Cognitive Behavioral Therapy

One of the central tools at rehab was Cognitive Behavioral Therapy, or CBT. The theory behind the therapy is that thoughts can effect emotions, so a conscious shift in negative thoughts can de-fang destructive feelings. Counselors implored us to look at emotionally-fraught situations, the kind we used to drink and use over, from different, less emotional points of view. We had to apply rationality to our emotional assumptions so we’d reach different conclusions than our addict brains normally defaulted to.

I didn’t begin to understand this until a counselor’s comments after one of my rehab mates finished telling his First Step story, his history of drug abuse. He’d grown up in a chaotic alcoholic household and had been physically, psychologically and sexually abused. He’d always felt he deserved his fate and lived a life of guilt, shame, and secrets from early childhood. Like his parents and grandparents before him, he abused alcohol from an early age to cope. Eventually, he used all manner of other drugs too, nearly costing him his life.

When he finished, the counselor said what impressed her wasn’t the weakness he thought he’d described, but his strength in overcoming his circumstances. She congratulated him for “doing a beautiful job of surviving.”

Until then I didn’t have a clue about CBT. Afterward I began to understand. A confession of weakness could be flipped to include a recognition of resilience and it wasn’t as much of a reach as I’d thought. And if you could recognize that resilience it could gradually change your assumption of weakness.

The counselors instructed us that we only knew one part of any situation and to look for alternate rational explanations that might shape our emotional perceptions. They used the daily, even hourly, emotional emergencies that confront patients in rehab to illustrate and practice the approach.

One personal lesson in CBT occurred the first time I attended the rehab’s Alumni Meeting. A counselor assigned me to raise my hand at the meeting and ask for help with a crisis I’d been struggling with that day. When I did, however, I felt the group’s response was belittling, that they treated my distress as trivial and not to be taken seriously. It felt like a slap in the face.

When I complained, bitterly, about having been dismissed, to my amazement the staff questioned whether what I’d seen had actually happened. They made me go to each of the other in-patients and ask them what they thought of the meeting’s response. After three others told me they thought the issue was covered completely and compassionately I stopped asking. The staff then made me examine my reaction to the meeting which opened up a discussion of whether I’d been truly listening or had been acting out my anger at being forced to bring the original issue up. (Guess which one it was…)

That was just the beginning. Every day in rehab seemed to involve multiple lessons in how my assumptions misled me. Each time the staff made me consider alternate explanations. It happened so consistently, I eventually had the feeling that everything I knew was wrong.

What I didn’t know at the time was how essential this was. I had to reach the point of doubting everything I thought I knew to be true to cut through my deep denial, admit I was an alcoholic, and look to the staff and other patients for help.

CBT isn’t something that comes naturally to drug addicts. But it’s a skill that’s useful and it gets less disorienting the more you practice it.


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One Response to “ Cognitive Behavioral Therapy ”

  1. Thank you for all you personal experiences, great information and developing a place for anyone with an interest in the disease of addiction. I hope to let all the great clients in the outpatient program I work know about it and encourage them to use it a resource for their recovery. Thanks for sharing to help others find their path toward recovery.

    J. SilveyBSW LADAC

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