You may have seen the letters, C, B, and T tossed around on social media by friends and acquaintances in treatment and therapy. If you’ve ever wondered what those letters mean and why you should care, read on.

CBT stands for Cognitive Behavioral Therapy, an evidence-based, therapeutic approach for treating substance use disorders and other issues. CBT has been around for decades, so it’s backed by lots of research, and that makes it something worth knowing about.

Here’s a little history about CBT. It is the brainchild of the psychiatrist, Aaron Beck. He pioneered the modality in the 1960s while still a student at the University of Pennsylvania. His big discovery? Automatic thoughts. The short part of a long story is that Beck realized many of his patients were having conversations in their heads – all the time. Beck surmised that these conversations were at the seat of their emotional struggles. He found that patients had patterns of automatic negative thoughts about themselves, the world, and the future.  Beck found that these patterns of automatic thoughts were predominant in patients struggling with depression and anxiety. While he initially focused on the cognitive aspect of CBT, Beck and colleagues were aware of and later expanded their focus to the connections between thought and behavior.  Further, he and his students and colleagues expanded their research and practice to include substance abuse and other mental health issues.

From a CBT perspective, a person struggling with substance use has developed certain ways of thinking that make them vulnerable to ongoing use. Thoughts like, “marijuana makes me feel more relaxed”, “my cravings and pain will ease when I use”, and “I work hard; I deserve this drink” are examples of automatic thoughts or beliefs associated with substance abuse.  These thoughts can be categorized as anticipatory, relief-oriented, and permissive beliefs that people might have about substances. Of course, the problem goes beyond the thoughts. Once the brain gets a dose of a substance like alcohol, marijuana, cocaine, or other drugs, it receives almost immediate positive reinforcement. That means that the thought, which leads to the action or behavior, is reinforced by the sensations induced by the drug. The next time that thought pops up, the brain remembers the positive feeling it received from the drug the last time. And so the cycle goes.

Dr. Cory Newman, a CBT therapist and colleague of Beck’s says that while positive reinforcement makes substance use very challenging, CBT provides psychological tools that can help a person find and maintain sobriety. These tools include methods of responding to the dysfunctional anticipatory, relief-oriented, and permissive beliefs associated with substance use. But that’s not all. CBT can also improve problem-solving skills, encourage self-instruction, and increase awareness of the onset of urges and cravings. Beyond that, there is abundant research supporting the use of CBT for anxiety and depression, which often co-occur with substance use disorders. CBT techniques can be helpful for people struggling with relationship and employment issues, grief and loss, and symptoms of PTSD, which can also be problematic for people abusing substances.

In short, if you or someone you love needs help with substance use, finding an individual therapist or treatment center with a strong background in CBT is a great start.  It’s a powerful clinical modality that, especially when combined with appropriate pharmacotherapy and other behavioral interventions, can positively impact ongoing sobriety and recovery.

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