National Institute on Alcohol Abuse and Alcoholism

Project MATCH Monograph Series

Volume 3

COGNITIVEBEHAVIORAL

COPING SKILLS

THERAPY

MANUAL

A Clinical Research Guide for

Therapists Treating Individuals

With Alcohol Abuse and Dependence

Compiled and edited by:

Ronald Kadden, Ph.D.

Kathleen Carroll, Ph.D.

Dennis Donovan, Ph.D.

Ned Cooney, Ph.D.

Peter Monti, Ph.D.

David Abrams, Ph.D. 

Mark Litt, Ph.D.

Reid Hester, Ph.D.

Project MATCH Monograph Series Editor: 

Margaret E. Mattson, Ph.D.

U.S. Department of Health and Human Services

Public Health Service

National Institutes of Health

National Institute on Alcohol Abuse and Alcoholism 

6000 Executive Boulevard

Rockville, Maryland 20892-7003
Project MATCH is supported by grants under a cooperative 

agreement funded by the National Institute on Alcohol Abuse and 

Alcoholism (NIAAA) and implemented by nine clinical research 

units and a data coordinating center. The project was initiated 

and is administered by the Treatment Research Branch, NIAAA.

COPYRIGHT STATUS

This volume is adapted from copyrighted material that is reproduced 

herein with the permission of the copyright holders. Before reprinting 

any part, readers are advised to determine the copyright status and 

to secure permission of the copyright holders. The authors would 

particularly like to thank Guilford Press for their kind permission 

to use extensive portions of the book Treating Alcohol Dependence: 

A Coping Skills Training Guide in the original version of the Project 

MATCH manual and in the overview of this volume.

The views and opinions expressed on the following pages are 

solely those of the authors and do not necessarily constitute an 

endorsement, real or implied, of the Institute or the U.S. Department 

of Health and Human Services.

NIH Publication No. 94–3724

Reprinted 2003
iii

Acknowledgments

Project MATCH Research Group and

Other Contributors

William Miller, Ph.D.

Reid Hester, Ph.D.

Center on Alcoholism, Substance Abuse and Addictions

University of New Mexico

Albuquerque, NM

Gerard Connors, Ph.D.

Robert Rychtarik, Ph.D.

Research Institute on Alcoholism

Buffalo, NY

Carrie Randall, Ph.D.

Raymond Anton, M.D.

Medical University of South Carolina and 

Veterans Administration Medical Center

Charleston, SC

Ronald Kadden, Ph.D.

Ned Cooney, Ph.D.

University of Connecticut School of Medicine

Farmington, CT

Carlo DiClemente, Ph.D. 

Joseph Carbonari, Ed.D. 

University of Houston 

Houston, TX

Allen Zweben, DSW

University of Wisconsin-Milwaukee

Milwaukee, WI

Richard Longabaugh, Ed.D. 

Robert Stout, Ph.D.

Brown University

Providence, RI

Principal and 

Coinvestigators 

at the Sites
iv

Cognitive-Behavioral Coping Skills Therapy Manual

Dale Walker, M.D.

Dennis Donovan, Ph.D.

University of Washington and Seattle VA Medical Center

Seattle, WA

Coordinating 

Center

Principal and 

Coinvestigators

Thomas Babor, Ph.D.

Frances Del Boca, Ph.D. 

University of Connecticut 

Farmington, CT

Kathleen Carroll, Ph.D.

Bruce Rounsaville, M.D.

Yale University 

New Haven, CT

Contributing 

Authors

Peter Monti, Ph.D.

David Abrams, Ph.D.

Butler Hospital/Brown University

Providence, RI

Mark Litt, Ph.D.

University of Connecticut Health Center

Farmington, CT

NIAAA Staff John Allen, Ph.D.

Project Officer for Project MATCH 

Chief, Treatment Research Branch

Margaret Mattson, Ph.D.

Staff Collaborator for Project MATCH

Cooperative 

Education 

Program

Consultants

Lisa Marshall

Gallaudet University

Washington, DC

Larry Muenz, Ph.D.

Gaithersburg, MD

Philip Wirtz, Ph.D.

George Washington University

Washington, DC

Contractor Jane K. Myers

President

Janus Associates

Bethesda, MD
v

Foreword

A major focus of the efforts of the National Institute on Alcohol Abuse 

and Alcoholism (NIAAA) in treatment research is to rigorously test the 

patient-treatment matching approach to the clinical management of 

alcoholism. This commitment is particularly reflected in its multi-site 

clinical trial, Project MATCH. This study is the first national, multisite 

trial of patient-treatment matching and one of the two largest current 

initiatives of NIAAA. Established under a cooperative agreement that 

allows direct collaboration between the Institute and the researcher, 

the project involves nine geographically representative clinical sites 

and a data coordinating center. Researchers in Project MATCH are 

among the most senior and experienced treatment scientists in the 

field. Both public and private treatment facilities, as well as hospital 

and university outpatient facilities, are represented.

The manuals in this series are the result of the collaborative efforts of 

the Project MATCH investigators and are used as guides by therapists 

in the trial. They are presented to the alcohol research community as 

standardized, well-documented intervention tools for alcoholism treatment research. The final reports of Project MATCH will inform us on 

the relative efficacy of the interventions being evaluated in the trial and 

on the types of clients who benefit the most from each of the therapies.

Until the final results from Project MATCH are presented to the community, these interim manuals will summarize the consensus of the 

investigators on reasonable intervention approaches based on present 

knowledge. We look forward to offering further refinements of these 

approaches as Project MATCH data are analyzed and published and as 

the alcohol treatment field advances through the efforts of other ongoing research.

Enoch Gordis, M.D.

Director

National Institute on Alcohol Abuse and Alcoholism

vii

Preface

This manual for therapists is provided to the public to permit replication of the treatment procedures employed in Project MATCH, a 

multisite clinical trial of patient-treatment matching sponsored by 

the National Institute on Alcohol Abuse and Alcoholism (NIAAA). It 

describes Cognitive-Behavioral Coping Skills Therapy (CBT), one of 

three treatment approaches studied in Project MATCH. Therapist manuals for the other treatments—Twelve-Step Facilitation Therapy (TSF) 

and Motivational Enhancement Therapy (MET)—are available in volumes 1 and 2 of this series, respectively.

Rationale for

PatientTreatment

Matching

Although a number of therapies have had varying degrees of success, 

no single treatment has been shown to be effective for all individuals 

diagnosed with alcohol abuse or dependence. In recent years, interest 

in the field has increasingly focused on patient-treatment matching to 

improve outcome. The hypothesis is that more beneficial results can 

be obtained if treatment is prescribed on the basis of individual patient 

needs and characteristics as opposed to treating all patients with the 

same diagnosis in the same manner.

Many investigators have turned their attention from main effects evaluations (i.e., studies that ask whether one intervention is more effective 

than another) to studies specifically designed to identify interactions 

between particular treatments and patient variables. While treatments 

may not appear to differ in effectiveness when applied to a heterogeneous client population, specific treatments may indeed be more or 

less effective for specific, clinically meaningful subgroups.

This reasoning has led to a new generation of alcoholism treatment 

research studies whose design is driven by the objective of finding 

effective “matches.” Ultimately, the goal of this line of research is to 

provide the clinician with valid and practical rules applicable across 

a variety of treatment settings to assign patients to those treatment 

regimens particularly suited to them.
viii

Cognitive-Behavioral Coping Skills Therapy Manual

Project

MATCH:

An Overview

Project MATCH, a 5-year study, was initiated by the Treatment Research 

Branch of NIAAA in 1989. The details of the design and implementation 

of Project MATCH will be described in full in forthcoming publications. 

This section outlines the major features of the study.

The objective of Project MATCH is to determine if varying subgroups 

of alcohol abusing or dependent patients respond differentially to 

three treatments: (1) Twelve-Step Facilitation Therapy, (2) CognitiveBehavioral Coping Skills Therapy, and (3) Motivational Enhancement 

Therapy. Each treatment is delivered during a 12-week period by 

trained therapists following a standardized protocol.

The project consists of two independent treatment-matching studies, 

one with clients recruited at five outpatient settings, the second with 

patients receiving aftercare treatment at four sites following an episode 

of standard inpatient treatment. Patients are randomly assigned to one 

of the three treatment approaches. Each study evaluates the interaction effects between selected patient characteristics and the three 

treatments.

Each of the nine study sites is recruiting approximately 150–200 clients. 

Clients are evaluated at intake and again at 3, 6, 9, 12, and 15 months. 

Outcome measures for the trial include drinking behavior, psychological and social function, and consequences of drinking. Analyses of a 

priori hypotheses, as well as exploratory analyses, will show whether 

different patient characteristics are associated with differential treatment outcomes in each of the three therapeutic interventions.

Cognitive-Behavioral Therapy. This therapy is based on the principles 

of social learning theory and views drinking behavior as functionally 

related to major problems in the person’s life. It posits that addressing 

this broad spectrum of problems will prove more effective than focusing on drinking alone. Emphasis is placed on overcoming skill deficits 

and increasing the person’s ability to cope with high-risk situations 

that commonly precipitate relapse, including both interpersonal difficulties and intrapersonal discomfort, such as anger or depression. The 

program consists of 12 sessions with the goal of training the individual 

to use active behavioral or cognitive coping methods to deal with problems, rather than relying on alcohol as a maladaptive coping strategy. 

The skills also provide a means of obtaining social support critical to 

the maintenance of sobriety.

Twelve-Step Facilitation Approach. This therapy is grounded in the 

concept of alcoholism as a spiritual and medical disease. The content of this intervention is consistent with the 12 Steps of Alcoholics 

Anonymous (AA), with primary emphasis given to Steps 1 though 5. In 

addition to abstinence from alcohol, a major goal of the treatment is 

to foster the patient’s commitment to participation in AA. During the 
ix

Preface

course of the program’s 12 sessions, patients are actively encouraged 

to attend AA meetings and to maintain journals of their AA attendance 

and participation. Therapy sessions are highly structured, following 

a similar format each week that includes symptoms inquiry, review 

and reinforcement for AA participation, introduction and explication 

of the week’s theme, and setting goals for AA participation for the next 

week. Material introduced during treatment sessions is complemented 

by reading assignments from AA literature.

Motivational Enhancement Therapy. MET is based on principles 

of motivational psychology and is designed to produce rapid, internally motivated change. This treatment strategy does not attempt to 

guide and train the client, step by step, through recovery, but instead 

employs motivational strategies to mobilize the client’s own resources. 

MET consists of four carefully planned and individualized treatment 

sessions. The first two sessions focus on structured feedback from the 

initial assessment, future plans, and motivation for change. The final 

two sessions at the midpoint and end of treatment provide opportunities for the therapist to reinforce progress, encourage reassessment, 

and provide an objective perspective on the process of change.

Caveats and

Critical

Considerations

Although all three manuals were developed for a randomized clinical trial focusing on patient-treatment matching hypotheses, the 

substance of the interventions is equally suitable for other research 

questions and designs. However, the reader needs to be aware of the 

parameters of Project MATCH.

Therapy is delivered in a structured research situation. All three treatments are manual guided and administered by experienced therapists 

who receive specialized training in one of the three project interventions. 

Therapists closely follow the procedures outlined in their manual, with 

regular supervision (by observation of videotapes) from both local and 

projectwide clinical supervisors.

This manual is written for therapists with similar intensive training 

and supervision. A summary of the procedures used to select, train, 

and supervise therapists in Project MATCH is provided in appendix B.

There is an important difference between a therapy textbook and a 

therapy manual. A therapy textbook is a comprehensive presentation 

of a particular therapeutic approach, usually describing a conceptual 

model, general principles, and a broad range of applications and examples. It is typically meant to facilitate broad utilization of a therapeutic 

approach by a wide range of practitioners in a variety of settings. A 

therapy manual, on the other hand, is intended to operationalize and 

standardize a treatment approach to be used in a particular context, 

usually a specific clinical trial. In writing a therapy manual, the authors 
x

Cognitive-Behavioral Coping Skills Therapy Manual

must make a number of specific decisions (e.g., the number and timing 

of sessions, the content of each session) that are ordinarily left to clinical judgment in a therapy textbook.

This manual is designed to standardize CBT as a 12-session treatment modality within the particular context of Project MATCH. All 

treatments are preceded by the same extensive assessment battery, 

requiring approximately 7–8 hours. Abstinence is the expressed goal of 

all treatments, and except in unusual situations, all sessions are videotaped. Each treatment session is preceded by a breath test to ensure 

sobriety, and a positive breath alcohol reading results in rescheduling the session. Therapists are prohibited from mixing CBT with other 

treatment approaches, and the purity of approach is maintained by 

local and national supervisors who review videotapes. All therapy has 

to be completed within 90 days. A significant other can be invited to 

participate in up to two sessions.

