Academic journal article Journal of Cognitive Psychotherapy

The Regulation of Cognitive States: A Cognitive Model of Psychoactive Substance Abuse

Academic journal article Journal of Cognitive Psychotherapy

The Regulation of Cognitive States: A Cognitive Model of Psychoactive Substance Abuse

Article excerpt

This paper describes a cognitive model of psychoactive substance abuse which emphasizes the ability of psychoactive substances to rapidly modify uncomfortable cognitive states. Cognitive states include any mental event of which one can become aware such as thoughts, feelings, sensations, perceptions and memories. It is suggested that substance abusers have learned to interpret such mental events (i.e., metacognitions) in such a way that they are construed as harmful, threatening, and undesirable. Psychoactive substance abuse becomes the preferred means of effectively modifying such cognitive states. A cognitive treatment of substance abuse, based on the model successfully employed in the treatment of anxiety disorders, is outlined which stresses the importance of gradually exposing substance-dependent clients to avoided cognitive states within a therapeutic environment that encourages disconfirmation of dysfunctional metacognitions and a more adaptive appraisal of their cognitive states.

The Regulation of the Cognitive States (RCS) model hypothesizes that abusive consumption of a psychoactive substance is maintained by the rapid modification of undesirable cognitive states subsequent to such consumption. Cognitive states encompass any mental event or process of which an individual can become consciously aware such as thoughts, perceptions, sensations, memories, imagery, and emotions. Cognitive states can be the product of interactions with the environment (e.g., interpersonal contact) or the result of internal cognitive processes (e.g., ruminations). One specific type of cognitive state, rnetacognition, is identified as particularly important in the maintenance of substance abuse and will be discussed in greater detail below.

Psychoactive substances can affect cognitive states in several highly reinforcing ways: the modification of biological arousal, modification of cognitive processes and content, and modification of the awareness of cognitive states. The modification of biological arousal includes, for example, the calming effects of sedative or anxiolytic drugs (e.g., diazepam), the increase in arousal or stimulation that is produced by stimulant drugs (e.g., cocaine), or the euphoria that accompanies opiate use (e.g., heroin). These effects tend to be most salient in the early experience with a drug and may diminish with chronic use. This effect of psychoactive substances impacts primarily on emotion (e.g., anxiety) and less directly on other cognitive states (e.g., discursive thought processes, perception).

The modification of the cognitive processes refers to the appraisals, judgments, or evaluations which produce cognitive states as well as the cognitiveperceptual tendencies identified by cognitive therapists such as selective abstraction, magnification and arbitrary inference (Beck & Emery, 1985). When intoxicated, these cognitive processes are modified such that the resultant cognitive content becomes more tolerable (e.g., judging a situation to be less unpleasant, less disturbed about marital stress) and increasing the probability of engaging in inhibited behaviors (e.g., increased assertiveness following drug-induced enhancements of self-esteem).

The modification of the awareness of cognitive states occurs primarily through the reduction of the awareness, or the allocation of attention, to undesirable cognitive states. This effect of substance use is often expressed as feeling 'numb' to or 'detached' from ongoing cognitive experiences.

The key feature of these substance-induced modifications of consciousness and their contents is change, from a less preferable to a more preferable cognitive state. Feeling, perceiving, imagining, remembering or thinking differently (although not necessarily euphorically), following the consumption of a psychoactive substance, is the primary reinforcing event that maintains such behavior. The nature of the change can be positive, when substance use produces pleasurable effects such as euphoria, or negative, when substance use leads to the elimination of dysphoric cognitive states such as traumatic memories, unpleasant emotions and uncomfortable discursive thoughts. …

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