Introduction
Addictive behaviours are common in the populations seen by NHS Talking Therapies, yet clinicians can sometimes feel uncertain about when and how to address them within psychological therapy. Substance use may be viewed as a barrier to treatment, a reason to refer elsewhere, or as something separate from the presenting mental health difficulty. For many people, however, addictive behaviours are closely intertwined with anxiety, depression, trauma and other psychological difficulties.
This half-day workshop will explore how addictive behaviours may be considered within wider psychological therapy. Rather than focusing solely on the substance being used, we will consider what the behaviour is doing for the individual, how it is maintained, and how formulation can identify opportunities for intervention. We will consider how to work effectively with motivation and ambivalence, avoidance, unhelpful beliefs and behavioural patterns.
Particular attention will be given to how clinicians can work within their role and competence while recognising when additional or specialist support may be required. The emphasis throughout will be on practical, evidence-informed strategies that clinicians can use in their everyday practice.
The event will be equivalent to 2.3/4hrs of CPD.
Content
The session will cover:
• Understanding addiction from a CBT perspective and considering why a psychological formulation matters.
• Recognising problematic substance use within NHS Talking Therapies presentations.
• Key principles for assessing substance use
• Developing a collaborative formulation of addictive behaviour.
• Exploring the role of positive and negative reinforcement, avoidance and emotion regulation.
• Understanding ambivalence and using strategies to support motivation for change.
• Identifying unhelpful beliefs about addiction, coping and the person's ability to change.
• Using behavioural experiments and behavioural activation principles to develop alternative sources of reward and coping.
• Developing relapse-prevention and lapse-management strategies.
• Considering how to integrate work on substance use with treatment for anxiety and depression rather than treating them as separate problems.
• Working with shame and self-criticism associated with addictive behaviour.
• Understanding the boundaries of NHS Talking Therapies practice and when to seek additional specialist addiction support.
• Applying the approach to clinical examples relevant to NHS Talking Therapies.
Learning Objectives
By the end of the session, participants will be able to:
1. Identify problematic substance use and and consider its relationship with common mental health difficulties within NHS Talking Therapies.
2. Develop a collaborative formulation that identifies the functions and maintaining factors associated with addictive behaviour.
3. Apply practical strategies to address motivation, triggers, craving, avoidance, coping and relapse prevention.
4. Integrate psychologically informed work on substance use into NHS Talking Therapies interventions while recognising when additional or specialist support is required.
Training Modalities
The session will combine didactic teaching, clinical examples, interactive formulation exercises, self-reflective components and Q&A. Participants will be invited to apply CBT models to clinical scenarios and consider how assessment information can be translated into a formulation and then into specific treatment strategies. Interactive exercises will focus on practical skills that can be incorporated into routine NHS Talking Therapies work.
Key References
Department of Health and Social Care (2025, updated 2026). Clinical guidelines for alcohol treatment. London: DHSC.
Buckman, J.E.J., Naismith, I., Saunders, R., Morrison, T., Linke, S., Leibowitz, J. & Pilling, S. (2018). The impact of alcohol use on drop-out and psychological treatment outcomes in Improving Access to Psychological Therapies Services: an audit. Behavioural and Cognitive Psychotherapy, 46(5), 513–527.
Shahriyarmolki, K., Hemingway, A. & Strang, J. (2025). What leads clinicians to exclude drug and alcohol users from NHS Talking Therapies services? An audit of decision-making within clinical records. The Cognitive Behaviour Therapist.
Beck, A.T., Wright, F.D., Newman, C.F. & Liese, B.S. (1993). Cognitive Therapy of Substance Abuse. New York: Guilford Press.
Marlatt, G.A. & Donovan, D.M. (Eds.). (2005). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors (2nd ed.). New York: Guilford Press.
Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). New York: Guilford Press.
About the presenter
Sarah Stacey is a Consultant Clinical Psychologist. She is an accredited CBT therapist with additional training in DBT, compassion-focused therapy and ACT, and has a particular clinical and professional interest in psychological approaches to addiction and co-occurring mental health difficulties.
Sarah has worked across prison and community addiction services and has extensive experience of developing and delivering psychologically informed interventions for people experiencing complex substance-use and mental health difficulties.
She has held national professional leadership roles within addictions psychology and has contributed to the development of guidance, capability frameworks and psychologically informed approaches across the addictions workforce.
Sarah has extensive experience of teaching, training and supervision and has presented nationally on addiction, trauma-informed practice and psychological approaches to substance use.
Who should attend
This workshop is particularly suitable for clinicians working within NHS Talking Therapies. It will also be relevant to clinicians working in other primary care services, secondary mental health services who want to strengthen their approach to working with addictive behaviours.
The session is aimed at practitioners who may encounter substance use within their routine caseload and want greater confidence in assessing, formulating and responding to this within psychological therapy. It will be particularly useful for clinicians who are unsure about whether addictions can be addressed within NHS Talking Therapies, how to incorporate into a CBT formulation, or when additional specialist addiction input may be needed.
No specialist addiction qualification or previous experience of delivering addiction treatment is required.