Cognitive Behavioral Therapy for Substance Use Disorders

in Medford, MA

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Substance use disorders (SUD) are an increasingly serious and borderless problem that affects millions of people worldwide. SUD is characterized by the prevalent and recurrent use of alcohol or drugs that cause substantial impairment or despair in various areas of life, such as health, work, and relationships. SUDs can also lead to physical and psychological dependence, tolerance, withdrawal, and overdose (the withdrawal cycle). Perhaps the most effective and widely utilized treatment for substance use disorders is cognitive behavioral therapy (CBT). CBT helps people change their thoughts, feelings, and behaviors that lead to their problems by targeting the cognitive patterns that trigger or reinforce substance use and teaching new coping skills to prevent relapse.
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What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a form of talk therapy that can help you manage your problems by changing the way you think and behave. It is most commonly used in the treatment of anxiety and depression, but it can be useful for other mental and physical health problems, as well as an option for alcohol use disorder (AUD) and substance use disorders (SUD).

The core concept of CBT is that your thoughts, feelings, physical sensations, and actions are all interconnected and that negative feelings, behaviors, and thoughts can trap you in a negative loop. Unlike other psychotherapeutic treatments, CBT focuses on your present problems (rather than trying to deal with past issues) by searching for practical ways to improve your daily state of mind.

Some of the common techniques used in CBT include:

Identifying negative thoughts

This is taking a deep look at the automatic and malformed thoughts you have that trigger adverse emotions and behaviors, and replacing them with more positive and realistic alternatives. For example, if your immediate thought after making a mistake is, “I’m a failure”, you can replace this thought with “No one gets it right all the time. I can learn from this.”

Facing your fears

CBT will show you a way to incrementally expose yourself to those objects and situations that fill you with anxiety or fear, instead of your usual avoidance. Through this, you will learn that your fear is senseless or exaggerated and that you can cope with it. For example, if you are afraid of bees, you can start by looking at pictures of bees, then watching videos of beehives in full swing, then visiting a honey farm, and finally suiting up and handling some bees yourself.

Relaxation and mindfulness

Probably the most fun part of CBT, you will learn how to calm your body and mind using such techniques as deep breathing, progressive muscle relaxation, meditation, or yoga. This will help you reduce stress, increase awareness of the present moment, and regulate your emotions. For example, if you feel agitated or anxious, you can practice breathing slowly and deeply, and focus on the sensations in your body.


This process will show you learning how to break down a complex or difficult circumstance into smaller, more manageable steps, and then finding and executing the best solution for each step. This will help you better cope with challenges, improve your confidence, and prevent or reduce negative emotions. For example, if you are overwhelmed by a large project, you can divide it into smaller tasks, group those tasks into tiers of priority, set deadlines, and seek help if you need it.
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What Are the Main Goals of CBT?

The generalized aim of CBT is to help people. This generalization can be broken down into the following 3 main components.
  1. Recognizing how your thoughts, emotions, and behaviors are interconnected and how they influence each other. CBT will help you identify your thought patterns and behaviors that cause or maintain your problems, and how you can alter them for the better.
For example, someone suffering from depression may see themselves as worthless and hopeless, which will make them feel sad and unmotivated, which will lead them to isolate themselves and avoid activities, which will reinforce their negative thoughts and feelings: a never-ending cycle. CBT will help them challenge and replace this negative cyclic thought pattern with more realistic and positive ones, which will improve their mood and motivation, which will help them engage in more social and enjoyable activities, which will boost their self-esteem and hopefulness: a positive cycle of thoughts and emotions.
  1. Develop proper coping methods and strategies to deal with your problems and achieve your set goals. CBT will teach you various techniques you can practice that can help you manage your emotions, solve your difficulties, reduce your stress, and enrich your well-being.
For example, someone with anxiety may learn relaxation and mindfulness skills to calm their nervous system (CNS), exposure and cognitive skills to face their fears head-on and reduce their anxiety, and problem-solving skills and healthy assertiveness techniques to deal with challenging situations and communicate their needs effectively.  
  1. Become more independent and self-reliant in your recovery and maintenance. CBT will help you become your therapist by teaching you how to monitor your progress, apply your newly learned skills, and evaluate your outcome. In recovery treatment, CBT will help you prevent relapse by helping you identify potential triggers and cope with them, deal with setbacks, and survive high-risk situations.
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What Are the Main Benefits of CBT?

