Introduction
In its simplest terms, cognitive behavioral therapy refers to a cathartic approach used by healers to come up with answers to the ever mind-triggering questions concerning non-adaptive behaviors, feelings as well as cognitions. To get such solutions, therapists employ much of methodical and goal-oriented measures.
Based on the usage of the term, cognitive behavioral therapy refers to medical aids premeditated in accordance with cognitive and behavioral studies. Cognitive-behavioral therapy, in its original form stood out as a method of relapse prevention when administering treatment to problems associated with alcoholism but later extended to cocaine-addicted people.
The schemes of cognitive-behavioral psychoanalysis rely on theoretical concerns that education procedures perform vital roles when it comes to the advancement of behavioral practices that are dysfunctional. Cognitive-behavioral therapy (CBT) proves effective to both group and individual settings. Commonly, the techniques employed remain structured for applications, which are self-helping in nature.
Researchers arrived at the development of CBT through a merger of cognitive therapy and behavioral therapy. Marque, some researchers and clinicians concerned in the field of CBT tend to appear more inclined on either behavioral or cognitive therapy.
The trends in health care are moving toward evidence-based treatments. Consequently, majority of varying CBT treatment programs have experienced radical scrutiny to unveil their effectiveness.
In case of treatments demanding diagnosis that follows symptom-based approach, CBT has received incredible favor in comparison to some other treatment approaches, among them psychodynamic treatments. In case of certain treatments techniques driven direct, time-limited and brief of certain psychological disorders using CBT approaches, treatments remain manualized more often.
Therapists, who do not embrace the CBT interventions in treating some disorders and as tools for intervention of aftermath problems of drugs abuse amongst the adolescents, argue that the existing data, which advocates for CBT, lack complete support to warrant the funding and the enormous attention it has received.
They also argue that the CBT concerns do not go beyond to capture issues like unemployment reduction, rather they focuses just on psychotherapy.
The notion that CBT stands out as more effective than other psychotherapy approaches has been heavily challenged over the years.
For instance during psychotherapy conference held at University of East Anglia in 2008, Professor Elliot, Mick cooper and others claimed that people have the capacity to improve enormously after therapy; no matter which therapy was undertaken and that escalated spending by governments on CBT programs discouraged other therapeutic interventions: something that hurt the public at large.
Among the many trials made, there s none applying both mental sop and blinding, that could figure out CBT as efficient for handling dementia praecox. In addition, it has been discovered also that only minimal ardently controlled CBT studies on depression actually prove to be effective and in case of the few found effective, the effectiveness was remarkably small.
The effectiveness of CBT, as one of the psychotherapeutic interventions for drug abuse among teenagers, consequently, presents a wonderful academic topic for introspection.
Literature review
There is a good deal of literature expounding much on the issue of the effectiveness of CBT with adolescent substance abusers. For instance, Covi, Hess, Schroeder, and Preston (2002) concluded that, even if people employ minimal intensive schedules, CBT is effective in reduction of cocaine usage (p.191).
Cognitive-behavioral therapy entangles “a cathartic approach geared towards coming up with solutions of dysfunctional behaviors, cognitions and emotions through the deployment of methodical and goal-oriented measures” (Waldron & Kaminer, 2004, p. 93).
People have recorded amicable empirical support for CBT models specifically designed for adolescent substance abusers in the course of recent years (Waldron & Kaminer, 2004, p.97). According to Crome, (2006) adolescents make use of substances in a maladaptive way in an attempt to proactively deal with environmental circumstances (p.209).
Treatments focus on aiding adolescents to interchange their drug use with behaviors that are less risky by giving them an opportunity to understand the antecedents of drug use.
Moreover, treatments seem designed to enable the adolescent drug users to keep off from circumstances likely to result to drug abuse as much as possible or to make them effectively handle the problems, which may end up translating into increased drug use (Mason & Posner, 2009, p.197).
Empirical evidence considers cognitive behavioral therapy as “…an effective approach for treatment of problems such as anxiety, substance abuse personality, mood psychotic disorders and eating disorders” (Hogue, Liddle, Dauber & Samuolis, 2004, p.94).
Crome (2006) observes, “CBT encompasses the use of varying therapeutic systems and approaches including multimodal therapy, cognitive therapy and behavior therapy” (p.204). However, attempts to define the scope of cognitive-behavioral therapy have proved a real problem throughout the development of the technique.
CBT is effective in the treatment of some psychological disorders like mood and anxiety disorders, people have evidently voiced out critics about its effectiveness.
