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What Is Cognitive Behavioral Therapy? Expert Interview with Dr. Andrew Mendonsa

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Dr. Mendonsa Shares How Reframing Your Thoughts Can Help You Reclaim Your Life.

If you or a loved one has ever struggled with substance abuse, you’ve probably learned that overcoming physical addiction is only part of the recovery journey. Learning to cope with stress, negative thoughts, and the urge to use drugs or alcohol is a lifelong process. This is why many leading addiction treatment centers recommend therapy after detox. One of the most common, and effective, approaches to therapy is called cognitive behavioral therapy (CBT). 

We talked to Dr. Andrew Mendonsa, a clinical psychologist who specializes in cognitive behavioral therapy, to learn more about how CBT helps individuals who struggle with addiction.    

What Is Cognitive Behavioral Therapy?

Before we explore cognitive behavioral therapy and addiction, let’s first look at how it works. 

Cognitive behavioral therapy is a form of psychological counseling that helps people change their behavior by identifying, then interrupting, harmful thought patterns. The treatment is short-term and goal-oriented, meaning it focuses on solving specific problems, like managing stress, rather than trying to explain how an addiction began. This practical approach helps clients stay focused and motivated. 

Whether as a stand-alone treatment or as part of a combination of treatments, cognitive behavioral therapy can help with a variety of conditions. Originally developed to treat depression, CBT also helps clients with anxiety, post-traumatic stress disorder (PTSD), eating disorders and, of course, substance abuse. 

A core principle of cognitive behavioral therapy is that psychological problems are based on maladaptive thought patterns and learned behaviors. Much of CBT focuses on recognizing harmful behavior before it escalates.  

“Behavior drives addiction,” explains Dr. Mendonsa. “Just one negative thought, or what we call a ‘drug dream,’ can set in motion the behavior. If you can stop that cascading sooner, you can stop the behavior.”  He outlined three common thought patterns that can lead to addictive behavior: 


Denial replaces the reality of addiction with a false narrative that feels more appealing. People in denial might think: “When I got high, life was actually pretty good.” They might reminisce about getting high with friends, rather than focusing on negative consequences, such as the job they lost or the legal trouble they experienced. Without acknowledging these consequences, they have no incentive to stop using. 


A “minimizing” mindset downplays negative consequences, while finding ways to justify harmful behavior. Those prone to this kind of thinking might acknowledge that drugs have caused problems in the past, but they tell themselves that this time, things will be different. They tend to think: “I can still manage my life and use drugs on occasion. I’m more in control of this now.”   


Catastrophizing is the opposite of minimizing. This form of black-and-white thinking turns even mild setbacks into catastrophes, creating a feeling that all hope is lost. For people with this mindset, a less-than-stellar review at work might become an irrational spiral into self-doubt and fear of losing one’s job. A minor fight with a spouse might lead to the feeling that divorce is imminent. Under this mindset, further consequences don’t matter. The thinking becomes: “I might as well use. I’m beyond help.”       

All of the above narratives are harmful. Left uninterrupted, each can lead to continued drug use. This is where cognitive behavioral therapy can help. 


Reframing Negative Thoughts

Cognitive behavioral therapy gives clients a healthier mental script to follow when negative thoughts arise, says Dr. Mendonsa. Rather than letting maladaptive thoughts escalate toward harmful behavior, CBT helps clients put the consequences of different choices in perspective. 

“It’s really peeling back the onion, so you go from A to B, instead of A to Z,” he explains. “The ‘all or nothing’ mindset is the kind of thinking we’re born with. We need speed bumps to change that.” 

The coping mechanisms learned in cognitive behavioral therapy act as these speed bumps. Psychologists will often start by asking clients to keep a thought record, since journaling can help identify the situations that spark negative thoughts. The goal is to recognize the thoughts that are likely to lead to unwanted behavior. 

“I’ll say, ‘Let’s back it up. What were you thinking?’” Dr. Mendonsa explains. He encourages clients to then stop and evaluate their thoughts. That interruption is what slows down the path from impulse to action.

When stressful situations arise, Dr. Mendonsa also recommends finding ways to boost the brain’s serotonin. This might include getting exercise, calling a good friend, or even playing video games. 

“Serotonin is what the brain needs to cope, but the brain doesn’t necessarily care how this need is met,” says Dr. Mendonsa. “Going for a run is almost as good as taking a Valium.” 

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When Rethinking Doesn’t Work 

Sometimes, clients still feel the urge to use drugs or alcohol after learning coping mechanisms through cognitive behavioral therapy. In these cases, Dr. Mendonsa encourages clients to focus on what prompted them to seek help. 

“Remember those five most toxic, poignant reasons,”  he recommends. “Remember the situation that prompted counseling.” 

With time, it becomes easy to forget that it took five or 10 years to rebound from substance abuse, Dr. Mendonsa explains. Keeping a decisive event or a primary motivation in mind, whether it’s remembering an overdose or focusing on the desire to raise a healthy child, can help individuals keep the consequences of addiction in focus even as the years pass. 

Ultimately, tapping into personal motivation is the key to freedom from addiction. “Scared straight rarely works,” says Dr. Mendonsa. “Change that comes from within is the most powerful.”

Through CBT, clients can learn to reframe their thoughts, and in the process, reclaim their lives. 

If you or a loved one struggles with addiction, know that you are not alone. Call the number below to take the first step. Sprout Health Group will help you find the right path toward real, lifelong recovery. 

Written By: Sprout Editorial Team

The Sprout Health Group editorial team is passionate about addiction treatment, recovery and mental health issues. Every article is expert-reviewed.