Robust evidence suggests the efficacy of classical/traditional CBT compared to minimal and usual care control conditions. CBT combined with another evidence-based treatment such as Motivational Interviewing, Contingency Management, or pharmacotherapy is also efficacious compared to minimal and usual care control conditions, but no form of CBT consistently demonstrates efficacy compared to other empirically-supported modalities. CBT and integrative forms of CBT have potential for flexible application such as use in a digital format. Data on mechanisms of action, however, are quite limited and this is despite preliminary evidence that shows that CBT effect sizes on mechanistic outcomes (ie, secondary measures of psychosocial adjustment) are moderate and typically larger than those for AOD use.

Studies meeting inclusion criteria were English language, peer-reviewed articles published between 1980 and 2018. All types of experimental control were of interest given the importance of this factor in predicting effect size magnitude in the addictions, mental health, and in psychotherapy more broadly (Imel, Wampold, Miller, & Fleming, 2008; Wampold & Imel, 2015; Wampold, Mondin, Moody, Stich, Benson, & Ahn, 1997; Wampold, 2001). Studies were included if they targeted adult populations (age ≥ 18) meeting criteria for an alcohol or other drug use disorder (DSM III-R through V; American Psychiatric Association, 1987; 1994; 2000; 2013) or problematic use (e.g., Saunders et al., 1993). The treatment must have been identified as either Cognitive Behavioral or Relapse Prevention, although some studies were included based on a description of key CBT elements such as functional analysis, avoidance of high risk situations, and/or coping skills training (see Supplemental Table 1 for details).

Kathleen Carroll

It
is thought that the anticipated positive effects of substances serve as an
incentive or motivation to use. Conversely, negative expectancies are
thought to act as a disincentive and contribute to reduced drinking or drug
use (McMahon and Jones, 1993;
Michalec et al., 1996). CBT is one of the most researched forms of treatments, so there is an abundance of evidence and support for its use with a variety of mental conditions, including alcohol and substance use disorders. More than 53 randomized controlled trials on alcohol and drug abuse were examined to assess the outcomes of CBT treatment. Cognitive behaviour therapy (CBT) is a structured, time limited, evidence based psychological therapy for a wide range of emotional and behavioural disorders, including addictive behaviours1,2. CBT belongs to a family of interventions that are focused on the identification and modification of dysfunctional cognitions in order to modify negative emotions and behaviours.

Cognitive restructuring techniques are employed to modifying beliefs related to perceived self-efficacy and substance related outcome expectancies (“such as drinking makes me more assertive”, “there is no point in trying to be abstinent I can’t do it”). CBT for AOD has a rich theoretical foundation, including general cognitive and behavioral theories, specific models of CBT for AOD (eg, Marlatt and Gordon’s Relapse Prevention Model), and numerous manuals to facilitate training and delivery with fidelity. In other words, the approach is well-articulated, but despite this, knowledge on MOBC (ie, how it works) and specific matching factors (ie, for whom it works) is limited. The limitations are not in study quality per se, but certainly in study quantity (ie, too few mediation studies to build a cohesive narrative of CBT MOBC) and heterogeneity (ie, varied assessment of potential mediators). This state-of-the-science stands in contrast to a large evidence-base for efficacy across a range of possible implementation conditions (ie, stand-alone, combined with other interventions, delivered in a digital format). From the two review studies considered and the subsequent 15 studies of mediators of CBT effects, coping skills, self-efficacy, and reduced craving show promise, but there is minimal evidence to suggest these processes are uniquely important to CBT and are more likely processes that are broadly relevant to AOD behavior change.

Summary of the Evidence Base, Stage 2 Studies

Self- efficacy increases and the probability of relapsing decreases when one is able to cope with this situation31. Several behavioural strategies are reported to be effective in the management of factors leading to addiction or substance use, such as anxiety, craving, skill deficits2,7. Various psychological factors were significant in initiating and maintaining Rajiv’s dependence on alcohol. At the start of treatment, Rajiv was not keen engage to in the process of recovery, having failed at multiple attempts over the years (motivation to change, influence of past learning experiences with abstinence). Our writers and reviewers are experienced professionals in medicine, addiction treatment, and healthcare. AddictionResource fact-checks all the information before publishing and uses only credible and trusted sources when citing any medical data.

These clients may believe that they are hopeless
addicts and failures, that they will never be able to achieve and maintain
sobriety, and that there is no use in trying to change because they think
that they cannot succeed. Treatment, cbt interventions for substance abuse therefore, is directed primarily at changing distorted or maladaptive
thoughts and related behavioral dysfunction. Cognitive
restructuring is the general term given to the process of changing the
client’s thought patterns.

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A review of outcome studies evaluating the efficacy of relapse
prevention interventions indicates that the support for relapse prevention
is more equivocal (Carroll,
1996b). Relapse prevention was found to be superior to no treatment,
but the results have been less consistent when it is compared to various
control conditions or to other active treatments. There are some outcomes on
which relapse prevention may have considerable impact (Carroll, 1996b); for instance, although not
necessarily reducing the rate of relapse, clients treated in relapse
prevention appear to have less severe relapses when they occur. Behavioral, cognitive, and cognitive-behavioral treatments all rely heavily
on an awareness of the antecedents and consequences of substance abuse. In
all of these therapeutic approaches, the client and therapist typically
begin therapy by conducting a thorough functional analysis of substance
abuse behavior (Carroll, 1998;
Monti et al., 1994; Rotgers, 1996). This analysis
attempts to identify the antecedents and consequences of substance abuse
behavior, which serve as triggering and maintaining factors.

• As noted, a variety of CM procedures have shown success in helping patients reduce drug use.
• Although MI incorporates the principles of the trans theoretical model, it has been distinguished from both trans theoretical model and CBT21.
• With regard to MBRP versus TAU, individuals who received MBRP and showed lower distress tolerance reported greater reductions in alcohol and other drugs use frequency over time (61) and craving scores (53, 69), although the changes were not maintained at the 4-month follow-up (61).
• Symptoms of substance abuse reflect the external consequences of problematic use such as failure to fulfill role obligations, legal problems, physically hazardous use, and interpersonal difficulty resulting from use.