Motivational Interviewing is an approach used to increase adherence to CBT and targets uncertainty to behavioral change surrounding drug and alcohol use. MI models can be used as stand-alone interventions and in combination with other treatment strategies. MI is usually offered individually. 


Motivational Interventions 


Contingency Management approaches involve administering a non-drug reinforcer after demonstration of abstinence from drug or alcohol use. CM approaches are grounded in operant learning theory. These procedures may use either stable or escalating reinforcement schedules. The reinforcer value adjusts according to duration of abstinence. The punchbowl method is an example of reinforcers, in which negative screens for drug use are rewarded with the opportunity to draw from a “punchbowl.” 


Contingency Management Strategies 


The approach, Relapse Prevention, focuses on identifying and preventing entering high risk situations in which patients are more than likely to engage in substance use. RP techniques include psychoeducation, in order to help patients make more informed decisions, and challenging the patients perception of positive effects of use. 


Relapse Prevention 


Behavioral Couples Therapy assumes there is a relationship in which substance use can lead to damaging effects on the relationship and the relationship distress can lead to increased substance abuse. This treatment involves improving the overall relationship functioning as well as improving a partner’s ability to cope with substance related situations. Some commonly used interventions are psychoeducation, application of reinforcement, inclusion of non-drug activities, and training in withdrawal of relationship contact. 


Behavioral Couples Therapy 


The Community Reinforcement Approach focuses on the inclusion of non substance related activities into the patient’s daily life in order to make sober activities more rewarding than substance use. 


Community Reinforcement Approach 


- Motivational Interventions 
- Contingency Management strategies 
- Relapse Prevention 
- Behavioral Couples Therapy 
- Community Reinforcement Approach 


University of San Diego

CBT has demonstrated efficacy as monotherapy and combination treatment strategies for substance use disorders. There are several distinct interventions included in CBT for substance use disorders. These interventions can either be combined or used in isolation, and many are administered in both individual and group format. CBT for substance use disorders varies according to the substances that are targeted and to the protocol being used. However, there is consistency across interventions in the use of motivational and cognitive barriers to change, skills deficits, and learning-based approaches to target maladaptive behavioral patterns. 


Cognitive Behavioral Therapy for Substance Use Disorders 


McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012


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