Sources for this Section:
NIDA. 2020, June 1. Behavioral Therapies. Retrieved from
on 2021, April 27.
National Institute on Mental Health, Substance Use and Co-Occurring Mental Disorders, accessed May 4, 2021 from https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health/
Research has found a number of behavioral therapies that have promise for treating individuals with co-occurring substance use and mental disorders. At First Step Community Recovery Center, we provide behavioral therapies alone or in combination with medications, tailored to the needs of the individual client. Examples of effective behavioral therapies for adults with SUDs and different co-occurring mental disorders that we offer include the following:
Cognitive Behavioral Therapy (CBT):
CBT is a type of talk therapy aimed at helping people learn how to cope with difficult situations by challenging irrational thoughts and changing behaviors.
Cognitive-Behavioral Therapy (CBT) was developed as a method to prevent relapse when treating problem drinking, and later it was adapted for cocaine-addicted individuals.
Cognitive-behavioral strategies are based on the theory that in the development of maladaptive behavioral patterns like substance abuse, learning processes play a critical role.
Individuals in CBT learn to identify and correct problematic behaviors by applying a range of different skills that can be used to stop drug abuse and to address a range of other problems that often co-occur with it.
A central element of CBT is anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies.
Specific techniques include exploring the positive and negative consequences of continued drug use, self-monitoring to recognize cravings early and identify situations that might put one at risk for use and developing strategies for coping with cravings and avoiding those high-risk situations.
Research indicates that the skills individuals learn through cognitive-behavioral approaches remain after the completion of treatment.
Dialectical Behavior Therapy (DBT): DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help control intense emotions, reduce self-destructive behaviors (e.g., suicide attempts, thoughts, or urges; self-harm; and drug use), and improve relationships.
“Designed in the early 1990s, DBT has given hope and confidence to clinicians and clients alike. Developed by Marsha Linehan, PhD, DBT was originally used to treat chronically suicidal individuals. DBT quickly became recognized as an evidence-based treatment of choice for Borderline Personality Disorder, Emotion Dysregulation Disorders, and is being used by clinicians across the country to help treat individuals with a wide range of mental illnesses including but not limited to eating disorders, substance use disorders and depression.” [Quoted with permission from author Josh Smith What is DBT (dbtimi.com).]
At First Step Community Recovery Center, all our counselors have received training in DBT.
Acceptance and Commitment Therapy (ACT):
At First Step Community Recovery Center, our counselors are trained in the use of Acceptance and Commitment Therapy (ACT), a radically new behavior change method that relies on the client’s commitment to making change while at the same time accepting their existing thoughts and feelings.
The pragmatic utility of psychological interventions on health behavior changes are judged by their effectiveness in promoting sustained and desired behavior change over an extended period of time.
For example, effective interventions are not only those that get people to increase their steps per day or to eat a healthy meal, but also are those that maintain such gains months or years beyond the initial intervention.
Mainstream health behavior change approaches have focused primarily on the content of cognitive and emotional variables that are thought to support long-term behavior change.
Traditionally, health behavior change interventions target the social cognitive and belief-based variables to increase individuals’ intention (i.e., a person’s motivation toward the target behavior in terms of direction and intensity) and self-efficacy (i.e., one’s confidence in being capable of performing a novel behavior) in the hopes of maintaining the health behavior change.
While these approaches can be helpful to a degree, the magnitude of health problems and the maintenance of health behavior change suggests that alternatives are needed, which is where ACT comes in.
Acceptance and Commitment Therapy is a radically new behavior change method that is oriented toward the development of greater psychological flexibility.
ACT-based interventions aim to promote client’s new health behavior patterns through “psychological flexibility”, i.e., the ability to contact the present moment with acceptance and mindfulness.
Clients are taught how to accept their thoughts and feelings, be mindful of and stay in the present moment, and commit to making and sustaining the desired behavior change over an extended period of time.
For health behavior change, instead of trying to directly change difficult thoughts or feelings, acceptance and mindfulness-based skills can be cultivated to foster greater behavioral regulation.
Accessed and edited on May 5, 2021 based on the “free and open access to research” policy of frontiers in Psychology:
Zhang Chun-Qing, Leeming Emily, Smith Patrick, Chung Pak-Kwong, Hagger Martin S., Hayes Steven C. – Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach – Frontiers in Psychology, Volume 8, January 2018.
Frontiers | Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach | Psychology (frontiersin.org)
Therapeutic Communities (TC): TCs are a common form of long-term residential treatment for SUDs that focuses on helping people develop new and healthier values, attitudes, and behaviors. They are self-supporting and democratically run residences to support abstinence and recovery from drug use. Examples include community lodges and Oxford Houses.
Initially TCs were run solely by peers in recovery. Over time and in response to the changing needs of participants, many TCs have begun incorporating professional staff with substance abuse counseling or mental health training, some of whom are also in recovery themselves.
At First Step Community Recovery Center, as part of discharge planning all clients are provided information about TCs in Wisconsin, and assistance is provided in securing placement in appropriate cases. A list of Oxford Houses in Wisconsin can be found here:
At First Step Community Recovery Center, we employ a variety of proven incentive-based strategies in order to encourage client compliance with treatment plans and directives.
Contingency Management (CM) Interventions/Motivational Incentives: CM principles encourage healthy behaviors by offering vouchers or rewards for desired behaviors.
Research has demonstrated the effectiveness of treatment approaches using contingency management (CM) principles, which involve giving patients tangible rewards to reinforce positive behaviors such as abstinence.
Studies conducted in both methadone programs and psychosocial counseling treatment programs demonstrate that incentive-based interventions are highly effective in increasing treatment retention and promoting abstinence from drugs.
Voucher-Based Reinforcement – (VBR) augments other community-based treatments for adults who primarily abuse opioids (especially heroin) or stimulants (especially cocaine) or both.
In VBR, the patient receives a voucher for every drug-free urine sample provided. The voucher has monetary value that can be exchanged for food items, movie passes, or other goods or services that are consistent with a drug-free lifestyle.
The voucher values are low at first but increase as the number of consecutive drug-free urine samples increases; positive urine samples reset the value of the vouchers to the initial low value.
VBR has been shown to be effective in promoting abstinence from opioids and cocaine in patients undergoing methadone detoxification.
Prize Incentives – CM applies similar principles as VBR but uses chances to win cash prizes instead of vouchers.
Over the course of the program…participants supplying drug-negative urine or breath tests draw from a bowl for the chance to win a prize worth between $1 and $100.
Participants may also receive draws for attending counseling sessions and completing weekly goal-related activities.
The number of draws starts at one and increases with consecutive negative drug tests and/or counseling sessions attended but resets to one with any drug-positive sample or unexcused absence.
The practitioner community has raised concerns that this intervention could promote gambling—as it contains an element of chance—and that pathological gambling and substance use disorders can be comorbid. However, studies examining this concern found that Prize Incentives CM did not promote gambling behavior.
Accessed May 4, 2021 from:
Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine) | National Institute on Drug Abuse (NIDA).