What is a core focus of cognitive-behavioral therapy (CBT) in substance use disorder treatment?

• A. Using confrontational strategies to force change.
• B. Identifying and altering maladaptive thoughts and behaviors; coping skills, relapse prevention, problem-solving.
• C. Relying on pharmacotherapy alone.
• D. Providing generic group support without skill training.

Answer: (B)

Cognitive-behavioral therapy in substance use treatment centers on how thoughts influence cravings and drug-use behaviors, and on teaching practical skills to change both thinking patterns and actions. It aims to help people identify distorted or maladaptive thoughts that fuel use, and to replace them with more accurate, coping-focused interpretations. Alongside this cognitive work, CBT emphasizes concrete skills: how to cope with cravings, manage high-risk situations, solve problems that block recovery, and plan for relapse prevention.

This approach is the best fit because it explicitly targets both the mental processes (thought patterns that drive use) and the actionable behaviors (coping skills, relapse planning, problem-solving) that sustain substance use and recovery. By practicing these skills and applying them in real-life situations, individuals build the tools needed to maintain abstinence or reduce use, rather than relying on confrontation, pharmacotherapy alone, or generic group support without targeted training.