Cognitive Behavior Therapy for Drug Use

Christian Counsellors Approach to Addiction: The Cognitive Behavioral Model

Psychologist, Dr. Alan. Marlatt, director of the Addictive Behaviors Research Center, a branch of the University of Washington, and his colleagues studied relapse prevention treatment for several years and , their research has resulted in one of the most comprehensive theoretical and clinical models, the Cognitive Behavioral Model for dealing with addiction. This model of treating addiction is a model that is well suited to approach taken by the Christian counsellors; the compatibility will be highlight throughout this article. The Cognitive Behavior Model is very flexible and can be used to treat any addiction, including pornography and food addiction.

Marlatt and his colleagues’ version of the model states that addictive behaviours are acquired habits that can be changed through new learning. This is compatible with the Christian scriptures which tell us that we can be changed by the renewing of our minds (Roman12:2).

The Cognitive Behavioral Model of relapse prevention is centered on three assumptions about behavior change. The first assumption is that the causes of addiction and the process of behavior are governed by different principles. The second assumption, is that the ability to change a habit such as substance abuse consist of three stages:

Stage 1: Making a commitment and becoming motivated to change.

This model only applies to those who have made a voluntary choice to change. Without this voluntary commitment change may not be possible. For example, if someone comes in for treatment to quit internet pornography because their spouse has threatened to leave, this may or may not be a motivation to change. Such clients may have come in to counselling to appease an angry spouse but has no real motivation to change the behavior. Stage one involves assessing the client for intrinsic motivation to change. If this is absent, lasting change may not be possible.

Stage 2: Implementing change.

The Cognitive Behavioral Model of relapse prevention emphasizes the difference between the treatment and maintenance phases of rehabilitation. In the maintenance phase the client is taught self-management skills which are aimed at helping clients quit unwanted behavior indefinitely. Implementing change is not a procedure that can be introduced initially before getting to know the client, his or her social influences, and the driving forces (childhood emotional wounds) behind the addiction.

Stage 3: Long-term maintenance.

During this stage, a person must work the hardest to maintain their sobriety, especially through problems that could lead to a potential relapse. The many that feel confident in the structured environment of rehabilitation often return home only to be faced with several stressors and temptations. Similarly, clients who, in the confines of a counselling center, vehemently denounce their addictive behaviors may relapse within hours of leaving the office. Christian counsellors realize that even though clients may be motivated to change, and have all the tools necessary to succeed, they may still relapse because of the stressors and temptations in the home and social environment. Relapse reflects the Christian scriptures expression of the conflict that exists within a person, between the will and the intellect. The Apostle Paul expresses this conflict eloquently when he wrote, “I don’t really understand myself, for I want to do what is right, but I don’t do it. Instead, I do what I hate” (Romans 7:15).

This brings us to the third assumption in the Cognitive Behavior Model, namely that the maintenance stage proves to be very difficult. It is far easier for clients to get sober, than stay sober because most relapses occur during the maintenance stage.

Determinants of Relapse

Although there are many causes of relapse, they fall into one of two categories, either intrapersonal or interpersonal factors. Intrapersonal factors are negative emotional states, urges, and overall temptations. Whereas interpersonal factors are social pressures to relapse and relationship conflicts. These two factors help clinicians help substance abusers identify which factors are “high-risk” or threaten their sobriety. High-risk is defined as being any situation that poses a threat to one’s sense of control thus increasing a risk of relapse. There are some clients that may fail to cope with these high-risk situations because they lack the coping skills, combined with fear and anxiety prevent any sort of positive coping response. Research has shown that relapsing usually follows soon after an unexpected high-risk situation. Recovery strategies should focus on each client’s unique high-risk factors, and then using said factors to create an individualized coping program.

The story of Jeff, a 25 year-old Christian who became addicted to cocaine because of peer pressure in high school, illustrates the power of both the intrapersonal and interpersonal pull in relapse. Jeff says he was doing quite well until his father passed away. It was then that he realized that his deep feelings of grief were making him yearn for the high of drug use. Despite the strong urge, he was able avoid relapse until he ran into an old friend that invited him over to his house. It was this latter interpersonal factor that led to his relapse after almost a year of being drug free. The Christian scripture warns us of the danger of exposing ourselves to strong interpersonal factors when it warns, “ Can you build a fire in your lap and not burn your pants?” Jeff’s decision to hang out with an old friend, with whom he once used drugs, was a step that would inevitably lead to a relapse. Part of relapse prevention strategies used by Christian counsellors is help clients see that exposing themselves to some interpersonal situations is most likely going to end in relapse.

Assessing high-risk situations involves two stages. In the first stage, the counselor must help the client identify situations that could potentially pose a risk to their sobriety. Self-monitoring tools such as daily journaling and self-efficacy ratings can be used to assess these risks. The second stage is assessing client’s copings skills through observation of an actual situation. Simulation and role-playing are equally as effective in assessing this as well.