CBT is the most researched, practiced, and effective form of talk therapy used by psychologists. This makes CBT extremely beneficial for people struggling with various mental or physical health issues, or who want to enhance their stress-coping skills and well-being. A few benefits of CBT are:  
  • It is based on scientific research and evidence, and it has been proven to be efficacious for many conditions, such as phobias, depression, anxiety, PTSD, eating disorders, substance abuse, and more.
  • It is short-term and focused, meaning that it normally takes fewer sessions than other therapies, and it provides clear and specific goals and strategies for each problem.
  • It is collaborative and empowering, which means that the therapist and the client work together as a team, and the client learns how to become their therapist through applying the skills and strategies they learn in therapy to their daily life.
  • It is practical and skill-based, which means that it teaches the client how to recognize and contest their negative thoughts, face their fears, relax their body and mind, solve their difficulties, and communicate their needs healthily and effectively.
  • It is flexible and adaptable, which allows it to be tailored to suit different people and problems, and it can be combined with other treatments, such as medication and other therapy modalities.
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Cognitive Behavioral Therapy for Alcoholism and Drug Abuse

CBT for alcoholism typically involves two main components: functional analysis and skills training.

  1. Functional analysis is the process of identifying the root cause for your drinking and the consequences, such as the situations, emotions, and thoughts that trigger or reinforce your alcohol use.
  2. Skills training is the process of learning and practicing new ways of dealing with these triggers, such as methods of relaxation, problem-solving strategies, positive assertiveness, and ways you can refuse alcohol when proffered.
CBT for alcoholism and drug addiction can take different forms, such as individual, group, or online therapy, and it can be combined with other treatment approaches, such as medication, detoxification, or mutual support groups.

What CBT Does to the Brain

CBT is a form of psychotherapy (talk therapy), and as such it deals mainly with your mind. Some research shows that CBT can alter your brain’s structure and activity in sundry ways, such as:
  • Increasing the volume and connectivity of the prefrontal cortex. This is the part of your brain that is involved in planning, reasoning, decision-making, and self-regulation. This can help you improve your cognitive and emotional control, and reduce your impulsivity and compulsivity.
  • Decreasing the activity and reactivity of the amygdala. This is the part of your brain that is involved in fear, anxiety, and stress responses. Decreased activity in this area can help you reduce their negative emotions and cope better with stressful situations.
  • Enhancing the functioning and communication of the anterior cingulate cortex, the part of your brain that is involved with conflict resolution, detecting functional errors, and regulating your emotions. This can help you resolve your cognitive and emotional conflicts, correct any distorted thoughts you may have, and positively regulate your mood.
  • Strengthening the connections between the hippocampus, the memory and learning control centers of your brain, and other sections of your brain, such as the prefrontal cortex and the amygdala. This can help you consolidate and generalize all the new skills and strategies you learn in CBT, and help you to apply them to different situations.
These are a few of the ways that CBT can alter your brain and its functioning, which can in turn lead to positive changes in thoughts, feelings, and behaviors. However, more research is needed to fully understand the exact ways CBT affects the brain, and how they vary from person to person depending on different factors.
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What Type of Disorders Can CBT Treat?

We have taken a good look at what CBT is, its benefits, goals, and how it affects the brain, but which disorders exactly is it used to treat? A few of these disorders are:

Anxiety disorders

CBT helps people cope with undue worry, panic attacks, phobias, social anxiety, and other forms of anxiety.


CBT helps people contest negative thoughts, improve their mood, and increase their motivation and activity levels, which can help them overcome depression.

Eating Disorders

CBT helps people identify and alter malformed beliefs about their body image (body dysmorphia), weight, and food intake. This addiction therapy can further help people develop healthier eating habits and cope with emotional triggers.

Bipolar disorders

CBT helps people manage their mood swings, reduce stress, and prevent relapse into substance-alcohol use. CBT can also help people cope with the impact of bipolar disorder, as well as other behavioral disorders, on their relationships, work, and self-esteem.

Obsessive-compulsive disorder (OCD)

Through CBT, people with OCD can reduce their obsessions and compulsions by exposing them to their feared situations and teaching them to resist their urges

Post-traumatic stress disorder (PTSD)

People undergoing CBT learn how to better process their traumatic memories, reduce instances of avoidance and numbing, and cope with flashbacks and nightmares, all while helping people increase their sense of safety and control.

Substance use disorders

CBT is a popular treatment method for substance use disorders (SUD). It helps people recognize and change their triggers, and cravings for substances through highlighting the negative consequences of substance use.


There is no cure for schizophrenia, but CBT has proven effective at helping people reduce their psychotic symptoms, such as hallucinations and delusions, by highlighting their distorted perceptions and testing their reality.

Sexual disorders

CBT can help people overcome their sexual complications, such as low libido, erectile dysfunction, premature ejaculation, vaginismus, and pain during sex. This therapy can also help people improve their intimacy, sexual communication, and satisfaction.