Another technique of CBT relapse prevention is challenging the client's positive self-expectancies about the effects of using alcohol or drugs. This is done in two ways: “change the client's belief about the positive effects” of using the substance and have him “pay more attention to the knowledge and experience of the negative effects” (p. 82). Clients often state “I'll feel more social at the gathering if I drink.” However, they fail to acknowledge the negative consequences such as “…but I always drink too much and get into an argument with my friend or do something else stupid.” It is the function of the CBT therapist to help the client acknowledge that the two usually go together and to remember both scenarios in the same context.

Relapse prevention also stresses that a relapse is possible and steps must be taken to avoid the relapse or to prepare in the event it does happen. Leading a “more balanced and healthier lifestyle” (p.83) helps the individual make better decisions that prevent relapse and high-risk behavior. Role-plays, talking directly about the possibility of relapse, and including family members in relapse planning are of great importance. Often the family will see the behaviors that lead to relapse before the addict will see them or admit them.

CBT and Other Models

CBT is similar to Cognitive Therapy in that it emphasizes “functional analysis of substance abuse and identifying cognitions associated with substance abuse” (NIDA, 1999, p. 9). CBT is different from Cognitive Therapy “in terms of emphasis on identifying, understanding, and changing underlying beliefs about the self and the self in relationship to substance abuse as the primary focus of treatment” (NIDA, 1999, p. 9). In CBT the initial strategies “stress the behavioral aspects of coping” (p. 9). In Cognitive Therapy, the treatment attempts to reduce substance use by changing the client's thinking. “CBT is thought to work by changing both what a client thinks and what he does” (p. 9).

The Community Reinforcement Approach (CRA) uses a “variety of reinforcers, often in the community to help substance users move into a drug-free lifestyle” (NIDA, 1999, p. 9). The most similar feature of both CBT and CRA are the “functional analysis of substance abuse and behavioral skill training” (NIDA, 1999, p. 10). CBT is different from CRA in that CBT does not typically use vouchers for abstinence or interventions outside the treatment sessions or clinic. CBT has some similarities to Motivational Enhancement Therapy by sharing an “exploration…of what the client stands to gain or lose by continuing substance use as a strategy to change the substance use” (NIDA, 1999, p. 10). CBT differs from Interpersonal Psychotherapies (IPT) in that CBT is structured and IPT is more exploratory. CBT attempts to “teach and encourage patients to use skills to control their substance use” while IPT views substance use as secondary to other difficulties (NIDA, 1999, p. 11).

Strengths and Limitations of CBT

One of the main strengths of CBT is its efficacy. Morgenstern and Longabaugh (2000) state, “over the past 25 years, numerous cognitive-behavioral interventions to treat alcohol dependence have been developed and tested…[and] have been demonstrated repeatedly to be effective” compared to other treatment methods (p.1475). As will be discussed below, CBT is also cost-effective in a number of settings (Holder, Cisler, Longabaugh, Stout, Treno, and Zwben, 2000). It also works well with clients who are resistant to the spiritual aspects of the 12-step recovery programs (Bristow-Braitman, 1995,).

SAMHSA (1999) also lists several strengths of CBT for substance abuse treatment. CBT is “flexible in meeting clients needs…readily accepted by clients…soundly grounded in established psychological theory…structured in its guidelines for assessing treatment progress…empowering clients” (p. 54). Limitations include the difficulty many therapists have in incorporating 12-step programs into treatment that uses CBT as the primary model (Bristow-Braitman, 1995). Since CBT encompasses a large number and variety of components, there needs to be more research to determine the most effective of these in treating substance-related disorders.

Implications for Social Worker Practice

Social workers are often the “first service providers to have contact with substance abusers through the major service delivery systems such as child welfare, family service, employee assistance, schools, programs for the elderly…and community mental health centers” (Hall, Amodeo, Shaffer, & Bilt, 2000, p.142). Hall, et al. found that social workers had “significantly higher levels of knowledge and skill in seven of twelve treatment areas investigated” (p.151). Areas where social workers were lacking in skill and knowledge were use of specific screening instruments, brief treatment techniques, motivational interviewing techniques and manual-guided treatment. Of concern is that CBT, 12-Step Facilitation and the Minnesota Model require brief treatment techniques. Motivational interviewing techniques are used in substance abuse treatment. Twelve-Step Facilitation is a “manual-driven treatment approach” NIDA, 2000, p.95). Social workers need more training to overcome deficits in these important areas.

Social workers and students need more training generally in the field of substance abuse and in the specific therapeutic models used in substance abuse agencies (Hall, Amodeo, Shaffer, & Bilt, 2000). Though social workers have the highest level of knowledge and skill in many substance abuse agencies, it is important not to rest there. Social workers encounter substance abusers and need the skills to recognize and deal with the problem when the opportunity presents itself. There is also a need for more training in the specific treatment models such as CBT and other models discussed above.