Behavioral Therapy Models
Behavioral therapies focus on changing an individual's behaviors concerning substance misuse, in part
by teaching life skills that help them to better cope with situations that may lead to substance
misuse and relapse. 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
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
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.
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.
Evidence-Based Models that Focus on the 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.
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.
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.
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.
Examples of Behavioral Therapy Models
The Southwest Montana Community Health
Center in Butte, Montana, has provided training in motivational interviewing for
all staff and provides cognitive behavioral therapy as part of its SUD screening and treatment program.
Great Lakes Recovery
Centers, serving the counties located in Michigan's Upper Peninsula, offers a variety
of outpatient services for alcohol use disorder and other SUDs. The centers provide SUD assessment and
counseling, as well as individual and group counseling.
The Na'nizhoozhi Center, Inc., in Gallup, New Mexico, has adapted the community-reinforcement
approach to serve Navajo Native Americans with alcohol use disorder in a residential program.
Appalachian State University has conducted a study in rural
western North Carolina on implementing the Matrix Model in rural communities. Preliminary findings
have shown that the Matrix Model resulted in high percentages of clients demonstrating continuous
abstinence from stimulants.
Considerations for Implementation
To be effectively implemented, many behavioral therapies require training. Trainings may be either in
person or online. Travel, certification fees, and other training expenses may be a
barrier for rural providers.
Some behavioral therapy models have tested computerized or web-based versions with promising results.
Examples of effective electronic-based therapies include:
A computer-assisted or web-based version of behavioral therapy could have significant benefits on the
expansion of behavioral therapy interventions to rural communities where transportation and access to
care are barriers to treatment.
management interventions does not necessarily require a counselor or other staff who have been formally
trained in behavioral therapy. The ability to implement the intervention with other healthcare providers can
benefit rural communities with limited mental health providers. Limitations to using contingency management
include costs for incentive items and lack
of familiarity with the intervention.
The community reinforcement
approach (CRA) also offers benefits to rural communities, including flexibility and adaptability
for implementation. CRA has been integrated into a family therapy approach
(community reinforcement and family training, or CRAFT) where concerned family members or significant others
receive assistance addressing resistance to
treatment from the person with SUD. Additionally, CRA Plus Vouchers has been effectively adapted for
adolescents aged 13 to 25.
While MI is typically used as a brief intervention for facilitating patients' entry into treatment, MI can be
used effectively as a stand-alone treatment in rural communities where patients may experience challenges
accessing treatment programs. MI can be integrated into a variety of treatment settings, making it beneficial to
rural communities that may lack intensive inpatient treatment programs.
Program Clearinghouse Example
Resources to Learn More
Provides two-day training for organizations and individuals in the Matrix Model, an evidence-based
outpatient SUD treatment and behavioral health program that can be customized for different needs and
settings. Offers on-site trainings in multiple locations.
Cognitive-Behavioral Therapy for
Substance Use Disorders
Provides background information on the use of cognitive behavioral therapy (CBT) for SUDs, covering
the treatment elements and common challenges.
Author(s): McHugh., R., Hearon, B., & Otto, M.
Citation: The Psychiatric Clinics of North America, 33(3), 511-525
Motivation for Change in Substance Use Disorder Treatment
Offers SUD treatment providers background information on motivational interviewing and tips on its
Organization(s): Substance Abuse and Mental Health Services Administration
Family Therapy (FFT)
Provides background information and evidence of effectiveness supporting functional family therapy
(FFT) as a treatment methodology for SUD in adolescents.
Organization(s): County Health Rankings & Roadmaps
Program Profile: Adolescent Community Reinforcement
Describes the Adolescent Community Reinforcement Approach (A-CRA), an effective outpatient program
for adolescents to replace alcohol and drug use with positive behaviors. Presents information on
evaluation outcomes and methodology used in case studies.
Organization(s): National Institute of Justice