How to Use a CBT When Working With SUD

Cognitive behavioral therapy (CBT) comprises a diverse group of empirically supported mental health treatments that can be very effective in a variety of behavior and mood disorders. CBT works by challenging and changing the learned attitudes and ideas that lead to problematic behavior, which ultimately allows the patient to change that behavior. Substance use disorder (SUD) is a mental health syndrome defined by a pathological use of drugs or alcohol. It is a difficult disorder to treat, and has a high rate of relapse. CBT is a common standalone treatment for SUD, as well as a method for relapse prevention in conjunction with other therapies.

Instructions

• 1

  Assess the client's attitude toward substance use. Identify the situations, thought patterns and decisions that trigger problematic behavior, and analyze the patient's feelings and actions before and after substance use. This is known as a functional analysis. When treating a client with SUD, the goal of a functional analysis might be to help the client recognize that when he is with a certain group of friends, or under a certain type of stress, he is much more likely to drink or use drugs.

• 2

  Work with the client to develop strategies for avoiding or modifying thoughts and situations that trigger substance use, based on the client's personal goals for behavior change. Such strategies might include improving communication and social skills, developing assertiveness to counteract peer pressure, and identifying alternative coping strategies for stress. A primary goal is to identify the reactive nature of the problematic behavior, and consider other possible reactions to the situations that trigger it.

• 3

  Guide the client in the acquisition of new skills, such as solving problems in high-risk situations, refusing offers of drugs or alcohol, identifying and overcoming maladaptive thoughts, and avoiding situations that are likely to lead to substance use. Help the client to develop her own plan for unlearning unwanted behaviors and acquiring new skills. For instance, if the client is uncomfortable with refusing an offer of drugs, she may initially need to focus on avoiding situations in which such offers are likely to occur.

• 4

  Practice these new skills using simulated situations and roleplay exercises. For example, ask the client to imagine a stressful situation, and then roleplay various possible reactions and outcomes within that scenario. This allows the client to test and improve positive tactics for dealing with high-pressure situations that trigger substance use, including cravings.

• 5

  Give the client a comprehensive list of SUD support services and community groups. Support groups can provide a strong social and educational network for patients recovering from substance abuse disorders, and give them an easy way to meet new people with similar experiences.