Other design requirements of clinical trials are likewise standardized 

across all sites, including features such as defined patient eligibility 

criteria, randomized assignment of treatment, and guidelines for dealing with patients who are late or absent for treatment sessions or who 

show significant clinical deterioration during the course of the intervention. Guidelines regulate and document the amount and type of 

therapy over and above that provided by Project MATCH that a client 

receives during the study. Data collection and delivery of treatment 

are kept strictly separate, with the former being handled by research 

assistants under the supervision of the project coordinators. The three 

manuals refer to these Project MATCH-specific procedures with the 

knowledge that some readers may wish to follow similar guidelines, 

while others may choose to devise new guidelines more appropriate to 

the requirements of their own project.

The therapeutic approach that underlies this manual is described in 

the references cited in the bibliography. The specific session-by-session 

instructions to the therapists were drawn from a number of sources. 

Chief among these was a previously published therapists’ manual, 

Treating Alcohol Dependence: A Coping Skills Training Guide by Monti, 

Abrams, Kadden, and Cooney (1989). The integration of material from 

the Monti text and other source material as well as the modifications 

introduced to address the requirements of Project MATCH are described 

in detail in the introduction.

The general therapeutic principles underlying CBT can be applied in 

many other ways than those delineated here. Under ordinary circumstances, the number, duration, and distribution of sessions could be 

flexible. Significant others might be involved in all sessions or none at 

all. The goals of therapy might be more flexible, and cognitive-behavioral procedures could be intermixed with other therapeutic strategies. 

The specific prescriptions outlined in this manual are imposed for 
xi

Preface

purposes of standardization and separation of treatments in Project 

MATCH.

The staff of Project MATCH and NIAAA make no claims or guarantees 

regarding the effectiveness of the treatment procedures described in 

this manual. Although the principles of CBT are well-grounded in clinical and experimental research, the specific efficacy of CBT as outlined 

in this manual remains to be tested. The final reports of Project MATCH 

will provide clearer information on the efficacy of this approach relative 

to others and on the types of clients for whom it may be optimal. In the 

interim, this manual offers a detailed description of CBT procedures as 

constructed by consensus among the investigators and implemented 

by the therapists of Project MATCH. All manuals of this kind should be 

regarded as under development and subject to ongoing improvement 

based on subsequent research and experience.

The planning and operation of Project MATCH and the products now 

resulting from it, including this series of manuals, reflect the efforts of 

many individuals over a period of several years. Their dedication and 

collegial collaboration have been remarkable and will enrich the field of 

alcoholism treatment research for years to come.

Margaret E. Mattson, Ph.D.

Project MATCH Staff Collaborator

Project MATCH Monograph Series Editor

Division of Clinical and Prevention Research

National Institute on Alcohol Abuse and Alcoholism

xiii

 Contents

Page

Acknowledgments ..................................................................... iii

Foreword .................................................................................... v

Preface ..................................................................................... vii

Introduction ................................................................................1

Modifications to Monti et al. ..................................................2

Additions ..........................................................................2

Group Versus Individual Therapy .....................................2

Length of Treatment ........................................................ 3

Supporting Data ....................................................................3

References .............................................................................5

Overview of the Program ............................................................ 7

Rationale for Outpatient Treatment .......................................7

Treatment Goals ....................................................................7

Client Role ............................................................................8

Therapist Role .......................................................................8

Adherence to the Manual ...................................................... 9

Menu of Topics ......................................................................9

Outpatient Versus Aftercare Settings .................................. 10

Discussion of Clients’ Recent Problems ............................... 11

Structure of Sessions ......................................................... 11

Guidelines for Behavior Rehearsal Role Plays ..................... 12

Homework .......................................................................... 14

Coping Skills Training With Significant Others ................... 15

Preventing Attrition ............................................................ 15

Alcohol and Other Drug Use ............................................... 16

Absences ............................................................................ 17

Lateness ............................................................................. 17

Extra Sessions ................................................................... 18

Concurrent Treatment ........................................................ 18

Clinical Deterioration ......................................................... 18

Termination ....................................................................... 18

Core Sessions .................................................................... 19

Session 1: Introduction to Coping Skills Training ..................... 21

Building Rapport ................................................................ 21

Conceptualizing Treatment: What Is Alcoholism? ................ 22

Assessing High-Risk Situations .......................................... 23
xiv

Cognitive-Behavioral Coping Skills Therapy Manual

Page

Motivation ...........................................................................23

Contract and Ground Rules ................................................ 24

Homework .......................................................................... 24

Session 2: Coping With Cravings and Urges to Drink .................27

Rationale .............................................................................27

Skill Guidelines ...................................................................27

In-Session Exercises ............................................................31

Session 3: Managing Thoughts About Alcohol and Drinking .......35

Rationale .............................................................................35

Skill Guidelines ...................................................................36

Introducing the Practice Exercise .........................................37

Session 4: Problem Solving ........................................................39

Rationale .............................................................................39

Skill Guidelines ...................................................................39

Behavior Rehearsal Role Plays .............................................40

Reminder Sheet and Practice Exercise .................................40

Session 5: Drink Refusal Skills .................................................41

Rationale..............................................................................41

Skill Guidelines ...................................................................41

In-Session Practice ..............................................................42

Modeling .............................................................................42

Behavioral Rehearsal Role Play ............................................42

Reminder Sheets and Practice Exercises ..............................43

Session 6: Planning for Emergencies and Coping With a Lapse ....45

Rationale .............................................................................45

Skill Guidelines ...................................................................45

Practice Exercise .................................................................45

Reminder Sheets .................................................................45

Session 7: Seemingly Irrelevant Decisions .................................49

Rationale .............................................................................49

Group Discussion ...............................................................50

Exercise in Group ...............................................................50

Final Core Session: Termination ...............................................51

Elective Sessions ................................................................ 53

Elective Session: Starting Conversations ...................................55

Elective Session: Nonverbal Communication .............................56

Elective Session: Introduction to Assertiveness .........................57

Skill Guidelines ...................................................................57

Behavior Reversal Role Play .................................................58

Modeling .............................................................................58

Practice Exercise .................................................................58

Elective Session: Receiving Criticism .........................................59

Rationale .............................................................................59

Skill Guidelines ...................................................................59

Modeling .............................................................................59

Behavior Reversal Role Play .................................................59

Practice Exercise .................................................................59
xv

Contents

Page

Elective Session: Awareness of Anger ....................................... 60

Elective Session: Anger Management ........................................ 61

Elective Session: Awareness of Negative Thinking ..................... 62

Elective Session: Managing Negative Thinking........................... 63

Elective Session: Increasing Pleasant Activities ........................ 64

Skill Guidelines .................................................................. 64

Elective Session: Managing Negative Moods and Depression.......65

Rationale ............................................................................ 65

Skill Guidelines .................................................................. 66

Thinking Errors .................................................................. 67

In-Session Exercise ............................................................ 75

Elective Session: Enhancing Social Support Networks .............. 77

Rationale ............................................................................ 77

Skill Guidelines .................................................................. 77

In-Session Exercise ............................................................ 77

Elective Session: Job-Seeking Skills ......................................... 79

Rationale ............................................................................ 79

Skill Guidelines .................................................................. 79

The Resume .................................................................. 79

The Job Application ....................................................... 80

Generating Job Leads .................................................... 80

Telephone Skills Training .............................................. 80

Rehearsal of Interview Process ....................................... 81

Goal Setting .................................................................. 81

Elective Session: Couples/Family Involvement I ....................... 84

Rationale ............................................................................ 84

Skill Guidelines .................................................................. 85

In-Session Exercise ............................................................ 86

Introducing the Practice Exercise ....................................... 86

Elective Session: Couples/Family Involvement II ...................... 88

Review of Practice Exercises ............................................... 88

Rationale ............................................................................ 88

Skill Guidelines .................................................................. 89

Behavioral Rehearsal Role Plays ......................................... 90

Wrap-Up ............................................................................ 90

Introducing the Practice Exercise ....................................... 90

Appendix A: Bibliography ......................................................... 93

Appendix B: Therapist Selection, Training, and Supervision in

Project MATCH .............................................................. 97

Therapist Selection ............................................................. 97

Therapist Training .............................................................. 98

Ongoing Monitoring ............................................................ 98

1

 Introduction

The interventions to be tested in Project MATCH were selected by the 

trial’s Steering Committee, a group composed of the principal investigators of the participating sites and a representative of the National 

Institute on Alcohol Abuse and Alcoholism (NIAAA). It was agreed that 

a cognitive-behavior therapy (CBT) approach would be among the 

treatments offered and that a recently published book, Treating Alcohol 

Dependence: A Coping Skills Training Guide by Monti, Abrams, Kadden, 

and Cooney (1989), would be the basic manual for this approach. This 

manual had been used in several treatment matching studies (Kadden 

et al. 1989; Monti et al. 1990; Rohsenow et al. 1991; Cooney et al. 

1991) and seemed generally well suited for the requirements of Project 

MATCH.

This manual contains material for 22 sessions—8 core or required sessions that are implemented with all subjects and 14 elective sessions, 

of which 4 are selected for each subject. Thus, each subject receives a 

total of 12 sessions composed of a fixed set of core sessions and several 

elective sessions chosen for the individual patient.

Sixteen sessions are taken from the Monti et al. text. Rather than reproduce entire sessions from Monti et al. here, the present manual makes 

extensive reference to treatment sessions in the Monti et al. book and 

describes departures from them. Thus, this publication is not the exact 

document that the Project MATCH CBT therapists worked from, but it 

contains sufficient material and references so that anyone could replicate the protocol employed in Project MATCH by using this manual 

and the Monti et al. book conjointly.

The six sessions that were not drawn from Monti et al. are reprinted 

in full. Numerous other sources (see appendix A) contributed to these 

sessions, and they are gratefully acknowledged.

Given the extensive overlap between this manual and Monti et al., it is 

reasonable to ask why this version merits separate publication. There 

have been numerous requests for the Project MATCH treatment manuals for use in other research studies. It was felt that the exact protocols 

that were employed should be furnished to the community at large for 

those desiring to replicate the Project MATCH treatments.
2

Cognitive-Behavioral Coping Skills Therapy Manual

This accounts for the format of the present volume, with new material 

being printed in full but without reprinting published material that is 

generally available. The only exception to this is the introductory chapter where, for reasons of comprehensibility, all of the text is presented, 

including the material taken directly from Monti et al.

Modifications 

to Monti et al.

The modifications made to the basic Monti et al. book to accommodate 

Project MATCH and the decisionmaking processes that led to them are 

summarized below.

Additions The Project MATCH Steering Committee decided to include some additional elements of the Community Reinforcement Approach (Sisson 

and Azrin 1989) because of its demonstrated success in several clinical trials. The added elements were marital counseling, training in job 

seeking and interviewing skills, and expanded material on coping with 

cravings and urges to drink. Another session focusing specifically on 

negative moods was added to the four on negative thinking and anger 

already present, because depression is a widespread problem among 

recovering alcoholics.

Group Versus 

Individual 

Therapy

The Monti et al. book is built around a group therapy approach to 

treatment, although it does contain a section discussing adaptation 

to the individual treatment setting. The Steering Committee considered the advantages and disadvantages of both group and individual 

approaches for the Project MATCH trial.

The advantages of group therapy include its widespread use in alcoholism rehabilitation; the potential facilitative effect of a group’s social 

environment on cognitive, affective, and behavioral changes; the support system that groups provide for newly recovering clients; and the 

potential for cost savings with group compared to individual treatment. 

However, group therapy presented a number of problems from the 

research perspective. Clients might have to wait weeks before beginning treatment while groups were being assembled; it is more difficult 

to assess the therapist factor in outcome, and some argue that the 

groups (as opposed to individual clients) should be considered as the 

unit of analysis (e.g., Kaul and Bednar 1986). To properly evaluate the 

treatment, an individual therapy format was selected. This meant that 

some of the wording in Monti et al. had to be edited to reflect the dyadic 

therapeutic relationship, and some of the group-oriented role playing 

exercises had to be restructured. In the present manual, minor modifications of role-plays are described in terms of the changes made to 

the Monti et al. book. When the changes were substantial, the modified 

exercises are presented verbatim.

Whenever reference is made to material in the Monti et al. book, it is 
3

Introduction

left to the reader to insert needed transpositions in the text from group 

to individual therapy.

