Rational Emotive Therapy in Substance Abuse Treatment

Substance abuse is a chronic relapsing brain disease characterized by denial, and the continuing abuse of substances in spite of negative consequences related to their use. Rational Emotive Behavior Therapy (REBT) is a treatment approach that focuses on the discovery of individuals' irrational beliefs and attempts to replace them with productive, rational alternatives. Its proponents hold that negative circumstances do not have to lead to unhealthy emotions or choices. REBT is not used in its pure form by substance abuse counselors, but its precepts are incorporated into cognitive behavioral therapy approaches.

Denial and Irrational Beliefs

• REBT holds that our beliefs contribute more to our behavior than the events to which we respond. Denial initially involves rejecting the drug problem itself; however, once the addict accepts his drug dependency as fact, denial also causes him to believe that he cannot alter his behavior to overcome his addiction. REBT attempts to help a substance abuser realize that his denial is a false belief that is placing limits on his choices. He is encouraged to consider other options that will enable him to react to his addiction with constructive approaches, rather than those associated with his false belief system.

Drug Associations

• Many people, places and situations within a recovering addict's life are associated with her former substance abuse. In order to remain abstinent, she must learn which life situations, people and behaviors, if repeated or allowed to reenter her life, will lead to drug relapse. Dealing with drug reminders requires her to believe she can change her thinking, habits and behavior patterns, ultimately changing her dependence on drugs and alcohol. REBT holds that the individual is free to reject irrational beliefs and, in doing so, change her behavior. This component of REBT is found in every substance abuse treatment program.

Functional Analysis

• Closely related to drug associations, and using the component of REBT that people choose their responses to life's situations, is functional analysis, an important aspect of relapse prevention strategy. The National Institute on Drug Abuse (NIDA) defines functional analysis as the identification of the addict's thoughts, feelings and circumstances before and after substance use. Early in the treatment process, functional analysis defines the situations that are going to be high risk in terms of relapse potential for the addict, and reveals the reasons why the addict typically ends up returning to drug use. Functional analysis prepares him for the next stage in his relapse prevention strategy, skills training.

Skills Training

• Again using the REBT precept that an individual is able to change his irrational beliefs, thus changing his way of reacting to life's events, skills training is a critical component of cognitive behavioral therapy. Skills training is an individualized effort to teach addicts new healthy and constructive habits that replace their former unhealthy ones leading to and involving substance addiction. In many cases, the addicted person never learned positive coping skills; in other situations, they have have been forgotten in the months, or years, he has been involved in drug abuse.

Brief Approach

• REBT is a short-term, here-and-now approach to substance abuse treatment, making it cost effective and suited to the capabilities of most clinical program budgets. It was originally meant for individual therapy sessions, but has been adapted to benefit group sessions as well. REBT is compatible with other forms of counseling and therapy, and also with pharmacology when medications are advised.