The development of pleasurable sober activities is of particular importance given the amount of time and energy that is often taken for substance use activities (i.e., obtaining, using, and feeling the effects of substances). When reducing substance use, patients can be left with a sense of absence where time was dedicated to use, which can serve as an impediment to abstinence. Thus, concurrently increasing pleasant and goal-directed activities while reducing use can be crucial for facilitating initial and maintained abstinence. During assessment and early treatment sessions, case conceptualization requires consideration of the heterogeneity of substance use disorders. For example, the relative contribution of affective and social/environmental factors can vary widely across patients.

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Exposure therapy is one of the common techniques that is widely used during the CBT sessions with the main goal of preparing the patients to avoid their unhealthy behaviours even in triggering situations. Recent technological developments provide promising insights that delivering CBT sessions for substance misuse, with the combination of Virtual Reality (VR) increases the effectiveness of the given psychotherapy sessions and exposure therapies. VR simulations can recreate real life scenarios about personalised Cognitive Behavioral Therapy risky situations or triggering situations, leading patients to practice healthy coping strategies that they have learned during their CBT session, in a controlled, safe environment. For instance, a virtual peer group setting can be recreated to help someone with substance misuse to learn how to handle the social pressure that they might have about using illicit substances. Furthermore, a virtual simulation of a triggering situation can also be recreated to teach the patient about how they can regulate and manage stressing situations without using the illicit substances. At the same time, exposing patients to triggering situations could enable the CBT psychotherapist to establish necessary tools within the sessions and provide immediate feedback to enhance the efficacy of the sessions.

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Risa Kerslake is a registered nurse, freelance writer, and mom of two from the Midwest. She specializes in topics related to women’s health, mental health, oncology, postpartum, and fertility content. She enjoys collecting coffee mugs, crocheting, and attempting to write her memoir. When it comes to addiction, CBT can help you take steps to reframe your situation to avoid triggers. When you find a therapist skilled in CBT, you can take steps to apply the skills you learn to future situations.

Cognitive-behavioral therapy for addictions and substance abuse

A variety of psychotherapies have been shown to effectively treat mental health disorders. For example, the treatment approach for someone who has obsessive-compulsive disorder is different than the approach for someone who has bipolar disorder. Therapists may use one primary approach or incorporate elements from multiple approaches depending on their training, the disorder being treated, and the needs of the person receiving treatment. CBT helps individuals to discover and realise distorted thinking patterns, triggering situations and maladaptive coping strategies that leads them to continue to their substance misuse. By targeting such cognitive and behavioural processes, CBT teaches individuals the necessary skills to resist cravings with healthier coping mechanism, making healthier choices and maintaining longer term recovery (McHugh et al., 2010). Moreover, the structured nature of CBT fosters accountability and ongoing support, ensuring individuals are more equipped to maintain sobriety in the long term.

• Cognitive behavioral therapy techniques can be practiced outside the therapist’s office.
• The CBT4CBT for alcohol-use disorders (AUD) program retained the structure, features, and basic core CBT skills of the original version, but with additional alcohol-specific content and skill-based examples drawn from the CBT manual published by the National Institute on Alcohol Abuse and Alcoholism (Kadden et al., 1992).
• In early review, a robust benefit of combined CBT with other psychosocial therapies such as MI and CM was observed.
• CBT frequency outcomes at early follow-up, in contrast to a non-specific therapy, showed smaller effect sizes among studies with older samples.

The neurobiological basis of mindfulness in substance use and craving have also been described in recent literature40. Platforms for delivering addiction interventions via technology are diverse and multiplying rapidly. In the sections below we will cover only those which (1) are explicitly or predominantly cognitive-behavioral in focus (although several include components of MI and other interventions), (2) the primary targeted outcome is alcohol or drug use, and (3) the intervention is delivered online. We include an expanded description of a computer-based CBT program developed by our research group as a possible paradigm for how CBT evolve in the future. Skills building can be broadly conceptualized as targeting interpersonal, emotion regulation, and organizational/problem-solving deficits. Clinical trials examining the addition of coping and communication skills training have demonstrated positive outcomes and are common components of CBT for substance abuse.60, 61 The use of strategies should be based on case conceptualization, building from patient report and behavioral observation of such deficits.

What is SMART Recovery?

• Discussions in therapy are deeply personal, and it’s important that you feel comfortable with the therapist and have confidence in their expertise.
• Taking a multi-therapy approach allows for comprehensive treatment, addressing various aspects of addiction, like motivation, coping strategies and social support.
• It equips individuals with practical strategies to manage stressors and triggers that may lead to substance use.
• To date, the Tolin Criteria have been applied to Exposure and Response Prevention for Obsessive-Compulsive Disorder (Tolin, Melnyk, et al., 2015), Cognitive Behavioral Therapy for Insomnia (Boness et al., 2020), and Contingency Management for Substance Use Disorders (Pfund et al., 2021).

As noted above, this type of contrast characterized the majority of studies reviewed despite the known phenomenon of limited evidence for differential efficacy between specific therapies (i.e., the dodo bird effect). While it is beyond the scope of this work, an important question for future research is – how or why this phenomenon continues to occur? A range of explanations have been offered including common factors and specific, yet equally effective, factors (e.g., Magill, Kiluk, McCrady, Tonigan, & Longabaugh, 2015), and it could be a combination of both.

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Being aware of the triggers, individuals can develop healthy and adaptive coping strategies to avoid triggering situations as this reduces the risk of relapse and enhances life-time recovery. In addition to learning unique healthy coping mechanism, developing a realistic support system is also another crucial factor which enhances the relapse prevention (Huppert & Siev, 2010). Despite the effectiveness of Cognitive Behavioral Therapy (CBT) in treating substance use disorders, several misconceptions hinder its adoption. One common belief is that CBT is only suitable for those with severe mental health issues.

Similar to advancements in the treatment of bipolar disorder and schizophrenia, where promise has been shown in combining cognitive therapy with pharmacotherapy, the study of best practices for alcohol and substance use disorders will probably involve more instances of coordinated care. For example, the strength of medication-based treatments that diminish the patients’ subjective desire for their drug(s) of choice can be paired with the strengths of cognitive therapy in modifying faulty beliefs and maximizing skill-building. CBT for substance use disorders includes several distinct interventions, either combined or used in isolation, many of which can be administered in both individual and group formats. Specific behavioral and cognitive-behavioral interventions administered to individuals are reviewed below, followed by a review of family-based treatments.