Length of 

Treatment

The Monti et al. book presents 27 treatment sessions. With increasing 

pressures on clinicians to reduce the length of treatment, a clinical 

trial involving a 6-month treatment protocol would have been excessively long. The Project MATCH Steering Committee decided upon a 

12-week duration for each study treatment. To best use the breadth of 

material in Monti et al. to meet clients’ needs, while at the same time 

assuring that all clients received certain essential sessions, the choice 

was made to have eight core sessions (introductory, termination, and 

six additional sessions) and to allow the therapist and client to jointly 

select the four most appropriate from among 14 elective sessions.

Supporting

Data

The final chapter in Monti et al. describes empirical findings that have 

been obtained using its treatment materials. What follows is a summary of studies using the Monti et al. book that have appeared since 

its publication.

The treatment sessions in the Monti et al. book were designed to 

address both interpersonal and intrapersonal coping skills. The final 

chapter described a treatment study in which these two types of sessions were compared: alcoholics were randomly assigned to a “standard 

treatment” combined with (1) cognitive-behavioral mood management, 

(2) individual communication skills training, or (3) communication 

training with a significant other present. Recently published results 

indicate that while all treatment groups improved significantly in a 

role-play assessment of coping skills and showed reduced anxiety 

in both general and alcohol-specific role-play situations (Monti et 

al. 1990), patients who received either of the communications skills 

training packages improved the most in the alcohol-specific role-play 

assessment. Followup results at 6 months after treatment showed that 

alcoholics who received communication skills training, with or without 

family involvement, consumed significantly less alcohol than alcoholics who received cognitive-behavioral mood management training. 

Rohsenow et al. (1991) found that individual or family communication 

skills training benefited a broader spectrum of patients, regardless of 

initial level of education, alcohol dependence, skill, anxiety, or beliefs, 

when compared to mood management training.

The Monti et al. book described another patient-treatment matching study by Kadden et al. (1989) in which inpatients were randomly 

assigned to aftercare consisting of either interactional group therapy 

or CBT groups using Monti et al. as the treatment manual. Survival 

analyses provided evidence for the durability of matching interactions over a 2-year outcome assessment period (Cooney et al. 1991). 

Relapse occurred more slowly when clients having more psychopathology or sociopathy received CBT rather than interactional therapy. For 
4

Cognitive-Behavioral Coping Skills Therapy Manual

those clients evidencing little psychopathology or sociopathy, relapse 

occurred more slowly when they received interactional therapy rather 

than CBT. Clients who were “matched” according to these results had 

2-year abstinence rates of about 45 percent, whereas those who were 

mismatched sustained only a 25-percent abstinent rate. Clients classified as cognitively impaired had better outcomes in interactional 

therapy and worse outcomes in the CBT groups.

In other analyses on the same data set, trained raters analyzed audiotape recordings of treatment sessions to assess the discriminability of 

the two treatments (Getter et al. 1992). They found that CBT sessions 

were characterized by significantly more educational and skill-training 

activities, application of problem-solving techniques, role playing, and 

identification of high-risk situations. Interactional sessions produced 

significantly more expression of feelings, interpersonal learning, and 

here-and-now focus.

Another analysis was based on two clusters of variables that characterized the clients at intake to the study (Litt et al. 1992). Clients in 

the less severe cluster fared better in interactional treatment, whereas 

those classified in the more severe cluster had better outcomes in CBT.

Role-play assessments (Abrams et al. 1991; Monti et al. 1990, 1992) 

were used to examine the relationship between clients’ coping skills and 

the two treatments offered. CBT resulted in better treatment outcomes 

for those with poorer observer-rated coping skills, greater observerrated anxiety, or greater self-reported urge to drink in the role-play 

assessments. Interactional therapy was better for those with greater 

skill, less anxiety, or fewer urges to drink in the role plays (Kadden et 

al. 1992).

These findings indicate the usefulness of this version of CBT for clinical 

research studies of patient-treatment matching and begin to delineate 

some of the parameters that define the clients for whom it will be the 

most appropriate treatment.

Ronald Kadden

Ned Cooney

Peter Monti

David Abrams

Authors of Treating Alcohol Dependence: A 

Coping Skills Training Guide
5

Introduction

References Abrams, D.B.; Binkoff, J.A.; Zwick, W.R.; Liepman, M.R.; Nirenberg, 

T.D.; Munroe, S.M.; and Monti, P.M. Alcohol abusers’ and social 

drinkers’ responses to alcohol-relevant and general situations. 

Journal of Studies on Alcohol 52:409–414, 1991.

Cooney, N.L.; Kadden, R.M.; Litt, M.D.; and Getter, H. Matching 

alcoholics to coping skills or interactional therapies: Two-year 

followup results. Journal of Consulting and Clinical Psychology 

59:598–601, 1991.

Getter, H.; Litt, M.D.; Kadden, R.M.; and Cooney, N.L. Measuring 

treatment process in coping skills and interactional group therapies for alcoholism. International Journal of Group Psychotherapy 

42:419–430, 1992.

Kadden, R.M.; Cooney, N.L.; Getter, H.; and Litt, M.D. Matching alcoholics to coping skills or interactional therapies: Posttreatment results. 

Journal of Consulting and Clinical Psychology 57:698–704,1989.

Kadden, R.M.; Litt, M.D.; Cooney, N.L.; and Busher, D.A. Relationship 

between role-play measures of coping skills and alcoholism treatment outcome. Addictive Behaviors 17:452–437, 1992.

Kaul, T.J., and Bednar, R.L. Experiential group research: Results, 

questions and suggestions. In: Garfield, S.L., and Bergin, A.E., 

eds. Handbook of Psychotherapy and Behavior Change. 3rd edition. New York: Wiley, 1986. pp. 671–714.

Litt, M.D.; Babor, T.F.; DelBoca, F.K.; Kadden, R.M.; and Cooney, 

N.L. Types of alcoholics: II. Application of an empirically-derived 

typology to treatment matching. Archives of General Psychiatry 

49:609–614,1992.

Monti, P.M.; Abrams, D.B.; Binkoff, J.A.; Zwick, W.R.; Liepman, M.R.; 

Nirenberg, T.D.; and Rohsenow, D.J. Communication skills 

training, communication skills training with family and cognitivebehavioral mood management training for alcoholics. Journal of 

Studies on Alcohol 51:263–270, 1990.

Monti, P.M.; Abrams, D.B.; Kadden, R.M.; and Cooney, N.L. Treating 

Alcohol Dependence: A Coping Skills Training Guide. New York: 

Guilford, 1989.

Monti, P.M.; Rohsenow, D.R.; Abrams, D.B.; Zwick, W.R.; Binkoff, J.A.; 

Munroe, S.M.; Fingeret, A.L.; Nirenberg, T.D.; Liepman, M.R.; 

Pedraza, M.; Kadden, R.M.; and Cooney, N.L. Development of a 

behavior analytically derived alcohol specific role play assessment 

instrument. Manuscript in submission, 1992.

Rohsenow, D.R.; Monti, P.M.; Binkoff, J.A.; Liepman, M.R.; Nirenberg, 

T.D.; and Abrams, D.B. Patient-treatment matching for alcoholic 

men in communication skills versus cognitive-behavioral mood 

management training. Addictive Behaviors 16:63–69, 1991.

Sisson, R.W., and Azrin, N.H. The community reinforcement approach. 

In: Hester, R.K., and Miller, W.R., eds. Handbook of Alcoholism 

Treatment Approaches: Effective Alternatives. New York: Pergamon, 

1989.

7

Overview of the Program

The treatment approach specified in this manual is based upon a 

cognitive-behavioral model, with a focus on the training of interpersonal and self-management skills. Research has provided some 

evidence for the efficacy of cognitive-behavioral approaches with alcoholic patients, but considerably more detailed information is needed. 

The present manual provides a basis for advancing that work by presenting a clearly specified treatment that can be reliably delivered, 

monitored, and evaluated.

Rationale for 

Outpatient 

Treatment

Outpatient treatment offers considerable opportunity for interaction 

between the treatment program and the realities of each client’s daily 

existence. The events of clients’ daily lives can be described in treatment sessions and used as the basis for problem-solving exercises, role 

plays, and homework assignments. Outpatients have the advantage of 

being able to practice new skills in a variety of problem situations. This 

greatly enhances generalization of new behaviors to various aspects of 

a client’s natural environment. In addition, the outpatient therapist 

can provide session-by-session monitoring of progress in applying new 

skills and supervised problem solving to deal with difficulties as they 

arise.

Treatment 

Goals

The primary goal of this treatment is to master skills that will help to 

maintain abstinence from alcohol and other drugs. In order to develop 

these skills, clients must identify high-risk situations that may increase 

the likelihood of renewed drinking. These high-risk situations include 

precipitants of drinking that are external to the individual as well as 

internal events such as cognitions and emotions.

Having identified situations that represent a high risk for relapse to 

drinking, clients must develop skills to cope with them. In this program, all clients are first taught basic skill elements for dealing with 

common high-risk problem areas; they are encouraged to engage in

NOTE: This overview makes extensive use of material from chapter 4, “Treatment 

Considerations for Inpatient and Outpatient Settings” (Monti et al. 1989). © Guilford 

Press. Used with permission.
8

Cognitive-Behavioral Coping Skills Therapy Manual

problem solving, role playing, and homework practice exercises that 

will enable participants to apply the new skills to meet their own particular needs.

Client Role Cognitive behavioral treatment for alcohol abuse requires active participation by individual clients as well as their assumption of responsibility 

for learning the necessary self-control skills to prevent future abuse. 

Through active participation in a training program in which new skills 

and cognitive strategies are acquired, an individual’s maladaptive 

habits can be replaced with healthy behaviors regulated by cognitive 

processes involving awareness and responsible planning.

Patients must get a chance to build their actual skills during role plays 

and to receive constructive feedback using relevant (client-centered) 

problems rather than simply discussing or reflecting on material. 

Active participation, modeling, and practice with positive, corrective 

feedback are the most effective ways to modify self-efficacy expectations and create long-lasting behavior change.

Therapist Role Since behavioral approaches to treatment are sometimes misunderstood as “cookbooks” to be applied without careful consideration of the 

unique needs of the individual receiving treatment, it is important that 

therapists be experienced in psychotherapy skills as well as behavioral 

principles. In addition, they must have good interpersonal skills and 

be familiar with the materials so as to impart skills successfully and 

serve as credible models. They must be willing to play a very active role 

in this type of directive therapy.

Despite this behavioral approach, many of the basic rules for conducting psychotherapy apply. Therapists must use many traditional 

therapy skills (e.g., establishing rapport, limit setting, empathy), while 

functioning as active teachers and role models.

Prior to each treatment session, therapists are encouraged to reread 

relevant sections of the manual. To ensure that the main points of 

each session are covered, we recommend outlining them or highlighting them in the text. In presenting the didactic material, we suggest 

briefly paraphrasing the main points and listing them on a chalkboard 

or flipchart.

Although standardization is essential when conducting a clinical trial, 

and covering all important points is desirable, it is essential that the 

desire to comply with the treatment protocol not lead to reading to clients from the text. As long as the major points are covered, a natural, 

free-flowing presentation style is preferred. It is crucial that clients 

not get the message that the therapist’s agenda of adhering strictly to
9

Overview of the Program

the manual is more important than the issues and concerns that constitute the client’s personal agenda.

Indeed, if clients are not routinely involved and encouraged to provide their own material as examples, we have found that treatment 

becomes boring and the energy level for learning drops off dramatically. 

Therapists may experience burnout as a result. Effective reinforcement 

of clients for their active participation can help prevent burnout on the 

part of both clients and therapists.

The “Rationale” and “Skill Guidelines” sections of each session are 

intended to provide therapists with adequate background information 

to guide discussion of the topic. Although the topics covered usually 

generate discussion that is meaningful, the discussion must be shaped 

by the therapist to prevent it from shifting focus onto other clinical 

issues. Since the treatment session can pass very quickly, it is important that the therapist keep the presentation of the rationale and skill 

guidelines brief, to allow adequate time for role playing, feedback, and 

discussion.

One self-disclosure issue likely to come up at the beginning of therapy is the drinking practice of the therapist.1 Therapists differ as to 

whether or not to answer this question directly; however, we agree 

with Vannicelli that the real concern that is usually being expressed 

is “Will you, therapist, be able to understand me, and can I get the 

kind of help here that I need?” (p. 21). Thus, although we leave the 

specific answer to this question up to the therapists’ judgment and 

individual therapeutic styles, we do encourage them to acknowledge to 

the client asking the question that they hear the underlying message. 

Acknowledgment of the clients’ underlying concern, coupled with an 

invitation to clients to judge the value of this program for themselves, 

usually is adequate.

Adherence to 

the Manual

When using this manual in a controlled research project, it is crucial that the guidelines in the manual be strictly followed. Deviations 

will add “noise” to the study, and supervision will therefore focus on 

adherence to the manual. If the concept of manual-based treatment is 

troublesome, or if any of the demands made by this particular manual 

seem difficult to follow or are incompatible with a therapist’s style or 

beliefs, this should be discussed in supervision as soon as possible.

