How Can Cognitive Behavioral Therapy (CBT) Help With Alcohol Misuse?

In the words of motivational speaker Billy Alsbrooks, “Our lives are the fruit of our most consistent thought patterns.” 

While it seems as though we do what we do because our external environment drives us to do so, in reality all behaviors originate in the mind. And while we assume that what our mind tells us is objectively true or in alignment with our core values and experiences, this isn’t always the case: our thoughts are susceptible to neurological “glitches” — habitual patterns that lead us into the murky waters of self-sabotage.

Enter CBT: Cognitive Behavioral Therapy

If you're new to the therapeutic world, CBT might just sound like another acronym. However, there’s a wealth of resources behind it! CBT is a form of talk therapy designed to help people become aware of and change negative thought patterns and behaviors. It's grounded in the idea that our thoughts, feelings, and behaviors are interconnected, and that by changing negative thought patterns, we can alter our feelings and behaviors. And yes, this includes behaviors related to alcohol misuse!

What Is Cognitive Behavioral Therapy (CBT)?

CBT evolved from years of scientific thought and research. Here's a quick timeline of its development:

• 1950s and 60s. This is the dawn of behavioral therapy. It was all about understanding how behaviors were learned and unlearned. Think of it as identifying what pushes our buttons.
• 1970s. Psychiatrist Aaron T. Beck observed that thoughts played a significant role in emotions and behaviors. Combining cognitive (thought-related) and behavioral techniques, he developed what we now know as CBT.
• 1980s and 90s. CBT became increasingly popular, thanks to its evidence-based results. It started being applied to a myriad of issues, including alcohol misuse.

The ABCs of CBT

Fast forward to today, and CBT is widely respected, practiced, and recommended worldwide for treating anxiety, depression, PTSD, substance misuse, and even sleep disturbances. 

CBT is typically a short-term, goal-oriented therapy focused on solving current challenges through a structured approach. While other therapies involve deep dives into our past, CBT is more about understanding the here and now.

At the heart of CBT is the belief that our thoughts, feelings, and behaviors are deeply interconnected. If we can identify and adjust harmful thought patterns, we can influence our feelings and actions. CBT helps us rewire our thoughts by changing the way we respond to them.

While the specifics can vary based on individual needs, typical CBT sessions might include the following:

• Thought records. This practice is the foundation of CBT. It’s about recording negative or self-defeating thoughts, evaluating their accuracy, and then restructuring them in a more positive or realistic way. 
• Behavioral experiments. These are mini "tests" that involve slightly altering our behavior to observe the outcome.
• Situational exposure. This helpful tool involves gradually exposing ourselves to situations we associate with harmful patterns, armed with a game plan to redirect an urge when it arises.
• Skill training. CBT can teach relaxation techniques, stress management, and assertiveness tactics to help us redirect destructive behavioral patterns.
• Problem solving. Life throws curveballs that we sometimes dodge in unproductive ways. CBT equips us with problem-solving strategies: defining the problem, brainstorming potential solutions, analyzing each solution's pros and cons, and then implementing and reviewing the chosen solution.
• Self-monitoring. Keeping a daily journal can help us understand our patterns and recognize which scenarios or emotions are our main triggers.
• Goal setting. Setting clear, specific, and achievable goals is an essential part of CBT.

The Science Behind CBT and Alcohol Misuse

By the 1990s, multiple studies showcased CBT's efficacy in treating alcohol misuse. It wasn’t just about quitting but also about understanding the "why" behind the drink. This was groundbreaking — it meant that we could learn to recognize situations or emotions that led to drinking and develop healthier coping strategies to use instead.

Today, CBT is one of the most frequently recommended therapies for alcohol misuse, with countless success stories and research-backed results. It's a trusted ally for many on their journey to healthier drinking habits. Here’s what makes this method especially effective in helping people cut back on alcohol or quit entirely:

• Awareness of triggers. Alcohol misuse often has triggers. CBT helps identify and understand them, whether they're stress, social settings, or negative emotions.
• Development of coping strategies. Once we're aware of these triggers, CBT equips us with coping strategies. This might mean developing ways to manage stress or seeking healthier alternatives to reaching for a drink.
• Changing thought patterns. A large part of CBT is reshaping our thought processes. By changing negative or unhelpful thought patterns related to alcohol, we're less likely to engage in harmful behaviors.

