Behavioral Therapy

Behavioral therapies focus on changing an individual’s behaviors concerning substance use, in part by teaching life skills that help them to better cope with situations that may lead to substance use and return to use. Several behavioral therapies have shown effectiveness in treating substance use disorders (SUDs), and some therapies are better suited for a particular type of substance. The National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Evidence-Based Practices Resource Center provide additional information about the evidence base for behavioral therapy models.

Evidence-Based Models that Focus on the Individual

• Cognitive-Behavioral Therapy (CBT) – Originally designed for the treatment of depression, CBT is effective in treating multiple types of SUDs. CBT teaches people how to identify problem behaviors and triggers for substance misuse and to develop coping strategies. Research has shown that the effects of CBT continue after therapy sessions are complete. NIDA considers CBT an evidence-based approach for treating a range of SUDs. Learn more about the benefits and costs of CBT.
• Contingency Management Interventions – Contingency management interventions encourage behavior modification through the provision of tangible rewards for a target behavior (for example, abstaining from substance use or attending a meeting). When a patient tests negative for drugs, they receive a reward such as money, vouchers, gift certificates, clinic privileges, or other tokens. Research suggests that contingency management interventions may be effective in the increase of treatment retention and abstinence from drugs. NIDA considers contingency management interventions an evidence-based approach for treating a range of SUDs. Learn more about the benefits and costs of lower cost and higher cost contingency management interventions.
• Community Reinforcement Approach (CRA) Plus Vouchers – CRA Plus Vouchers is an outpatient therapy that uses multiple treatment strategies, including building motivation, analyzing substance use patterns, positive reinforcement, and the involvement of family members in order to engage participants. SAMHSA and NIDA consider CRA an evidence-based approach for treating a range of SUDs. Learn more about the benefits and costs of CRA Plus Vouchers.
• Motivational Interviewing (MI) – MI is a counseling style that is especially beneficial at addressing ambivalence toward unhealthy behaviors. This evidence-based treatment builds an individuals’ confidence in their ability to successfully make a change (self-efficacy), and helps people with SUD explore their own desire for change and begin the process of making a change. MI is designed as a brief intervention and could therefore be beneficial in rural primary care settings where access to specialists may not be possible. NIDA considers MI an evidence-based approach for treating SUD. Learn more about the benefits and costs of MI.
• Motivational Enhancement Therapy – Motivational enhancement therapy (MET) uses motivational interviewing approaches to strengthen motivation for behavioral change. This approach can be used for addressing behaviors from healthy eating to physical activity and behaviors associated with chronic disease. SAMHSA and NIDA consider MET an evidence-based approach for treating a range of SUDs. Learn more about the benefits and costs of MET.
• The Matrix Model – The Matrix Model is an intensive outpatient treatment intervention that has demonstrated particular effectiveness in the treatment of stimulant use disorder. This model is a multi-component intervention, using counseling, recovery skills development, relapse prevention techniques, and social supports to help maintain abstinence. The Matrix Model includes education for friends and family members of the individual with SUD. SAMHSA and NIDA consider the Matrix Model an evidence-based approach for treating SUD. Learn more about the benefits and costs of the Matrix Model.
• Twelve Step Facilitation Therapy – Twelve step facilitation therapy is a brief, structured program that has behavioral, spiritual, and cognitive components. This intervention is based on the principles of 12 step peer support programs like Alcoholics Anonymous and Narcotics Anonymous. However, twelve step facilitation is a therapeutic intervention with a counselor. The therapy can be conducted either in individual or group sessions. SAMHSA and NIDA consider twelve-step facilitation therapy an evidence-based approach for the treatment of SUD.

Family therapy focuses on using the strength and assets of the family to address substance misuse and reduce the impact of the misuse on the individual and family. There are several common family therapy models used to treat SUD.

• Family Behavior Therapy (FBT) – FBT is unique from other therapies in that it involves not only the patient, but a family member or significant other. FBT involves vocational skills training, communication skills training, and training on resisting urges, among other interventions. This intervention has shown positive results in both adults and in adolescents. In addition to treating SUD, FBT also addresses co-occurring issues like child mistreatment, depression, conduct disorders, and family conflict. SAMHSA and NIDA consider FBT an evidence-based approach for the treatment of SUD. Learn more about the benefits and costs of FBT.
• Functional Family Therapy (FFT) – In FFT, therapists work with adolescents and their families to identify the youth’s strengths and protective and risk factors. FFT consists of 12 sessions on average. During this time, therapists work to establish credibility with the family while exploring the dynamics that may affect and change an individual’s behavior while motivating them and also provide the family with resources such as relapse plans. In addition to treating SUD, FFT also addresses delinquency and violence. SAMHSA and NIDA consider FFT an evidence-based approach for the treatment of SUD in adolescents.
• Multisystemic Therapy (MST) – MST is an intensive family and community-based treatment program targeting adolescents aged 12 to 17 who already have a history of arrests related to substance misuse. MST focuses on behavior change among the youth and the parenting skills of their caregivers. MST therapists meet with adolescents at home, school, or other places convenient to the adolescent and family. NIDA considers MST an evidence-based approach for the treatment of SUD in adolescents.
• Multidimensional Family Therapy (MDFT) – MDFT is a family-based outpatient treatment program for adolescents with SUD and co-occurring disorders. MDFT can be offered in a variety of settings. The program is delivered in 12 to 16 weekly or multi-weekly sessions, focusing on interpersonal relationships with parents and peers, parenting practices, parent-adolescent interaction, and improved family communication. NIDA and the National Institute of Justice consider MDFT an evidence-based approach for the treatment of SUD in adolescents. Learn more about the benefits and costs of MDFT.
• Brief Strategic Family Therapy (BSFT) – BSFT was designed to prevent, reduce, and/or treat behavioral issues among adolescents, including substance misuse. Sessions can be conducted in the home or at other locations convenient to the family and are generally delivered in 12 to 16 family sessions. Research indicates that BSFT reduces substance use among adolescents as well as decreases alcohol abuse among parents. NIDA considers BSFT an evidence-based approach for the treatment of SUD in adolescents.
• Behavioral Couples Therapy – In behavioral couples therapy (BCT), therapists work with the individual who has an SUD and their spouse or partner. Spouses and partners are included in SUD treatment to provide support with abstinence and help to prevent relapse. Couples attend therapy sessions together, developing a recovery contract, completing homework assignments, and learning effective communication skills. Research shows that BCT leads to increased abstinence and improved relationships when compared to individual-based treatments. BCT is listed in Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health as an evidence-based treatment for SUD.