Menu of Topics A word is needed about the sequence in which clients are exposed to 

the various topics. An ambulatory program presents an inherent conflict regarding the order in which skills are taught and rehearsed.

1 Vannicelli, M. Group therapy with alcoholics: Special techniques. Journal of 

Studies on Alcohol 43:17–37, 1982.
10

Cognitive-Behavioral Coping Skills Therapy Manual

Good teaching practice demands that skills be taught in a logical 

sequence, in which more basic topics are covered first and serve as the 

foundation for subsequent presentation of higher order skills. However, 

there is a conflicting need to help clients deal with immediate threats 

to their sobriety, which may lead them to an early relapse and undermine their continuation in the program. Therefore, sessions such as 

“Managing Thoughts About Alcohol” and “Drink Refusal Skills,” which 

might otherwise have come late in the program after more fundamental 

skills have been acquired, are instead presented early to give clients 

the tools to cope with situations that may overwhelm them and lead 

them to relapse or drop out of treatment. Another session, “Problem 

Solving,” consists of a complex set of cognitive skills that would be 

more appropriately taught late in the program but is instead also presented early to provide clients and therapists with a common language 

and framework for dealing with problems and crises in clients’ lives 

that can lead to early relapse. Following these sessions, other topics 

may be selected based on their potential for helping clients cope with 

high-risk situations that they may face or based on the client’s apparent skills deficits.

This cognitive-behavioral treatment program is composed of eight core 

elements to which all the clients will be exposed. There is also a menu 

of additional sessions that may be selected based on the therapist’s 

assessment of a client’s problems or on needs or desires expressed by 

the client. Although it may be obvious to the therapist which of the 

elective topics should be included, it is advised that clients be allowed 

to participate as much as possible in making the selection. If a difference of opinion on the choice of sessions arises between clients and 

therapist, it is probably advisable to defer to the patients, in the interest of maximizing their involvement in treatment.

Outpatient

Versus

Aftercare

Settings

The overall treatment goals and methods are the same for those sites 

doing outpatient or aftercare treatment. At the outpatient treatment 

sites, however, the focus is more on achieving abstinence and managing some of the problems of early recovery. The choice among which 

optional sessions to include may be determined in part by problems 

that are likely to pose an imminent threat to the client’s sobriety.

At the aftercare sites, the focus is more on maintenance of sobriety. 

Clients have already been exposed to an intensive treatment program 

and may have received training in some of the skills offered here. They 

nevertheless should be given all the core elements of this program, but 

the choice among the optional sessions may be guided by a client’s 

need for additional skill building or by topics that may not have been 

covered during the prior treatment.
11

Overview of the Program

Discussion of

Clients’

Recent

Problems

Clients experience numerous problems, cravings, and actual slips as 

they struggle with sobriety. Although the focus of the sessions must be 

on the structured program, ignoring clients’ real life problems entails 

the risk that they will view treatment as peripheral or irrelevant to their 

current needs. As a compromise between the demands of the protocol 

and the clients’ perceived needs, it is suggested that 15–20 minutes be 

spent at the outset of each session discussing current problems.

Efforts should be made to structure these discussions along lines that 

are consistent with a skills-training approach. This can be accomplished most easily using the problem-solving format presented in 

session 3. In subsequent sessions, this format should be used whenever possible in discussing clients’ problems. However, problem solving 

will not be appropriate for all situations that are brought up. In such 

instances, a functional analysis may be helpful, focusing on identification of the ABC’s (antecedents, behavior, consequences) and on ways 

that the patient can try to change them. The general rule is that these 

opening discussions should be structured along behavioral lines to 

keep them consistent with the approach of this manual.

There is frequently conflict between the desire of clients to get help 

with their immediate problems and the desire of the therapist to get 

on with the day’s agenda. As a result, the first phase of a session often 

lasts longer than the therapist would like but shorter than the client desires. Clients must be reminded that this time-limited therapy 

cannot always explore problems to the point of complete resolution. 

In Project MATCH, if serious problems arise repeatedly, the project 

coordinator is consulted. Criteria have been developed to determine if 

additional treatment is needed or if participation in the program is in 

the patient’s best interest.

Structure of

Sessions

After the initial period of supportive therapy, the structured portion 

of the session is initiated with a review of the skills taught in the preceding session and of the homework assignment. New material is 

then introduced, beginning with the rationale, which emphasizes the 

relationship of the new skills both to maintaining sobriety and to dealing with problems that are commonly faced by recovering alcoholics. 

The skill guidelines are presented verbally, listed on a chalkboard or 

poster board, and printed in handouts for the client to take home. It 

is critically important that therapists not spend large amounts of time 

lecturing to clients. It is essential that the therapist solicit input and 

reactions from the clients during the presentation of the rationale and 

skill guidelines sections to engage their interest and prevent them from 

tuning out. Therapists model the performance of the skills, and clients 

are then encouraged to generate role-play scenes based on their daily 

experience.
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Cognitive-Behavioral Coping Skills Therapy Manual

Role playing is viewed as a critical part of the experience, and at least 

one-third of each session should be allocated to it. Nevertheless, it is 

sometimes a struggle to engage clients in role plays. Therapists may 

have to provide considerable structure and encouragement to get the 

process underway.

There is a danger that, with such a full agenda and such highly structured sessions, the clients may come to feel that the therapist’s agenda 

is more important than their own needs. Therefore, it is essential that 

the therapist not read from written material or be too rigid in following 

the set agenda and strive as much as possible to provide examples from 

material that the client has previously brought up. Usually this is not 

difficult, because the skills-training sessions cover commonly encountered problems that are likely to have been raised already by the client. 

Occasionally, it is necessary to sharply curtail a session’s agenda in 

order to deal with some individual crisis. However, this should be a 

rare event and avoided as much as possible.

Guidelines for

Behavior

Rehearsal

Role Plays

Behavior rehearsal plays a central part in this skills-training program 

and is the main strategy by which clients acquire new skills. Each session provides a safe haven where clients can practice and improve their 

skills prior to trying them in the real world. Although some amount of 

discussion during the introduction to each new skill is useful, therapists should discourage lengthy discussion about problem situations 

and instead should focus on setting up and processing role plays.

Clients normally feel a bit uncomfortable or embarrassed at first about 

role playing. Therapists should acknowledge that this is a normal 

reaction and that behavior rehearsal becomes easier after a few experiences with it. After a while, participants are able to get into a scene 

more realistically and to focus on their role in it. Resistance can take 

subtle forms, such as focusing on other issues or asking many questions. Therapists can acknowledge that they also feel uncomfortable 

role playing. They may have to take the lead and demonstrate the first 

role plays.

Therapists should encourage clients initially to generate and describe 

personally relevant scenes that are of only moderate difficulty. As clients demonstrate ability to handle these situations effectively, they 

should be encouraged to generate and practice more difficult ones. An 

adequate description of a scene will include specifying where it takes 

place, what the primary problems are, whom the role play partner 

should portray (boss, stranger, child, spouse, date), relevant behaviors 

of the person portrayed so that the partner can act accordingly, and 

specification of the client’s goal in the interaction.
13

Overview of the Program

The following strategies are useful in helping clients to generate scenes:

■ Ask clients to recall a situation in the recent past where use of 

the new skill being taught would have been desirable (e.g., a client 

wanted to start a conversation but could not; another yelled at a 

neighbor about an unleashed dog tearing up the garden; another 

wanted to express positive feelings toward his spouse but could not 

without drinking first).

■ Ask clients to anticipate a difficult situation that may arise in the 

near future and that calls for use of the skill (e.g., a client’s apartment has been cold this winter and she wants to ask the building 

owner to raise the setting on the thermostat; another client is going 

to a retirement party this weekend and will be offered alcoholic 

drinks).

■ Therapists can suggest appropriate situations based on their 

knowledge of a client’s recent circumstances.

It is essential that every role play be effectively processed. It is an 

opportunity for clients to receive praise/recognition for practice and 

improvement as well as constructive criticism about the less effective elements of their behavior. During this portion of the session, the 

therapist’s primary goals are to identify specific problem areas and to 

shape and reinforce successive approximations to more effective communication skills.

Immediately after every role play, the therapist should reinforce the client for participating. Next, the therapist and the client should both give 

their reactions to the performance (e.g., How does the protagonist feel 

about the way he handled the situation? What effect did the interaction 

have on the partner?).

The therapist then offers comments about the role play. These comments should be both supportive/reinforcing and constructively 

critical. If a role play performance has several deficiencies, the therapist should choose only one or two to work on at a time. All positive 

and negative feedback should focus on specific aspects of the person’s 

behavior, since global evaluations do not pinpoint what was particularly effective or ineffective. Finally, the praise/reinforcement provided 

should always be sincere. The therapist should refrain from being 

unnecessarily effusive so that the value of the positive feedback is not 

undermined. Therapists may repeat a scene to give clients an opportunity to try out the feedback they received the first time around.

“Role reversal” is a role-play strategy in which the therapist models 

use of a new skill, with the client playing the role of the target person 

(e.g., spouse, employer, neighbor). This strategy is particularly useful
14

Cognitive-Behavioral Coping Skills Therapy Manual

if clients are having difficulty using a skill or are pessimistic about the 

effectiveness of a suggested communication approach. By playing the 

“other,” they have an opportunity to observe and to experience firsthand the effects of the suggested skill.

Homework Homework is a powerful adjunct to treatment, because real life situations can be utilized for practice, enhancing the likelihood that these 

behaviors will be repeated in similar situations (generalization). A preplanned homework exercise has been designed for every session of this 

program. Most require that the clients try in a real life situation what 

they have already role played in the session. The homework assignment also requires that the clients record facts concerning the setting, 

their behavior, the response they evoked, and an evaluation of the adequacy of their performance. Homework exercises can be modified to 

fit the specific details of individual situations more closely, and extra 

homework assignments are sometimes given to help clients cope with 

problem situations they have encountered.

Compliance with homework is often a problem in behavior therapy. A 

number of steps are taken to foster compliance:

■ The assignments may be referred to as “practice exercises” to 

avoid the negative connotations often associated with the term 

“homework.”

■ When giving each assignment, the therapist should provide a careful rationale and description of the assignment.

■ Ask the client what problems can be foreseen in completing the 

assignment, and discuss ways to overcome these obstacles.

■ Ask clients to identify a specific time that can be set aside to work 

on the assignment.

■ The therapist should review the preceding session’s exercises at the 

beginning of each session, making an effort to praise all approximations to compliance with the assignment.

Although problems that clients have with the exercises should certainly 

be discussed and understood, the main emphasis is on reinforcing the 

positive aspects of performance. For those who did not do an assignment, discuss what could be done to ensure compliance with the next 

assignment. No contingencies other than social praise or disapproval 

are imposed by the therapists to enhance compliance with homework 

assignments.
15

Overview of the Program

Coping Skills 

Training With 

Significant 

Others

Clients are strongly urged to bring in their spouse, someone they live 

with, or a close supportive friend for two of the sessions. The emphasis in these sessions should be placed on interpersonal skills-training 

topics, saving the more individually focused cognitive and intrapersonal exercises for individual therapy sessions. Communication skills 

training can be beneficial to clients and significant others for reducing 

dysfunctional interactions.

As an illustration, a spouse may challenge/criticize an alcoholic in a 

suspicious manner that, while intended to prevent drinking, may actually exacerbate the situation and increase the likelihood of drinking. 

The client and spouse can be taught directly, in role plays with each 

other, how to give and receive criticism in a more adaptive fashion. 

If the role play and feedback reduce misunderstanding and improve 

communication, then maintenance of sobriety is more likely.

Occasionally, the relationship between a significant other and the alcoholic is so conflicted that effective role playing cannot take place. In 

these circumstances, it is helpful to first have the therapist model the 

skills in question. Following this, the significant other is paired with 

the therapist and the scenario is repeated. Next, the alcoholic role plays 

with the therapist. Finally, the alcoholic is paired with the significant 

other. By this time, after receiving feedback on several role plays, the 

pair may be better equipped to engage in effective role playing together.

In couples with a great deal of marital distress, it is best not to try to 

deal with all of the complex marital, and perhaps sexual dysfunction, 

issues. Limit the skills-training focus to more basic, safe skills (e.g., 

giving and receiving compliments, criticism, assertiveness, nonverbal 

behavior).

Although it is essential to explore communication concerning drinking 

behaviors and triggers of drinking, such exploration may lead to more 

deep-seated marital conflicts over trust, anger, intimacy, abandonment, dependency, and narcissistic needs. Sometimes these issues can 

be dealt with briefly, but they tend to require large amounts of time, 

and consequently the didactic skills materials may not get covered. 

