Cognitive Behavioral Therapy for Substance Use

Introduction

Cognitive Behavioral Therapy for Substance Use (CBT-SUD) is a research-backed treatment that helps individuals change their relationship with alcohol and other substances. As a version of Cognitive Behavioral Therapy, CBT-SUD helps clients identify how their thoughts, feelings, and behaviors impact their substance use.

Whether you are interested in exploring your relationship with substances, cutting back, or stopping altogether, CBT-SUD is an effective treatment that can help you reach your goals.

Research shows CBT-SUD can help you:

• Understand your relationship with substance use
• Decrease how often and/or how much you drink or use
• Target the issues underneath substance use (relationship difficulties, stress, dealing with difficult emotions, social pressures, living a life you don’t enjoy, etc.)

In your first few sessions, you and your provider will explore what is leading you to drink or use. Whether it is work stress, anxiety, depression, relationship problems, or just feeling in a funk, you and your provider will identify your triggers so that you can start addressing them in the moment. You will then create a concrete plan to help you cope with urges to drink or use. Through practice, you will start to see how certain automatic thoughts (such as, “just one more wouldn’t hurt” or “a drink would makes this so much better”) can get you pulled into using more than you want. You then learn how to replace these thoughts with more effective thinking and wait out the cravings till they pass.

As sessions continue, you and your provider will also work on deeper issues behind substance use, such as feelings of depression, worthlessness, anxiety, stress, difficulty saying no, relationship difficulties, or living a life that just doesn’t feel meaningful. As you learn to meet your needs through healthier avenues, your need for substances will decrease.

CBT-SUD in Action

Click below to read how Marcus used CBT-SUD to cut back on his drinking and regain his confidence.

Marcus

Marcus is coming to therapy because no matter what he does, he always seems to find a drink in his hand. Even though he feels better right after he pours the drink, his hangovers make it hard to focus the next day and his sleep is slowly getting worse. But no matter how many times he tells himself he is going to slow down, whenever he gets stressed he finds himself thinking, “I just need a drink.” When he gets nervous at parties or after a long day at work, he finds himself thinking, “just one drink won’t hurt.” Unfortunately, one drink always seems to lead to another and then the next day he suffers the consequences.

In this example, Marcus’ thoughts and emotions lead him to drink. While drinking makes him feel better in the short-term, in the long-term, he ends up drinking more than he wants, feeling hungover, and having worse sleep. He also feels embarrassed as he wonders if he did anything wrong the night before in front of his friends and colleagues.

Marcus's CBT Triangle:

In CBT-SUD, Marcus learns to slow down and identify what thoughts and feelings lead him to drink.

With the help of his therapist, Marcus identifies a list of the things that triggers him to drink and creates a plan for how to deal with them. He also writes down all the consequences of drinking so he can remind himself why he is cutting back when he feels cravings. While dealing with the cravings is hard at first, with practice he begins to notice how they only last for a little while and get weaker over time. He also learns how to distract himself and reach out for help.

Marcus also begins to work on the issues underneath his substance use. With the help of his therapist, he identifies how his negative self-talk (“I always make mistakes” and “I’m such a failure”) make him even more anxious at work and around others. While he used to cope by drinking, Marcus learns to challenge the thoughts around his self-worth. With practice, he learns to acknowledge the things he does well and even begins to realize that he can’t be a total failure. Marcus also identifies strategies to make fewer mistakes and how to learn from his mistakes when he did make them. As he makes shifts in his life, he also starts having conversations with his friends and family about why he is cutting back. He practices saying “no” to friends when they offer him a drink and starts exploring hobbies that don’t depend on drinking. With practice, he starts to trust himself more in social settings and find friends he feels comfortable with while not drinking. While it takes some time and effort, Marcus leaves therapy feeling more confident about himself, better able to manage stress, and able to express himself in relationships.

In CBT-SUD you and your therapist will create a personalized treatment plan to help you reach your goals. In addition to the core components of treatment (coping with cravings and learning to say “no”) you can also pick other topics that fit with your specific needs.

Core Components of Treatment:

Cope with cravings

• Learn about cravings and how they show up in your own life
• Learn how to cope with cravings using practical skills
• Create a concrete plan to help set you up for success

Say “no” (refusal skills)

• Learn how to deal with social pressure to use
• Learn how to say “no” in different situations with different levels of intensity
• Learn about basic communication styles to improve your overall communication

Optional Areas of Focus:

Dealing with difficult emotions (anxiety, depression, stress, burn out, etc.)

• Learn practical skills to identify what you are feeling
• Learn to navigate emotions without using substance use as a crutch

Social and recreational counseling

• Reconnecting with hobbies, creating a life worth living, and growing relationships

Building stronger relationships

• Listening skills
• Expressing your needs
• Learning how to have fun outside of substances

Creating a supportive community

Learning to solve the problems leading you to use

Treatment Overview

• Session Length: 50 min
• Duration: ~12 weekly, sessions
• Empowers you to better understand your relationship with alcohol and/or other substances
• Tailored to your individual goals with substance use
• Can help you use less, work towards sobriety, or stay sober
• Research backed to help you decrease how often and how much you use
• Tailored to address the issues behind substance use (relationship difficulties, difficult emotions such as depression and anxiety, building a supportive community, etc.)
• Strongly recommended by American Psychological Association (Div. 12), Department of Veterans Affairs, and National Institute on Drug Abuse (NIDA)

Additional Resources:

• Substance Abuse and Mental Health Service Administration
• Alcoholics Anonymous
• Narcotics Anonymous
• Smart Recovery (Non-religious/higher power focused alternative to AA/NA)

References