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Cognitive Behavioral Therapy for Addiction

What Is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is a form of talk therapy that focuses on reducing or eliminating harmful thoughts, feelings, and behaviors that lead to or reinforce substance use.1 It was originally created to help prevent relapse of problematic drinking behaviors.1,2 Today, CBT is widely used to help  treat substance use disorders, as well as co-occurring mental health disorders, such as depression, anxiety, eating disorders, and personality disorders.2

The goal of CBT is to help people develop new ways of responding to difficult thoughts and feelings by replacing their harmful thoughts and feeling with healthy thought patterns. In doing so, CBT can teach people coping skills that help them change their behaviors, including substance misuse.1

How Does CBT Work?

Cognitive behavioral therapy works by helping people change their thinking patterns, which in turn leads to changes in behavior.3 CBT has 3 fundamental principles:3

  • Mental and behavioral health disorders are caused in part by faulty thinking patterns.
  • Negative learned behavioral patterns also contribute to mental and behavioral health disorders.
  • People can learn coping skills to reduce their symptoms and create positive changes.

CBT typically starts with a thorough assessment to identify treatment goals.2 Your therapist will use these to help customize your treatment plan.2 This is important because no two people are the same, and CBT essentially teaches you how to overcome negative thought and behavioral patterns through skill-building and practice.3

Once treatment has started, therapy sessions typically focus on the here and now, rather than the past or future, helping you learn more skillful ways of coping with your situation.3 For substance use treatment, this may involve identifying triggers (the people, places, or things that make you want to use substances), then learning about and practicing new ways to deal with them.

In addition, standard CBT practices include the use of homework assignments in between sessions.3 Each therapy session usually involves a check-in and a review of the last session.2

Cognitive Behavioral Therapy Strategies

CBT strategies that can be useful to gain greater self-control over the use of substances include:1,3,4

  • Exploring the positive and negative outcomes of substance use.1
  • Developing problem-solving skills.
  • Role-playing, in which you rehearse ways to cope with triggers or other difficulties through practice with the therapist.
  • Learning how to calm yourself and release stress and anxiety.
  • Homework assignments, which can include monitoring thoughts throughout the week, journaling, and practicing various skills learned in sessions, such as replacing negative thoughts with realistic ones.

Effectiveness of CBT for Addiction

CBT has become fairly standard in addiction treatment, and studies show that it has good outcomes compared to treatment as usual.5 Research also shows that the CBT skills that people learn in treatment tend to remain after treatment ends, and it may be even more helpful when combined with other addiction therapies or medications.1

There is also evidence that CBT helps to regulate the prefrontal cortex, which generally becomes less active during addiction.5 The prefrontal cortex is responsible for impulse control, attention, and other functions essential to decision-making. During active addiction, this part of the brain is blunted, or inhibited, making these functions less accessible, but CBT can help to change it over time to a more adaptive function.5

Benefits of CBT for Addiction

CBT is found to have multiple benefits for treating addiction, including:1,4,5

  • Reducing cravings and urges to use or drink. CBT helps patients to cope more effectively with internal triggers, such as difficult emotions or memories, as well as external triggers, like being around people who drink or use.
  • Increasing resilience and confidence. CBT increases cognitive flexibility (the ability to change your thoughts or take in new information) and self-efficacy (the belief that you can successfully make necessary changes).
  • Fortifying relapse prevention skills. This may include learning to recognize and avoid high-risk situations or using other coping skills to manage cravings and urges.
  • Flexible and widely available. CBT can also be used in combination with other therapies, medication, or computer-based approaches. It is also one of the most common therapy types.

In short, there are numerous benefits to pursuing CBT for substance abuse treatment. By choosing an addiction treatment program that utilizes CBT techniques, you will learn to challenge unhelpful thought patterns, manage your emotions more effectively, and ultimately alter the behavior that contributes to addiction.

How to Find Cognitive Behavioral Therapy for Substance Use

If you or a loved one is struggling with a substance abuse disorder, you are not alone.
Treatment can help you start to heal from addiction. Many treatment centers, including American Addiction Centers (AAC), offer cognitive behavioral therapy as part of treatment. Contact our free, private helpline at for more information. We can help you review different treatment options to find the program that is right for you.

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