The therapist needs to bring the focus back to the specific observable 

behaviors that appear to be functionally related to drinking or poor 

communication skills.

Preventing 

Attrition

In the first session, it is important to anticipate potential obstacles to 

successful treatment, especially factors that may lead to early attrition. Therefore, the therapist should explore any instances in which 

clients previously dropped out of treatment and advise clients that they 

should discuss any thoughts of quitting treatment. Such thoughts
16

Cognitive-Behavioral Coping Skills Therapy Manual

are not uncommon, and open discussion can resolve problems before 

clients drop out. Progress in treatment is not steady—there are ups 

and downs. Most clients experience hopelessness, anger, frustration, 

and other negative feelings at times. Clients should be advised to discuss such feelings, even if they fear that it might be embarrassing to 

the therapist.

It is useful for the therapist to point out that terminating treatment 

may be one of a series of “seemingly irrelevant decisions” that eventually lead to a client’s later drinking. For this reason, any hint that a 

client is considering dropping out should be taken very seriously and 

fully discussed.

Many clients quit treatment after their first drinking episode. Clients 

should be warned that, even with efforts to maintain abstinence, some 

of them may slip and begin drinking. At the first session, they should be 

told not to come to treatment intoxicated, but they should be strongly 

encouraged to continue to attend after a drinking episode so that they 

can receive help in regaining sobriety, coping with their reaction to the 

slip, and avoiding future lapses.

There is a delicate balance between setting the stage for clients’ feeling 

that it is permissible to return after a lapse and actually giving them 

permission to drink. Therapists should take care that clients understand this distinction.

Alcohol and

Other Drug

Use

Clients are asked to accept the goal of total abstinence from alcohol 

and all nonprescribed psychoactive drugs, at least for the duration of 

treatment. They are also asked to talk about any drinking or drug use 

that occurs and about any cravings or fears of relapse that they experience. They are told that it is common to have some ambivalent feelings 

about accepting abstinence as a goal, and they are encouraged to discuss these feelings as well as any actual slips that might occur. Clients 

are allowed to continue even after an episode of alcohol or other drug 

use, as long as they make the commitment to work toward renewed 

abstinence. However, they are asked not to come to a session under 

the influence of alcohol and other drugs because they would not be 

able to concentrate on or recall the topics covered.

In this program, anyone found to be under the influence of alcohol or 

other drugs is asked to leave the session. This is done in such a way 

that clients do not view it as a punishment; anyone asked to leave 

is encouraged to return to the next session sober and to continue in 

treatment.

Clients asked to leave are not allowed to drive themselves home. Their 

car keys are taken away, and they are asked to arrange safe transportation with a family member, a friend, or public transportation.
17

Overview of the Program

When discussing episodes of drinking or drug use, emphasize that 

these are common occurrences. An atmosphere of openness about this 

topic should be fostered. Clients are encouraged to conduct a functional analysis of their alcohol use and of urges to drink, identifying 

specific people, places, events, thoughts, emotions, and behaviors that 

preceded and followed the drinking or urges.

Clients are given specific guidelines for dealing with the immediate 

aftermath of a drinking episode. They are advised to get rid of the alcohol, remove themselves from the setting in which the drinking occurred, 

and call someone for help (a friend or spouse). They are cautioned 

about feelings of guilt and self-blame that often accompany a slip and 

are warned not to allow such reactions to prompt further drinking.

Guidelines are also given for dealing with the longer term impact of 

drinking episodes. Clients are urged to examine a slip with someone, 

not to sweep it under the rug. They are advised to analyze possible 

triggers, including the who, when, and where of the situation and 

anticipatory thoughts. Did they expect substance use to change something or meet some need? Reactions to the drinking episode should 

also be analyzed, including behavior, thoughts, and feelings, with special attention to feelings of guilt, depression, and self-blame. Clients 

are warned about catastrophizing thoughts, such as “Here I go again; 

I guess I’ll never change” or “I’ll quit again after I finish this bottle.” If 

allowed to proceed unchecked, these common reactions can contribute 

to further drinking. The value of reminder cards, listing the troubles 

that addictive behavior has caused and the benefits that sobriety has 

brought, is stressed.

Absences If a client does not come for a scheduled therapy session, the therapist 

should immediately attempt to contact the client by telephone to ascertain why the session was missed and to reschedule if possible. If the 

therapist is unable to contact the client within 2 days by telephone, a 

brief letter should be sent to the client. (In Project MATCH, the project 

coordinator is in charge of sending the letter). It is important that all 

reasonable efforts be made to keep clients in treatment. These efforts 

are continued until clients miss two sessions or clearly state that they 

wish to quit. When clients return after an absence, they are urged to 

make future attendance a priority and to make whatever arrangements 

are necessary to avoid further absences.

Lateness Therapists should convey the attitude that sessions are too important 

to waste time by being late and should make reasonable efforts to help 

clients solve whatever problems may be causing them to be late.

If a client is less than 15–20 minutes late, the session should take place
18

Cognitive-Behavioral Coping Skills Therapy Manual

and end at the regularly scheduled time. If a client is more than 25 

minutes late, the therapist should attempt to reschedule within the 

next few days.

Extra Sessions Some patients will request extra sessions with the therapist, particularly in the early weeks of treatment. The need for extra sessions 

should be determined by the clinical judgment of the therapist, based 

on the seriousness of the situation. The maximum number of permissible extra sessions in the Project MATCH protocol is two (making the 

maximum number of sessions 14). If a patient requires more than two 

additional sessions with the therapist, the possibility of clinical deterioration and/or withdrawal from the study is considered.

Concurrent 

Treatment

In Project MATCH, certain limitations are placed on participation in 

other forms of therapy during the 12-week intervention period. Since 

12-step treatment is another modality in this clinical trial, therapists 

in the cognitive-behavioral modality are instructed to assume a neutral stance toward clients’ participation in 12-step fellowship activities. 

Attendance at Alcoholics Anonymous (AA) is neither encouraged nor 

discouraged. If therapists have difficulty with this requirement, they 

discuss their concerns at once with their project coordinator, supervisor, or training staff.

In addition, Project MATCH clients may not be seen by other mental 

health professionals for more than a total of 6 contact hours during 

their 12 weeks of treatment in the study. If clients express interest in 

other forms of treatment, they are urged to postpone them, if possible, 

until after this treatment is completed.

Clinical 

Deterioration

Criteria have been developed to define clinical deterioration. All 

instances must be reviewed with the project coordinator. These include 

development of acute psychosis, suicidal or homicidal ideation, onset 

of cognitive impairment, deterioration of physical health, and extensive drinking or drug use. Project MATCH has developed procedures 

for responding to these developments, and therapists are instructed 

to review them with the project coordinator at the first indication of a 

problem.

Termination Termination can be problematic for many clients, and can lead to clinical deterioration or acting out prior to the end of treatment. About 4–5 

weeks before the end of treatment, therapists should review the session on termination to sensitize themselves to the issues involved and 

to ensure that they respond to them in a manner consistent with this 

manual.
19

Core Sessions

In order to provide patients with effective cognitive-behavioral coping 

skills, therapists need to be sure to cover all eight core topics and 

to do so thoroughly. “Introduction” must be presented first, and the 

final session in the 12-week intervention must be “Termination.” The 

remaining core topics can be discussed in any order. We suggest the 

sequence in which they are presented here:

Session 1: Introduction to Coping Skills Training

Session 2: Coping With Cravings and Urges to Drink

Session 3: Managing Thoughts About Alcohol and Drinking 

Session 4: Problem Solving

Session 5: Drink Refusal Skills

Session 6: Planning for Emergencies and Coping With a Lapse 

Session 7: Seemingly Irrelevant Decisions

After the first seven core sessions have been completed, the therapist 

may move on to one or more elective topics.

Final Session: Termination

21

Session 1: Introduction to Coping 

Skills Training

This session has two major purposes: first, to establish rapport with 

the client, and second, to introduce the client to the reasoning behind 

coping skills training. By doing this, clients can have very clear expectations about how treatment will proceed and about what behaviors 

may be expected of them. The time shown for each topic area is only 

suggested, and some areas (e.g., building rapport) may take longer 

than the time shown, while others may require less.

Building

Rapport

(45 minutes)

This is an extremely important part of the treatment, where the therapist first gets to know the client. Therapists should begin by introducing 

themselves and by explaining who they are (e.g., a private practitioner 

in the area, a VA psychologist). The therapist should then explain the 

purpose of this first meeting: to get to know the client, to get an idea 

of the client’s drinking patterns and motivation, and to discuss the 

rationale for treatment and what the sessions will be like. The initial 

interview should be informal, but it is desirable to obtain some key 

information in the first session. Questions to be asked of the client 

include the following (not necessarily in this order):

■ Tell me a bit about yourself. What do you do for a living? Married? 

How do you spend your free time? What is your living situation like 

(lives alone, apartment, own house, children, extended family)?

■ How serious do you think your drinking problem is?

■ Why are you seeking treatment now?

■ Why did you seek treatment here? How did you hear about this 

treatment program?

■ Have you been treated before for alcoholism or drug abuse? (If yes: 

What were your experiences like?)
22

Cognitive-Behavioral Coping Skills Therapy Manual

■ Have you ever tried to quit on your own? (If yes: How did you do?)

■ When you think about alcoholism treatment, what do you think 

about? That is, what is your idea of what treatment should be like?

■ What do you want out of treatment? How will you get it?

■ How confident are you that you can succeed, that is, remain 

abstinent?

Conceptualizing

Treatment:

What Is

Alcoholism?

(5 minutes)

Having begun to establish rapport with the client, therapists may begin 

to explain the rationale for coping-skills training. This begins with a 

social learning explanation of alcohol abuse. As therapists go through 

this explanation, they may illustrate the various points by drawing on 

what the client has already described. The explanation may run as 

follows:

In thinking about alcoholism, we view excessive drinking as 

harmful behavior. Once people start to drink alcohol a lot, they 

sometimes learn that it changes the way they feel. For example, 

some people use it like a tranquilizer to help them deal with stressful situations. Other people expect that it will make good times 

seem even better. Some people think it will make them more confident. Some people use it just to keep from thinking about things.

After a while, drinking can be triggered by things in the environment, sometimes without the person even realizing it. Often, 

things in the environment can trigger feelings of craving, but that 

does not happen with everyone. Things in the environment that 

often trigger drinking may include seeing alcoholic drinks, being 

in the presence of people who are drinking, or being in situations 

that are stressful.

Finally, people often develop beliefs about alcohol and about their 

own drinking (e.g., “Drinking is not a problem for me. I can stop 

whenever I want.” “I need to change, but it’s not worth the effort.” 

“Stopping drinking is not possible for me.”).

Alcohol can change the way a person feels, thinks, and acts. This 

can make substance abuse very easy to start and very difficult to 

stop. The purpose of this treatment is to help you avoid or cope 

better with those situations in which you tend to drink and to help 

you find behaviors that you can do instead of drinking.
23

Session 1: Introduction to Coping Skills Training

The therapist should probe for understanding.

Assessing

High-Risk

Situations

(15 minutes)

The therapist should give a brief explanation of how treatment works, 

again capitalizing on the client’s experiences to make points more 

clearly.

If drinking changes the way a person acts, thinks, and feels, we 

need to begin by finding out what situations you are most likely to 

drink in and what you are thinking and feeling in those situations. 

We call these high-risk situations. What we want to find out is 

what kinds of things are triggering or maintaining your drinking. 

Then we can try to develop other ways you can deal with high-risk 

situations without drinking. This involves learning specific skills 

and strategies to use.

The main point is that once we know about the situations and 

problems that contribute to your drinking, we can look for other 

ways to deal with those situations.

The therapist should again probe for understanding or resistance.

Having given the client a rationale for treatment, the therapist should 

begin an informal assessment of high-risk situations. Among the 

questions the therapist might ask are—

■ In what kinds of situations do you drink? What are your triggers 

for drinking?

■ Can you give a specific example (e.g., a relapse story)?

■ Can you remember your thoughts and feelings at the time?

■ What were the positive consequences of drinking?

■ What were the negative consequences of drinking?

The therapist should show the client the self-monitoring record handout and demonstrate its use by recording the above responses on it. 

The therapist should summarize with the client the apparent determinants of drinking in this episode and follow up by asking for other 

examples.

Motivation

(5 minutes)

At this point, if clients are sufficiently engaged, the therapist can try 

to boost motivation by expressing confidence in their ability to do well 

in treatment. The therapist may also help the client review reasons to 

stop drinking and may elicit examples of the client’s successes in the
24

Cognitive-Behavioral Coping Skills Therapy Manual

past (e.g., longest period of abstinence or controlled drinking to date). 