Moreover, the nature of the CBT process itself is especially relevant to breaking free from alcohol. Here’s why:

• It’s evidence-based. Multiple studies have shown that CBT is effective in reducing alcohol misuse.
• It’s flexible. CBT can be tailored to the individual and adapted to our unique needs and situation.
• It’s empowering. Instead of feeling controlled by alcohol, CBT provides the tools to take control of our own actions.

Cognitive Distortions: Unmasking the Thought Villains With CBT

Within the realm of CBT, we often hear about “cognitive distortions” — biased perspectives we have about ourselves and the world. Think of them as little viruses of the mind, skewing our perceptions and leading us to decisions that might not be in our best interest.

So how does CBT come to the rescue? It helps us recognize these distortions and then challenge and replace them with more balanced thoughts — a practice that’s especially useful in overcoming alcohol misuse. Let’s briefly look at 10 common cognitive distortions:

• All-or-nothing thinking (aka black-and-white thinking) involves viewing a situation as binary rather than on a continuum — it’s either perfection or complete defeat. Example: "If I can't abstain from drinking entirely, I'm a total failure."
• Overgeneralization means using one isolated incident to make broad generalizations. Example: "I drank too much at last night's party; I always mess up."
• Mental filter refers to picking out a single negative detail and dwelling on it exclusively, as if one minor setback in our journey can overshadow all our progress. Example: You’ve been abstinent for 13 days, but one night of drinking causes you to consider all two weeks a bust.
• Discounting the positive involves rejecting positive experiences by insisting they “don’t count.” If someone praises your progress, you might think, "They're just saying that to make me feel better."
• Jumping to conclusions can manifest in two ways: mind reading (assuming we know what people think without sufficient evidence) or fortune telling (predicting things will turn out badly). Example: "My friends probably think I’m boring because I declined a drink."
• Magnification (catastrophizing) or minimization means blowing things way out of proportion or inappropriately shrinking something to make it seem less important. Example: "I had a sip of champagne at the toast, now everything's ruined."
• Emotional reasoning is believing that because we feel a certain way, it must be true. Example: "I feel guilty, so I must have done something bad."
• Should statements involve having a strict list of what we “should” and “shouldn't” do and beating ourselves up if we don’t live up to those rules. Example: "I shouldn't have any urge to drink at all."
• Labeling and mislabeling involves attaching a label to ourselves or others based on one instance or behavior. Instead of thinking, "I made a mistake," you label yourself: "I'm a loser."
• Personalization refers to taking responsibility for something that wasn’t entirely our fault or attributing external events to ourselves. Example: "My friend seemed upset at the party; it must have been because I didn't drink with her."

Potential Pitfall

As powerful as CBT is, there’s one potential drawback to keep in mind. CBT can sometimes become too “local,” missing the bigger picture of our relationship with alcohol. In other words, while taking a bubble bath as a distraction might do the trick at a given time, there’s more to our drinking patterns than coping with triggers.

While it’s great for addressing individual urges and patterns around drinking, it’s important to address why we’re having those urges in the first place by examining our subconscious beliefs about alcohol and what it does (or seems to do) for us.

For example, let’s say you ended up drinking at a party even though you weren’t planning to because you didn’t know anyone there and felt awkward. Later, when applying CBT to analyze the situation, you realized that being around strangers was the trigger and drinking was the behavior that helped you cope with the unease. 

However, there’s a deeper cognitive trap behind this situation: the belief that alcohol helps us socialize. CBT does, in fact, have the tools to address this: the concept of limiting beliefs that drive cognitive distortions. 

Limiting Beliefs

A limiting belief is sort of the trigger behind the trigger — a deeper structural element that drives the production of specific urges. We can use the knowledge of limiting beliefs to examine our overall relationship with alcohol (outside of the context of an immediate urge) to continue building a foundation for healing at a deeper level. 

