Cognitive Behavioral Therapy (CBT) for Veterans With Substance Use Disorders

What is Cognitive Behavioral Therapy (CBT)?

Rooted in the behavioral therapy movement launched by B.F. Skinner and Joseph Wolpe in the 1950s, cognitive behavioral therapy (CBT) is a treatment approach that has been proven effective for a variety of problems, including mental health issues and substance use disorders.^1,2 At its core, CBT explores relationships between a person’s thoughts, feelings, and behaviors.³

CBT is grounded in several core principles, including:¹

1. Flawed or otherwise unhelpful ways of thinking can contribute to psychological problems.
2. Unhelpful or damaging behaviors can also foster psychological issues.
3. People can learn better ways of coping with psychological problems, leading to symptom reduction and improved outcomes.

CBT for addiction often seeks to uncover unhealthy thought patterns and understand how they can cause self-destructive behaviors and beliefs. To address these patterns, patients strive to develop constructive ways of thinking, eventually identifying negative or false beliefs, testing them, and restructuring them.³

Ultimately, CBT for substance abuse and other disorders helps individuals reframe their own thinking and behavior, allowing them to develop better coping skills that can help to avoid addictive behaviors and prevent relapse.

Veteran CBT Uses and Addiction Treatment

Research suggests that millions of Veterans suffer from mental health and substance misuse issues. In fact, data from the Substance Abuse and Mental Health Services Administration indicates that in 2020, roughly 5.2 million Veterans had some type of behavioral health condition.⁴ Additionally, more than 1 in 10 Veterans—a ratio higher than that of the general population—have been diagnosed with a substance use disorder.⁵

Often, substance use disorders and mental health disorders go hand in hand. In fact, the term “co-occurring disorder” refers to simultaneous existence of both of these conditions. Within the U.S., roughly 21 million people have a substance use disorder, of which 8 million also have a form of mental illness. Although one doesn’t always cause the other, it’s possible for a mental health condition to lead to a substance use disorder and vice versa.⁶

When it comes to treatment, research has shown that treating both conditions—i.e., substance use disorders and mental health issues—is more effective than treating them independently.⁷ Cognitive behavioral therapy can be an effective part of this solution.

CBT is used to treat a host of conditions, including anxiety, depression, SUDs, eating disorders, mental illness, marital issues, post-traumatic stress disorder (PTSD), social anxiety, obsessive-compulsive disorder (OCD), phobias, etc.).^1,2 Working to change thoughts, feelings, and behaviors related to both mental health and substance use disorders, CBT can be an integral part of treatment for many Veterans.

How Does Cognitive Behavioral Therapy for Veterans Work?

In substance use disorder treatment, CBT can be used in a variety of formats, including individual, group, and family therapy sessions.⁸ While each treatment program is unique and the use of cognitive behavioral therapies is tailored to the needs of each person, some of the approaches used in CBT for Veterans and others include:^8,9,10

• Motivational interviewing: This approach helps to identify an individuals’ readiness for change and motivation to stay in treatment. For Veterans, this can be an essential step in understanding why they may have used substances, as well as why they want to enter recovery.
• Motivational enhancement: Similar to motivational interviewing, motivational enhancement focuses on a person’s reasons for pursuing treatment and emphasizes personal agency in the change process. This approach can be effective in working with Veterans who may have felt disempowered in the past.
• Contingency management: By providing participants with rewards when they abstain from substance use, contingency management helps to promote behavior change through positive reinforcement. Rewards can include vouchers for goods, small items, gifts, etc. This approach has proven effective both in positively reinforcing negative drug screens and appointment attendance, and it may help Veterans with retention in treatment through this secondary motivation.
• Relapse prevention: This approach focuses on identifying the situations that may cause a person to experience cravings or urges or to relapse, and it then helps to prevent those situations from reoccurring. CBT-related relapse prevention centers on challenging an individual’s preexisting ideas about the positive effects of using substances by examining all of the evidence. For Veterans in substance use disorder treatment, this approach can help them recognize what patterns exist around their substance use, identify triggers, and plan ahead to avoid them.
• Community reinforcement: Much like contingency management approaches, community reinforcement focuses on changing a person’s environment to make abstinence more desirable. This approach can be helpful for Veterans who are reintegrating into life outside of the military, as it fosters new situations where substance use isn’t the norm.
• Mindfulness-based relapse prevention: Mindfulness is the practice of nonjudgmental noticing and acceptance of your thoughts, feelings, and bodily sensations, which can be utilized as part of relapse prevention by creating awareness and understanding around cravings and urges. Veterans may hold a lot of judgment around the experience of cravings, labeling them as “bad” or “weak,” and mindfulness-based approaches can be helpful to accept that cravings are an expected part of the recovery process.
• Dialectical behavior therapy (DBT): This approach focuses on the idea that people use drugs or alcohol as a method of self-medicating emotional pain. After military service, many Veterans struggle with emotional regulation, a common symptom of post-traumatic stress disorder. DBT can assist with emotional regulation among other things.

CBT Statistics and Success Rates

Many studies have found CBT techniques are highly effective at treating Veterans’ mental health and substance use problems. For example, one study from 2021 reported that after 12 sessions of CBT through the Veterans Affairs health system, participants reported a 29% reduction in days experiencing a craving and a 47% reduction in substance-related problems.¹¹

Another study from 2018 reported that attending 8 to 12 sessions of integrated cognitive behavioral therapy that was designed to address co-occurring disorders produced a noticeable decrease in PTSD symptoms as well as alcohol or other substance use in participants.¹²

Is CBT Covered by the VA or Veteran Benefits?

The U.S. Department of Veterans Affairs provides substance use and mental health benefits to eligible Veterans, including peer support, therapy, medication management, and other options.¹² While each VA medical center offers a unique menu of services, many of them provide evidence-based therapies such as cognitive behavioral therapy for addiction and mental health issues.¹³

When it comes to insurance—including Tricare, Medicaid, Medicare, and private insurance—the Affordable Care Act and Mental Health Parity and Addiction Equity Act ensure that almost all insurance providers cover some or all treatment for mental health and substance use disorders.^14,15 Keep in mind, however, that each facility accepts different types of insurance, so it’s important to discuss insurance and payment options with each.

If you or a loved one wants to learn more about cognitive behavioral therapy and substance use and/or mental health disorders, American Addiction Centers can help. With treatment centers located across the country, AAC offers all levels of care, and many facilities offer CBT for Veterans and other populations. In addition, several AAC facilities offer a Veteran Program, a special treatment track to address the unique needs of Veterans and first responders.

Admissions navigators at are available 24/7 for a free and confidential conversation to discuss your needs and treatment options. They can even verify your insurance—or you can verify your benefits online—and discuss alternative payment options. Contact us today to take your first step toward lasting recovery.