The therapist should commend the patient for making this effort now.

Contract and

Ground Rules

(10 minutes)

The therapist needs to stress at this point that treatment can help but 

that it will require certain commitments on the part of the client. The 

therapist will be there to help the client figure out how to deal with 

alcohol problems, but the client will have to work at it. That work will 

include certain ground rules:

■ Attendance. The client must attend without fail. Cancellations must 

be made in advance, and the client must have a good reason to cancel. The client may withdraw from treatment but must discuss this 

decision with the therapist first (i.e., not just fail to show up).

■ Promptness. The client must be on time for sessions. If for some 

reason clients cannot be on time on a given day, they must contact 

the therapist to that effect.

■ Alcohol and drug use. This treatment is intended for people who 

want to abstain from alcohol. Although clients may not want to 

have total abstinence as the goal, they must work on remaining 

abstinent for the program to be most effective.

■ Completion of homework. One of the ways in which this treatment 

works is that therapist and client decide the appropriate skills to 

learn and how best to learn them. This may include homework 

assignments, such as practicing specific skills, that clients must 

do if they are to benefit from treatment. The client, therefore, must 

agree to complete homework assignments.

These ground rules are set out in a contract that the therapist asks the 

client to read and sign. Included in the contract is a statement of the 

short-term goals that the client agrees to work on.

Homework

(5 minutes)

The therapist sends the client home with the self-monitoring record, 

gives instructions in its use, and requests that the patient take time 

once a day to record episodes of craving or desire for alcohol. The therapist then sets the next appointment.
 Treatment Contract

1. I understand that this treatment will last 12 weeks, and I agree to participate for that 

length of time. If I want to withdraw from the program, I agree to discuss this decision 

with my therapist prior to taking this action.

2. I agree to attend all sessions and to be prompt. If it is absolutely necessary that I cancel a 

session, I will call in advance to reschedule. I also agree to call in advance if I will be late 

to a session.

3. I understand that this treatment is intended for people who want to abstain from drugs 

and alcohol. I understand that I must work on remaining abstinent for this program to be 

most effective.

4. I agree that it is essential for me to come to the session drug and alcohol free. I understand 

that I will be asked to leave any session to which I come after using drugs or alcohol. I will 

be asked to arrange safe transportation home.

5. I understand that I will be expected to practice and implement some of the skills I discuss 

in treatment. I agree to bring in the practice exercise sheet each week to discuss with my 

therapist.

6. I agree to work on the following specific goals during the next 12 weeks.

1. ___________________________________________________________________________________

2. ___________________________________________________________________________________

3. ___________________________________________________________________________________

I have reviewed the above statements with my therapist, and we both agree to abide by them.

______________________________________________________ ____________________

Date

______________________________________________________ ____________________

Date
Self-Monitoring Record

THOUGHTS AND POSITIVE NEGATIVE 

TRIGGER FEELINGS BEHAVIOR CONSEQUENCES CONSEQUENCES 

(What sets me up to use?) (What was I thinking? (What did I do then?) (What positive thing (What negative thing 

What was I feeling?) happened?) happened?)

Reprinted with permission from Jaffe et al. 1988.
27

Session 2: Coping With Cravings

and Urges to Drink

Rationale 1. Craving is most often experienced early in treatment, but episodes 

of craving may persist for weeks, months, and sometimes even years 

after some alcoholics stop drinking Craving may be uncomfortable 

but is a very common experience and does not mean something is 

wrong. You should expect craving to occur from time to time and be 

prepared to cope with it if and when it occurs.

2. Urges to drink, or cravings, can be triggered by things you see in the 

environment that remind you of using alcohol. Physical signs may 

include tightness in your stomach or feeling nervous through your 

body; psychological signs may include increased thoughts of how 

good you would like to feel from using alcohol or drugs, remembering times you used alcohol in the past, planning how you would go 

about getting a drink, or feeling you need alcohol.

3. Craving and urges are time-limited, that is, they usually last only 

a few minutes and at most a few hours. Rather than increasing 

steadily until they become unbearable, they usually peak after a 

few minutes and then die down, like a wave. Urges will become less 

frequent and less intense as you learn how to cope with them.

Skill 

Guidelines

1. Learn how to recognize urge “triggers” so you can reduce your exposure to them.

a. Common triggers include—

— Exposure to alcohol itself.

— Seeing other people drinking.

— Contact with people, places, times of day, and situations 

commonly associated with drinking (such as drinking buddies, parties and bars, getting home from work, weekends.

— Particular types of emotions (such as frustration, fatigue,
28

Cognitive-Behavioral Coping Skills Therapy Manual

feeling stressed out). Even positive emotions (elation, excitement, feelings of accomplishment) can be triggers.

— Physical feelings (feeling sick, shaky, tense).

b. Some triggers are hard to recognize, and self-monitoring, which 

will be assigned as the practice exercise this week, can help you 

recognize them.

c. The easiest way to deal with cravings and urges is to try to avoid 

them in the first place. This can be done by reducing your exposure to craving triggers (getting rid of alcohol in the house, not 

going to parties or bars, reducing contact with friends who drink, 

and so on).

2. Sometimes craving cannot be avoided, and it is necessary to find a 

way to cope with it. There are many different strategies for coping 

with craving:

a. Get involved in some distracting activity. Reading, a hobby, going 

to a movie, exercising (jogging, biking) are good examples of distracting activities. Once you get interested in something else, 

you’ll find the urges go away. Another effective response to craving is eating, as most people do not feel like drinking after eating 

a big meal or something very sweet.

b. Talk it through. Talk to friends or family members about craving 

when it occurs. Talking about cravings and urges can be very 

helpful in pinpointing the source of the craving. Also, talking 

about craving often helps to discharge and relieve the feeling and 

will help restore honesty in your relationship. Craving is nothing 

to feel bad about.

c. Urge surf. Many people try to cope with their urges by gritting 

their teeth and toughing it out. Some urges, especially when 

you first return to your old drinking environment, are just too 

strong to ignore. When this happens, it can be useful to stay 

with your urge to drink until it passes. This technique is called 

urge surfing.

Urges are a lot like ocean waves. They are small when they 

start, grow in size, and then break up and dissipate. You can 

imagine yourself as a surfer who will ride the wave, staying on 

top of it until it crests, breaks, and turns into less powerful, 

foamy surf. The idea behind urge surfing is similar to the idea 

behind many martial arts. In judo, one overpowers an opponent 

by first going with the force of the attack. By joining with the 

opponent’s force, one can take control of it and redirect it to 

one’s advantage. This technique of gaining control by first going
29

Session 2: Coping With Cravings and Urges to Drink

with the opponent also allows one to take control while expending minimal energy. Urge surfing is similar. You can initially join 

with an urge (as opposed to meeting it with a strong opposing

force) as a way of taking control of it. After you have practiced 

urge surfing several times and become familiar with it, you may 

find it a useful technique when you have a strong urge to drink.

There are three basic steps in urge surfing:

1. Take an inventory of how you experience the craving. Do this 

by sitting in a comfortable chair with your feet flat on the 

floor and your hands in a comfortable position. Take a few 

deep breaths and focus your attention inward. Allow your 

attention to wander through your body. Notice where in your 

body you experience the craving and what the sensations are 

like. Notice each area where you experience the urge, and tell 

yourself what you are experiencing. For example, “Let me see 

. . . My craving is in my mouth and nose and in my stomach.”

2. Focus on one area where you are experiencing the urge. 

Notice the exact sensations in that area. For example, do you 

feel hot, cold, tingly, or numb? Are your muscles tense or 

relaxed? How large an area is involved? Notice the sensations 

and describe them to yourself. Notice the changes that occur 

in the sensation. “Well, my mouth feels dry and parched. 

There is tension in my lips and tongue. I keep swallowing. As 

I exhale, I can imagine the smell and tingle of booze.”

3. Repeat the focusing with each part of your body that experiences the craving. Pay attention to and describe to yourself 

the changes that occur in the sensations. Notice how the urge 

comes and goes. Many people, when they urge surf, notice 

that after a few minutes the craving has vanished. The purpose of this exercise, however, is not to make the craving go 

away but to experience the craving in a new way. If you practice urge surfing, you will become familiar with your cravings 

and learn how to ride them out until they go away naturally.

d. Challenge and change your thoughts. When experiencing a craving, many people have a tendency to remember only the positive 

effects of alcohol and often forget the negative consequences of 

drinking. Therefore, when experiencing craving, many people 

find it helpful to remind themselves of the benefits of not drinking and the negative consequences of drinking. This way, you 

can remind yourself that you really won’t “feel better if you just 

have one drink,” and that you stand to lose a lot by drinking. 

Sometimes it is helpful to have these benefits and consequences 

listed on a small card that you can keep with you.
30

Cognitive-Behavioral Coping Skills Therapy Manual

People constantly appraise and think about things that happen 

to them and the things that they do. The way that you feel and 

act can be highly influenced by these subjective facts or appraisals as well as objective facts. What you tell yourself about your 

urges to drink will affect how you experience and handle them. 

Your self-talk can be put to use to strengthen or weaken your 

urges. The process of making self-statements becomes so automatic by the time you are an adult, you may not notice that you 

do this; it simply does not require any attention now. A selfstatement that has become automatic for you is, “The big hand 

is on the 7, so it is 35 minutes after. The little hand is between 

the 2 and 3, so it is 2 o’clock. That means that the time is 2:35.” 

Instead, you automatically read the clock to tell time. Hidden or 

automatic self-statements about urges can make them harder 

to handle (“Now I want a drink. I won’t be able to stand this. 

The urge is going to keep getting stronger and stronger until I 

blow up or drink.”) Other types of self-statements can make the 

urge easier to handle (“Even though my mind is made up to stay 

sober, my body will take a while to learn this too. This urge is 

uncomfortable, but in 15 minutes or so, I’ll be feeling like myself 

again.”).

There are two basic steps in using self-talk constructively:

1. Pinpoint what you tell yourself about an urge that makes it 

harder to cope with the urge. One way to tell if you are on 

the right track is when you hit upon a self-statement that 

increases your discomfort. That discomfort-raising self-statement is a leading suspect for challenge, since it pushes your 

buttons.

2. Use self-talk constructively to challenge that statement. 

An effective challenge will make you feel better (less tense, 

anxious, panicky) even though it may not make the feelings 

disappear entirely. The most effective challenges are ones that 

are tailored to your specific upsetting self-statements. Listed 

below are some stock challenges that people find useful:

What is the evidence? What is the evidence that if you don’t 

have a drink in the next 10 minutes, you will die? Has anyone 

(who has been detoxed) ever died from not drinking? What’s 

the evidence that people who are recovering from an alcohol 

problem don’t experience the feelings that you have? What is 

the evidence that there is something the matter with you, that 

you will never improve?

What is so awful about that? What’s so awful about feeling 

bad? Of course you can survive it. Who said that sobriety 

would be easy? What’s so terrible about experiencing an urge? 

If you hang in there, you will feel fine. These urges are not like 
31

Session 2: Coping With Cravings and Urges to Drink

being hungry or thirsty or needing to relieve yourself—they 

are more like a craving for food or an urge to talk to a particular person—they pass, in time.

You are a regular human being and have a right to make mistakes. Maybe you worry about being irritable, preoccupied, or 

hard to get along with. What’s so bad about that? We all make 

mistakes, and in a situation that is complicated, there is no 

right or perfect way to get along. Our most memorable lessons, invariably, are learned in the school of hard knocks. It’s 

a school that every single one of us attends throughout life.

Some of the substitute thoughts or self-statements will only be 

necessary or helpful initially, as ways of distracting yourself 

from persistent urges; you’ll have an easier time if you replace 

the uncomfortable thoughts with other activities. After a while, 

sobriety will feel less unnatural; many of the urges will diminish 

and drop out, and you won’t need constant replacements.

In-Session 

Exercises

1. Make a list of craving triggers. Circle the triggers that you can avoid 

or to which you can reduce your exposure (like not having alcohol 

in your home).

2. Make up a craving plan. Pick two or three of the general strategies 

that were discussed and make up a plan about how you would put 

them into practice if you experience an urge. Remember—cravings 

can come when you least expect them! For example, if you think 

getting involved in a distracting activity would be helpful, which 

activities would you pick? Are these available to you now? Which 

may take some preparation? If you were feeling craving, who would 

be best for you to call? If you have not tried urge surfing before, it 

might be very helpful to practice with your therapist before trying it 

when facing an urge.
Coping With Cravings and Urges

Reminder Sheet

■ Urges are common in the recovery process. They are not a sign of failure. Instead, try to 

learn from them about what your craving triggers are.

■ Urges are like ocean waves. They get stronger only to a point, then they start to go away.

