In CBT for substance use, what is cognitive restructuring?

• A. Identifying and reinforcing use-related thoughts to increase control.
• B. Ignoring automatic thoughts to reduce distress.
• C. Identifying and challenging automatic, maladaptive thoughts about use and replacing them with healthier alternatives.
• D. Only changing behavior without addressing thoughts.

Answer: (C)

Cognitive restructuring in CBT for substance use focuses on the quick, automatic thoughts people have about drinking or using, and the process of examining and changing those thoughts rather than simply reacting to them. The correct approach involves spotting these automatic, often distorted thoughts, challenging their accuracy or usefulness, and replacing them with more balanced, adaptive beliefs. For example, when a craving surfaces with “I’ll never cope without a drink,” the client learns to test that thought—recognizing that cravings are temporary, that they have successfully managed urges before, and that effective coping skills are available. The new, healthier thought might be, “Cravings pass and I can handle this with my coping plan.” This is what makes cognitive restructuring the best answer: it directly targets the beliefs that sustain use and reshapes them, rather than reinforcing use-related thoughts, ignoring thoughts, or changing only behavior without addressing the underlying cognition.