Have you ever seen the bumper sticker that says: “Don’t believe everything you think”?
It’s cheeky, but it’s actually based on science. This saying is based on the principles of a type of psychotherapy called “Cognitive Behavioral Therapy,” or “CBT.” CBT is one of the most widespread and commonly studied therapy techniques that exists today, and it’s considered the “gold standard” of treatment for a variety of different mental health concerns —including substance use disorder.
CBT is one of many therapies that’s used to treat substance use disorder, and research shows that it works. If you’re ready to break through the prison of addiction and get the help you deserve, then CBT is a great place to start. In this guide, we’ll talk about what CBT is, how it’s used to treat substance use disorder, and how to figure out whether or not it’s right for you.
What Is Cognitive Behavioral Therapy?
If you have any experience at all with mental health treatment, you’ve probably heard of Cognitive Behavioral Therapy (CBT). CBT is one of the most commonly used psychological treatments in existence today, and for good reason. Evidence consistently supports the claim that CBT is effective in helping people recover from all kinds of mental health disorders, including depression, anxiety disorders, and —most importantly for readers of this article— substance use disorder.
In short, CBT helps people to challenge the irrational thoughts that cause them to feel miserable. CBT is a short-term, problem-focused psychotherapy intervention. This means that, rather than exploring deeply into your past traumas and childhood experiences, CBT focuses on the problem-at-hand and teaches you the skills to better cope with them.
The History of Cognitive Behavioral Therapy
Although CBT as a modern psychological science didn’t come around until the 20th century, the origins of the practice’s root beliefs are almost as old as time. Experts have drawn parallels between the principles of CBT and classic Greek philosophies, especially Stoicism.
CBT as a modern science was developed by psychiatrist Aaron T. Beck in the 1960s. Both cognitive and behavioral theories of human behaviors had been circulating since the early 20th century, but Dr. Beck was the first person to use the concept of automatic negative thoughts to help people combat the symptoms of depression.
Although Beck is now referred to as the “father of cognitive behavioral therapy,” another psychologist was almost just as influential in the development of CBT: Dr. Albert Ellis. Around the time that Beck was working on his theory of automatic thoughts, Ellis was creating a theory of psychotherapy that’s now called rational emotive therapy. Rational emotive therapy is very similar to Beck’s model of CBT, and helps people to realize that their reactions to “activating events” (external circumstances) are what causes distress, not the event itself.
CBT as it’s practiced today is a combination of both Aaron T. Beck and Albert Ellis’ work. It’s also been combined with the behaviorism theories of the early 20th century.
Since the 1960s, the study and practice of CBT has exploded into being what it is today: one of the most widely used psychotherapy techniques in existence. Most modern therapists are trained in some form of CBT, and research continues to prove how effective it is in helping people with the symptoms of a wide variety of mental illnesses.
Main Concepts of Cognitive Behavioral Therapy
CBT, essentially, teaches that our thoughts, emotions, and behaviors are all interconnected. Furthermore, CBT practitioners believe that our thoughts are within our control. When we can change our thoughts, especially our irrational or unhelpful ones, we can start to change how we feel.
CBT helps people to realize that it’s not external events themselves, but how we perceive external events, that makes us feel upset. For example, imagine that someone cuts you off in traffic. You think to yourself: “What a jerk! Now there goes a person who has no consideration for other people. I was just in my lane, minding my own business, and I didn’t deserve that.” Naturally, by thinking this way, you’d feel upset, angry, and maybe even outraged. This anger will probably affect the way you react in the moment, and might even affect how you behave the rest of your day.
Now, imagine the same external event happening: someone cuts you off in traffic. However, in this scenario, you think to yourself: “Wow, that guy must be in a rush. I wonder what’s going on in his day that he felt the need to do that. I hope he gets to wherever he’s going on time.” In this situation, you’re less likely to feel upset or react in anger.
This is the basic premise behind CBT: by changing the way you perceive and think about external events, you’re less likely to feel negative emotions or react in negative ways. CBT uses both cognitive and behavioral interventions to help people react more healthily (and rationally) to what’s going on around them.
Many different interventions fall under the general umbrella of CBT, and the following are just a few.
CBT Cognitive Interventions
One of the most essential CBT interventions is called cognitive restructuring, or helping people to challenge their irrational thoughts.
Irrational thoughts are referred to as cognitive distortions in CBT. In essence, cognitive distortions are any pattern of thought we have that isn’t representative of the truth. Cognitive distortions usually make us think negatively; by catching ourselves and challenging these types of thinking patterns, we can relieve painful emotions, like depression or anger.
Some of the most common examples of common cognitive distortions include:
- Polarization (all-or-nothing thinking): Thinking in black-or-white terms; ex: “I had one drink, so I’ve already messed up. I might as well just keep drinking.”
- Catastrophizing: Making a mountain out of a molehill, or thinking something is the end of the world when it isn’t; ex: “I’ve just had a drink. I’ve relapsed and now my wife is going to leave me and I’m going to lose my job.”
