Cognitive Behaviour Therapy

Cognitive Behaviour Therapy (CBT) addresses cognitive, affective, and situational triggers for drinking and usually involves ~12 weekly individual sessions. CBT aims to increase drinking refusal self-efficacy through the development of more effective coping strategies. Typically, CBT includes strategies to:  

1. Identify and modify dysfunctional cognitions (cognitive restructuring), especially expectations about the consequences of drinking (alcohol expectancies);
2. Identify and manage high-risk situations for drinking;
3. Improve coping skills, including problem-solving and relaxation;
4. Increase non-drinking related activities. 

CBT is the most extensively evaluated psychosocial treatment for substance use disorders. There is good evidence for its effectiveness as a standalone psychosocial intervention for alcohol dependence against various comparison conditions, including standard care and other active treatments. The therapeutic benefit of CBT is enhanced when combined with pharmacotherapy (Chapter 10) and when delivered in combination with other psychosocial interventions.  

In modern practice, CBT for alcohol dependence typically begins with a comprehensive assessment combined with Motivational Interviewing to resolve ambivalence about change prior to skills training. CBT should be utilised as a first-line psychosocial intervention for alcohol dependence, and for patients who have not responded to lower-intensity intervention.