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CBT for Substance Abuse

Relative to adult substance users, adolescents who drink or use drugs have a more rapid progression from casual use to dependence, longer substance use careers, and a greater number of co-occurring psychiatric problems (Kandel et al., 1997; Winters, 1999). In recent years, cognitive behavioral therapy (CBT) models tailored specifically for adolescent substance users have gained significant empirical support. According to the cognitive-behavioral model, adolescents use substances as a maladaptive way of coping with environmental circumstances or getting needs met (MacKay et al., 1991). Treatment aims to help adolescents replace their drinking or drug use with less risky behavior by recognizing antecedents of their use, avoiding those circumstances if possible, and coping more effectively with problems that lead to increased use.

While specific CBT models vary in the extent that they emphasize changing behavior, modifying thoughts, and teaching new coping skills, most models contain two key components: functional analysis and skills building. In a functional analysis, the therapist and adolescent work collaboratively to identify the specific thoughts, feelings, and circumstances the adolescent had before and after drinking or using drugs. This exercise helps the adolescent to identify high-risk situations that lead to increased use, while gaining insight into why s/he drinks or uses drugs in those situations. The therapist applies the information obtained through functional analysis to identify specific areas where the adolescent would benefit from learning or practicing new skills. Skills that a CBT therapist would commonly consider include: questioning and testing the adolescent's assumptions about substance use, practicing assertiveness to resist peer pressure, building a social network supportive of recovery, increasing pleasant activities, problem solving during high risk situations, and gradually trying out new ways of behaving and reacting. To address the developmental needs of adolescents, CBT therapists might choose to combine these core skills with motivation enhancement, parent education, school outreach, and treatment of comorbid conditions.

Both individual and group models of CBT have been tested in well-controlled clinical trials. In addition, a number of studies have tested interventions that integrate CBT principles with motivation enhancement therapy and family functional therapy. A recent metaanalysis of evidence-based psychosocial treatments for adolescent substance abuse classified group CBT as a well-established intervention, and noted that individual CBT appears promising but requires further testing (Waldron & Turner, 2008). Further support for CBT was found in a recent review of the quality of evidence in support of outpatient interventions for adolescent substance abuse (Becker & Curry, 2008). Across 31 randomized controlled trials, CBT was the outpatient intervention supported by the highest proportion of methodologically stronger studies.



Becker, S. J. & Curry, J. F. (2008). Outpatient interventions for adolescent substance abuse: A quality of evidence review. Journal of Consulting and Clinical Psychology, 76, 531-544.

Kandel, D. B., Johnson, J. G., Bird, H. R., Canino, G., Goodman, S. H., Lahey, B. B., Regier, D. A., Schwab-Stone, M. (1997). Psychiatric disorders associated with substance use among children and adolescents: Findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Journal of Abnormal Child Psychology, 25, 121 - 132. .

Mackay, P. W., Donovan, D. M., Marlatt, G. A. (1991). Cognitive and behavioral approaches to alcohol abuse. In R. J. Frances & S. I. Miller (Eds.), Clinical textbook of addictive disorders (pp 452 - 481). New York: Guilford Press.

Waldron, H. B., & Turner, C. W. (2008). Evidence-based psychosocial treatments for adolescent substance abuse. Journal of Clinical Child & Adolescent Psychology, 37, 238 - 261.

Winters, K. (1999). Treating adolescents with substance use disorders: An overview of practice issues and treatment outcome. Substance Abuse, 20, 203 - 225.

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