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
How Cognitive Behavioral Therapy Works
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.
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.4
Other Therapies and Support
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. Other types of behavioral therapy may be used, such as contingency management or motivational interviewing. For some drugs of abuse, as well as alcohol, medications can help to reduce drug cravings.
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.6 Attending mutual-help meetings helps to provide consistent real-world practice and reinforcement of the skills and cognitive restructuring that started with CBT.1,5,6
- 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.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: Cognitive-Behavioral Therapy.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- 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.
- 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.