What Is Cognitive Behavioral Therapy?
Cognitive Behavioral Therapy (CBT) is a type of psychotherapy based on the relationships between emotions, thoughts and behaviors.1,2 Key to CBT is the concept that behavior is learned and that new ways of reacting can also be learned.1 When being treated for addiction, CBT is an effective way to help a person recognize maladaptive behavioral patterns in order to reduce the risk of relapse, maintain abstinence and discourage substance use.1
What Does Behavior Therapy Treat?
Behavior therapy can be used in the treatment of numerous mental health disorders and behavioral issues, from depression and anxiety to eating disorders to criminal actions.3 Behavioral approaches are often used to treat those struggling with substance use disorders.4
According to the National Institute on Drug Abuse (NIDA), behavioral therapies like CBT help patients in recovery from addiction to:4
- Engage in treatment.
- Feel incentivized to remain sober.
- Adjust harmful attitudes and behaviors.
- Improve life skills to better cope with triggers and cravings.
What Is CBT and How Does it Work?
By recognizing one’s thoughts, emotions and behaviors that lead to substance use, an individual can anticipate problematic actions, thoughts, or other triggers resulting in the use of drugs or alcohol. Examples of CBT include:1
- Exploring the positive vs. negative outcomes of substance use.
- Recognizing the circumstances and emotions that lead to craving drugs or alcohol.
- Identifying risky circumstances that could potentially lead to substance use.
- Developing healthy ways to managing cravings and impulses to use drugs or alcohol.
A treatment program that’s rooted in CBT will be both structured and individualized. Patients can expect to receive an agenda, identify and agree upon goals, and receive homework assignments that they’ll be expected to complete.
What Happens in a CBT Session?
The typical course of treatment will follow the general model below:5
- Functional analysis where antecedents or triggers for drug use are identified. These triggers are high-risk situations, events, people, places, or noticeable changes in emotion like becoming upset or the feeling of having a bad day.
- Identifying strategies to avoid the triggers or otherwise decreasing the likelihood that these changes will occur or to enhance motivation for alternative activities.
- Role playing, rehearsal or similar exercises to support the person’s ability to follow through when faced with the trigger post-therapy.
As an individual works through CBT under the guidance of a therapist they are building both the skills they need beyond rehab and the practice gives them the confidence to implement those skills. In addition to role play and rehearsal with the threrapist or with other patients during a group session, practice may be done via individual homework assignments.6
Effectiveness of CBT for Substance Abuse
CBT was developed as a strategy to prevent relapse among problem drinkers and was then adapted for the treatment of those addicted to cocaine. 8 Today, it is widely used in the treatment of substance use disorders because it is shown to be effective, both in individual and group settings.7
Evidence shows that the skills that a person learns in CBT sessions remain after treatment is complete.8 Combining CBT with other behavioral therapies may be even more beneficial for individuals in recovery from addiction.8
For some drugs of abuse, as well as alcohol, medications can help to reduce drug cravings.
Different Types of Behavioral Therapy
CBT has been shown to be effective in the clinical setting, but there are additional tools that may supplement CBT or may be used to maximize its effectiveness. Behavioral therapies include not only CBT but also approaches such as:4
- Contingency management. This therapy involves providing incentives for positive behavior changes.
- Motivational enhancement therapy. This therapy helps a person to resolve ambivalent feelings and grow their own internal motivation for change.
- Matrix Model. This therapy type combines multiple approaches to help stimulant users achieve sobriety.
Other Forms of Support
Continuing care—that is, care beyond formal treatment—is also an important part of recovery and will likely be incorporated into an individual’s formal treatment plan.1 Mutual-help groups such as Alcoholics Anonymous and Narcotics Anonymous are an important component as well.1
Sometimes referred to as “aftercare,” mutual-help groups actually play an important role in maintaining sobriety and abstinence from substances of abuse.9 Attending mutual-help meetings helps to provide consistent real-world practice and reinforcement of the skills and cognitive restructuring that started with CBT.1,5,9
- Substance Abuse and Mental Health Services Administration. (2013). TIP 47: Substance Abuse: Clinical Issues in Intensive Outpatient Treatment.
- National Alliance on Mental Illness. (n.d.). Learn More: Treatment: Psychotherapy.
- Regis College. (n.d.). What Is Behavior Therapy, and Why Is It Important?
- National Institute on Drug Abuse. (2018). Behavioral Therapies.
- McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric Clinics of North America, 33(3), 511–525.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. Journal of studies on alcohol and drugs, 70(4), 516–527.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: Cognitive-Behavioral Therapy.
- Kelly, J. F., & Yeterian, J. D. (2011). The role of mutual-help groups in extending the framework of treatment. Alcohol Research & Health, 33(4), 350–355.