The extent to which CBT models emphasize on alteration of behaviors, thoughts modifications and teaching new skills that would help adolescents to cope with substance abuse varies considerably. However, majority of the models encompass two crucial components: skills building and functional analysis (Waldron & Kaminer, 2004, p.101).
In case of function analysis, the adolescent work in collaboration with a therapist to pinpoint particular thoughts, circumstances and or feelings, which the adolescent encountered prior and after drugs use. Functional analysis aids the adolescent to substantially identify situations which are characterized by high risks and hence posses the capacity to result to hiked drug use.
The exercise also enables the adolescent to gain insight as to why he or she embraces drugs usage in such and similar situations. Information acquired during the functional analysis turns out crucial for the skills-building exercise since the therapist applies it to identify certain areas that would turn out to be of benefit to the adolescent by learning coupled with practice on the prescribed practices.
Gathering such information from the adolescent however, demands that the therapist be assertive in an attempt to resist peer pressure during the questioning of the adolescent and testing of his or her assumptions regarding substance abuse (Waldron & Kaminer, 2004, p.103).
For effectiveness, there must exist a prescribed particular way of adolescents’ management during CBT administration (Cavanaugh, Kraf, Muck & Merrigan, 2011, p.5). This calls upon the therapist to construct a social network, which supports recovery process, increase desirable activities, embrace problem-solving strategies in case of a high-risk behavior and in a gradual way, practice new ways of reacting and behaving.
These are core skills, which according to Waldron and Kaminer (2004), the therapist might consider combining with parent education, motivation enhancement, and comorbid conditions treatments and school outreach programs (p.101).
Through well-controlled clinical trials, both group and individual CBT models have been positively tested. Numerous studies have also sought to test clinically solutions, which integrate the principles of CBT with strategies such as functional therapy, which is a family as well as motivation-oriented therapy.
Waldron and Kaminer (2004) recognize CBT and its proposed interventions as one of the evidence-based substance abuse treatment among adolescents. However, they feel that even though individual CBT interventions seem promising, people need to conduct adequate further testing on its effectiveness (p.97).
However, acquiring of additional CBT support through reviews of the quality of evidence; studies that support outpatient treatments substance abuse interventions are also crucial.
In the 31 controlled trials randomized in one of such studies, CBT turned out as the “outpatient intervention, which proved widely supported by the highest number of strong studies methodological approaches” (Hogue, Liddle, Dauber, & Samuolis, 2004, p.94).
Cannabis stands out as one of the widely abused substances among American adolescents (Crome, 2006). A study of 11,426 teens revealed that 25% of the investigated youths admitted to have smoked cannabis with 13 % having smoked it within a month before and 6% having smoked it at least four times within the month before.
“Poor grades, fear of death, diminished self-esteem, and accessibility of cannabis by household, inadequate religious identity and lack of subtle school experience” (Kadden, 2002, p.2) among others are some of the factors identified by some experts to have the ability to increase cannabis abuse risks among adolescents.
Taking into account the vast negative health effects that the abuse of substances such as cannabis has on adolescents, an effective intervention needs to come into place. Amongst the five evidence-based efficient local treatments of cannabis exploitation, CBT stands out clearly as one of the interventions, which seem cost-effective.
Others include adolescent community reinforcement approach –A-CRA and multidimensional family therapy (MDFT). CBT at times combines with FSN (Family Support Network), which entangles a substance abuse treatment program that targets youths belonging to 10 up to 18 years (adolescents), which normally goes to the outpatients.
The CBT sessions are effective in teaching the adolescents on how to say no to marijuana, seeking solutions to problems likely to render youths to smoke cannabis, dealing with criticisms, anger awareness, thoughts management and coping skills coupled with indulgence in activities unaffiliated to drug abuse.
On the other hand, people have probed the various coping skills prescribed by CBT programs aimed at dealing with dependence on substances or rather drug abuse. They have shed light that from the dimension of cognitive behavior theory, substance abuse and alcohol dependence stems from experiences acquired from the environment through interactions with it.
Drugs create certain longed for desires, including good feelings, dwindled tensions among others. Consequently, if the victims consume the drugs more frequently, the results might be that, the only way out to achieve such results would be only through drug use, particularly if other options to achieve similar results are not available.
The treatment tasks therefore encompass the identification of specific desires that addictive substances and alcohol are employed to achieve: thereby, deriving the possible alternative methods of dealing with such desires (Kadden, 2002, p.2). These are somewhat the main concerns of CBT. Cognitive-behavioral therapy according to Kadden comprises of looking at the entire treatment process form two dimensions: behavior and cognition.