- Mental Filtering: Only seeing what supports what you already believe; ex: “See? My friend is drinking, and he’s a totally normal, successful guy. Drinking alcohol isn’t a big deal at all.” (ignoring other friends who have had problems with addiction)
- Emotional Reasoning: Thinking that because you feel a certain way, it must be true; ex: “I feel so ashamed of what I’ve done. That must mean I’m a terrible person.”
- Jumping to Conclusions: Mind-reading or fortune-telling; ex: “That person must be looking at me like that because they think I’m just a junkie. Who are they to judge me?”
- Personalization: Thinking things are about you when they have nothing to do with you at all; ex: “My friend must not be calling me because they don’t want to hang out with me anymore. They must just think I’m a loser who’s not worth being friends with.”
- Labeling: Putting a label on yourself or someone else; ex: “I’m just an alcoholic and I’ll never be anything else.”
- Disqualifying the Positive: Only paying attention to negative parts of life or yourself; ex: “Nothing good ever happens to me. I’ve crashed my car, and now I’m going to have to pay to fix it. My life is terrible.”
- Fallacy of Fairness: Thinking that life is always supposed to be fair, or that you’re entitled to fairness; ex: “I’ve been a good person, and I’ve never hurt anyone. Why have I now been robbed? Why me?”
CBT helps patients to identify their irrational thinking patterns and consciously work to replace their cognitive distortions with more rational, and helpful, thoughts. Ideally, this helps them to both feel better emotionally and react in healthier ways to the world around them.
CBT Behavioral Interventions
Another important component of CBT is the “B:” behavioral.
Although a large focus of CBT is on changing your thoughts, CBT practitioners also help people to engage in behaviors that make them feel better emotionally. Remember, through a CBT lens, our thoughts, behaviors, and feelings are all connected. The idea is that we should consciously engage in relaxing or soothing behaviors that make us feel better emotionally.
This is called behavioral activation, and it’s especially important for patients with depression. When people are depressed, they get caught in a negative spiral. Ironically, their depression symptoms keep them from doing the very things that would make them feel less depressed: things like getting some sun, seeing friends, or exercising.
Behavioral activation, a specific CBT skill, asks people to engage in these helpful behaviors even when their emotions and thoughts are telling them to stay in bed (or engage in another unhelpful behavior). In essence, the CBT “triangle” is interrupted at the point of behaviors instead of thoughts. The more people engage in helpful behaviors, the more their thoughts and feelings will improve.
On top of behavioral activation, CBT practitioners also teach patients specific relaxation and problem-solving skills. Some examples are diaphragmatic breathing and the five-step problem-solving model. Patients are asked to practice these skills, and then record how they felt afterward.
What Is Relapse Prevention Therapy?
Relapse Prevention therapy (RP) is a specific CBT intervention that’s used for substance use disorder. It’s also sometimes used for other mental illnesses in which someone must change their behaviors in order to recover (like obsessive-compulsive disorders, in which the patient must stop performing compulsions, or eating disorders, in which the patient must change their eating habits). RP has been found to be especially effective for alcohol use disorder.
The basic assumption underlying RP is that relapse is a complex process that happens in stages. If you wait until later stages, it’s harder to prevent yourself from relapsing. RP teaches people to identify the emotional stages that come along earlier in the relapse process and then work to cope with them in healthy ways.
A specific behavioral technique that’s used in this type of CBT is to anticipate and avoid triggers. The clinician and patient make a list of situations that are likely to make the patient be tempted to relapse. Then, they’ll make a plan for how to both avoid these situations as much as possible, and how to cope with them when they’re unavoidable.
For example, you might be encouraged to delete the contact information of old drinking buddies, or avoid going to parties where there are drugs available. You might make a plan of how to engage in healthy behaviors if you know you’re going to be in a situation that is going to trigger a craving.
Relapse is, unfortunately, a common part of the recovery process. Going through CBT, and RP specifically, can make it less likely that you’ll be able to fight the triggers for relapse and continue on the road to recovery.
What Is Cognitive Behavioral Therapy Used For?
CBT is one of the most studied psychological interventions, and there are countless scientific studies proving its effectiveness for a whole host of mental illnesses and life problems. Therapists have effectively used CBT to help people with:
- Depression
- Anxiety Disorders
- OCD (a specific type of CBT called “Exposure and Response Prevention”)
- Panic Disorder
- Insomnia (a specific type of CBT called CBT-I)
- Body Dysmorphic Disorder
- Eating Disorders
- Anger Management Problems
- Bipolar Disorder (along with medication)
- Substance Use Disorder
- Gambling Addiction
- Sex Addiction
- Nicotine Addiction
- Internet Addiction
With many of these conditions (including depression, OCD, and anxiety disorders), CBT has consistently been found to be the most effective psychotherapy method and is suggested as the frontline treatment. It’s considered the gold standard of treatment because there is no other psychotherapy model that has systematically been proven to be more effective than CBT across the board.
