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Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a type of therapy that helps individuals understand how thoughts and feelings influence behaviors. Therapists commonly use this therapy to treat a wide range of disorders, including phobias, addiction, depression, and anxiety by working with the individual, their thought patterns and how they process information.

CBT is especially effective when it comes to treating substance abuse. Many recovery programs consider it a crucial part of treatment and often use it in combination with other therapies.

How Does CBT Work for Substance Abuse?

CBT is a therapy that helps people gain insight into their thought patterns and thinking errors, reducing the intensity of the feelings, or changing how they feel about a situation, thus allowing for new or different behaviors that are chosen rather than impulsive. These changes can increase self-efficacy, self-confidence, resiliency, improve interpersonal relationships, and improve overall mental health.

CBT for substance abuse involves a combination of strategies that aim to enhance control over one’s thoughts and behaviors, avoid relapse, manage intense cravings for drugs, depression, and address a range of other cognitive, behavioral, and interpersonal issues. CBT teaches skills to manage stress, improve communication and problem solving, prevent relapse. Client’s will learn to manage stressful circumstances and environmental cues that can trigger impulsive behavior’s that often cause harm to oneself and others.

One of the key strategies in CBT for substance abuse is cognitive restructuring, which involves identifying and challenging irrational or negative thoughts that lead to substance use or harmful and unhealthy behaviors. Simply put. there is an event followed by one’s thoughts and interpretations of the event, this influences the emotions or feelings around the event, which is followed by an action urge and behavior, then the outcome or results. If the thoughts and interpretations can be changed there is a chain reaction, allowing for a behavior change and you get a different outcome.

What Does it Look Like in Action?

Here are two examples using the cognitive restructuring skill from a person in long term recovery.

Example 1

I have been in recovery for several years; my husband is also in recovery and has relapsed twice. The first time he relapsed it wasn’t pretty; I did not have the CBT coping skills. We had recently moved into our first home and our son was about five years old, I found out that my husband had relapsed and was using heroin (Event), my first thought was “I couldn’t believe that he would do that to me and his son, he must not really love us” (Thoughts and Interpretations) I felt an intense rage come over me (Feelings), I threw my car keys at the bathroom mirror and started screaming at him, I said “how could you do this to me, why aren’t we enough for you to stay clean” I said something about wanting to physically hurt him and other hurtful things, I screamed at him to get out of the house. (action urge and behavior) He left, and I was devastated, my heart was broken, I was hurt and angry and I wanted to use. I also felt horrible about how I had acted and the things that I said to him (Outcome or Results).

Fast forward several years, add some CBT skills and I was able to handle his second relapse better. This time when I found out that he had relapsed (Event) my first thought was similar, “Are you serious, you did this to me again” (thoughts and interpretations) I felt that same rage and wanted to lash out (feelings action urges) then I took a breath and used the cognitive restructuring, I reminded myself that “his relapse had nothing to do with me and our son, that it had nothing to do with how much he loved us, he is an addict and he has a disease.” (new thoughts interpretations) the feeling shifted from rage to sadness, hurt, and anger, (New Feelings) I said to him “I feel sad, hurt and angry, you can’t be here if you are using, it puts our child in danger and my recovery, I love you and you have to go.” (different behavior)He left, and I felt sad and hurt, I called my best friend and my sponsor and reached out for support. I was sad but this time I did not cause any harm and I did not feel guilty about the way I acted or want to use (Different Outcome).

Example 2

Here is a simple everyday example, someone cuts me off in traffic, my first thought is usually something like “are you serious, what a jerk, you obviously didn’t even care that I was there” I feel angry and degraded, I honk my horn, flip him off and tailgate him. The outcome, I obsess about the incident for a while, I am the jerk, I feel angry and frustrated, and it ruins part of my day.

Using CBT looks more like this; someone cuts me off, I have the same first thought and feelings as before but this time I pause and think, “he must not have seen me, I have accidently cut someone off before, maybe he is in a hurry or there is an emergency”, I feel calm and back off, I don’t think about it for long and I go about my day. I am happier believing that it was an accident, and I didn’t act like a jerk.

Benefits of CBT for Substance Abuse Recovery

  1. Development of Coping Strategies: Individuals learn how to cope with situations that lead to substance abuse. This can include learning to avoid certain triggers or learning how to deal with stress and other negative feelings without turning to substance use.
  2. Improved Self-Control: Through CBT, individuals can gain better control over their behaviors and actions. This can be particularly helpful in preventing relapse. CBT helps individuals develop self-control by teaching them how to identify problematic behaviors and develop healthier responses.
  3. Increased Self-Efficacy: CBT can help increase an individual's belief in their ability to succeed in specific situations or accomplish a task. This can be beneficial in promoting long-term recovery.
  4. Addressing Co-occurring Disorders: Many individuals with substance use disorders also have other mental health disorders. CBT can be effective in treating these co-occurring disorders, which can improve overall recovery outcomes.
  5. Building resilience: Through CBT, individuals learn how to cope with stress and triggers that might otherwise lead to substance use.
  6. Enhancing self-confidence: As individuals gain control over their addiction, they often experience an increase in self-esteem and confidence.
  7. Improving interpersonal relationships: CBT can help individuals improve their communication and relationship skills, leading to healthier and more supportive relationships.
  8. Promoting overall mental health: In addition to addressing substance abuse, CBT can also be beneficial for treating co-occurring mental health disorders such as depression and anxiety.


Substance abuse and addiction are complex issues that require a comprehensive treatment approach. Cognitive Behavioral Therapy is a powerful tool that can help individuals on their journey to recovery. By helping individuals understand the connection between their thoughts, feelings, and behaviors, CBT can equip them with the skills and strategies necessary to maintain long-term recovery.


  1. Beck, A. T. (1993). Cognitive therapy: Past, present, and future. Journal of Consulting and Clinical Psychology.
  2. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research.
  3. McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive Behavioral Therapy for Substance Use Disorders. Psychiatric Clinics of North America.
About the Author High Desert Counseling

High Desert Counseling is an outpatient treatment center for substance abuse disorders. High Desert Counseling offers Day Treatment (PHP), Intensive Outpatient (IOP), and General Outpatient services in two convenient locations: St.George and Cedar City, Utah. You can reach us at 435-673-2899. If you or a loved one are looking for help in recovery from substance abuse, call today. To learn more, visit our website at https://highdesert.help

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