Behavioral approaches place more weight on observable consequences and antecedents of the behavior without inferring from internal invents among them cognitions. Cognitive-behavioral approaches, opposed to behavioral approaches takes into corporation internal events such as emotions, thoughts and cognitions, which seem reflected in behaviors and acts, directly and/or indirectly, to ensure the maintenance of such behaviors.
Learning through associations and learning through consequences are the two mainly identified learning behaviors in the laboratories, which remain reflected in the CBT treatment model. This means that CBT is consistent with the results obtained via scientific research methodologies, which stand out evidence-oriented.
Even though CBT may prove effective, by taking into consideration the above discussion, some weak points exist in its interventions. For instance, existing deficits in the coping skills, especially with consequences and the antecedents of substance abuse among the adolescents, serve to maintain and ensure continuing of the addictive behaviors.
Consequently, ardent effort to enhance studies on the most amicable training programs on coping skills in an attempt to deduce practicability of various utilities as avenues for curtailment and reduction of addictive behaviors are being sort (Kadden, 2002, p.10).
Deficits in coping skills, in addition, prove magnificent challenges that face CBT programs implementations due to existence of the probability that the deficits may result to dependency of substance abuse as the only coping strategies operating in default mode among teenagers.
Leichsenring, Hiller, Weissberg and Leibing conducted an empirical research to unveil the evidence of effectiveness of CBT in treatment of particular mental disorders. The data for their study was availed by searching through databases using certain keywords in 2005.
Their study followed the guidance of the evidences that CBT approaches were vital for the treatment of certain mental disorders put forward by Canadian Task Force on Preventive Health Care (Leichsenring et al, 2006, p.234).
Effectiveness of CBT in treatment of a number of mental disorders was found out to be demonstrated by various randomized trials which were well controlled followed by a number of meta-analyses (Leichsenring et al, 2006, p.249).
However, the authors voiced out that despite the fact some evidence existed to support the efficacy of CBT enormously in psychotherapeutic treatments of some mental disorders, a gap exists that demands the conducting of further extensive studies in an attempt to clarify or correlate the current evidence.
Especially for adolescents, the initial milestone of substance abuse entails cigarettes smoking, followed by alcohol and or taking drugs with perceptions of experimentation. The entire problem of substance abuse amongst teenagers has to do with faulty perceptions and believes about drugs abuse.
Treatment programs, which people may consider as effective, should thus incorporate strategies that aid in alteration of such faulty attitudes and beliefs. The programs need also to teach the youths on the rejection behaviors when presented with opportunities to abuse alcohol, marijuana, tobacco or any other addictive substance.
Well-documented scholarly evidence proves that, inculcating resistance skills turns out to be the only proactive way of reducing substance abuse amongst the adolescents. Waldron and Kaminer (2004) hold similar opinions but look at substance use problems amongst adolescents as involving behavior learning started and maintained in accordance to environmental factors contexts (p.259).
Programs that revolve around this premise focus on aiding adolescents to expect and keep at bay situations perceived as to present high risks as a strategy to promote abstinence of substance use.
The major techniques that amicably help in behavior change entails clear understanding of the circumstances prevailing in the environment, making attempts to learn ways which help in urges management without forgetting to take part in positive behavior activities. Evidently, drawing from the definition and operational elements of CBT, the techniques advocated for by Waldron and Kaminer address the CBT issues.
Anxiety is perhaps one of the reasons that adolescents might find themselves in the helm of substance abuse. With reference to Burleson and Kaminer (2005), using CBT treatment approaches constitute the most effective modern approaches in substance abuse-related disorders among adolescents (p.1752). Employing CBT to treat anxiety associated psychological disorders require the CBT intervention strategies to be highly effective.
In April 2007, researchers in Boston University carried out extensive literature review regarding all cognitive therapy studies, which reviewed the effectiveness of CBT in relation to anxiety disorders placebo. Surprisingly, out of 1,165 studies that were identified relevance to their research topic, only 27 were consistent with their research criteria. There was no evidence supporting the use of CBT in anxiety disorder treatment.
In particular, the intensity of symptoms of anxiety disorders immensely dwindled upon administration of CBT as opposed to placebo. The decrement effects seemed particularly pronounced for those individuals inflicted by obsessive-compulsive disorder and acute stress disorder.
These results are essential since a part from identifying CBT interventions as effective for management of anxiety, takes adolescent substance abuse treatments to an extra mile. However, people should view CBT as a cure-all for anxiety. It rather provides beneficial and helpful results for adolescents inflicted by anxiety disorder.
