Addiction Treatment in Maryland: Cognitive Behavioral Therapy (CBT)


Table of Contents

  1. CBT Addiction Treatment in Maryland
  2. What is Cognitive Behavioral Therapy (CBT)?
  3. How Does CBT Work?
  4. What Techniques Does CBT Employ?
  5. Why CBT Might Be Better Than Other Psychotherapies?
  6. CBT at Avenues Recovery in Maryland

1. CBT Addiction Treatment in Maryland

Addiction and mental illness often go hand in hand, fueling a cycle of poor mental and physical health. When someone is diagnosed with both a psychiatric condition and a substance use disorder, this is called a dual diagnosis.

In Maryland, 40% of adult admissions for addiction treatment in 2013 were dual diagnoses. Among children, 7.4% had a dual diagnosis, which is higher than the national average of 6.2%. Benzodiazepines (benzos), heroin, and alcohol tend to be the most widely abused drugs in cases of dual diagnosis.

The good news is that there is an effective way to treat both conditions at once: cognitive behavioral therapy (CBT). Even if you don’t have a dual diagnosis, CBT works to dismantle the thought processes that lead people toward destructive behaviors.

2. What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is a form of therapy that helps people address problematic thought processes and feelings.

With the help of a therapist, CBT is used to help addiction recoverers identify the connections between their thoughts, feelings, and actions, which often follow a self-destructive cycle. After identifying these negative patterns, patients work to replace them with positive, constructive patterns that eventually translate into feeling better and behaving more responsibly. Over time, they rewire their thinking to align with a long-term, sober mindset.

People with addiction often have multiple diagnoses. CBT can treat the root causes of addiction as well as these co-occurring mental disorders:

  • Anxiety
  • Depression
  • Attention deficit disorder (ADD)
  • Bipolar disorder
  • Obsessive compulsive disorder (OCD)
  • Eating disorders
  • Post-traumatic stress disorder (PTSD)

3. How Does CBT Work?

CBT works by showing the individual that their negative thought patterns are illogical. In most cases, these patterns form as a result of past experiences or environmental factors. Often these patterns are so ingrained that they are “automatic thoughts,” which are based on impulse rather than rational thought. And, because these impulses often derive from painful memories or feelings of self-doubt, many people choose to drink or self-medicate, which frequently leads to addiction.

CBT’s job is to unravel these automatic thoughts by exploring their underlying causes. This is perhaps the most difficult part, because people will need to repeatedly revisit some of their most painful memories. Therapists help patients process these episodes in a healthier way so that, over time, the memories don’t cause as much pain and the patient won’t feel the need to self-medicate.

Automatic thoughts make it easier for people to abuse drugs and alcohol, so taking these thoughts out of the equation altogether is a crucial step to recovery. Ultimately, CBT helps retrain the brain by:

  • dispelling false beliefs and insecurities that lead to substance abuse
  • creating positive patterns of thinking
  • introducing healthy coping mechanisms to manage triggers
  • teaching effective communication skills

CBT takes many forms and is adaptable for self-help — a therapist doesn’t always need to be on standby in order for it to work.

4. What Techniques Does CBT Employ?

Therapists will employ different strategies or techniques depending on the patient’s unique needs, but here are some of the most common ones.

Exposure Therapy

This is the technique used to help people with phobias or traumatic memories develop mental calluses against the pain of those memories. By exposing them little by little to the things that cause them fear or anxiety, the therapist can guide them through these difficult emotions so that they aren’t so crippling.

For addiction patients, an anxiety-inducing trigger could be an everyday occurrence associated with a bad memory. To exercise exposure therapy, your therapist will have you think of this memory, using the five senses to immerse yourself. Your counselor will talk you through this experience so that you can cope with your emotions better the next time the memory resurfaces. The goal is to make you feel more comfortable and confident when you confront these triggers in daily life.

Cognitive Reframing

Oftentimes, people with mental health problems and addiction will catastrophize, or make things out to be much worse than they actually are. They jump to hasty, hyperbolic conclusions, which are examples of automatic thoughts.

