Cognitive Behavioral Therapy (CBT) for Substance Abuse and Addiction

An Evidence-Based Psychological Technique For Treating a Range of Addictions

Ways that CBT can help those with addiction

Verywell / Madelyn Goodnight

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Cognitive behavioral therapy (CBT) is a type of talk therapy based on the psychological principles of behaviorism (which deals with the ways that behavior can be controlled or modified) and theories of cognition (which focuses on understanding how people think, feel, and view themselves and the world around them).

CBT is a psychological treatment that focuses on efforts to change thinking and behavioral patterns. This article will talk about how CBT is used to help people with addictions and/or substance abuse issues and will discuss its effectiveness as a form of treatment.

How CBT Works

CBT examines the way our behavior is connected with our cognition. When treating someone with substance abuse or addiction, a CBT therapist would look for the ways in which thoughts and beliefs influence their client's addictive behavior.

Behaviorism focuses on what reinforces the behaviors or actions a person takes, whereas theories of cognition focus on people's perceptions—what they see, hear, and feel—their thoughts, and their emotions.

The human experience of cognition is made up of our perceptions, thoughts, emotions, and understanding. This includes everything that comes into our mind through our senses, or through the way we think or feel about our past experiences.

Instead of just observing and controlling someone's behaviors, the therapist also pays attention to what is going on in the client's mind, and how their perceptions, thoughts, and feelings lead them to behave in particular ways.

Addiction is a good example of this kind of conflicted behavior. While we might know that is it healthier and safer to avoid addictive behaviors and substances, we choose to engage in the behavior anyway. This can lead to very upsetting consequences.

People with addictions may regret these behaviors, but it can be hard to stop repeating them, sometimes without the person really knowing why.


CBT explores the relationships between our thoughts, feelings, and behaviors. It looks at underlying beliefs and conflicts between what we want to do and what we actually do.

CBT for Addiction

Addiction involves using a substance or taking other actions compulsively, often in spite of negative consequences. While someone who is trying to overcome addictive behaviors will often say they want to change—and they may genuinely want to—they find it extremely difficult to do so.

According to the CBT approach, addictive behaviors are the result of inaccurate thoughts and subsequent negative feelings.

Many of us have thoughts that are based on beliefs that are untrue, unrealistic, or impossible to live up to. These thoughts can then cause negative feelings that feed anxiety, depression, and addictive behaviors like:

When used to treat addictions, CBT focuses on systematically recording thoughts, associated feelings, and the events that trigger those thoughts and feelings. Once we understand where the addictive behavior comes from, we can begin to change the automatic processes that sabotage our efforts at changing our behaviors.

CBT helps people look at patterns of thoughts and feelings that they repeatedly experience. Over time, they can begin to change those thoughts by taking a more realistic point of view that does not automatically lead to negative emotions and resulting cycles of harmful behaviors.

By rewarding ourselves for healthier behaviors, over time, the healthier behaviors become associated with more positive emotions and become more automatic.

CBT for Substance Abuse

Substance abuse involves using a substance in a way that’s not intended or using more than the amount that is prescribed. Treatment for substance abuse often involves a form of therapy, like CBT, sometimes used together with medication.

CBT may help people change their substance usage habits. This is because CBT is focused on helping people learn how to identify and challenge the negative, irrational thought patterns that lead to substance use. CBT also teaches new coping skills to help people deal with stress, cravings, and relapses.


CBT may be helpful for people experiencing addiction and substance abuse. Because this form of therapy focuses on changing thoughts and beliefs, it may help change the behavior that leads to substance use. CBT may be used alone or together with medication.


CBT has an excellent track record, with numerous studies demonstrating its effectiveness in treating depression, anxiety, and other conditions, including addiction.

CBT may be effective at teaching people better coping skills, which helps them reduce their substance use. CBT may also offer lasting benefits after treatment ends and could protect against relapses.

The CBT approaches that became popularized towards the end of the 20th century are themselves being refined and supplemented by the so-called “third wave” of behavior therapy, which focuses on mindfulness, acceptance, and being in the moment.

These approaches include:

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.


CBT is meant to help you learn how to identify the beliefs and thought patterns associated with addiction or substance abuse. By learning to spot these negative thoughts, you may be able to take steps to counter them and change your behavior.

CBT also teaches coping skills to help you deal with daily stressors in a more constructive way. It may be used alone or together with medication to treat substance use.

4 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Elizabeth Hartney, BSc, MSc, MA, PhD
Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada.