Cognitive Behavioral Therapy (CBT) for Addiction Treatment

Cognitive behavioral therapy (CBT) is a leading intervention for substance use disorders that applies elements of both behavioral and cognitive therapy to help patients break free from addiction.¹ CBT has a vast amount of empirical support and is broadly accepted as an evidence-based methodology for establishing behavioral change.²

This article will review what CBT is, discuss how it can help someone with a substance use disorder (SUD), and review what a person can expect from this form of therapy.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy for substance use disorders is a therapeutic intervention that happens across multiple sessions in which a therapist works with a patient to examine their risk factors for substance use—environmental, cognitive, and affective—and provides coping skills and training to help the patient achieve treatment goals.¹

In CBT, the patient develops an understanding of the reciprocal interaction between their thoughts, feelings, and behavior. The patient and therapist then work together to establish coping strategies that will elicit a different emotional response and lead to a different behavioral outcome.³

Because behavior change is integral to the success of CBT for drug addiction, it is important to also understand behavioral therapy for addiction. Behavioral therapy is a targeted approach to changing behavior that utilizes the following basic principles of learning:⁴

• Operant conditioning—Learning (behavior change) that occurs in response to the consequence of, that behavior.
• Classical or respondent conditioning—Learning (behavior change) that occurs in response to environmental stimuli.

There are various methods for providing CBT as an addiction therapy or treatment for substance use disorder, such as:

• Contingency management programs which provide incentives (positive reinforcement) for participation in treatment.⁵
• Relapse prevention programs which help patients identify high-risk situations and develop coping strategies for use in those situations to increase the likelihood of a healthier behavioral outcome.²
• Assigning the patient homework or “practice exercises” to do between sessions, which reinforces newly learned coping skills and increases the likelihood of generalization, or incorporating the skills into daily life.²

Family therapy is also a type of behavioral therapy for drug addiction in which family members are incorporated into certain sessions to help the patient increase their motivation for change and build skills to support abstinence.⁵

Opportunities for both individual and group therapies are also available. When comparing individual vs group therapy, both types of therapy have their own unique advantages:

• Individual therapy offers individualized attention for processing difficult emotions and instills a stronger sense of privacy and confidentiality.
• Group therapy conveys to SUD patients that they are not alone, validates their experience of triggers, and provides social reinforcement for accomplishing periods of abstinence.⁵

What Does CBT Treat?

While CBT was developed for use with depressed patients, its clinical application is effective for treating a wide variety of mental health issues including:⁶

• Substance use disorders.
• Anxiety disorders.
• Eating disorders.
• Personality disorders.

It has also been shown to be an effective adjunctive treatment to medication for bipolar disorder and schizophrenia, which are known as serious mental disorders.⁶

Cognitive behavioral therapy may also be helpful for those coping with certain long-term medical conditions such as:⁶

• Irritable bowel syndrome.
• Chronic fatigue syndrome.
• Fibromyalgia.
• Migraines.
• Chronic pain.

How Does CBT Work?

Cognitive behavioral therapy for addiction helps the patient develop an understanding of the reciprocal interactions between their thoughts, their feelings or emotional experience, and their behavior. The approach focuses on enabling a person to help themself and requires a trusting relationship between the patient and therapist.^3,6

CBT often involves journaling, guided introspection, and other techniques such as stress relief and relaxation.³ Compared to other methods of therapy, CBT takes a solution-oriented approach to current problems, rather than inspecting the past.³ It requires the patient’s active involvement in treatment.⁶

What to Expect During a CBT Session

When a person first begins CBT, their therapist will help them express:

• What problems they are looking to work on.
• What they are looking to achieve in treatment.
• What their expectations are.

Treatment then focuses on that overall plan, with regular, often weekly, 1-hour sessions. In each session, the patient may be provided homework and exercises, which are reviewed and discussed in the subsequent session.⁶

There is ideally a continuity from session to session, with the discussions focused on the patient’s therapy goals. If those goals change, the CBT approach and nature of the sessions may change as well.⁶

CBT for Substance Use Disorders

When used as a treatment for substance use disorders, CBT can include a variety of interventions. These can take place either as part of individual, group, or family therapy.⁷

CBT methods like motivational therapy encourage patients to develop the desire to change by recognizing what problems arise from their substance use.⁷

Contingency management uses CBT foundations to encourage treatment participation and adherence. With this method, patients are rewarded for positive behaviors, which helps them adjust how they think of substance use and therefore reduce substance use behaviors.⁷

Cognitive behavioral therapy is also used in relapse prevention. Relapse may be due, in part, to environmental and emotional cues that trigger a person to want to use substances. CBT helps patients recognize and work to rewire the patterns between their triggers and substance use behaviors.⁷

CBT methods may also include skill building for problem-solving, refusing drugs, and general coping skills needed to change the behaviors that are intertwined with substance use disorder.⁷

Is CBT Effective for Substance Use Disorder?

There is empirical support for the effectiveness of cognitive behavioral therapy for substance use disorders. Studies have revealed that:²

• The effects of CBT are long-lasting, helping patients to maintain abstinence over time.
• Higher levels of treatment compliance in early treatment stages are found in programs that combine contingency management with motivational interviewing.
• Cognitive behavioral therapy for addiction works well in combination with medication or pharmacological interventions.

The effectiveness of cognitive behavioral therapy for substance abuse may depend on which substances a person uses.² Research found that effectiveness may be higher for marijuana than for alcohol, cocaine, and stimulants, for example.² However, more research is needed.

Cognitive behavioral therapy for addiction recovery may be more effective when combined with additional psychosocial treatment and other methods.²

Is Therapy Enough to Treat Substance Use Disorders?

The structural and chemical changes associated with an addicted brain directly disrupt the user’s perception of reward and their ability to inhibit drug-seeking behavior.⁵ Studies have found that patients who receive CBT treatment, undergo changes in brain activity from pre to post-treatment.⁸ However, these changes from therapy alone may need additional support.

The factors that contribute to a person’s substance use behavior and recovery depend on their individual needs, substance use history, genetics, environment, and more. Therefore, successful treatment should be individually tailored. For many, this means using a combination of pharmacological interventions and talk therapy under the supervision of medical staff.⁵

Is CBT Covered by Insurance?

Most insurance plans are required to provide some coverage for addiction treatment.⁹ In addition, the coverage they provide for addiction and mental health treatment must equal the amount they cover for other medical services.¹⁰

CBT is an essential part of many evidence-based addiction treatment programs that are practiced in a variety of settings. When the insurance policy covers treatment at the relevant facility, CBT and other interventions should be covered.

Find Cognitive Behavioral Therapy for Addiction Recovery at Oxford

Oxford Treatment Center is a leading outpatient and inpatient drug and alcohol rehab in Mississippi. Our staff utilizes cognitive behavioral therapy and other treatment modalities to help people recover from substance use disorders every day.

The team at Oxford Treatment Center is available 24/7 to answer your questions about inpatient addiction treatment and outpatient drug and alcohol rehab in Mississippi. Our admissions navigators can help you explore different rehab payment options and verify your drug and alcohol rehab insurance coverage.

You can also verify your insurance coverage online by completing the secure .

There are various levels of addiction treatment available, and we can help you determine the best plan for you. Call now to speak with a compassionate admissions navigator and learn about the rehab admissions process.