What Is Cognitive Behavioral Counseling?

A CBT social learning model focuses on teaching interpersonal and self-management skills (CSAT 1999a). CBT is a skill-building rather than a deficit-oriented approach. Marijuana dependence is considered a learned behavior that developed in response to external (e.g., environmental, relational) and internal (e.g., feelings, thoughts) conditions. A CBT perspective suggests that the addictive behavior has become a favored strategy because of its repeated associations with predictable outcomes. For example, someone uses marijuana when he or she is sad, angry, lonely, or upset; he or she feels less bad when smoking and associates marijuana use with feeling better (at least in the short term). Over time, marijuana may be selected more often as a strategy to escape negative feelings or thoughts.

CBT views compulsive or addictive behaviors and certain negative moods as learned and not the result of a character defect. Because these behaviors are learned, they can be unlearned. The unlearning occurs through learning new skills and enhancing the client’s capabilities. The client develops skills to identify and cope with high-risk internal states and external situations that increase the likelihood of a slip. The counselor assigns the client homework to practice using the new skills. The client’s participation and the counselor’s positive feedback enhance client confidence in managing situations and create long-lasting behavior change.

This perspective of addiction as learned is therapeutic because it

• Reduces blame and criticism

• Fosters hope and optimism

• Identifies development and improvement processes.

CBT differs from other models of treatment because it

• Addresses interpretations of events as important cues for compulsive behavior

• Provides structure (every week the counselor devotes a specific amount of time at a specific time in the session to a particular activity)

• Informs and teaches (but is still collaborative).