As societal and medical understanding of addiction grows, particularly in relation to its link to mental health, Cognitive Behaviour Therapies are increasingly being used as treatment for substance and alcohol abuse.

“Mental health problems are intrinsically linked to alcohol and other drug problems,” says drug and alcohol policy and practice expert, Professor Nicole Lee.

“Up to 80% of people in alcohol and other drug treatment have some kind of mental health symptoms, most commonly anxiety or depression,” says Dr Lee.

“Alcohol and other drug use cause or can exacerbate mental health problems.

“We also know that existing mental health issues increase the risk of developing alcohol and other drug, including things like the effects of childhood or adult trauma.”

As a result, CBT has become one of the most common, effective treatments for alcohol and other drug addictions.

“I’ve definitely noticed a resurgence of interest in CBT in the last few years, especially as people realise that the quite rigid forms of CBT that were developed in the 1960s have evolved significantly over the last 40-50 years, with a lot more attention paid to process in therapy and the role of emotions, and a lot more flexibility.

“There’s a lot more art to the science now.”

According to Dr Lee, Cognitive Behaviour Therapy is an umbrella term that encompasses a number of solution oriented therapies, with the common underlying theory that emotions are influenced by thoughts and behaviour, and that the way to address difficult emotions is to modify thinking -or cognitions - and behaviours.

The different therapies include behaviour therapy, cognitive therapy, acceptance and commitment therapy (ACT), Dialectical behaviour therapy  (DBT), metacognitive therapy and mindfulness based cognitive therapy.

They differ mainly in the emphasis they put on the importance of different components and the strategies they use to enable cognitive and behavioural change.

“CBT is used for a wide range of problems, including common mental health issues like anxiety and depression.

“Along with more complex mental health issues like substance use problems and psychotic disorders; behavioural disorders such as ADHD and as well as health problems like chronic pain, sleep problems and eating disorders, just to name a few.”

“CBT is now one of the most effective treatments for alcohol and other drug problems, including dependence.

“It’s also the most researched therapy for alcohol and other drug problems.”

Dr Lee says CBT helps people with alcohol and other drug problems recognise unhelpful patterns of thinking and behaving that can increase problematic use.

It can also help people to regulate emotions that may also lead to problematic drinking or drug taking.

“CBT for alcohol and other drug problems is effective as group or individual therapy, typically weekly in Australia.

“Most people receive CBT in non-residential counselling settings.

“It is also a common component of treatment in residential rehabilitation and day rehabilitation settings.”

When it comes to the public perception of alcohol and drug treatment, often the first assumption is AA or one of the other 12-step programs.

“Probably because they feature heavily in movies and TV a lot.

“But there’s virtually no evidence that this approach is effective, and also not everyone needs to be or wants to be abstinent.

“The best estimates are less than 10% of people are successful in 12-step.

“CBT is well researched and is known to be effective and I believe it should be used widely for that reason. There are lots of different varieties of CBT to choose from.”

According to Dr Lee, one of the most beneficial aspects to CBT is that it can be used for people who meet criteria for substance use disorder and for people who have milder problems.

“For example, I recently saw a 40 year old woman who was experiencing some anxiety, especially when she saw her parents and siblings at family gatherings where there was a lot of arguing and tension.

“So she would have a few drinks before she went to see them to calm herself.

“But they would criticise her for drinking which would make her more anxious and drink more.

“She wasn’t dependent on alcohol but she was using alcohol in a way that wasn’t helpful for her.

“She had over time started to drink more heavily at other times as well.

“So we worked on anxiety management, reducing her drinking and some strategies to manage the family dynamics all using CBT.

“I only saw her for 5 sessions as she had improved so much over that short time and was able to continue on her own.

“CBT is really about teaching the client to be their own therapist.”