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Brief-Cognitive Behavior Therapy of Substance Abuse

Brief Cognitive-Behavioral Therapy, or CBT, has widespread applications in the treatment of substance abuse. CBT is a combination of Cognitive Therapy and Behavioral Therapy.

Behavior therapy is based on two types of learning: classical conditioning and operant conditioning. Techniques such as Extinction and Cue Exposure and Counter Conditioning/Aversion are based on classical conditioning. Techniques such as Contingency Management and Behavior Contracting are based on operant conditioning.

Cognitive therapy uses the concept of Activating Event, Belief & Consequence (ABC) along with challenging/reframing thoughts and beliefs that lead to substance use in the first place. The underlying assumption of this therapy is that thoughts, feelings and behaviors all affect one another and that faulty thinking leads to faulty thoughts and behaviors, i.e. substance abuse. Examples of faulty thoughts include polarization (black & white thinking), blaming (self or others) or personalization (it’s all about me!).

Brief Cognitive Behavior Therapy, or CBT, is a blend of cognitive and behavior therapies. The goal is to change thoughts and beliefs to produce desired changes in affect and behavior. Key elements include an analysis of use/abuse patterns (called a Functional Analysis), developing coping skills to replace the substance use and reframing/challenging thoughts and beliefs that lead to use and/or relapse. A chain analysis is done when relapse occurs or behaviors that lead to relapse occur to help the individual see where they can make changes. A positive chain analysis can be used to reward the individual when they are doing well to reinforce change. Goals for treatment are an important element as well and should be measurable, attainable, positive and significant to the client. Brief CBT can be used in outpatient and in-patient settings, it is well suited for group and/or individual sessions and typically lasts for 12-16 sessions. CBT is also represented in longer-term therapies such as Dialectical Behavioral Therapy (DBT), the Matrix Model and many other evidence based practices.

There are times when brief CBT is not recommended. Brief therapies are not generally recommended for individuals with serious and persistent mental health disorders (e.g. Bipolar, Schizophrenia) . Other complex conditions in those individuals who have unstable medical conditions, are homeless or who are polysubstance users, respond better to lengthier treatments.

Please see SAMHSA’s TIP 34 for more information about this form of treatment.

Written by Stacey Tisler

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