Cognitive Behavioral Therapy (CBT) Techniques for Addiction Recovery

When you’re getting into recovery, you’re seeking a long-term solution to sobriety, but in the moment of realization that you need help, your primary focus is on getting clean. An inpatient medical detox program will clean out your physiology and remove the physical addiction to drugs and alcohol.

But if users can get clean so easily, why do so many relapse into addiction?

The reality is you can clean out the body of addiction to substances and alcohol, but it takes a lot more than a medical procedure to rewire your mind into living sober. Earl Nightingale once wrote, “You become what you think about.”

Many addicts find themselves struggling with negative thought patterns and cycles of thinking about using their substance of choice, even after they are physically clean. It’s these thoughts— combined with triggers—that prey on the recovering addicts thinking, pushing them into relapse.

So, what can we do to change our thinking and embrace a mental headspace where we value sobriety more than using?

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy or CBT is an organized, evidence-based form of psychotherapy that helps individuals identify and alter negative cognitive processes and activities responsible for creating emotional distress.

CBT is most often utilized to treat depression, anxiety, posttraumatic stress disorder or PTSD, and obsessive-compulsive disorder or OCD, but it has a place in any addiction recovery program due to its ability to help addicts change their thinking and behavior, giving them the coping strategies they need to live a sober life.

The rationale behind CBT is that our feelings, actions, and ideas are interconnected. If we change them, it creates a cascading effect through our mental processes, changing the way we think and behave, and how we approach life.

Unpacking the Principles of CBT

The Interconnection of Thoughts, Emotions, and Actions

CBT is based on the belief that our actions have a direct relationship with our feelings. When our mindset is negative or we have false beliefs about ourself, our feelings of low self-worth cause stress that reinforces any co-occurring mental illness.

For example, if one is perpetually believing that they are an addict and there’s no chance of getting sober, they’ll discourage themselves from ever reaching out for help and entering a recovery program to get clean.

CBT transforms our mode of thinking to improve our ability to control our feelings and emotions, giving us the mental framework we need to start building and maintaining constructive, healthy, sober habits.

Identifying And Challenging Negative Patterns of Thoughts

A key aspect of CBT is helping individuals recognize cognitive distortions—habitual, irrational thought patterns that contribute to negative emotions driving their addiction. Cognitive distortions can give addicts a negative mindset where they always expect the worst in every life situation and it leads to “black-and-white” thinking where they see their actions either as wholly bad or good, with no middle-ground.

Addicts often take an overgeneralized approach to thinking, drawing broad conclusions from limited experiences. So, they might see recovery as ineffective for them, even though they’ve never enrolled in an inpatient program.

CBT teaches patients in recovery how to challenge their cognitive distortions by questioning their validity and accuracy and replacing them with more balanced, realistic perspectives.

Behavioral Change through Self-Monitoring and Self-Awareness

CBT emphasizes that awareness of self is the only way to break free of negative thinking and habits. The patient is instructed to observe their feelings, ideas, and activities by maintaining a diary of their thought records.

It helps individuals identify negative habits that perpetuate in their mind, replacing them with healthy coping habits. Self-monitoring also makes individuals accountable and empowers them to take responsibility for maintaining their mental health.

Unlike some of its more unstructured therapy counterparts, CBT is a structured and direct form of psychotherapy that’s exceptionally effective in treating addiction. Therapists meet with patients in individual and group settings to set concrete goals and plans of action.

Key Evidence-Based CBT Strategies Used in Recovery Programs

Because negative attitudes, emotional distress, and poor coping habits drive substance use disorders, CBT is a key component of every recovery program, offering the patients the tools they need to make a sustainable recovery.

CBT helps the patient control and manage their cravings by giving them the skills they need to identify the stressful situations, negative thought patterns and environmental, physical, and psychological triggers that set off the compulsion to relapse and use again.

Cognitive Restructuring (Reframing Negative Thought Patterns in Addiction)

Cognitive restructuring is one of CBT’s most powerful strategies, helping patients recognize and challenge negative cognitive processes that perpetuate their substance use cycle and leave them feeling helpless to their addiction.

By identifying cognitive distortions, patients learn to challenge the validity of their thinking and behaviors and replace them with healthier perspectives. Instead of believing, “If I relapse, I’ve blown it,” individuals can reinterpret it to mean, “Relapse is a slip, but not a failure, and I can and will continue my recovery.”

Replacing these cognitive distortions with positive reinforcement diminishes feelings of hopelessness and raises the patient’s motivation to stay sober.

Behavioral Activation or Replacing Substance Use with Better Activities

Behavioral activation is the targeted reintroduction of satisfying, enjoyable activities replaces the addicts habit of substance use. Substance use is likely to lead to withdrawal from activities, and initiate feelings of loneliness, boredom, and depression—which all contribute to a toxic mental state that primes the patient for relapse.

CBT encourages individuals to identify how behavior is linked to mood. Instead of using substances to numb emotional pain, patients learn to engage in healthy alternatives like exercise, social activities, and relationships, making substance use unappealing.

Exposure Therapy and Coping Strategies (Managing Triggers and Cravings)

A major challenge of recovery is managing triggers—people, situations, or feelings that make individuals crave their chosen substance of abuse. Avoiding triggers is a common strategy for people in recovery, but this approach actually does the opposite of what they intend it to do, resulting in their triggers creating a stronger negative emotional state, pulling them toward relapse.

