CBT and ABC Model

CBT/ABC Model

Twenty-three-year-old Maria is unwilling to acknowledge her addiction to methamphetamines. As a consequence of her drug abuse, she has lost her son to the foster care system, she has a dysfunctional relationship with the child's father -- also a drug addict, and she has no real job or housing. Five months pregnant, she has lost the support of her family because they are tired of her behaviors. Maria is in the pre-compliance stage. She will not acknowledge that she has a drug problem, she does not want to be in a rehabilitation program, and she does not want to meet with a social worker, even though the court has ordered her to do so. Cognitive behavior therapy (CBT) using the Antecedent-Behavior-Consequence (ABC) Model is indicated, but without acknowledgement of her drug problem, these further steps will not be possible with Maria.

Following a psychological examination, the first step in a treatment plan is motivational interviewing (MI), a technique which uses calm, non-judgmental questioning that leads Maria to her own conclusions. Maria must acknowledge that she is addicted to meth and she must sincerely want to make changes in her life. The goal of MI is to help Maria realize that she has a problem and there is a solution. It is meant to empower her to be able to make the decisions that will change her life for the better. Only when Maria truly acknowledges her addiction will she be ready for a detox facility or outpatient treatment program. She should continue to work with a counselor no matter which course she chooses. It would be helpful to join a support group such as Narcotics Anonymous and participate actively by attending regular meetings, sharing her struggles with the group, and listening closely to what sober group members have to say.

Maria has many difficulties ahead, even after attaining sobriety. It will be essential that she maintain sobriety, and the support group can be a big part of that. She can also use a self-monitoring technique in which she journals when she is anxious or upset. She can change her negative thinking into positive thinking using the ABC Model.

When Maria is stressed, she needs to first journal about the antecedents. She will reflect on what happened that day and with whom she was in contact to try to pinpoint the source of the stress. Perhaps she was stuck in traffic or had a fight with her boyfriend. It could be something as small as running five minutes late because she had to find misplaced keys. Maria needs to recognize what -- or who -- made her upset.

Next, Maria has to look at her behavior. When she was upset, what did she do? Her first thought might have been to get some meth to find some escape from the situation she finds uncomfortable. Maria then can write about the consequences of that behavior. If she had broken her sobriety, she could have been arrested. She could lose custody of her child again (assuming she has regained care of Dominick). She could lose her job, lose her apartment, and lose the life she has struggled to rebuild. As Maria journals about the consequences of her actions, she can see the pattern that led her to a lifestyle that made her miserable. She can better see what she needs to do to stay on a healthy path.