Understanding what motivates people to drink abusively involves knowing their drinking behaviors and patterns and their perceptions, or cognitions, about themselves and about alcohol. Cognitive-behavioral psychology incorporates all of these elements, expanding the basis of traditional behavior theory beyond an exclusive focus on observable behaviors to include thoughts and emotions. Although it has broadened the scope of behavior theory, this perspective still employs many behavioral techniques to help clients who have psychological problems to change. As applied to alcoholism,(1) the cognitive-behavioral approach (see box; Kazdin 1982) views the etiology and persistence of pathological drinking as learned behavior (discussed below) and has led to the application of learning-based clinical methods to alcoholism treatment. These clinical techniques include coping skills training, relapse prevention, marital or family interventions, and development of broad-based social supports for clients. These and other related methods are described in this article, along with considerations of their effectiveness.
OVERVIEW OF THE COGNITIVE-BEHAVIORAL THEORY
Cognitive-behavioral theory views alcohol dependence as a maladaptive means of coping with problems (e.g., social problems) or meeting certain needs. From this point of view, alcoholic drinking is a sequence of learned behaviors acquired in the same manner as any other learned behaviors: through imitating role models, as a result of experiencing the positive effects of alcohol (e.g., reducing anxiety, relieving pain, or enhancing sociability), or based on expectations that alcohol will have one or more of these effects (Monti et al. 1989). After repeated positive experiences with alcohol, some individuals begin to rely on alcohol consumption as the preferred way of coping with problems or meeting needs, especially because alcohol's effects are felt fairly rapidly and require relatively little effort on the part of the drinker. According to cognitive-behavioral theory, these learned drinking patterns can be altered through the application of combined cognitive and behavior modification interventions, which can help people with alcohol dependence achieve and maintain sobriety (Miller and Hester 1989).
In addition to the view of alcoholism as a learned phenomenon, other theories have been developed to account for its origins. One of these focuses on genetics as a factor in the development of alcohol dependence. Even from this perspective, however, the way in which a genetic vulnerability is expressed is dependent upon a person's psychosocial experiences (Tarter and Vanyukov 1994). As a result, whatever drinking patterns are acquired ought to be amenable to remediation by cognitive-behavioral interventions (Monti et al. 1989).
Antecedents of Drinking Alcohol
The cognitive-behavioral approach to alcoholism treatment focuses on the factors that precipitate and sustain drinking. Antecedents are the events that occur prior to drinking and either set the occasion for it or initiate a chain of behaviors that culminates in drinking. Different types of antecedent factors may lead to a person's drinking (Miller and Mastria 1977). They can be social, such as interpersonal conflict or peer pressure; environmental, such as alcohol advertisements or seeing others drink; emotional, such as anger or depression; cognitive, such as negative thoughts about oneself; and physiological, such as chronic pain or withdrawal symptoms. The focus of cognitive-behavioral treatment is on identifying the most common and most potent antecedents for each client and breaking their connection with alcohol use by training the client to respond to them in new ways.
Consequences That Reinforce Drinking
Other factors may contribute to a client's alcoholism by maintaining the drinking behavior pattern after it has begun; these include various positive consequences that reinforce drinking. …