Cognitive reframing works by getting the patient to step back and reevaluate the situation in a more reasonable light. The therapist will ask about the patient’s thought process — verbalizing it is the first step to identifying it. The patient will then learn how to scale back these thoughts so that they are a better reflection of reality.

For example, a patient repeatedly beats themselves up for relapsing. They might say, “I’m too weak to stay sober. I should just give up.” Cognitive reframing would help the person get to a place where they say instead, “It’s normal to relapse. I can learn from this experience so that my next attempt is more successful. Even if it isn’t, maybe the next time will be. No one’s recovery is perfect, and I shouldn’t feel bad about not getting it right the first time.”

Journaling or Thought Records

Similar to cognitive reframing, journaling or keeping thought records helps patients recognize their negative patterns and be less harsh on themselves. The difference, however, is that thought journaling also practices looking for objective evidence to disprove these thoughts. The use of evidence puts things into perspective, showing the person that their negative cycles lack reason.

Keeping a record of one’s thoughts also allows people to keep track of how far they’ve come. When confronted with hard evidence of progress, people tend to feel more encouraged. And when people feel encouraged, sobriety becomes easier to maintain.

Behavioral Experiments

Behavioral experiments also utilize an evidence-based approach. These planned activities are used to test the accuracy of a belief.

The patient will be asked to do something that makes them anxious, but before they do it, they’ll be asked what they think is going to happen. After they perform the task, they’ll be asked how it actually went. Usually, comparing the real results to their prior thinking acts as a wake-up call, alerting the person to the fact that their beliefs — and associated anxiety — are unfounded.

Stress Reduction

Part of learning how to cope with difficult emotions is stress reduction. The therapist will teach the patient relaxation techniques to use when things get too overwhelming. These include deep breathing exercises, muscle relaxation, positive guided imagery, and meditation. These techniques help deal with anxiety, relapse triggers, and other stressors.

Role Playing

Role playing is another exercise that can help reduce fear and anxiety in potentially difficult situations. Patients can anticipate and practice different behaviors in order to find the responses that make them most comfortable. Eventually, role playing can lead to improved social and problem-solving skills, which are applicable even to totally new situations.

Setting Incremental Goals

You may have heard that goals should be SMART: specific, measurable, achievable, realistic, and time-limited. Breaking up big goals like sobriety into smaller, more manageable milestones makes the big goal all the more attainable.

5. Why Might CBT Be Better Than Other Psychotherapies?

Your specific diagnosis will call for an individualized treatment plan that may or may not include CBT, but here’s why CBT is better than many other psychotherapies out there.

CBT is meant to be a short-term, effective treatment. Traditional therapy — where patients talk and therapists simply listen — often goes on for an indefinite number of weeks, even years, after which there may or may not be significant improvement. CBT shortens this process by forcing both therapist and patient to take more active roles in recovery. CBT produces a meaningful impact over the course of just two to three months, the period of time over which most rehab programs take place.

Another advantage of CBT is its versatility. It can be practiced one-on-one with a therapist, in group therapy, or on one’s own. Instead of making the patient dependent on the therapist for recovery, CBT gives them tools and techniques they can take with them wherever they go.

5. CBT at Avenues Recovery in Maryland

Mental health counseling is an integral part of recovering from addiction. In Maryland, there are many CBT providers to choose from.

At Avenues Recovery, CBT is available from clinical professionals with a background in addiction recovery. Because we know that addiction often comes with mental health conditions, we are well-equipped to customize treatment at every stage of recovery, using a combination of therapy and medication where necessary.

We offer residential treatment, Partial Hospitalization (PHP), Intensive Outpatient (IOP), and Outpatient (OP) treatment programs that are all customizable to your unique needs. These options can include family and couple therapy sessions, Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), immersive 12-step programming, outdoor activities, and more. Our modern facilities are home to a casual atmosphere, beautiful grounds, and advanced amenities so that you can recover comfortably. At the center of every treatment plan are our core values: life skills, wellness, nutrition, social acceptan

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Brooke Abner,

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