Exposure therapy introduces patients to triggers but in a controlled environment, giving the patient the chance to learn how to handle cravings. This systematic desensitization, or systematic exposure therapy, exposes patients to high-risk situations, teaching them coping skills like breathing or mindfulness to manage the situation. With practice, gradual exposure weakens the patients fear of triggers and makes them more emotionally and mentally resilient to cravings.

Mindfulness and Relaxation Strategies (De-Stressing Without Substances)

Stress is among the most common relapse triggers, so learning relaxation techniques and improving self-awareness becomes paramount to developing the necessary coping skills to overcome the pull of triggers and the temptation to use again.

Mindfulness helps individuals recognize what’s going on in their mental headspace, giving them the skills to take a step back from their thought processes and identify the problematic emotions and thoughts without reacting to them.

Practicing mindfulness daily raises self-awareness and impulse control. Deep breathing, progressive muscle relaxation, and guided meditation induces relaxation and emotional control and using these strategies reduces levels of cortisol—the stress hormone–and enhances the patients coping capacity without resorting to relapsing back into substance abuse.

Problem-Solving Therapy (Learning Adaptive Coping Responses to Life Issues)

Many individuals turn to substances to handle the pressures of life. PST teaches patients how to use organized decision-making processes to better handle stress.

The process is initiated by defining a problem causing the negative thinking and emotional responses in the patients, such as financial distress or relationship issues.

Journaling (Tracking your Triggers and Emotions)

Thought records, or structured writing, also help patients reflect on negative thoughts and reformulate them into better options. If the addict is going through thoughts of relapse such as, “I can’t cope without using,” they can challenge this false belief by reminding themselves that they managed to cope without resorting to relapse before, and they can do it again.

Journaling facilitates cognitive restructuring by giving the patient greater awareness of their inner thought processes.

Setting Goals and Aftercare Planning (Sustaining Long-Term Recovery)

As the patient transitions form their inpatient treatment to an outpatient program, their therapist and case manager work with them to develop an aftercare program to keep them on track. This program sets SMART goals to make them realistic and achievable. Aftercare planning, therapy, group therapy, and monitoring actions are key to maintaining a sober lifestyle.

How to Apply CBT Techniques in Your Daily Experience

Attending therapy is part of recovery, but real  change happens outside of the therapy sessions in the addicts everyday experience as they reintegrate into sober society. Addiction is built on habits that develop on a fundamental level, so practicing CBT strategies when you encounter triggers or negative thinking in your daily experience becomes essential to giving you the strength you need to persist with your outpatient recovery and stay sober.

The first step is to learn what triggers—events, people, or feelings make it likely for you to relapse. Keeping a journal or thought record tracks exposure to triggers and the negative thinking patterns that arise over the weeks and months after leaving the inpatient program.

Another key is cognitive restructuring, where negative thoughts that reinforce substance use are challenged by the patient, weakening the hold that cravings have over their physiology and psychology.

Another daily skill patients can use to reprogram their thought processes and actions is “behavioral activation.” This skill involves identifying feelings of emptiness and meaninglessness caused by addiction and pro-actively plans to engage the patient in healthy activities like exercise, hobby pursuits, or social pursuits to curb these emotions and thought processes.

Developing Self-Awareness and Emotional Control

One of the most basic challenges in recovery is learning how to cope with stress, anxiety, and negative emotions without using alcohol or substances. Awareness of your feelings and learning how to manage them is key to overcoming this behavioral pattern.

Mindfulness is one of the most useful CBT skills to make patients aware of what’s going on in their thoughts without jumping to immediate action. Mindfulness means focusing on what’s going on with you right now and observing your thoughts and behaviors without judging them.

When you experience a craving, instead of responding immediately, patients pause, slowly inhale, slowly exhale, and observe what’s going on in their brain and body. The self-awareness generated in that moment can pull the patient out of their current mindset and give them the strength they need to cope and overcome the trigger or mental loop playing out in their head that’s compelling them to use.

Relaxation techniques, like progressive muscle relaxation and breathing, can be incredibly useful in managing emotional distress. These techniques engage the body’s relaxation response, diminish tension, and reduce the risk and probability of the patient relapsing.

CBT also values problem-solving competence, giving patients the tools they need to face challenges in life without using drugs or alcohol to get through it. Instead of allowing stress to engulf their thinking and emotions, patients break down issues into manageable tasks, and take tangible actions towards finding a healthy, productive resolution.

By consistently employing problem-solving techniques, patients in recovery learn to believe that they can manage to cope with life’s stressors without resorting to substance abuse.

Reach Out for Help and Enter an Inpatient Recovery Program

While CBT is highly effective at giving addicts the skills they need to turn around their life, they’re only effective if you give yourself the chance to learn and use them. That means getting yourself into an inpatient recovery program should become your primary goal.

During your admission, you’ll receive a dual diagnosis from a medical doctor and a trained, certified psychotherapist who analyze your current state of mental health. They’ll introduce you to your case manager who outlines your therapy progression and what you can expect from your time in inpatient recovery.

You’ll get all the coping strategies you need to handle readjusting to sober society. But beyond the health benefits of CBT, the biggest benefit is that you’ll gain a deeper understanding of yourself and take back control of your thinking and emotions from the clutch of addiction to alcohol and drugs.