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Cognitive Behavioral Therapy (CBT) for Substance Use Disorders

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Cognitive behavioral therapy—abbreviated to CBT—is a psychotherapy approach used to treat various mental health and substance use disorders.1 Therapy can be a helpful tool in managing mental health symptoms and navigating difficult life transitions, such as when you quit drinking or using drugs. CBT works by targeting your thoughts, emotions, and behaviors to challenge unhelpful patterns and teach new coping skills.2,3

In this article, we will define CBT and its key components, discuss how CBT is used in the treatment of substance use disorders, and help you to determine if CBT is the right therapy approach for you.

What Is Cognitive Behavioral Therapy (CBT)?

Psychiatrist Aaron Beck created CBT in the 1960s and, since that time, it has been adapted for treating a variety of conditions, such as depression, anxiety, eating disorders, and substance use disorders.1 CBT works by identifying the unhealthy relationships between your thoughts, emotions, and behaviors to find patterns which lead to the behaviors you are trying to halt.2

Beck originally developed CBT in response to a trend he noticed in treating depression wherein patients would verbalize thoughts that lacked evidence or validity, but which they felt to be true.1 This led Beck to view depression not as a mood disorder, but as a cognitive disorder, meaning that the problem stemmed from the patient’s thoughts.1

Later on, CBT for alcoholism was developed to treat problem drinking by viewing it through the same lens: patients had learned to use alcohol to cope with painful thoughts or emotions.3

How Does Cognitive Behavioral Therapy for Addiction Work?

In CBT for substance abuse, you will learn how to identify and challenge behaviors that have contributed to the problem you are targeting.3 Your therapist’s role is to help you gain an awareness of negative thoughts that lead to poor self-image, such as, “I can’t do anything right.”2 This negative self-talk can cause self-destructive behaviors and beliefs, and in this stage of therapy, your goal is to identify and replace them.2

Once you have an awareness of the thought patterns that lead you to drink or misuse substances, you will learn and implement coping strategies to replace these parts of the patterns.2 This is done by developing new skills to replace past behaviors, which in substance use treatment is called relapse prevention.3 In a therapy session, a CBT therapist might teach you to replace negative self-talk with a different thought, such as, “I am capable of doing many things right.”2

A core principle of CBT is uncovering and restructuring negative core beliefs that have been learned over time.2,3 In substance use treatment, this may look like exploring the consequences of continued drinking or using, learning to recognize cravings or urges, and developing strategies to avoid high-risk situations that might lead to relapse.3

Cognitive Behavioral Therapy for Substance Use Disorders

Cognitive behavioral therapy helps people to identify and correct problematic behaviors that contribute to substance misuse through learning and practicing different coping skills.3 CBT for addiction helps clients learn to anticipate problems that are likely to come up in the future and practice skills to address them ahead of time.3 In CBT for substance use, you may also be asked to complete homework like journaling, keeping a record of your thoughts, or practicing coping skills between sessions.2

When it is combined with medication for substance abuse or to treat underlying psychiatric conditions, CBT is demonstrated to be highly effective in treating addiction.3 Research has also indicated that the combined use of CBT and pharmacotherapy has yielded positive outcomes in multiple studies.4

It is also worth noting that CBT can be used to treat the mental health disorders that frequently co-occur with addiction—including depression, anxiety, and others—which may contribute to or worsen substance misuse.5 While each person is different and their treatment plan will be customized to their unique needs, CBT has proved effective in treating a variety of conditions in psychotherapy.

An important distinction between CBT for drug addiction and other treatment modalities is its ability to help clients learn to anticipate problematic scenarios that may lead to relapse. Central to CBT is the idea that people living with psychological problems can learn healthy ways to cope with them and, in turn, unlearn maladaptive patterns of thinking and behaving.5

In substance use treatment, this can include CBT techniques for addiction like exploring the negative and positive consequences of continuing to drink or misuse substances, learning to calm your mind and body, and using role play with a therapist to prepare for difficult situations.3,5 In the research, patients who underwent 8 weeks of outpatient CBT for substance misuse demonstrated changes in the area of the brain responsible for impulse control and response inhibition on functional MRI images.6 This suggests that, over time, CBT can change how the brain responds to potential triggers, cravings, or urges to use substances.

What Are Cognitive Distortions?

Cognitive distortions are a key element of CBT that are best described as illogical beliefs which lead to inaccurate assessments or conclusions.1 CBT therapists are well-versed in the various types of cognitive distortions, and a goal of therapy may be to help clients learn to identify them in their own thinking. Some common cognitive distortions include:

  • Overgeneralization—you see one negative event as indicative of a larger pattern, usually indicated by using the words “never” or “always.”7 For example, you might hit every red light on your way to work, and have the thought, “I’m always running late. I’ll never get myself together in the mornings.”
  • Mind-reading—you assume that someone is judging you or reacting negatively to you without any evidence for this thought.7 This might look like waving to your neighbor as they walk by and when they do not wave back, thinking this must be proof that they dislike you.
  • Disqualifying the positive—you tell yourself that your effort was not enough, or that it “did not count” for one reason or another.7 An example might be starting a new workout plan and saying it was nothing special because you only stayed at the gym for 20 minutes.

