Cognitive Behavioural Therapies for Substance Use Problems

Abstract

Cognitive behavior therapy (CBT) is an umbrella term that describes a group of therapies, that although many in number and broad in their approach, have in common a focus on thoughts and beliefs (cognitions) as the central driver of, and the solution to, effective emotion regulationemotion regulation. The early CBTCBTmodels (sometimes referred to as the ``first wave'') focused primarily on response to stimuli and included the theories of B.F. Skinner and Joseph Wolpe. The ``second wave'' introduced the concept of cognition into the behavioral models; the most well known of these models were developed by Aaron Beck (Cognitive Therapy) and Albert Ellis (Rational Emotive Behavior Therapy). The ``third wave'' models are primarily the mindfulness-based cognitive therapies, although a range of other integrative therapies, such as Schema Focused Therapy and Emotion Focused Therapy, are sometimes included in the group of newer CBT models. This chapter describes how these models work and how they have been adapted to substance use treatment, ranging from intensive to brief and low-intensity interventions. The evidence shows that CBT is one of the most effective interventions for substance use issues, as well as for co-occurring substance use and mental health problems. Traditional (second wave) CBT has the most evidence for its effectiveness, and the mindfulnessmindfulnesstherapies have a growing body of evidence that shows that they potentially have similar outcomes for substance use disorders. CBT has been adapted and applied across a range of cultures and countries.