In the 2008 National Survey on Drug Use and Health, reported by the Substance Abuse and Mental Health Services Administration, an estimated 129 million people ages 12 and older were reported to be users of alcohol. Because of the high prevalence of alcohol use, abuse and dependence among people, there is a constant need for treatment programs that can teach ways to effectively stop use and maintain an alcohol free-lifestyle. Behavioral treatment programs are one form of therapeutic interventions that are evidence-based and effective.
Cognitive Behavioral Treatment
The most notable of the behavioral treatment approaches is cognitive behavioral therapy (CBT). This form of therapy is considered active and requires the client not only to speak about what is of most concern within the therapeutic sessions but also to work toward recovery through gaining insight for change. CBT is a structured and goal-focused program that typically takes no longer than 16 weeks of sessions to complete. The emphasis in CBT is altering thinking to change feelings, leading to changing actions despite any differences in the external environment. An example of this would be to teach the client to recognize thoughts associated with cravings that might be occurring for alcohol use. The client can then associate the thought and feeling in order to identify typical actions that proceed as a reaction to the thoughts and feelings experienced. Once a client is able to pair thought to feeling to action, then learning techniques to redirect the maladaptive thoughts begin the process of change. As CBT continues, the client is introduced to cue exposure to further teach a form of extinguishing cravings via repeated exposure to the alcohol. As this process continues, the goal is to have weaker alcohol cravings despite the alcohol being present and directing the alcohol-related thoughts toward recovery vs. relapse. The work required during CBT is then extended into homework to solidify the skills learned.
Behavior Modification Therapy
Behavioral modification therapy emphasizes change in actions as the core to recovery. Behavioral modification therapy is typically briefer than CBT, with less than 12 weekly sessions prior to completion. Although thoughts and feelings are significant in CBT, this is not necessarily the case for strict behavioral modification treatments. A typical session would include creation of a contract for sobriety with goals for the week that are then expected to be met and reviewed at the next session. The contract would specify limits toward alcohol use per day, self-monitoring of behavior, practicing refusals to alcohol, having a reward system when goals are achieved, learning what precedes drinking behavior, learning what to do instead of drinking and building coping skills for ongoing recovery. The client is in control of his choices, and this is emphasized through conditioning techniques. Behavioral therapy does not emphasize motivation for change, merely accountability and choices toward sobriety.
Rational Emotive Behavioral Therapy
Rational emotive behavioral therapy (REBT) is a behavioral approach that attempts to help a person explore emotional and behavioral problems to find resolution and create fulfillment in life. The premise is an ABC model, which concludes that an activating event (A), contributes to disturbed beliefs (B) and emotional and behavior consequences (C). Rational and irrational tendencies are explored through REBT and ultimately lead to empowering a person to realize personal choice can prevent unhealthy behavior. REBT is also a shorter-term therapeutic approach and emphasizes active participation of the client throughout the process.
