The University of Arizona

Treatment Modalities and Treatment Settings for Illicit Drug Abuse
Psychosocial Treatment:
Behavioral Therapy

Behavioral therapy is based on learning theory which deals with the role of externally applied positive or negative contingencies on the learning of behaviors, including complex behaviors such as using drugs. Substance abuse is seen as behavior that is reinforced by consequences such as how it makes the user feel (better, stronger, etc.). Additionally, internal and external cues, which are reminders or associations with substance use, are thought to trigger craving and desires to use again.[1] All behavioral therapies have the same goal: to stop substance abuse by changing contingencies. This can be accomplished by (1) rewarding behaviors that are inconsistent with substance abuse, (2) removing or deactivating the cues that initiate substance abuse, and/or (3) pairing unpleasant experiences with substance abuse. Specific types of behavioral therapies are described below.

Contingency Management

Contingency management (CM) interventions are reported to be among the most successful behavioral therapies for the treatment of substance abuse.[2,3] The conceptual basis for CM approaches came from the view that drug use is a form of operant behavior, and therefore making available non-drug reinforcers should decrease drug use.[3] In general, CM is a behavioral therapy that provides immediate reinforcement in the form of cash or voucher incentives as long as the patient can provide biological evidence of drug abstinence.[4]

Community Reinforcement Approach

The community reinforcement approach (CRA) is based on the theory that environmental reinforcers for substance use perpetuate substance use disorders and that, at the same time, patients with substance use disorders lack positive environmental reinforcers for sober activities and pleasures.[5,6]

CRA provides the means of changing various lifestyle choices in order to have a successful recovery. This includes:[7]

  • Marital therapy for non-user spouses of clients
  • Guidance for clients who are unemployed, employed in high-risk jobs for substance abuse, or any other reason for which vocational help is needed
  • Counseling and assistance in developing new social networks and recreational practices to support recovery
  • Various types of skills training depending on the patient’s needs

Overall, CRA aims to improve the social environment of a substance abuser so that a sober lifestyle is seen as more preferable than a substance-dependent lifestyle.[5]

Cue Exposure and Relaxation Training

Cue exposure therapy refers to treatment in which an abstinent drug user is exposed to cues that induce craving for a drug while preventing the user’s habitual response; that is, actual use of the drug. Cue exposure therapy can be paired with relaxation techniques and drug-refusal training to facilitate the extinction of classically conditioned craving.[5]

Aversion Therapy

This treatment prevents substance use behaviors by combining them with punishment. It couples substance use with an unpleasant experience such as a mild electric shock or medically induced vomiting.[5]



  • (1) Carroll KM, Onken LS. Behavioral Therapies for Drug Abuse. American Journal of Psychiatry 2005;162(8):1452-60.
  • (2) Roll JM, Shoptaw S. Contingency management: Schedule effects. Psychiatry Research 2006 Sep 30;144(1):91-3.
  • (3) Roll JM, Petry NM, Stitzer ML, Brecht ML, Peirce JM, McCann MJ, et al. Contingency management for the treatment of methamphetamine use disorders. American Journal of Psychiatry 2006 Nov;163(11):1993-9.
  • (4) Shoptaw S, Klausner JD, Reback CJ, Tierney S, Stansell J, Hare CB, et al. A public health response to the methamphetamine epidemic: the implementation of contingency management to treat methamphetamine dependence. BMC Public Health 2006 Aug 18;6:214-8.
  • (5) American Psychiatric Association. Practice Guideline for the Treatment of Patients with Substance Use Disorders. Arlington, VA: APA; 2007 Apr. Report No.: 164.
  • (6) Meyers RJ, Smith JE. Clinical Guide to Alcohol Treatment: The Cimmunity Reinforcement Approach. New York: Guilford; 1995.
  • (7) CSAT. TIP 34: Brief Interventions and Brief Therapies for Substance Abuse. Treatment Improvement Protocols.Rockville, MD: SAMHSA; 1999.