Treating Depression and Addiction: CBT and Drugs
Treating Psychological Problems: CBT and Drugs
Depression and addiction are both treated using two main approaches: drug treatments, which change the body’s chemistry, and Cognitive Behaviour Therapy (CBT), which changes the way a person thinks and behaves. The same two approaches are used for both problems, but the details differ depending on what is being treated.
Drug treatments and CBT are both used for depression and for addiction. Drug treatments target the body’s chemistry; CBT targets thoughts and behaviours. The exact drug or CBT technique used differs between depression and addiction.
Drug Treatment for Depression
Antidepressant medications, particularly SSRIs (Selective Serotonin Reuptake Inhibitors), work by blocking the reuptake of serotonin into the neuron that released it. This leaves more serotonin available at the synapse to keep stimulating the next neuron, which is associated with improved mood.
Antidepressants are prescribed by a doctor and usually take several weeks to reach their full effect. They reduce the chemical symptoms of depression but do not address the thought patterns that may have contributed to it — which is why they are often combined with a talking therapy such as CBT.
CBT for Depression
CBT is based on the idea that depression is maintained by automatic negative thoughts and the behaviours that follow from them. A therapist helps the client spot patterns such as catastrophising or overgeneralising, then challenges them using cognitive restructuring — examining the evidence for and against a negative thought.
CBT also uses behavioural activation, gradually reintroducing activities the person has withdrawn from because of low mood. Because it teaches skills the client can keep using after treatment ends, its effects can outlast a course of medication.
Antidepressants are a reductionist treatment for depression — they target one cause, brain chemistry. CBT is a more holistic treatment — it addresses thoughts, behaviours and the whole person.
Drug Treatment for Addiction
Drug treatments for addiction usually work by reducing cravings or withdrawal symptoms rather than by directly targeting mood. One example is nicotine replacement therapy (NRT), used to help people addicted to nicotine reduce cravings while they break the habit of smoking. Substitute medications are also used for other addictions, replacing a more harmful substance with a controlled, medically supervised alternative.
CBT for Addiction
CBT has also been adapted specifically to treat addiction. Young developed CBT-IA (Cognitive Behaviour Therapy for Internet Addiction), a three-stage model — behaviour modification (helping the client manage and reduce time spent online), cognitive restructuring (challenging distorted thoughts that trigger excessive use) and harm reduction therapy (addressing the underlying problems, such as loneliness or relationship difficulties, that led to the addiction developing).
Aim: Young aimed to investigate whether a structured course of CBT could help reduce symptoms of internet addiction in a sample of clients who identified as internet addicts.
Procedure: 114 clients who identified as addicted to the internet received a structured course of CBT sessions. Their internet use and psychological wellbeing were assessed at the end of treatment and again at follow-up.
Results: Participants who completed the course of CBT were able to manage and reduce the time they spent online, and many also reported improvement in the underlying problems, such as low mood or relationship difficulties, that had contributed to their addiction — both at the end of treatment and at follow-up.
Conclusion: Young concluded that CBT is an effective treatment for internet addiction, helping clients manage their internet use in the short term and maintain improvements over time.
Young’s CBT-IA has three stages: behaviour modification, cognitive restructuring, and harm reduction therapy. Young (2007) also found that a course of CBT helped internet-addicted clients manage their internet use and the problems underlying it.
The Nature and Nurture Debate
Psychologists debate whether psychological problems are caused mainly by nature — innate, inherited factors such as genes — or by nurture — environment, experience and learning. This is one of the key debates you need to apply to depression and addiction.
The genetic explanation of depression treats it as a nature issue — something inherited that a person is more vulnerable to because of their genes. Learning theory explanations of addiction treat it as more of a nurture issue — behaviour learned through reinforcement and role models. Most psychologists now take an interactionist position: nature creates a vulnerability, and nurture (life experience) determines whether that vulnerability develops into an actual problem.
Drug treatments reflect a nature assumption: if depression or addiction is rooted in the body’s chemistry, then changing that chemistry with medication should relieve it. This is why drug treatments are reductionist — they treat the biological cause directly.
CBT and CBT-IA reflect a nurture assumption: if thoughts and behaviours have been learned, they can also be unlearned and replaced through therapy. The fact that CBT and CBT-IA are effective treatments is sometimes used as evidence that learned (nurture) factors play an important role, even where a biological vulnerability also exists.
Evaluating the Treatments
Drug treatments are widely accessible — a doctor can prescribe them without a long waiting list — and can be taken independently. CBT and CBT-IA have longer-lasting effects because they teach skills the client keeps using after treatment ends, and Young’s study provides evidence that CBT improves both the addictive behaviour and the problems underlying it.
Both approaches have weaknesses. Drug treatments can have side effects and do not address the underlying causes of a problem, so symptoms may return once medication stops. CBT and CBT-IA require time, motivation and engagement from the client, and may not suit everyone, particularly those with severe symptoms. Young’s study also used a specific sample of people who identified as internet addicts, which raises questions about how far the findings generalise to other types of addiction.
When evaluating treatments, use validity, reliability, generalisability and ethics as your lenses. Drug treatments are accessible but reductionist; CBT and CBT-IA are holistic but resource-intensive and depend on the client’s engagement.