However, according to Crome, 2006) adolescents’ substance abuse requires special demands (p.205). Hogue, Liddle, Dauber and Samuolis (2004) attempted to evaluate the differences in the various substance abuse interventions by comparing two approaches: CBT and MDFT.
The results indicated that family-focused substance abuse interventions yielded better responses (p.59), especially with the strategies shrouded within CBT approaches. On a different dimension, Researches reveal that substance abuse treatments engineered for adults hardly work satisfactorily to adolescents and thus requires modification before they become effective to them (Crome, 2006, p.94).
Some of the modifications include incorporation of family perspectives for the CBT interventions meant for adolescents. To this end, Multi-Systemic Therapy, Multidimensional Family Therapy for Adolescents (NDFT) and Brief Strategic Family Therapy remain the most preferred interventions for substance abuse among adolescents (Crome, 2006, p.94).
The multidimensional family therapy encompasses a family-based outpatient substance abuse treatment specifically designed for adolescents. This approach looks at the adolescents’ substance abuse problem form the network influences context. It therefore employs the networks in its attempts to cope with undesired behaviors and increase the indulgence in the wanted behaviors among adolescent substance abusers.
Brief strategic family therapy entangles the treatment of adolescent substance abuse indulgencies normally accompanied by unacceptable conducts either at school, or at home. Multi-systemic therapy on the other hand targets composite systems that result to delinquent undesired behaviors.
These three treatments are, however, behavioral approaches which in actual sense forms an integral part of CBT. The effectiveness of these interventions also translate to effectiveness of the CBT in the treatment of substance abuse among teenagers since all CBT does, is to go an extra mile to incorporate cognitive aspect of substance abuse coping strategies.
A number of CBT programs have been evaluated using various program evaluation techniques. Ringwalt et al. (2010), claims that “investigators have used both one and two-tailed tests to determine the significance of findings yielded by program evolutions but, many authorities now are in agreement that one-tailed test is not effective” (p.135).
Again, “there remains some conceptual confusion as to how one-tailed tests should be used when investigators find that the program they are evaluating has yielded results in an unanticipated direction” (Ringwalt et al., 2010, p.137). Consequently attempting to evaluate the effectiveness of CBT interventions on adolescent substance abuse on the basis of one-tailed tests, would be a subject of comprise and arguments.
Boisvert, Martin, Grosek and Clarie (2008) conducted a study to evaluate the effectiveness of drug abuse interventions by use of mixed methods. The results indicated that abundant relapse risk reduction was possessed by all members who were involved in the study.
Consequently, ardent evidence “suggests that a peer-supported community program focused on self-determination can have a significant positive impact on recovery from substance addictions and homelessness” (Boisvert et al., 2008, p.217).
Discussion
Based on the above revelations, cognitive behavioral therapy encompasses one of the psychological interventions guided by human conducts, emotions and cognition. Within its sphere, it takes into account numerous treatment strategies that require ardent knowledge of etiology, coupled with the maintenance of varying treatments for mental disorders.
In substance abuse management among the adolescents, the CBT approach requires therapists and the patients to work in collaboration in an attempt to identify the problems related to behavior, thoughts and feelings. The chief concerns of CBT focus on symptoms, distress reduction and promotion of crucial behavior responses.
The therapist deserves to be well acquainted with practical and psychological skills to aid him or her in harnessing the patient’s problems and where possible prevent reversion of the problems upon administration of the treatment.
The existing literature on effectiveness of CBT in treatment of substance abuse among adolescents largely records an immense efficacy with some of the literatures giving a picture of existence of gaps in the studies on CBT interventions.
Consequently, therapists have called attempts to conduct further research on effectiveness of the CBT programs for particularly, an attempt to provide pivotal information deemed vital to warrant the heavy spending on the programs.
Empirical studies however, prove the benefit of cognitive-behavioral therapy, in that its one of the cost-effective psychotherapeutic interventions and since it shrouds the commonly advocated for special interventions for substance abuse amongst the teenagers such as Multi-Systemic Therapy, Multidimensional Family Therapy for Adolescents (NDFT) and Brief Strategic Family Therapy.
However, it then extends beyond to incorporate cognitive interventions, CBT evidently prove efficient in the management of substance abuse in adolescents. Anxiety arising from various environmental factors whether at home or school may plunge adolescents into the substance abuse mayhem.
People need to consider a conclusive study seeking to unveil relationships existing between anxiety and substance abuse among adolescents. The current reviews, however, depict that any form of psychotherapy which can aid teenagers to develop and inculcate ardent coping skills while still giving them an opportunity to identify substantially everything that bother them has the ability to reduce anxiety among adolescents.
References
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