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A cognitive formulation of substance misuse based on Beck et al.'s (1993) model. Maps the pathway from early experiences through beliefs and automatic thoughts to substance use and its maintaining cycle.
Work through each section to develop a shared understanding of how substance use developed and what maintains it. This formulation should be completed collaboratively between therapist and client, and revisited as therapy progresses.
Use in the assessment and formulation phase of CBT for substance misuse. Map the cognitive, behavioural, emotional, and situational factors maintaining the client's substance use, including trigger situations, permissive beliefs, and the role of substance use in the client's coping repertoire.
Frame as understanding the bigger picture of substance use — not just what the client uses, but why, when, and what keeps the pattern going. Use Beck et al.'s cognitive model of substance misuse to map anticipatory beliefs, relief-oriented beliefs, and permissive beliefs.
For clients using multiple substances, formulate each substance separately initially, then identify common maintaining factors. For those with comorbid mental health conditions (depression, anxiety, PTSD), formulate the interaction between substance use and the comorbid condition explicitly.
If the client is in acute withdrawal or intoxicated, defer formulation until they are medically stable and cognitively able to engage. If the client is pre-contemplative about change, focus on motivational work before detailed formulation.
Key maintaining factors to map include: high-risk situations, drug-related beliefs and expectancies, automatic thoughts ('Just one won't hurt'), emotional triggers, social reinforcement, and avoidance of withdrawal. The formulation should make clear why the client uses substances despite the costs — understanding the function is essential for finding alternatives.
Suitable for clients working with substance-misuse, formulation, cbt, beck, cognitive-model. This tool can be used as a standalone worksheet or as part of a structured homework plan.
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Weigh up the pros and cons of continuing to use substances versus making a change. A core motivational interviewing technique.
Track urges to use substances without acting on them. Practice the skill of riding the wave of craving until it passes.
A simplified motivational tool to explore your reasons for and against changing your substance use.
Explore the triggers, thoughts, feelings, and consequences associated with substance use to understand its function in your life.