Cognitive Behavioral Therapy for Alcohol Use Disorder

Therapy is finally becoming more widely acknowledged as an effective tool for building resilience, treating mental health conditions, and becoming the best version of oneself. What many people are less aware of is therapy’s effectiveness in treating alcohol use disorder.  As a therapist on the Monument platform, I use cognitive behavioral therapy (CBT) to help my patients identify the underlying influences behind their unhealthy drinking habits and build alternative coping mechanisms.  And I’m not the only one seeing incredible results and progress from my patients. Evidence shows cognitive therapy can help reduce alcohol consumption, which is why it’s largely considered the gold standard in alcohol treatment by leading addiction professionals. 

Learning more about how CBT can treat unhealthy alcohol use can be an empowering step in discovering the right tools for you and your journey. 

What is cognitive behavioral therapy?

Cognitive behavioral therapy was founded by the pioneering psychiatrist Dr. Aaron Beck in the 1960s.

CBT treatment is a combination of two therapeutic approaches: psychotherapy and behavioral therapy. Psychotherapy focuses on understanding one’s thinking patterns and the meaning we place on different things. Behavioral therapy explores the relationship between our thinking patterns and our problems. Combining these two approaches, CBT treatment helps people learn how to identify and change destructive thought patterns that negatively impact their behavior and emotions. In the context of changing your relationship with alcohol, CBT can help you change how you think about drinking, empower healthier coping mechanisms, and reduce the role alcohol plays in your life. 

Why is CBT effective in treating AUD specifically?

While CBT is well-known for treating various mental health conditions such as depression and anxiety, it’s also been shown to effectively treat substance use disorders like alcohol use disorder. There are several reasons why the structure of CBT is especially helpful for those looking to change their drinking habits.

Helps build the foundation for healthy habits

With alcohol use specifically, understanding the consequences of drinking can be a huge motivation for making a change. Cognitive behavioral therapy for alcohol use disorder can help the patient process past, present, and future consequences of their alcohol use. This greater understanding of undesirable outcomes can encourage patients to make vital behavioral changes and transform old habits. 

Addresses complex thoughts and emotions

With CBT, patients learn to manage painful thoughts, feelings, and emotions about their alcohol use, many of which can contribute to self-doubt, low self-esteem, and self-destructive mindsets. 

For example, CBT can guide a patient to replace self-defeating thought patterns with more supportive ones, which can help break the cycle of drinking to cope with feelings of hopelessness. It’s inspiring to watch my patients start to understand how they have the power to make positive changes despite their past and current circumstances.

woman looking at water

Improves problem-solving and ability to handle setbacks 

When talking about CBT skills, I often make the comparison to cheat codes in a video game or cliff notes for a book. Therapy can give you the tools and information ahead of time to be more prepared when making a choice or overcoming obstacles. When it comes to drinking habits, this often means identifying triggers and making a plan for how you will address them.

Provides a helpful model for change

The way CBT sessions are structured also has many advantages for treating AUD. The goal-oriented approach has been found to be effective in helping patients address their current drinking habits and make meaningful and sustainable change. Following a CBT program allows patients to stay focused on their sobriety or moderation goals and truly embrace their progress. 

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Works well with other treatment approaches

CBT can be especially effective in combination with other forms of alcohol treatment, such as medication to stop drinking and peer support groups. In my experience, people who are treated with CBT for a substance use problem are significantly more equipped to maintain their sobriety when in combination with medicated assisted treatment. 

Explore therapy + medication plans at Monument → 

Given its unique approach and benefits, many healthcare experts consider CBT the preferred form of therapy to treat alcohol use disorder. The therapists at Monument, such as myself, are all trained in CBT and use it as the foundation for treating alcohol use disorder. Exploring specialized online alcohol treatment is an act of self-care, and I get to witness every day the ways in which drinking less changes the overall health and happiness of my patients.

What are the core principles of CBT?

To gain a deeper understanding of CBT and decide if it’s right for you, it can be helpful to learn about the values and principles of this unique modality. According to the American Psychological Association, the core principles of CBT are as follows:

1. “CBT emphasizes collaboration and active participation” 

Collaboration and trust between patient and therapist is a key value in cognitive behavioral therapy CBT. The process of working together allows a patient to build their own healthy decision-making skills and continue practicing CBT tools after they conclude treatment.

2. “CBT is goal-oriented and problem-focused” 

During the first few cognitive therapy sessions, I have my patients set specific goals. With goals in place, it becomes easier to evaluate and respond to thoughts that may interfere with those goals. At Monument, goals often include setting drink limits or incorporating activities that promote sobriety.

therapist and client talking together

3. “CBT sessions are structured” 

Another key distinction about CBT is that the cognitive behavior therapy session is more organized than other types of therapy. An example CBT therapy session might open with a general check-in, go into a discussion and review of takeaway exercises on topics such as recognizing thought patterns and relapse prevention, and then end with a summary, re-evaluation of goals, and time for feedback. 