Often, CBT has been found to be the most effective when it’s delivered in conjunction with psychiatric medication.
How Effective Is Cognitive Behavioral Therapy for Addiction?
CBT is one of the most commonly used techniques for almost every mental illness out there, and substance use disorder is no exception. Although recovery from substance use disorder, especially when it’s severe, often requires medical intervention (like medically-assisted detox or opioid replacement medications), CBT is often used for the behavioral portion of addiction treatment.
CBT Effectiveness: Research Outcomes
Again, there are countless studies proving the effectiveness of CBT, including in the treatment of substance use disorder.
One meta-analysis found a moderate effect size across the board for CBT and substance use disorder. How effective CBT was for treating addiction varied quite widely across studies, but almost all studies found that CBT was at least moderately effective compared with no treatment or traditional substance abuse counseling.
CBT has also been found to have a long-lasting effect. Not only does the intervention help people to take their first steps toward recovery, but people who received CBT were also more likely to be sober at the 52-week follow-up mark.
Curiously, CBT has been found to be the most effective for cannabis use disorder, or marijuana addiction. The reasons for this are unknown, but if you are addicted to marijuana, then you may be a particularly good candidate for a CBT intervention.
Is CBT for Me?
Since CBT has been so well-studied, it’s usually recommended as a frontline treatment. If you’re working toward recovering from addiction, you may receive a variety of different interventions. Because of the immense research supporting its effectiveness, CBT interventions are usually included in this range of options.
CBT is unlikely to have any negative side effects, and most therapists use some variation of CBT intervention.
Although anyone could be a good fit for CBT, you may be particularly well-suited for CBT intervention if you:
Are Motivated to Change Your Behaviors?
If you have decided that you want to stop drinking or using drugs, and you’re motivated enough to be engaged in treatment and complete your homework or between-session activities, then CBT will probably be the most helpful for you. If you still have some unresolved ambivalence about wanting to quit, then you might need an extra intervention like Motivational Interviewing.
Have Comorbid Depression or Anxiety?
CBT is the first-line treatment for both depression and anxiety disorders. If you struggle with depression or anxiety on top of substance use disorder, then CBT is likely to be able to help you with your other symptoms. Again, CBT is considered the gold standard in depression and anxiety treatment. Learning how to challenge your negative thoughts should help decrease your depression and anxiety.
Are Looking For Short-Term Therapy?
CBT is generally a short-term, problem-focused intervention. Instead of exploring your childhood and past traumas, CBT usually focuses on the now. What are you thinking/feeling/doing now, and how can you change it? This is what CBT interventions usually consist of. If you’re looking for a short-term, efficient therapy, then CBT would be a great option for you.
Limitations of CBT
There is no other type of psychotherapy that’s been proven to be more effective than CBT for a wide variety of mental health concerns. But that doesn’t mean that CBT is for everyone. If you haven’t received any type of treatment before, then CBT would be the best place to start. However, people might choose later on to switch to another type of therapy because:
- They’re looking for a more long-term treatment: if you’re looking to explore the root causes of your addiction and childhood traumas, then something like psychodynamic therapy may be a better fit for you.
- They aren’t ready to commit to therapy: A large part of CBT is completing “homework” like journals and thought logs in between sessions. If you aren’t committed to your treatment process and don’t want to spend the time doing this, then CBT might be less effective.
- They have a severe and persistent mental illness, like psychosis: Research is mixed on whether or not CBT alone is effective for severe psychotic disorders. If you suffer from psychosis, CBT alone may not be enough; you should also take prescribed antipsychotic medication.
Next Steps: How to Get Started With Cognitive Behavioral Therapy
If you’re interested in receiving CBT to help with substance use disorder, then it’s simple to get started. Psychotherapists are commonly trained in CBT interventions, and it shouldn’t be difficult to find a CBT provider near you.
To start, use RehabAid’s search function to find a rehab facility near you. Contact the rehabs directly to ask them questions about what treatment methods they use, and whether their counselors are trained in CBT.
Whether or not you decide to receive CBT or another intervention, there is hope for recovery. With the right treatment, you can beat the addiction you’ve been battling and live a happy, successful life.
Key Sources
David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Frontiers in psychiatry, 9, 4. https://doi.org/10.3389/fpsyt.2018.00004
Holmes J. (2002). All you need is cognitive behaviour therapy?. BMJ (Clinical research ed.), 324(7332), 288–294. https://doi.org/10.1136/bmj.324.7332.288
Magill, M., & Ray, L. A. (2009). Cognitive-Behavioral Treatment With Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials. Journal of studies on alcohol and drugs, 70(4), 516–527. https://doi.org/10.15288/jsad.2009.70.516
McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive Behavioral Therapy for Substance Use Disorders. The Psychiatric clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012
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