Rational emotive behavior therapy for substance use

Rational emotive behavior therapy (REBT) is one of the oldest cognitive approaches in psychotherapy. It rests on a simple claim: people are upset less by events than by the rigid beliefs they hold about those events. In substance use settings REBT is better known as a source of ideas than as a heavily tested treatment, and this page keeps that distinction in view.

What REBT is

The APA Dictionary of Psychology defines REBT as a form of cognitive behavior therapy based on the idea that self-defeating beliefs cause negative feelings and undesirable behavior. Albert Ellis developed it in 1955. A person's problems, in this view, come from turning healthy desires for success, approval or pleasure into demands, such as "I must achieve outstandingly well or I am inadequate."

The therapy has had several names. The APA entry says it began as rational therapy, became rational emotive therapy, and took its present name during the 1990s. Because REBT treats thinking, feeling and acting as linked, it uses cognitive, emotional and behavioral techniques to interrupt irrational beliefs and encourage more effective ones.

How it works: the ABC model

REBT's core framework is called ABC theory. According to the APA Dictionary, Activating events (adversities) are mediated by irrational Beliefs in producing emotional and behavioral Consequences. In plain terms, the event does not directly cause the reaction; the belief about the event does.

Applied to substance use, the chain might run like this: an argument happens (A), the person believes "I can't stand this feeling and I have to escape it" (B), and drinking or using follows (C). The therapist and patient look for the demand inside the belief and work on holding a more flexible view. The APA lists an extended ABCDE technique as a related entry, which adds steps for working on the belief.

The link to SMART Recovery

REBT is connected to a mutual-help program called SMART Recovery. In a tribute published by the REBT Network, authors Tom Horvath and Alan Marlatt call Ellis the "patron saint of SMART Recovery" and write that he is widely viewed within it as the foundation of its cognitive-behavioral approach to addiction. They describe members doing "their ABCs" and watching for thinking habits such as awfulizing and catastrophizing. They also say Ellis supported the organization by reviewing books for its newsletter, hosting trainings at his institute, and serving on its advisory council. The piece is a tribute written by people close to the program, not an independent evaluation, and it is undated. For how such groups are described neutrally, see mutual-help groups.

What sessions can look like

The sources opened for this page do not describe a standard REBT session for substance use. A review of an REBT-based book on people with co-occurring problems, published by SMART Recovery, says the book presents constructed demonstration sessions in which Ellis works with people who use methamphetamine, alcohol or cannabis, some also living with serious mental health conditions. The APA description says REBT uses a variety of cognitive, emotional and behavioral techniques, so sessions may mix discussion of beliefs with exercises and practice between meetings. A clinician can explain what a course would involve.

What the research says

REBT as a whole has been studied widely. A 2024 systematic review in PLOS ONE found 162 REBT intervention studies across many settings. Overall they reported fewer irrational beliefs, more rational beliefs and better mental health outcomes such as lower depression. The reviewers also reported that methodological quality was good in sport and exercise studies but low in all other areas, with poor reporting of how interventions were delivered, and that the studies were too varied to pool in a meta-analysis.

That review was not limited to substance use. Among the sources opened for this page, none gave a clear, trial-based summary of REBT outcomes for substance use disorders in particular, so the honest summary is that substance-specific evidence is limited. Closely related approaches have a stronger record; cognitive behavioral therapy is the best known, and the National Institute on Drug Abuse (NIDA) lists it among the behavioral therapies that help people change unhealthy thought processes that lead to substance use.

Limits and who it may not suit

• Because the substance-specific research is thin, REBT is hard to compare directly with CBT, motivational interviewing or acceptance and commitment therapy.
• The sources opened here do not say who should avoid REBT. Because the approach involves reflecting on beliefs, timing and fit are questions for a clinician.

Anyone with a co-occurring condition may benefit from reading about dual diagnosis before choosing an approach.

Questions to ask a clinician

• Do you practice REBT, CBT or a blend, and how is it used for substance use?
• What is the evidence for this approach for someone in my situation?
• How would we spot the beliefs that come before cravings or use?
• Can this be combined with a mutual-help program I may already attend?
• What would we do if progress stalls?