing the long term efficacy of CBT, the personalization of CBT for drug addiction, and the combination therapies involving CBT and their efficacy in combating relapse rates.
References
- Arunkumar Singh Koijam, Kabrambam Dasanta Singh, Bunindro Singh Nameirakpam, Haobam, R., & Yallappa Rajashekar. (2024). Drug addiction and treatment: An epigenetic perspective. Biomedicine & Pharmacotherapy, 170, 115951–115951. https://doi.org/10.1016/j.biopha.2023.115951 [↩]
- Guenzel, N., & McChargue, D. (2023, July 21). Addiction relapse prevention. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK551500/ [↩] [↩]
- Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1). https://doi.org/10.1186/s13030-021-00219-w [↩] [↩] [↩] [↩]
- McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive Behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012 [↩] [↩] [↩] [↩]
- McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010b). Cognitive Behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012 [↩]
- Sripada, C. (2021). Impaired control in addiction involves cognitive distortions and unreliable self-control, not compulsive desires and overwhelmed self-control. Behavioural Brain Research, 418, 113639. https://doi.org/10.1016/j.bbr.2021.113639 [↩]
- Kaviyani, F., Khorrami, M., Heydari, H., & Namvar, M. (2023). Understanding the laps and relapse process: in-depth interviews with individual who use methamphetamine. Substance Abuse Treatment Prevention and Policy, 18(1). https://doi.org/10.1186/s13011-023-00548-9 [↩]
- Chaudhury, S., Srivastava, K., Prakash, J., Bhat, P., Chatterjee, K., & Chauhan, V. (2022). Cognitive behavior therapy as an adjuvant in management of alcohol dependence syndrome. Industrial Psychiatry Journal, 31(2), 255. https://doi.org/10.4103/ipj.ipj_267_21 [↩]
