Cognitive-behavioral therapy (CBT) is one of the most studied and most successful treatments for substance use disorders.[1] CBT helps address the most complicated parts of addiction, and can help patients understand and change the many different factors involved in their addiction. CBT can help address any unique issues that may have led an individual to develop or continue an addiction, such as depression, the influence of family/friends, or a sensation-seeking personality.
What is CBT?
CBT can help patients understand why they use drugs, what situations are most likely to lead to drug use, and the consequences of drug use in their lives. CBT also teaches patients skills and strategies to cope with problems and habits associated with drug use. This kind of therapy can help patients learn to avoid or deal with drug-related situations in a more positive way.
CBT takes advantage of well-studied principles of human behavior to help patients overcome addiction.
1) Overcoming reminders of drug use: When individuals recovering from drug addiction come into contact with people, places, or things that were previously involved in their drug use, they may experience withdrawal symptoms and cravings for the drug simply because of these reminders. CBT helps patients discover both what triggers these memories and how to avoid or overcome them in their everyday lives. CBT can help patients understand their cravings, predict when and how they will occur, and develop skills to overcome them.
2) Rewarding healthy behavior: People are more likely to continue behaviors that receive positive reinforcement and less likely to continue behaviors that cause pain or that have no immediate effect. Unfortunately, opioid abuse is a behavior that – at least initially, before tolerance sets in — provides immediate pleasure and positive reinforcement, and can be very hard to unlearn. Likewise, abstaining from drug use can cause pain and negative reinforcement at first, and can be difficult to keep up. CBT addresses these difficulties by helping patients understand these patterns of behavior. CBT can also help provide positive rewards when patients stay away from drugs, making it easier to learn new habits.
3) Learning coping skills: How an individual perceives and thinks about life events is very important to how they will act in response. CBT makes patients more aware of any potentially harmful ways that they interpret or respond to people, places, or things in their lives. This therapy helps patients learn coping skills and how to avoid drug use in everyday life. Patients learn how to assertively say “no” to drugs and to plan for unexpected risky situations.
4) Continued help: CBT has also been shown to help patients continue to decrease their drug use even after therapy ends, by teaching effective skills and strategies to use in everyday life.[2] These problem-solving skills can also be applied to many other everyday, difficult situations.
What is CBT like?
CBT is effective either in individual therapy sessions or in small groups. CBT is often combined with other therapies, like medications for opioid use disorder (MOUD) and other therapy. Besides weekly therapy sessions, CBT may include “homework” during the week to practice new skills learned in the session.
How long does CBT last?
CBT usually lasts 3-6 months, a shorter time than many other therapies. However, the skills learned in CBT therapy can continue to benefit patients long after treatment sessions end.
Who benefits from CBT?
CBT is helpful not only in helping patients overcome addiction but also in the treatment of depression, anxiety, and other common disorders that often accompany drug abuse.
However, CBT is not right for everyone. It can be difficult for some patients to complete “homework” and to spend the time necessary to learn new skills outside of therapy sessions.
[1] Carroll, K. M. (2008). Cognitive-Behavioral Therapies. In M. Galanter & H. Kleber (Eds.), Textbook of Substance Abuse and Treatment (4th ed.) Arlington, VA: American Psychiatric Publishing.
[2]Carroll, K.M., Rounsaville, B.J., Nich, C., et al. (1994.) One year follow-up of psychotherapy and pharmacotherapy for cocaine dependence: delayed emergence of psychotherapy effects. Arch Gen Psychiatry 51. 989–997.