■ You win every time you defeat an urge by not using. Urges only get stronger if you give in 

and feed them. An urge will eventually weaken and die if you do not feed it.

Practice Exercises

For next week, make a daily record of urges to use drugs or drink, the intensity of those 

urges, and the coping behaviors you used.

1. Fill out the DAILY RECORD OF URGES TO DRINK

a. Date

b. Situation: Include anything about the situation or your thoughts or feelings that 

seemed to trigger the urge to drink.

c. Intensity of thirst: Rate your thirst, where 1 = none at all, 100 = worst ever.

d. Coping behavior: Use this column to note how you attempted to cope with the urge to 

drink. If it seems like it would help, note the effectiveness of your coping.

2. Below is an example of how to fill out the record form.

DAILY RECORD OF URGES TO DRINK

Date Situation (include your thoughts and 

feelings)

Intensity 

of 

cravings 

(1–100)

Coping behaviors used

5/16/91 Was feeling stressed. Had a disagreement 

with my boss. 75 Shut myself in office and relaxed. Felt better after 20 minutes

5/17/91 Antsy at bed time. Trouble getting ready to go 

to bed. 60 Took a hot shower, listened to the relaxation tape. Shower better than tape.

5/18/91 Went to Andy’s Diner for lunch, where I always 

used toorder something to drink. 80 Ordered tonic with lime. It was a close 

call. Should have prepared in advance.

5/19/91 Pay day. Bob wanted to party after work. 68 Suggested we go for coffee. Bob agreed. 

Boy—was I surprised!
DAILY RECORD OF URGES TO DRINK

Intensity 

of Date Situation (include your thoughts and feelings) Coping behaviors used cravings 

(1–100)

35

Session 3: Managing Thoughts About 

Alcohol and Drinking

Rationale The following paragraph is inserted between the first and second elements of the Monti et al. rationale:

Recovering alcoholics need to be aware of a state of mind that can 

predispose them to a relapse—a state of mind characterized by 

certain dangerous attitudes and thought processes. This state of 

mind is often described as “negative tapes.” These thought processes and attitudes are dangerous because they induce alcoholics 

to relax their guard (decrease vigilance). Stinking thinking, as 

the saying goes, leads to drinking thinking, and then, usually, to 

drinking without thinking. It is not the thinking itself that creates 

the problem, but how people deal with it. If alcoholics can learn to 

dismiss this thinking from their minds whenever it appears, recognize it for what it is, or counter it with contrary thoughts, it need 

not lead to a relapse.

The following items are added to the list of situations that may lead 

clients to have thoughts about resuming drinking:

f. Escape. Individuals wish to avoid the discomfort aroused by 

unpleasant situations, conflicts, or memories. Failure, rejection, 

disappointment, hurt, humiliation, embarrassment, discontent, 

or sadness all tend to demand relief. People get tired of feeling 

hassled, lousy, and upset. They just want to get away from it 

all and, more to the point, from themselves. It is not necessarily 

intoxication that is sought; rather it is numbness, the absence of 

problems, and peace.

g. Relaxation. Thoughts of wanting to unwind are perfectly normal, 

but they go awry when they are coupled with the expectations of

NOTE: The major portion of this session is based on the corresponding session in 

Monti et al. (pp. 79–83). A number of additions made to the original materials are 

derived from Ludwig (1988). © Oxford University Press. Used with permission.
36

Cognitive-Behavioral Coping Skills Therapy Manual

this happening immediately, without the benefit of doing something relaxing. Rather than engaging in a wide variety of possibly 

enjoyable and relaxing activities, the individual may choose the 

more immediate route induced through alcohol.

h. Socialization. This overlaps with relaxation but is confined to 

social situations. Many individuals, shy or uncomfortable in 

social settings, may feel a need for a social lubricant to feel more 

at ease and decrease the awkwardness and inhibitions they feel 

around others.

i. Improved self-image. This situation typically involves a relatively pervasive negative and low self-esteem. When individuals 

start becoming unhappy with themselves, when they are feeling 

inferior to others, when they regard themselves as lacking in 

essential qualities, when they feel unattractive or deficient, they 

often begin to think again of alcohol, through which they may 

have previously achieved immediate and temporary relief.

j. Romance. Individuals often indulge in adolescent fantasies. 

When bored or unhappy with their lives, they yearn for excitement, romance, the joy of flirtation, and the thrill of being in 

love. This is usually the kind of thought that, when engaged in 

too seriously, requires a drug like alcohol to sustain it and make 

it more vivid and real.

k. To hell with it. Some individuals seem to have lost all incentive 

for pursuing any worthwhile goals. Their thoughts express disillusionment; nothing really matters. There is no reason to try. 

Why should they give a damn? Such an attitudinal set leads 

these individuals to be less vigilant and not care whether they 

remain sober.

l. No control. This represents the other side of the coin from the 

“Testing Control” script. Just as believing in one’s ability to 

handle alcohol is usually a setup for relapse, the opposite attitude of not being able to control one’s cravings virtually insures 

it. Individuals give up the fight, conceding defeat even before 

they have made any effort to resist. Alcohol is seen as one of 

the few viable options available. This differs from the “hell with 

it” attitude. In that situation, individuals do not necessarily feel 

powerless; they just do not want to exert the effort to continue 

what they have been doing.

Skill 

Guidelines

The following introductory paragraph is added:

All recovering people have thoughts about drinking at one time 

or another. The thinking itself does not create the problem, but 

how people deal with it. If alcoholics can learn to dismiss this 

thinking from their minds whenever it appears, recognize it for 
37

Session 3: Managing Thoughts About Alcohol and Drinking

what it is, or counter it with contrary thoughts, it need not lead 

to a relapse. There are three general and overriding prerequisites 

for an individual to cope effectively with thoughts about drinking: (1) one needs to be firmly committed to recovery in order to 

choose to remain abstinent and not give in to persistent thoughts; 

(2) one must be aware of the persistent aspects of thinking that 

would allow the individual to rationalize and justify (and provide 

guilt-free) drinking; (3) one must maintain a high level of vigilance, 

always anticipating potential risks to relapse and never assuming 

that one is immune from the prospect of giving into urges, cravings, or thoughts of drinking.

Add the following paragraph after the first skill guideline:

An important aspect of challenging possible thoughts about 

drinking (as well as forms of thought distraction and substitute 

behaviors incompatible with drinking) is not to visualize what one 

is not going to do but to picture a substitute or opposing behavior 

that one is going to do. To begin a new habit, individuals should 

have a behavioral image of themselves engaging in the new behavior, not just on occasion but every time the unwanted habit pops 

into mind.

The following paragraph is added after the third skill guideline:

The individual is asked to think beyond the more immediate pleasure associated with alcohol, to play out the mental image of the 

possible drinking episode to the end, and to include all the detrimental consequences that could arise if drinking occurs.

In skill guideline number 8, the reference to calling one’s AA sponsor is 

eliminated in Project MATCH to reduce overlap with the 12-Step facilitation treatment.

Introducing 

the Practice 

Exercise

The practice exercise in Monti et al. has been modified somewhat. The 

following paragraph replaces the one on page 83 in Monti et al.:

Ask clients to write out lists of (1) the 5 to 10 most anticipated 

positive consequences of sobriety and not drinking, (2) the 5 to 

10 most negative personal consequences associated with drinking, and (3) the 5 to 10 greatest stumbling blocks or high-risk 

situations that will make it difficult to achieve or maintain sobriety. Then, ask clients to use this information (the positive benefits 

of sobriety and the negative consequences of drinking) to rate 

how committed they are to stop using and to stay sober. The rating of the person’s perceived level of commitment ranges from 

1 (no commitment) to 10 (extremely high level of commitment).
Practice Exercise

The following composite Practice Exercise incorporates the modifications to the one in 

Monti et al.:

One way to cope with thoughts about using alcohol is to remind yourself of the benefits of 

not using, the unpleasant consequences of using, and the stumbling blocks or high-risk 

situations that may make it hard to keep your commitment to abstinence. Use this sheet to 

make a list of the 5 to 10 reminders in each category, then transfer this list onto a pocketsized index card. Read this card whenever you start to have thoughts about drinking.

Positive benefits of not using: _________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Unpleasant effects or negative consequences of using: __________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Stumbling blocks, or high-risk situations, to keeping commitment to abstinence:________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Overall level of personal commitment to remain abstinent:

None 1 2 3 4 5 6 7 8 9 10 Extremely

high
39

Session 4: Problem Solving

This session is based on the similar one in Monti et al., pages 83–87, 

with the following modifications.

Rationale Item 2 of the Monti et al. rationale section is replaced with the following:

2. Alcohol and drug abusers are likely to encounter the following general types of problems:

a. Situations where drinking and drug use has occurred in the past

b. Situations that arise only after you have stopped drinking or 

using drugs (i.e., social pressure, cravings, and slips)

c. Difficulty in developing activities that may be useful to maintain 

sobriety (e.g., new recreational habits)

 What sort of problems have you encountered so far?

Skill

Guidelines

Items 3b and 3c are dropped and replaced with the following:

b. Consider both behavioral and cognitive coping strategies 

(Sanchez-Craig 1983). When a problem involves conflict with 

other people, it is often better to employ behavioral coping and 

speak up (in an assertive way) so as to change the situation for 

the better. Negative emotional reactions to uncontrollable events 

may be best handled with cognitive coping, changing the way 

you think about the situation. In this manner, you may reduce 

your negative emotional reaction without changing a situation 

that may be beyond your control. In some situations, both cognitive and behavioral coping strategies are necessary to deal with a 

problem.
40

Cognitive-Behavioral Coping Skills Therapy Manual

Behavior Rehearsal Role Plays

Retain the first paragraph in Monti et al., but omit the subsequent 

group exercises.

Reminder Sheet and Practice Exercise

These are retained as in Monti et al., page 212.
41

Session 5: Drink Refusal Skills

The majority of this session is based on the corresponding session in 

Monti et al., pages 61–63. The following changes have been made.

Rationale Item 2 in Monti et al. is added to item 4. The following two elements are 

inserted in place of the relocated item 2:

As drinking increases in severity over time, there appears to be a 

“funneling” effect or narrowing of social relationships: individuals 

begin to eliminate sober friends, and their peer group becomes 

populated with others who support and reinforce continued 

drinking. Being with such individuals and former drinking buddies increases the risk of relapse through multiple avenues: (1) 

overt and covert pressure to drink; (2) conditioned craving associated with people, places, activities, and emotional states related to 

past drinking; (3) increased positive outcome expectancies about 

the effects of drinking; and (4) increased access/availability of 

substances.

Two forms of social/peer pressure are often experienced by individuals in recovery: direct and indirect social pressure. The former 

occurs when someone offers the individual a drink directly and up 

front. This is most likely to happen in high-risk situations. Indirect 

social pressure involves returning to the same old settings (e.g., 

taverns, lounges, parties), with the same people, doing the same 

things, and experiencing the same feelings previously associated 

with drinking.

The following is added at the beginning of item 3 in the Monti et al. 

rationale:

Given the increased risk associated with social pressure, the first 

action that should be considered is behavioral avoidance. However, 

avoidance is not always possible or practical.

Skill

Guidelines

The following paragraph is added at the beginning of the skill guidelines section:
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Cognitive-Behavioral Coping Skills Therapy Manual

If unable to avoid high-risk situations and people, the next level of 

response is being able to refuse requests to drink. The more rapidly a person is able to say “no” to such requests, the less likely 

he/she is to relapse. Why is this so? The old notion of “he who 

hesitates is lost”; that is, being unsure and hesitant allows you to 

begin rationalizing (e.g., “One beer wouldn’t be so bad.”). The goal 

then is to learn to say “no” in a convincing manner and to have 

your response at the tip of your tongue.

In-Session

Practice

The following material is added prior to the Modeling exercise. It 

requires having available the “Drinking Locations” and the “Social 

Situations” cards from the “Comprehensive Drinker Profile” (Miller and 

Marlatt 1984).2

Provide the clients with the “Drinking Locations” cards from the 

“Comprehensive Drinker Profile.” Have them sort the cards from the 

most to the least frequent drinking setting. This listing of drinking settings will enable the client to anticipate settings having high risk for 

drinking and social pressure to drink.

Next, provide the clients with the “Social Situations” cards from the 

“Comprehensive Drinker Profile.” Have them sort the cards from the 

most to the least frequent drinking situation. Have the clients indicate 

which of the people identified in their social network they anticipate 

contacting during the next 90 days. Ask them to indicate which of 

these individuals are likely to support sobriety and which are likely to 

tempt/pressure them to drink.

This exercise will help clients identify people and situations to avoid 

because they represent a high risk to their sobriety. It will also help the 

therapist identify specific individuals and situations to include in the 

behavioral rehearsal role play.

