From the Guidelines
Cognitive Behavioral Therapy (CBT) is a crucial component of treatment for alcoholism and should be combined with pharmacotherapy for optimal outcomes. According to a systematic review and meta-analysis published in JAMA Network Open in 2020 1, combined pharmacotherapy and CBT was associated with increased benefit compared to usual care and pharmacotherapy. This suggests that CBT, when used in conjunction with medication, can lead to improved outcomes for individuals with alcohol use disorder.
The key aspects of CBT for alcoholism include:
- Identifying and changing negative thought patterns and behaviors that contribute to drinking
- Developing coping skills and recognizing drinking triggers
- Managing cravings and building problem-solving abilities
- Practicing new skills through homework assignments between sessions
CBT can be delivered individually or in group settings, and its effectiveness stems from its ability to help patients understand the connection between thoughts, feelings, and behaviors, creating lasting cognitive changes that support long-term sobriety 1. While CBT may not perform better than other evidence-based modalities, it is a valuable addition to pharmacotherapy and should be considered a primary treatment option for alcoholism.
In terms of specific treatment regimens, a typical CBT course involves weekly 60-90 minute sessions over 12-16 weeks, and may be combined with medications such as naltrexone, acamprosate, or disulfiram. The combination of CBT and pharmacotherapy can help patients challenge distorted thinking about alcohol, develop healthier coping mechanisms, and build confidence in their ability to maintain sobriety 1.
From the Research
CBT and Alcoholism
- Cognitive Behavioral Therapy (CBT) is a widely used treatment approach for alcoholism, and its effectiveness has been studied in various research studies 2, 3, 4, 5.
- Studies have shown that CBT can be used in combination with pharmacotherapies such as naltrexone and acamprosate to improve treatment outcomes for alcohol dependence 3, 4.
- The COMBINE study, a randomized controlled trial, found that patients receiving medical management with naltrexone, CBI, or both had higher percent days abstinent than those receiving placebos and medical management only 4.
- Another study found that CBT + combined medication (naltrexone and acamprosate) produced the greatest improvement across all outcome measures, including programme attendance, programme abstinence, and cumulative abstinence duration 3.
- CBT approaches have been shown to have a modest effect size with evidence of relatively durable effects, but limited diffusion in clinical practice 5.
- Technology may provide a means for CBT interventions to circumvent the "implementation cliff" and offer a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations 5.
Pharmacotherapies and CBT
- Naltrexone and acamprosate are two medications that have been shown to be effective in relapse prevention of alcoholism, and can be used in combination with CBT to improve treatment outcomes 2, 3, 4.
- The combination of naltrexone and acamprosate has been shown to be more effective than either medication alone in preventing relapse in alcohol-dependent patients 2, 3.
- CBT can be used to enhance the effectiveness of pharmacotherapies such as naltrexone and acamprosate, and to improve patient outcomes 3, 4.
Effectiveness of CBT
- CBT has been shown to be an effective treatment approach for alcoholism, with a modest effect size and relatively durable effects 5.
- CBT can be used to improve treatment outcomes for alcohol dependence, including reducing drinking days and improving abstinence rates 3, 4.
- The effectiveness of CBT can be enhanced by combining it with pharmacotherapies such as naltrexone and acamprosate 3, 4.