DIAGNOSIS: Substance and Alcohol Use Disorders
2015 EST Status: StrongResearch Support (SEE REPORT)Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings
Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources
Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved
Insufficient Evidence: No meta-analytic study could be identified
Insufficient Evidence: Existing meta-analyses are not of sufficient quality
Treatment pending re-evaluation
1998 EST Status: N/A Research Support
Strong: Support from two well-designed studies conducted by independent investigators.
Modest: Support from one well-designed study or several adequately designed studies.
Controversial: Conflicting results, or claims regarding mechanisms are unsupported.
Find a Therapist specializing in Cognitive-Behavioral Therapy for Substance Use DisordersList your practice
Brief Summary
- Basic premise: As individuals understand the thoughts and behaviors associated with their substance use and gain skills to modify unwanted behaviors, they are better equipped to identify and cope with triggers for use, manage high risk situations, reinforce behaviors that align with their recovery goals, and challenge thoughts that precipitate substance use.
- Essence of therapy: Cognitive-Behavioral Therapy (CBT) is a transdiagnostic psychosocial treatment that is premised on learning principles. CBT aims to treat substance use disorders (SUD) through targeting behavioral and cognitive processes that underlie one’s substance use. CBT for SUD focuses on intervening upon these processes through increasing awareness of antecedents and consequences of substance use and leveraging behavior change principles to reduce or eliminate substance use through environment and social reinforcement.
- Length: Although the number of sessions and treatment length of CBT for substance use varies widely, standard approaches are delivered over approximately 6-14 sessions.
Treatment Resources
Editors:David I.K. Moniz-Lewis, Cassandra L. Boness, Victoria R. Votaw, Frank J. Schwebel, R. Kathryn McHugh, Katie Witkiewitz
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice
Treatment Manuals / Outlines
Treatment Manuals
- A Cognitive-Behavioral Approach: Treating Cocaine Addiction (Carroll et al., 1998)
- Cognitive-Behavioral Coping Skills Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence (Kadden et al., 2003)
Books Available for Purchase Through External Sites
- A Cognitive-Behavioral Treatment Program for Overcoming Alcohol Problems: Therapist Guide (Epstein & McCrady, 2009)
- Relapse Prevention Counseling: Clinical Strategies to Guide Addiction Recovery and Reduce Relapse (Daley & Douaihy, 2015)
- Managing Your Substance Use Disorder (Treatments That Work), 3rd Edition (Daley & Douaihy, 2019)
Training Materials and Workshops
- Relapse Prevention: An Overview of Marlatt’s Cognitive-Behavioral Model (Larimer, Palmer, & Marlatt, 1999)
- Clinical Guidelines for Implementing Relapse Prevention Training (Marlatt, Parks, and Witkiewitz, 2002)
- What To Do If CBT Isn’t Working (Liese, 2020)
- Group Cognitive-Behavioral Therapy for Substance Use Disorders and Addictive Behaviors (Liese, 2017)
- CBT: It’s Not What You Think (Liese, 2016)
Measures, Handouts and Worksheets
- A Cognitive-Behavioral Approach: Treating Cocaine Addiction (Carroll et al., 1998)
- A Cognitive-Behavioral Treatment Program for Overcoming Alcohol Problems: Therapist Guide Forms and Worksheets (Epstein & McCrady, 2009)
- SMART Recovery Toolbox (SMART Recovery International, 2022)
Smartphone Apps
There are a plethora of smartphone applications, many of which have not been rigorously tested, as described by Tofighi and colleagues in this review: Smartphone Apps Targeting Alcohol and Illicit Substance Use: Systematic Search in in Commercial App Stores and Critical Content Analysis (Tofighi et al., 2019)
Those with the most empirical support and grounding in CBT principles include the following:
- Saying When Developed by the Centre for Addiction and Mental Health, Toronto, Canada
- Vorvida® Commercial app by Orexo
- A-CHESS Developed by CHESS Health
- Checkup and Choices web-based program with applications
- reSET (prescription digital therapeutic) by Pear Therapeutics
Video Demonstrations
- Cognitive-Behavioral Relapse Prevention for Addictions (Marlatt, n.d.)
Videos Available for Purchase Through External Sites
- Cognitive Behavioral Therapy to Address Substance Use Triggers (Addiction Technology Transfer Center Network, 2021)
Video Descriptions
Clinical Trials
- Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT (Carroll et al., 2008)
- Network Support II: Randomized controlled trial of Network Support treatment and cognitive behavioral therapy for alcohol use disorder (Litt et al., 2016)
- Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: A randomized clinical trial (Bowen et al., 2014)
- Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women. (Lanza et al., 2014)
- Psychosocial treatment for methamphetamine use disorders: A preliminary randomized controlled trial of cognitive behavior therapy and acceptance and commitment therapy (Smout et al., 2010)
- Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: within treatment and posttreatment findings (Morgenstern et al., 2001)
- Cognitive behavioral relapse prevention strategies and aftercare in alcoholism rehabilitation. (Donovan & Ito, 1988)
- Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: Initial results (McKay et al., 1997)
- Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH posttreatment drinking outcomes (Project MATCH Research Group, 1997)
Meta-analyses and Systematic Reviews
- Efficacy of Relapse Prevention: A Meta-Analytic Review (Irvin et al., 1999)
- Cognitive-Behavioral Treatment With Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials (Magill & Ray, 2009)
- Cognitive Behavioral Therapy: A Meta-Analysis of Race and Substance Use Outcomes (Windsor et al., 2015)
- A Meta-Analysis of Cognitive-Behavioral Therapy for Alcohol or Other Drug Use Disorders: Treatment Efficacy by Contrast Condition (Magill et al., 2019)
Other Treatment Resources
- Cognitive-Behavioral Therapy for Substance Use Disorders (McHugh, Hearon, & Otto, 2010)