Cognitive Behavioral Therapy For Addiction

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

A woman talking to her therapist.

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Cognitive behavioral therapy, or CBT for short, is a type of talk therapy, based on the psychological principles of behaviorism (which focuses on how behaviors can be controlled or modified) and theories of cognition (which focuses on understanding how people think, feel, and understand themselves and the world around them). CBT is a psychological treatment that focuses on efforts to change thinking and behavioral patterns.

How CBT Works

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 includes 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.

Adding analysis of cognition to behavior therapy led to the development of cognitive behavioral therapy by taking into account people's thoughts and feelings about their behaviors. Instead of just observing and controlling behaviors, there is also attention paid to what is going on in the mind of the person, and how those perceptions, thoughts, and feelings lead them to behave in particular ways.

CBT particularly 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.

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 go ahead and engage in the behavior anyway. This can sometimes lead to very upsetting consequences for ourselves and other people. People with addictions may regret these behaviors, but it can be hard to stop repeating them, sometimes without the person really knowing why.

Cognitive Behavioral Therapy for Addiction

Addiction is a clear example of a pattern of behavior that goes against what the person experiencing it wants to do. While people trying to overcome addictive behaviors will often say they want to change those behaviors, and may genuinely want to quit alcohol, drugs, or other compulsive behaviors that are causing them problems, they find it extremely difficult to do so.

According to the cognitive behavioral therapy approach, addictive behaviors, such as drinking, drug use, problem gambling, compulsive shopping, video game addiction, food addiction, and other types of harmful excessive behavior, are the result of inaccurate thoughts and subsequent negative feelings.

Cognitive behavioral therapy explains this by clarifying the way that people’s thoughts and emotions interact. Psychologists realized that many of us have thoughts, 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 conditions such as alcohol and substance use disorders.

When used to treat addictions, CBT focuses on systematically recording thoughts, associated feelings, and the events that trigger those thoughts and feelings. This allows us to look at the behavior that we carry out as a result of those thoughts and emotions. Once this happens, 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 consciously looking at situations in more realistic ways that do not automatically lead to negative emotions and resulting cycles of harmful behaviors.

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

Effectiveness

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

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 acceptance and commitment therapy (ACT), dialectical behavioral therapy (DBT), mindfulness-based cognitive therapy, and functional analytic psychotherapy.

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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Article Sources
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  1. Kiluk BD, Carroll KM. New developments in behavioral treatments for substance use disordersCurr Psychiatry Rep. 2013;15(12):420. doi:10.1007/s11920-013-0420-1

  2. Sudhir PM. Cognitive behavioural interventions in addictive disordersIndian J Psychiatry. 2018;60(Suppl 4):S479–S484. doi:10.4103/psychiatry.IndianJPsychiatry_15_18

Additional Reading
  • Burns, D. Feeling Good: The New Mood Therapy. (Revised Edition). HarperCollins: New York. 1980.
  • Burns, D. The Feeling Good Handbook. (Revised Edition). Penguin: Harmondsworth. 1999.
  • Ledley, D., Marx, B. and Heimberg, R. Making Cognitive Behavioral Therapy Work. New York: Guilford Press. 2005.
  • Linehan, M. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press. 1993.