Part of learning to notice and reframe cognitive distortions is exploring why they are coming up in the first place and whether there are elements you can change.7 In CBT, your therapist will help you to identify benefits to the situation you are in and embrace the notion that you can feel more than one emotion at the same time, as opposed to thinking in black and white.7

Co-Occurring Disorders

Mental health and substance use disorders that exist at the same time are called co-occurring disorders, and clients with co-occurring disorders can benefit from specialized treatment.8 People with substance use disorders are more likely to have co-occurring chronic physical or mental health problems and, for this reason, CBT is an ideal choice for treatment.9

Many people experience substance use and mental health problems at the same time and may even experience interrelated symptoms. Some common co-occurring disorders include anxiety, mood disorders, schizophrenia, and post-traumatic stress disorder (PTSD).9 It is important to treat co-occurring disorders simultaneously in order to address both issues. Individuals with co-occurring mental health disorders can benefit from CBT to help with mental health symptoms.3 This is especially true when CBT is combined with medication to treat underlying physical or mental health conditions.3

Benefits of Cognitive Behavioral Therapy

There are many benefits of cognitive behavioral therapy that make it an ideal choice for addiction treatment. A few of these benefits include:

  • CBT is an evidence-based therapy approach.1
  • CBT can be combined with other types of therapy for a more customized treatment plan.3
  • CBT can be personalized to meet your unique needs.1
  • CBT can improve your mood symptoms.1
  • CBT can end substance misuse by removing the power behind triggers, cravings, and urges.3
  • CBT has been shown to improve brain functioning, proving that you can unlearn harmful patterns.2
  • CBT skills can help you stay sober after you have left treatment.3

Does Insurance Cover Cognitive Behavioral Therapy?

Cognitive behavioral therapy can be paid for using your health insurance benefits. Depending on your plan, you may have a co-pay due at the time of service, you may have to meet a certain deductible before your coverage kicks in, or you may have other out-of-pocket costs. This is determined based on your insurance plan itself, the state you live in, and what type of care you are seeking, such as outpatient mental health therapy versus an inpatient rehab stay.10 To find out for sure, contact your health insurance provider directly.

The Affordable Care Act (ACA) mandates that insurance providers must cover treatment for mental health and substance use treatment.10 This means that your insurance plan is required to cover at least a portion of your care. The ACA applies to all insurance companies, including employer-sponsored coverage, Medicaid and Medicare, and marketplace insurance.

Depending on what stage of treatment you are in and what setting it is held in, your insurance may cover the service at a higher or lower percentage. For example, inpatient coverage may be covered at a higher rate than outpatient, and outpatient may be covered more than aftercare. You can instantly check your insurance coverage online now.

Other Supplemental Therapies

A major benefit of CBT for addiction is that it integrates aspects of various therapy styles while allowing clients to benefit from other services. Many CBT therapists utilize or encourage the following therapies:

  • Motivational Interviewing—This style of therapy involves a certain method of questioning that is particularly helpful in addiction treatment and works well alongside CBT.
  • Holistic Approach—A holistic approach will look at your overall well-being to find ways to improve your physical, emotional, and spiritual health.
  • 12-Step Programs—Programs like Alcoholics Anonymous (AA) and Narcotic Anonymous (NA) work well alongside CBT. Many patients will attend regular meetings in conjunction with their CBT sessions.
  • Medication Management—When you work with a CBT therapist, they might recommend a psychiatric evaluation. You may be prescribed medication to help improve your symptoms. Many studies show that CBT and medication work better together than either one on its own.

Finding CBT for Substance Use Treatment

If you are interested in learning more about CBT for substance use treatment, there is help available. One of the best predictors of success in recovery is staying connected to treatment for the appropriate amount of time. This means that, from the first step, it is important to follow a treatment plan which is customized to your needs. CBT is a widely effective treatment approach for many people and can help you challenge negative beliefs about yourself and start to create a new worldview.

Rehab programs that offer CBT are located throughout the U.S. You can use SAMHSA’s Behavioral Services Locator to search for facilities. Many state government websites will also provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.

American Addiction Centers (AAC) is a leading treatment provider and has trusted programs across the country. To find a rehab center near you offering CBT services, please visit our online directory or contact one of our admissions navigators today for a free phone consultation. You can call us free at for advice, information, and admissions.

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Kristen Fuller, MD, enjoys writing about evidence-based topics in the cutting-edge world of mental health and addiction medicine and contributes to medicine board education. Her passion lies in educating the public on the stigma associated with mental health. Dr. Fuller is also an outdoor activist, an avid photographer, and is the founder of an outdoor women's blog titled, GoldenStateofMinds. In her free time, she enjoys hiking, backpacking, skiing, camping, and paddle boarding with her dogs in Mammoth Lakes, California, where she calls home.
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