Here are a few “frequent flyers” when it comes to limiting beliefs around alcohol:

• "I need alcohol to have fun” (many people believe that social events, parties, or gatherings are only enjoyable with a drink in hand).
• "Drinking helps me relax and cope with stress” (some view alcohol as an essential tool to deal with pressure).
• "I can't be social or fit in without drinking" (the belief that we need to drink to be accepted as part of a group).
• "I don't have a problem because I only drink on weekends” (the idea that problematic drinking is only an everyday occurrence, which isn't necessarily true).
• "I'm only drinking the 'safe' kind of alcohol” (believing that certain types of alcohol, like wine, are less harmful or indicative of a drinking problem).
• "It's too hard to quit” (the belief that the challenge of reducing or quitting alcohol is insurmountable).
• "I've tried to cut back before and failed, so why try again?" (past failures might lead to the belief that future attempts are destined to fail).
• "I don’t drink as much as [person X], so I'm fine” (justifying our drinking by comparing ourselves to others who seem to drink more).
• "It's a part of my culture or family tradition" (the belief that our cultural or family background requires alcohol consumption).
• "I can handle my liquor, so I don't have a problem” (thinking that being able to drink large quantities without appearing intoxicated means there's no issue).
• "I only drink expensive or high-quality alcohol, so it's not a problem” (associating the quality or price of alcohol with the absence of a drinking problem).
• "People will find me boring if I don’t drink” (the belief that personality or likability is tied to alcohol consumption).

CBT vs. Other Therapeutic Approaches

Finally, let's see how CBT compares with other popular therapies. There are many approaches out there, and choosing a therapeutic method isn't about which is "best" universally — rather, it’s important to find one that’s best suited for you and your needs. 

• CBT vs. psychodynamic therapy: 

CBT is structured, short-term, and goal-oriented. It focuses on present challenges and provides tangible tools to manage or alter negative thought patterns and behaviors.

Psychodynamic therapy delves deeper into past experiences, unconscious thoughts, and childhood memories to uncover patterns in behavior. It's usually longer-term and less structured than CBT.

• CBT vs. humanistic (or person-centered) therapy:

CBT is about identifying and restructuring problematic thought patterns that lead to maladaptive behaviors.

Humanistic therapy focuses on self-exploration, fostering self-acceptance, and personal growth. It operates on the principle that everyone has innate potential and can find their path if given the right environment.

• CBT vs. motivational interviewing: 

While it has a motivational “flavor,” CBT places a stronger emphasis on equipping people with the skills to change their behaviors.

Motivational interviewing specifically targets a person’s motivation to change by resolving ambivalence. 

• CBT vs. family therapy: 

CBT is primarily individual-focused, even though group sessions exist. 

Family therapy focuses on improving family dynamics and relationships and addresses how these dynamics contribute to individual behaviors and challenges.

Embark on the CBT Journey

Now here's the exciting part — some tangible steps to get you started:

• Recognize the need. The first step is acknowledging the desire to change. Recognizing that alcohol might be controlling more of your life than you'd like is key.
• Find a therapist. Look for a therapist or counselor who specializes in CBT and has experience with alcohol misuse.
• Journaling. Start noting down instances when you feel the urge to drink. What were you feeling or thinking at that moment?
• Build a support system. Let a trusted friend or family member know about your journey. They can help you stay accountable.
• Educate yourself. There are loads of resources about CBT. Dive in! Knowledge is power, and understanding the therapy will only help you further.
• Practice mindfulness. You don’t need to meditate for hours. Simply taking moments in the day to be present can be hugely beneficial.
• Celebrate small wins. Cut back on one drink? Choose a non-alcoholic beverage at a social event? Every step counts, and celebrating them boosts your confidence.

Next Steps

In the words of life coach Rasheed Ogunlaru, “Peace of mind arrives the moment you come to peace with the contents of your mind.” CBT might be just the way to do that!

As you consider your next step, remember: your story is in your hands. And with CBT as a guide, you've got a science-backed technique to help rewrite those chapters. Dive into the world of CBT and watch as the narrative of alcohol in your life shifts, page by page!