Cognitive Behavioral Therapy

If you are in rehab for alcohol or substance abuse, there’s a good chance cognitive behavioral therapy (CBT) is part of your treatment regime.

CBT is a type of psychotherapy designed to deal with problem behaviors, thoughts, and emotional patterns.

Research has already shown that it can be effective in helping people whose minds have been altered by stress or other difficult circumstances. It is one of the most commonly offered forms of therapy in substance abuse treatment programs.

History of CBT

CBT was borne out of psychoanalysis, which was pioneered by Sigmund Freud. Psychoanalysis was the most commonly found form of therapy up until the 1940s. It mostly consisted of talk therapy and prescribing medication to patients.

doctor diagnosing a patient

In the 1960s, experts began eschewing practices of the past by ensuring that clients knew it was their responsibility to change maladaptive behaviors. Again, the 1960s were a time of great social change.

The Vietnam War and other conflicts, as well as various changes in society, necessitated a new way to treat mental health issues.

Times have changed, and today, some people receive CBT online. While in-person sessions are preferred, online CBT sessions have been shown to be effective.

CBT can be practiced in both individual and group sessions.

Goals of CBT

Cognitive behavioral therapy has many applications, such as helping clients with phobias, anxiety, depression, and substance misuse. Its main goal is to help participants recognize negative thoughts that have the capacity to get in the way of their daily lives.

Eventually, clients should be able to notice thought patterns that have caused problems in their lives. Once these thoughts have been identified, they can be changed. If thoughts are changed, the resulting behavior will also change.

You can expect your CBT treatment to go something like this:
  • Phase 1: Functional analysis
    Clients start identifying negative thoughts and beliefs. Most people who deal with substance abuse know they need to stop the behavior, but they make choices that go against this goal. CBT is a great way to learn and understand why.This involves digging into the underlying issues that led to substance abuse in the first place. The therapist will assess the client’s motivation for change.
  • Phase 2: Behavior identification
    Together, the therapist and client will identify the problematic thoughts and behaviors. During this phase, clients will learn strategies to change negative thoughts. This, in turn, alters the linked behavior.
  • Phase 3: Relapse prevention
    The final phase aims to prevent relapse. The client and therapist will identify triggers that could cause a relapse and devise strategies to deal with those triggers.
    They also make a plan to end the therapy. CBT is not intended to go on indefinitely. There is generally a set end date, outlined by a certain number of sessions.

Duration and Frequency of Sessions Needed for Success


When you start with CBT, you can reasonably expect to attend 5 to 20 sessions. Sessions usually last 30 to 60 minutes.

All clients are different, and you may be dealing with additional mental health issues that necessitate longer treatment.

The American Psychological Association (APA) outlines some estimates for recovery based on their research:

  • Approximately 50 percent of clients improve after anywhere from 15 to 20 sessions.
  • Many clients and therapists choose durations of 20 to 30 sessions for up to six months so they can more confidently put their recently learned skills into practice.
  • Certain people may benefit from longer treatment for some mental health issues or co-occurring disorders. This extended treatment regime can last 12 to 18 months.
  • Only a small fraction of clients require other therapies after CBT or a course of treatment that is longer than average.

Other Therapies

Cognitive behavior therapy is not the only method used to treat people with substance use disorders. The following forms of evidence-based therapy are also commonly used:

  • Contingency management: This is sometimes referred to as motivational incentives. This therapy provides incentives or prizes to encourage clients to abstain from substances of abuse. Some examples include giving clients a voucher every time a urine sample is negative for drugs.Vouchers may start out with a small value, and they may increase in value as treatment continues and the person has more days of sustained sobriety. Other programs give participants raffle or prize tickets.
  • Motivational enhancement therapy (MET): This is meant to prevent clients from being indifferent to treatment. The goal is to motivate clients to want to change their lives. Clients learn how to abstain from drugs and commit to change.
  • The Matrix Model: This form of therapy is most commonly used for those who abuse stimulants. It creates an engaging framework of treatment that involves self-help groups, education about drug addiction and relapse, and counseling. Urine samples are monitored to ensure treatment compliance.


Complementary Treatments

While therapy is the core of treatment for substance use disorders, medication and support group participation are also vital pillars of the recovery process.

person in a soma recovery group
  • Support groups: Often in the form of 12-step groups, social support groups are led by people in recovery. They provide essential support for ongoing recovery, and they can be particularly important during the early stages of recovery when the risk of relapse is often highest.People often need to visit and try out multiple support groups before they find the one that is the best fit. Besides the well-known Alcoholic Anonymous (AA) and Narcotics Anonymous (NA) chapters, there are many secular and alternative support group options, such as SMART Recovery and Secular Organizations for Sobriety (S.O.S).
  • Medication: People may be prescribed medication that lessen withdrawal symptoms and alleviate cravings for certain substances of abuse, such as opioids and alcohol. In addition, people who deal with mental health issues can be prescribed antidepressants, anti-anxiety drugs, or other medications to address specific disorders.


A Full Treatment Plan


Cognitive Behavioral Therapy has been shown to greatly benefit those in recovery from substance abuse as well as those with various mental health issues. It works best when it is tailored to the individual and part of a complete treatment program.

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