Cognitive-Behavioral Therapy (CBT) for Addiction and Substance Abuse

This article will break down the clinical conditions that CBT addresses, how it helps those struggling with substance use disorders and other mental health conditions, and who this type of treatment might be right for.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is a form of behavioral therapy and a well-established treatment intervention for people suffering from a wide range of mental health disorders. Cognitive behavioral therapy focuses on cognition, or how your thoughts can influence your mood – not vice-versa.² CBT is a goal-oriented type of therapy that addresses cognitive issues such as dysfunctional automatic thoughts, maladaptive thinking (or cognitive distortions), and underlying core beliefs.² Most therapists who use CBT customize the therapy to the specific needs of each patient.²

Cognitive behavioral therapy was developed in the 1960s by psychiatrist Aaron Beck.² CBT originated when Beck’s perspective changed on mental health conditions from viewing depression and anxiety as mood disorders to viewing these conditions as cognitive disorders.²

For example, if a CBT patient’s automatic interpretation of a situation is seen through a negative lens of cognition (thoughts and beliefs), then it is likely to impact their mood negatively.² Maladaptive thinking or cognitive distortions, such as overgeneralizing, catastrophizing, or personalizing situations, can cause errors in logic and misguided conclusions, sometimes resulting in or worsening of symptoms of depression, anxiety, and other mental health conditions.²

Underlying core beliefs can shape someone’s life and be the foundation for automatic thinking. Someone’s ways of thinking and perceiving can undoubtedly shape the way that they interpret the world around them (and their role in it).²

Beck believed that dysfunctional, automatic thinking, even if it exaggerated or distorted, plays a significant role in mental and behavioral disorders.²

The ultimate goal of CBT is to address these negative patterns of thinking and subsequent behaviors to create positive change in a person’s life for the better.² 

Although CBT is effective in treating mental disorders, CBT can be helpful for anyone looking to make a shift in the quality and health of their thinking or improve their mood.

How Does CBT Work?

The fundamental principles of CBT are:¹

• Psychological disorders are based, in part, on inaccurate ways of thinking.
• Psychological disorders are also based on learned patterns of negative behavior.
• People suffering from psychological disorders can learn better ways of coping, thereby relieving their symptoms and subsequently creating positive changes in their lives.

Therapists may also help clients by using role-playing techniques to develop a plan for how to deal with potentially problematic situations in the future.¹

For example, creating a pros and cons list of reactions to various situations can help people gain an understanding of how their thoughts and actions may make things better or worse. It is important to play out those scenarios in therapy before they need to draw on them in life. Having a plan of action before a person needs this plan can help people feel more prepared and confident. Every person’s challenges in life are unique, so it is up to both the therapist and patient to develop a treatment strategy to address the patient’s needs. What works for one person may not work for another.¹

CBT with a trained therapist helps clients take control of their cognition and develop healthier ways to think, emote, and behave independently and through tangible exercises. The therapist and client work collaboratively to develop strategies to not only have an awareness of negative thought patterns and beliefs but to learn to problem solve and change their behaviors.¹ It is a solution-based form of therapy focused less on the past and more on the present and what to do now to make things better.¹

Goals of CBT

The goals of CBT will include developing an awareness of one’s misguided thinking patterns that are creating problems in their life and re-evaluating such thinking in light of reality.¹ CBT also encourages people to understand the motivation and behavior of themselves and others, as well as using realistic problem-solving techniques to solve problems.¹ As a result, this should build a person’s confidence in their abilities to manage stressful situations.

Another goal of CBT treatment is to help people learn how to calm their mind and body and begin to face their fears instead of avoiding them.¹ CBT can be an empowering tool to help people realize that they can manage their emotions and various situations they may encounter throughout their lives in a healthier manner.

Benefits of Cognitive Behavioral Therapy

CBT is a practical, goal-oriented form of therapy. It is a collaborative effort between the therapist and patient that can help the patient improve many aspects of their life.² Treatment is individualized, so cognitive behavioral therapy may look different for different people. CBT has been shown to be beneficial in treating anxiety, depression, and even ADHD.² It is also a form of short-term therapy, with weekly sessions typically lasting 2-3 months.²

Is CBT Covered by Insurance?

The short answer is yes, cognitive behavioral therapy is typically covered by insurance. The Affordable Care Act mandates that health insurance companies must cover mental health and substance use disorders on par with coverage for medical or surgical procedures.⁵

However, individual plans and coverage will vary depending on carriers. If you have questions about your coverage, call the number on your insurance card to find out more information about your specific plan. Some cognitive behavioral therapists accept insurance, but others may not accept insurance. Others may be out-of-network (OON) but offer patients the option of paying their therapy costs up-front and then sending a superbill to their insurance company for reimbursement. In that case, the therapist gives the client the paperwork necessary to submit their insurance claim directly to their provider.

Is CBT Covered by Medicare and Medicaid?

Medicaid is the largest payer for mental health services in the United States.⁶ The Affordable Care Act also expanded Medicaid benefits to millions of Americans that didn’t previously qualify. All Marketplace plans cover both mental health and substance use disorder treatments as “essential health benefits.⁷

CBT is considered an evidence-based treatment option for mental health and SUDs. To find a provider in your area who accepts Medicaid and Medicare, click here to be directed to the U.S. Department of Health and Human Services webpage, which provides links to various resources and information regarding providers who accept these types of insurance.⁸