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Substance use disorder is a complex health condition that involves brain chemistry, genetics, life experiences, and your environment.

Severe substance use disorder, or addiction, is repeated drug use despite harmful effects, and not being able to stop using the substance.

In June 2020, 13 percent of people in the United States either started using substances or increased their use as a way to cope with the COVID-19 pandemic.

Addictions may also be behavioral. There are only two clinically recognized behavioral addictions: gambling addiction and internet gaming disorder. But people seek treatment for:

  • sex addiction
  • food and exercise addiction
  • shopping addiction

There are many effective treatments for addiction. One of these shown to be beneficial is cognitive behavioral therapy (CBT).

CBT is a form of talk therapy that helps you explore how your thoughts, feelings, and behaviors all work together.

You and your therapist will learn how to discover patterns in your thinking that are unhealthy, and how these thoughts have a negative impact on your behaviors and your own beliefs.

When you can identify these patterns, you start to work with your therapist on changing your negative thoughts into positive, healthier ones. By doing this, you can develop healthier beliefs and behaviors.

A general example of this might be feeling inadequate in your job and telling yourself, “I’m always messing up.”

CBT can help you learn to change those negative thoughts into a more positive expectation, such as, “It may not be perfect, but I can still do this because I’ve accomplished it in the past.”

“CBT is a nice combination of looking at how you think and how you behave. Instead of looking backward, which is a very important thing to do in other kinds of therapy, it works well for people to gain insight as to why these things occurred,” explains Dr. Robin Hornstein, a Philadelphia-based psychologist who works with a variety of populations using CBT as well as many other therapies.

“CBT keeps us a little more focused on the present,” she says.

CBT can help with a range of issues, such as:

  • anxiety and phobias
  • sleep disorders
  • eating disorders
  • addictions

CBT can give you the tools and a way to apply newly formed skills to make changes and feel successful, according to Hornstein.

In CBT, you might be asked to think about your core beliefs about your behaviors and activating them to make changes. This technique is known as the ABC model. It stands for:

  • A: activating event
  • B: beliefs about that event
  • C: consequences of your behavior

In CBT, the B, or your beliefs, is considered the most important, as it helps you change your beliefs to have better consequences, or outcomes.

CBT can be very effective for addiction, including how well it can work against your triggers.

Hornstein gives an example of gambling addiction:

Let’s say you’re buying lottery tickets every month, but buying these tickets causes you to come up short for your household bills and groceries.

“You haven’t been able to get control over the compulsive behavior of going and buying a lot of lottery tickets. You can’t hold yourself back from it at this moment,” Hornstein explains.

You start to develop a set of cognitive beliefs: You’re going to win, and all that money can pay off your bills. But these beliefs make you feel guilty.

Hornstein often asks her clients what is rewarding about changing their behavior. If you changed it, what would happen?

You might say your family won’t stress so much over the unpaid bills. You could buy your kids new clothes. You’re not going to feel angry or sad because you can’t get out of this cycle.

You’ll start to identify the things you’re going to work on. Using the ABC model, Hornstein explains that the A in the activating event might be buying the lottery tickets because you (B) believe it’s going to make you wealthy.

“You have to challenge your beliefs about what is a healthier strategy with your money, for your family, for yourself,” she adds.

Finally, what are the (C) consequences of that behavior?

“[Addiction] is a disorder just like anxiety,” Hornstein says. “You have to address the underlying behaviors, and factor in the emotions and beliefs.”

As you start healthier thoughts and behaviors, you start associating them with healthier emotions, and this can start to become second nature the more you do it.

A benefit of CBT is that you can start making changes right away and use these skills for the rest of your life. You can work with your therapist on the techniques that work for you and your unique situation.

The techniques used in CBT can be applied specifically to treat addiction. Here are some of the common techniques that might be used:

Journaling

Write down the negative thoughts you might have between therapy sessions and how you replaced them with more positive ones.

It can help to look back and see how your thought patterns have changed over time.

Thought challenges

In this technique, you look at the whole situation and consider it from multiple angles. Instead of assuming your own thoughts are the truth, you challenge yourself to look at the situation objectively.

“A lot of the stories we write are fiction, and we tell ourselves they’re true,” Hornstein says. “Then we react as if they’re happening, and we can stimulate our own anxiety response.”

For example, she says, “If I don’t get high right now, or if I don’t have a beer right now, I will jump out of my skin. The challenge is, is that true? You have to decide which thoughts are real and which ones are things your body and mind are inventing.”

Relaxation techniques

Relaxation techniques can look different for everyone. It might be listening to music, gardening, or taking a bath. These can be helpful when you have a stressor that causes you to have a craving.

Relaxation exercises such as deep breathing can be done anywhere.

Guided discovery

Your therapist will gather information from you on your viewpoint, and then will ask questions that challenge that viewpoint.

This can help you consider different perspectives that you may not have thought of before.

Cognitive restructuring

You look at your thoughts, such as thinking about the worst case scenario or either-or thinking, and your therapist helps you reframe those thoughts into something healthier and productive.

There are many ways to find a CBT professional. A good place to start is searching online for therapists in your area. You might try Healthline’s FindCare database to search for therapists in your state.

Online-Therapy.com, a company that specializes in CBT, gives you options for online therapy but also helps you learn CBT techniques using self-guided workbooks.

Online therapy can be a great option if you have a busy or unpredictable schedule, or want to have sessions from the comfort of your own home.

Another option is to ask around, according to Hornstein.

If you’re in a recovery process, she recommends asking people if they have any recommendations for therapists. Word of mouth can be a great way to find a clinic or a therapist that someone you know has personally used. That way you can try them out to see whether they’re a good fit for you too.

Make sure you choose someone you’re comfortable with. Consider gender, age, and more. If you’re not comfortable with one therapist, don’t give up. Consider finding someone else until you get a match.

CBT is a way to restructure negative thought patterns and behaviors into healthier ones. It’s changing the way you feel or act toward something by changing how you think about the situation.

When it comes to addiction, CBT can help you take steps to reframe your situation to avoid triggers. When you find a therapist skilled in CBT, you can take steps to apply the skills you learn to future situations.


Risa Kerslake is a registered nurse, freelance writer, and mom of two from the Midwest. She specializes in topics related to women’s health, mental health, oncology, postpartum, and fertility content. She enjoys collecting coffee mugs, crocheting, and attempting to write her memoir. Read more about her work at herwebsite.