Cognitive Behavioral Therapy & Mindfulness-

Based Relapse Prevention

CBT basics

CBT for SUD

Psychoeducation.

Teaching skills designed to improve

management of negative emotions.

Identification of maladaptive thinking patterns that may be

related to returning to substance use.

Functional analysis –Helping patients

better understand the function of their substance use.

Identifying triggers to use drugs; increase

coping skills that help patients manage

emotions.

Enhancing interpersonal functioning.

Increasing recovery-focused activities.

Promoting behavioral activation, i.e.,

activities that improve mood & increase

pleasure.

Enhancing drug refusal and problem

solving skills.

Why people return to

using

• According to research*, what we know about why people return to using:

• Self-efficacy• Outcome expectancies• Motivation• Coping (skills for managing high risk situations,

active vs. inactive coping)• Emotional statuses (negative affect, positive)• Craving• Social support

Returning to use: The cycle“Cognitive Behavioral Model of Relapse”

Marlatt & Gordon, 1985

Evidence for CBT

• OUD• No benefit to adding CBT to MAT for OUD (Fiellin et

al., 2013; Ling et al., 2013; & Moore et al., 2012).• Non-OUD SUD

• Modest effect of adding CBT, especially when control group is no treatment (Magill & Ray, 2009).

Hatching a CBT-informed Tx planhttps://www.recoveryanswers.org/resource/stages-of-recovery/

CBT is prefrontal cortex intensive

• Best done when brain not on fire.

References• Fiellin, D. A., Barry, D. T., Sullivan, L. E., Cutter, C. J., Moore, B. A., O'Connor, P. G., & Schottenfeld,

R. S. (2013). A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine. The American journal of medicine, 126(1), 74-e11.

• Ling, W., Hillhouse, M., Ang, A., Jenkins, J., & Fahey, J. (2013). Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction, 108(10), 1788-1798.

• Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. Journal of studies on alcohol and drugs, 70(4), 516-527.

• Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse prevention; maintenance strategies in the treatment of addictive behaviors (2nd ed.). New York, NY: Guilford Press.

• Marlatt, G.A., & Gordon, J.R. (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.

• Moore, B. A., Barry, D. T., Sullivan, L. E., O’Connor, P. G., Cutter, C. J., Schottenfeld, R. S., & Fiellin, D. A. (2012). Counseling and directly observed medication for primary care buprenorphine/naloxone maintenance: a pilot study. Journal of addiction medicine, 6(3), 205.