Reading more about what to expect from therapy can help you better understand what an individual cognitive behavior therapy session might be like. 

4. “CBT teaches patients to identify, evaluate, and respond to their thoughts and beliefs” 

CBT aims to arm patients with the tools to identify negative thoughts and explore new, rational perspectives. Your therapist is there to guide you as you arrive at new ways of thinking through cognitive behavioral therapy

5. “CBT uses a variety of techniques to change thinking, mood, and behavior” 

There are many different strategies involved in cognitive behavioral therapy, including mindfulness techniques and motivational interviewing. These tools help patients restructure their thoughts and implement behavioral changes. Learning new coping skills is also a crucial component of the treatment plan roadmap.

Overall, the goal of CBT is to help the patient change their thinking and behavior patterns in order to achieve more positive outcomes. The therapy space becomes a place to brainstorm and realize all of the different choices available at any given time.

 In my CBT practice, I often talk about the importance of “The Three C’s”, which can provide a helpful framework for this process of discovering options: 

  • C, choice
  • C, common sense
  • C, and consequence

What are the tools or strategies involved with CBT?

Some of the CBT techniques that therapists use to treat alcohol use disorder include: 

1. Reframing

This cognitive behavioral therapy tool involves assessing one’s thought patterns, identifying which thoughts are automatic and/or negative, and reframing these thoughts with more positive, rational thinking. Learning how to reframe negative thoughts that tend to lead to drinking can be a powerful way to create new patterns.

2. Guided discovery

Similar to reframing, this technique involves working with a therapist to look at circumstances from different and potentially more positive perspectives. When drinking habits are repeated over an extended period of time, it can be difficult to imagine what a change would look like, and how the results might benefit you. Through tools like guided discovery, a therapist can help a patient evaluate their own relationship with alcohol, identify achievable goals, and help them take steps to get there.

Person journaling in their room

3. Journaling

This exercise can help identify and clarify one’s emotions and thoughts by putting them on paper. Getting clarity on the feelings and thoughts that lead you to drink can help you identify and avoid triggers and address underlying issues. Looking back on past entries can also serve as a helpful reflection tool to learn from past drinking behavior and track your progress.

4. Relaxation techniques for stress reduction

During CBT sessions, patients are often taught various relaxation techniques as a way to cope with various stressors while changing your relationship with alcohol. These techniques can lower stress and improve decision-making, which can be especially helpful when confronted with a drinking trigger. Some of these techniques could include:

  • Deep breathing exercises
  • Muscle relaxation exercises
  • Guided imagery

5. Role playing

Role playing with a therapist can help illuminate current behaviors and provide the space to practice new, healthier ways of acting in certain situations. Role playing can also provide a space to practice setting boundaries, saying no to alcohol, and talking to loved ones about your treatment plan.

What makes CBT different from other types of therapy?

Many other forms of therapy place a lot of focus on addressing the past and early childhood.  While CBT considers the influences of the past, it places the most focus on working through current issues and situations. CBT is also unlike other types of therapy because it aims to be time-limited. Many people go through the CBT process and no longer feel they need therapy, while others naturally decide to meet with their therapist less frequently or return to therapy on an as-needed basis. While CBT aims to be more short-term than other therapy methods, it’s recommended to continue with it for as long as it’s providing a benefit.  

CBT is also unique in that it’s very specific in its focus. The goal is to immediately address current issues and accompanying symptoms by assisting patients in making active changes. CBT focuses on an individual’s thoughts, feelings and behaviors, and how they impact one another. Lastly, CBT often involves completing exercises or “take-away” assignments that help educate patients on developing and implementing new skills.

For the last 20 years, my “go-to” therapy modality has been CBT. This approach cultivates a change in mindset, which can open the door to all new possibilities and behaviors. The motivation to make better choices, and learn from past decisions, can build the foundation for meaningful and long-term changes as well as a fulfilling life overall. As patients engage with CBT, they find that they already possess the tools and wisdom they need to achieve their goals, and that can be an incredibly empowering life lesson.

Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.

About the Author

Nathaniel Alexander headshotNathaniel Alexander is a firm believer in the 3 C’s: Choice, Common Sense and Consequences. If a person uses sound common sense, their decision-making efforts improve, and so does their outcomes for life. Graduating from the College of William & Mary, he has extensive education with training in several modalities, including Trauma-Informed Care, Cognitive Behavior Therapy, Motivational Interviewing, and Rational Emotive Behavioral Therapy. He is always interested in learning new approaches to meeting client needs. With over 25 years of experience, he has worked in several outpatient substance use and mental health programs, including inpatient, residential and outpatient services. He is very excited to help those who desire change via virtual therapy. The hope is to break down walls and barriers for clients to get the care they need in the most accessible ways possible. He values adapting with clients changing needs. He has a desire for empowering, encouraging and educating clients to recognize their strengths amidst their life situations in order to transition towards a sense of efficacy and fulfillment.