Can Cognitive Behavioral Therapy (CBT) Treat Addiction?

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Cognitive behavioral therapy (CBT) is a psychotherapy approach that can be used to help treat substance use disorders. CBT is commonly used to treat depression, anxiety disorders, phobias, and other mental disorders, but it has also been shown to be valuable in treating alcoholism and drug addiction. This is especially true when it's part of an overall program of recovery.

CBT helps people learn to better identify the negative and self-defeating thoughts and actions that can contribute to substance use. It is a short-term, focused therapeutic approach to helping drug-dependent people become abstinent.

CBT uses the same learning processes that led to the development of alcohol and drug dependence in the first place to help people unlearn maladaptive behaviors.

What Is CBT?

Cognitive behavioral therapy is based on the idea that feelings and behaviors are caused by a person's thoughts, not on outside stimuli like people, situations, and events. While you may not be able to change your circumstances, you can change how you think about them. According to cognitive behavioral therapists, this helps you change how you feel and behave.

In the treatment of alcohol and drug dependence, CBT can help a person:

  • Improve self-control
  • Recognize situations in which they are most likely to drink or use drugs
  • Avoid trigging circumstances, if possible
  • Develop coping strategies that will help when they are faced with situations that trigger cravings
  • Cope with other problems and behaviors that may lead to their substance abuse

The primary goals of CBT in the treatment of substance use are to improve motivation, learn new coping skills, change old habits, and learn to better manage painful feelings.

Types of CBT

There are several approaches to CBT. This includes: 

How It Works

In its use to treat alcohol and drug dependence, CBT has two main components: functional analysis and skills training.

Functional Analysis

Functional analysis is a process in CBT that involves looking at the causes and consequences of a behavior. Working together, the therapist and individual try to identify the thoughts, feelings, and circumstances that led to and followed drinking or using. This helps determine the risks that are likely to lead to a relapse.

When doing functional analysis, a therapist might ask the individual questions designed to elicit insight into how a person was thinking or feeling before the behaviors. They might ask the client to recall the last time they used a substance and then ask:

  • What were you doing before you used the substance?
  • How were you feeling?
  • What happened right before?
  • Did anything positive happen as a result of the behavior?
  • What were the negative consequences of your actions?

Functional analysis can also give insight into why they drink or use drugs in the first place. People may examine the situations, emotions, and thoughts that played a role in their drug or alcohol use. This helps identify situations in which the person has coping difficulties.

By better understanding the difficulties that contribute to substance use, people can then look for ways to better manage difficult thoughts, emotions, or situations.

Skills Training

When people are struggling with difficult situations, life stress, trauma, anxiety, depression, or other problems, they sometimes turn to substance or alcohol use as a way to manage. If someone is at the point where they need professional treatment for their addiction, chances are they are using alcohol or drugs as their main means of coping with problems.

The goal of CBT is to get the person to unlearn maladaptive behaviors and learn or relearn better-coping skills. By learning such skills, they can then start working to apply them in situations that would typically trigger drug or alcohol use. Skills training works by:

  • Helping individuals unlearn old habits and learn to develop healthier skills and habits
  • Educating people about ways to change how they think about their substance abuse
  • Learning new ways to cope with the situations and circumstances that led to their drinking or drugging episodes in the past

Another aspect of skills training is helping people learn to better tolerate feelings of distress. This way, people can manage their feelings of anxiety or depression in positive ways, rather than turning to substance misuse for a quick fix.

Substituting old habits that contribute to substance use with more positive and enduring actions enhances a person's ability to function and aids in long-term recovery. 

Benefits of CBT for Addiction

People who have a substance or alcohol use disorder may often struggle with negative feelings or thoughts that make recovery more difficult. Because CBT focuses on identifying and replacing such thought patterns with more adaptive ones, it can help improve a person's outlook and support skills that support long-term recovery.

Some of the ways that CBT can be beneficial for people who have an addiction include:

  • Learning to identify self-destructive thoughts and actions
  • Finding ways to monitor such thought patterns
  • Learning new, more adaptive ways of thinking 
  • Applying skills that have been learned in new situations and settings
  • Exploring new ways to handle stress and difficulties

Research suggests that the skills obtained through CBT are enduring and can also be applied in other areas of an individual's life as well. Approximately 60% of people who are treated with cognitive behavioral therapy for a substance use problem are able to maintain their recovery for a year.

How Long Does Treatment Take?

Because cognitive behavioral therapy is a structured, goal-oriented educational process focused on immediate problems, the process is usually short term. Although other forms of therapy can be long term and are not time limited, CBT is usually completed in 12 to 16 sessions with the therapist.

Effectiveness

Research has shown that CBT can be an effective treatment for substance use disorders, both on its own and in combination with other treatment strategies. CBT typically involves a number of distinct interventions—such as operant learning strategies, skills building, and motivational elements—that can either be used on their own or combined.

CBT is one of the most researched forms of treatments, so there is an abundance of evidence and support for its use with a variety of mental conditions, including alcohol and substance use disorders. More than 53 randomized controlled trials on alcohol and drug abuse were examined to assess the outcomes of CBT treatment.

Cognitive behavioral treatments are one of the most frequently evaluated psychosocial approaches to treating substance use disorders.

In these studies, CBT has been shown most effective when compared with having no other treatment at all. When compared with other treatment approaches, studies have had mixed results. Some show CBT to be more effective, while others show it to be of equal, but not greater, effectiveness than other treatments.

As with other treatments for alcoholism and drug abuse, including pharmaceutical treatments, cognitive behavioral therapy works best when combined with other recovery efforts. This includes participation in support groups like Alcoholics Anonymous or Narcotics Anonymous.

In short, cognitive behavioral therapy works well for some, but not for everyone. This is the case with all alcoholism and drug treatment approaches, because every person deals with and recovers from addiction in a different way.

A Word From Verywell

Cognitive behavioral therapy can be a highly effective choice for treating alcohol and substance use disorders. It can be used on its own or combined with other approaches that work together to support a person's long-term recovery. However, it is not the only option out there, so talk to your doctor about what is available in order to decide what approach is best for your needs.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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