Cognitive-Behavior Therapy for Substance Dependence: Coping Skills Training

His clinical orientation is cognitive-behavioral. His research focuses on treatment efficacy for chemical dependence. From the perspective of cognitive-behavior theory, alcohol and drug dependence are viewed as learned behaviors that are acquired through experience. If alcohol or a drug provides certain desired results (e.g., good feelings, reduced tension, etc.) on repeated occasions, it may become the preferred way of achieving those results, particularly in the absence of other ways of meeting those desired ends. From this perspective, the primary tasks of treatment are to (1) identify the specific needs that alcohol and drugs are being used to meet, and (2) develop skills that provide alternative ways of meeting those needs. There are different viewpoints within this general perspective. "Behavioral" approaches emphasize observable antecedents and consequences of behavior, without making reference to internal events, such as cognitions, that can only be known by self-report. "Cognitive-behavioral" approaches, on the other hand, include cognitions, thoughts, and emotions among the factors that are considered to precipitate or maintain behavior. The latter approaches often utilize behavioral methods (e.g., repeated practice, reinforcement) to modify cognitive and emotional processes. The present guidelines employ a cognitive-behavioral framework for conceptualizing drinking and drug-abuse problems, and as a basis for designing interventions that focus on developing more adequate coping skills. The conceptual models that are more strictly behavioral, contingency management and the community reinforcement approach, are both presented in other guidelines that are available at this web site. The cognitive-behavioral model incorporates the two major types of learning that have been identified in behavior laboratories: learning by association and learning by CBT for Substance Dependence Page 3 consequences. In learning by association (also called 'Pavlovian' or 'classical' conditioning), stimuli that are originally neutral can become triggers for alcohol/drug use, or for cravings, as a result of repeated associations between those stimuli and alcohol/drug use. Triggers may be external to the individual, such as objects in one's environment, settings and locations, or certain people (e.g., the people one uses with regularly), or they may be internal events like thoughts, emotions, or physiological changes. Associations between these various objects/occurrences and alcohol/drug use can develop if they repeatedly occur in close temporal proximity to one another. As these associations are gradually strengthened during the course of repeated occurrences, the alcohol/drug user becomes subject to cravings that can be stimulated by a growing array of stimuli that were previously neutral but have now become …