Modeling The therapist plays the role of the person being pressured to drink (by 

the client) and demonstrates an effective and assertive way to handle 

the situation.

Behavior 

Rehearsal 

Role Play

This is conducted essentially the same way as described in Monti et al. 

An additional source of ideas for role plays derives from the in-session 

practice exercise: those locations and situations that were identified 

as high frequency represent considerable risk and would therefore 

provide good scenarios for role playing. The following suggestions are 

added at the end of the Role Play section:

2 Miller, W.R., and Marlatt, G.A. Comprehensive Drinker Profile. Odessa, FL: 

Psychological Assessment Resources, Inc., 1984.
43

Session 5: Drink Refusal Skills

■ The therapist should encourage the client to try to visualize scenarios involving a group of people, even though the individual therapy 

situation does not provide an opportunity for the use of multiple 

role-play partners.

■ In many cases, it may be useful for the therapist to elicit the client’s fantasies about how the target person will react to the client’s 

refusal to drink.

Reminder Sheets and Practice Exercises

These are retained as in Monti et al., page 205.

45

Session 6: Planning for Emergencies 

and Coping With a Lapse

This session is based almost entirely on the similar session in Monti 

et al. entitled “Planning for Emergencies” (pp. 120–121). The Project 

MATCH manual included a few modifications, as follows.

Rationale The fifth item in the Monti et al. rationale section is replaced by the 

following two items:

5. If a lapse or slip back to drinking does occur, it is likely to be accompanied by feelings of guilt and shame. These must be dealt with at 

once, before they lead to further drinking After a slip, one should 

try to learn, from the events that preceded it, to reduce the likelihood of a repetition.

6. Ask the client to describe one or more life events or life changes 

that might lead to craving for alcohol or to a lapse. The therapist 

should list these on the chalkboard and ask clients to consider how 

they might affect their behavior and interactions with others.

Skill

Guidelines

Two additional skill guidelines items have been added. These are taken 

from page 157 of Monti et al., the paragraphs on dealing with the 

immediate aftermath and the longer term impact of a drinking episode.

Practice

Exercise

The practice exercise remains as specified in Monti et al.

Reminder

Sheets

Two reminder sheets from Jaffe et al. (1988) have been added. These 

are reproduced below.
 Personal Emergency Plan:

High-Risk Situation

Reminder Sheet

If I encounter a life event that puts me in a high-risk situation:

1. I will leave or change the situation or environment.

2. I will put off the decision to drink for 15 minutes. I will remember that most cravings are 

time-limited and I can wait it out—not drink.

3. I will challenge my thoughts about drinking. Do I really need a drink? I will remind 

myself that my only true needs are for air, water, food, and shelter.

4. I will think of something unrelated to drinking.

5. I will remind myself of my successes to this point.

6. I will call my list of emergency numbers:

NAME PHONE NUMBER

1. ___________________________________________ _____________________________

2. ___________________________________________ _____________________________

3. ___________________________________________ _____________________________

4. ___________________________________________ _____________________________

5. ___________________________________________ _____________________________

6. ___________________________________________ _____________________________

GOOD LUCK!

REMEMBER: RIDING OUT THIS CRISIS WILL STRENGTHEN YOUR RECOVERY
Personal Emergency Plan: Lapse

Reminder Sheet

A slip is a major crisis in recovery. Returning to abstinence will require an all-out effort. 

Here are some things that can be done.

If I experience a lapse:

1. I will get rid of the alcohol and get away from the setting where I lapsed.

2. I will realize that one drink or even one day of drinking/drug use does not have to result 

in a full blown relapse. I will not give in to feelings of guilt or blame because I know these 

feelings will pass in time.

3. I will call for help from someone else.

4. At my next session, I will examine this lapse with my therapist, discuss the events prior 

to my lapse, and identify triggers and my reaction to them. I will explore with my therapist what I expected alcohol to change or provide. I will work with my therapist to set up 

a plan so that I will be able to cope with a similar situation in the future.

REMEMBER: THIS LAPSE IS ONLY A TEMPORARY DETOUR ON THE 

ROAD TO ABSTINENCE

49

Session 7: Seemingly Irrelevant

Decisions

The goals of this session are to (1) convey to the client the kinds of 

seemingly irrelevant thoughts, behaviors, and decisions that may culminate in a high-risk situation and (2) encourage the client to articulate 

and think through all decisions, no matter how small, in order to avoid 

rationalizations or minimizations of risk (e.g., “I need to keep a few 

beers in the refrigerator in case my brother-in-law comes over.”).

Material for this session was taken from Monti et al., pages 116–120, 

with a few modifications.

Rationale Marlatt and Gordon’s (1985, p. 273) “George the Drinker” story is substituted for the “Sam the Gambler” story on pages 117–118 because of 

its more direct link to drinking.

The following is added to point 3 on page 117:

By paying more attention to the decisionmaking process, you will 

have a greater chance to interrupt the chain of decisions that could 

lead to a relapse. This is important because it is much easier to 

stop the process early, before you wind up in a high-risk situation, 

than later when you are in a situation that is harder to handle and 

may expose you to a number of triggers.

Also, by paying attention to your decisionmaking process, you will 

be able to recognize certain kinds of thoughts that can lead to 

making risky decisions, such as George’s thought that he “had to” 

have a cigarette in the story (“George the Drinker”). Thoughts like 

“I have to” go to a party, “should” see a certain drinking buddy, 

or “have to” drive by a particular place, often occur at the beginning of a Seemingly Irrelevant Decision and should be treated as 

a warning or red flag. Other red-flag thoughts often start with “It 

doesn’t matter if I . . . ,” “I can handle . . . ,” and so on.
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Cognitive-Behavioral Coping Skills Therapy Manual

Group

Discussion

This exercise is easily accomplished in the individual therapy setting. 

The item referring to AA or Narcotics Anonymous meetings is omitted 

in Project MATCH.

Exercise in

Group

This too is easily adapted to individual therapy. The following exercises are added:

■ Think about the most recent time you drank. Trace back through 

the decisionmaking chain. What was the starting point (exposure 

to a trigger, certain thoughts)? Can you recognize the choice points 

where you made risky decisions?

■ What plans have you made for this weekend? If none, why? Is this a 

seemingly irrelevant decision? Sometimes not planning means planning to drink. What plans could you make for this weekend that 

would reduce the risk of winding up in a risky situation?
51

Final Core Session: Termination

This session is based on materials from two sections in Monti et al. It 

begins with material from chapter 4, pages 160–161, the subheadings 

entitled “Termination,” “Considering the Need for More Treatment,” 

and “Planning for Emergencies,” with material on taking Antabuse 

and attending AA deleted. The session description then picks up two 

subheadings from the session “Wrap-Up and Goodbyes,” page 124: 

“Feedback to the Therapists” and “Goodbyes.” The session description 

concludes with “Coping With Persistent Problems,” pages 161–162.

53

Elective Sessions

Therapists may present up to four elective sessions after the first seven 

core sessions. The therapist and client should agree on which sessions 

to use. If the therapist feels that a particular session is especially relevant to a client, but the client disagrees, it is probably better to go 

along with the client’s choice.

The sessions listed here can be offered in any order.

Starting Conversations

Nonverbal Communication

Introduction to Assertiveness 

Receiving Criticism

Awareness of Anger

Anger Management

Awareness of Negative Thinking

Managing Negative Thinking 

Increasing Pleasant Activities

Managing Negative Moods and Depression

Enhancing Social Support Networks 

Job-Seeking Skills

Couples/Family Involvement I 

Couples/Family Involvement II

55

Elective Session: Starting 

Conversations

This session is exactly as presented in Monti et al., pages 28–32. The 

only modification is elimination of the modeling section, which would 

require an interaction between cotherapists.
56

Elective Session: Nonverbal 

Communication

This session has no changes from the corresponding session in Monti 

et al., pages 35–40 except for minor modifications in wording to accomodate individually administered treatment.
57

Elective Session: Introduction to 

Assertiveness

The majority of this session is exactly as found in Monti et al., pages 

46–49, with the few following changes.

Skill

Guidelines

A 7th skill guideline is added:

7. Some of the most difficult situations in which to respond assertively 

are those that may potentially end with negative consequences. 

These often involve anticipatory anxiety, which can have a disorganizing effect. Examine the cognitions that may be preventing you 

from acting assertively (e.g., “I’ll get fired if I tell my boss I can’t 

work overtime tonight because I have to get to my therapy session”). In examining these cognitions, apply many of the same skills 

discussed for managing thoughts about drinking These include:

a. Determine the thought or fear. What’s stopping me from asserting myself? What am I afraid will happen? What’s the worst that 

could happen if I stand up for myself? What’s so upsetting about 

that?

b. Assess the probabilities. How likely is the negative consequence? 

(How likely is it that I get fired for not working overtime once?)

c. Evaluate the catastrophe. What would happen if the dire consequence occurred? Would I be able to get another job? Would my 

life be over?

d. Identify the rules. What assumptions and beliefs are governing 

my feelings in this situation? (Should I please everybody? Is it 

necessary that everyone like me?)
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Cognitive-Behavioral Coping Skills Therapy Manual

Behavior

Reversal Role

Play

Omit this exercise.

Modeling Omit the Monti et al. modeling exercise and replace it with the following:

1. Have the client role play a coworker who suggests that the therapist 

accompany him/her for a drink after work. The therapist will model 

passive, aggressive, passive-aggressive, and assertive responses, 

respectively. After each type of response, ask the client to identify 

the type of behavior that was demonstrated and how successful 

each of the approaches would be in avoiding drinking.

2. Practicing assertive responses

Have the client generate a number of situations that were difficult 

in the past (not necessarily those involving drinking) and practice 

assertive responses in role plays. If the client has trouble supplying 

these readily, try some easy ones (e.g., returning an item bought in 

a store to the clerk, dismissing a pesky salesperson) and some difficult ones (e.g., asking a good friend to return a loan made several 

months ago or confronting a supervisor who took credit for an idea 

of the client’s).

Practice

Exercise

If the response style in any of the three social situations specified in 

the Monti et al. exercise (p. 201) is not assertive, the client is asked to 

think of an assertive response and write it down.
59

Elective Session: Receiving Criticism

This session represents a combination of the two sessions in Monti 

et al. on “Receiving Criticism,” pages 55–58, and “Receiving Criticism 

About Drinking,” pages 58–61.

Rationale Combine the two rationale sections from Monti et al. on pages 55–56 

and 58–59.

Skill 

Guidelines

Combine the skill guidelines sections on pages 56–57 and 59.

Modeling The modeling exercise from the “Receiving Criticism” session (p. 57) is 

utilized, with the client first playing the part of the critical store manager and the therapist modeling receipt of criticism in the role of clerk, 

followed by a role reversal.

Behavior 

Reversal Role 

Play

The behavior rehearsal role plays of both sessions are omitted in Project 

MATCH.

Practice

Exercise

The practice exercises from both sessions are retained (pp. 203–204).
60

 Elective Session: Awareness of Anger

This session has no changes from the corresponding session in Monti 

et al., pages 103–105, except for minor modifications in wording to 

accommodate individually administered treatment.
61

Elective Session: Anger Management

This session has no changes from the corresponding session in Monti 

et al., pages 106–108, except for minor modifications in wording to 

accommodate individually administered treatment.
62

Elective Session: Awareness of 

Negative Thinking

This session has no changes from the corresponding session in Monti 

et al., pages 108–111, except for minor modifications in wording to 

accommodate individually administered treatment.
63

Elective Session: Managing

Negative Thinking

This session has no changes from the corresponding session in Monti 

et al., pages 111–116, except for minor modifications in wording to 

accommodate individually administered treatment.
64

Elective Session: Increasing

Pleasant Activities

The goal of this session is to encourage the client to participate in activities which are pleasurable in order to provide a constructive behavioral 

alternative to alcohol use and to help the client counter the feelings of 

boredom and loneliness many problem drinkers experience when they 

stop drinking.

Material for this session was taken from pages 87–89 of the Monti et al. 

book, with the following modifications.

Skill

Guidelines

Add to skill guideline number 1:

Try to think of some activities you would enjoy doing by yourself and some you would enjoy with other people. A balanced life 

includes both private time and social time. Asking others to participate in pleasant activities with you is a good ice breaker and 

another way to enlarge your circle of friends and supporters.

Add to skill guideline number 3:

Try to schedule this time during high-risk periods (e.g., after work, 

after dinner, on weekends). This way, you can reward yourself 

with positive activities rather than with drinking. Keeping yourself 

active with pleasant activities when you might be likely to think 

about drinking can result in your not thinking about drinking 

at all.

Add skill guideline number 5:

5. Also remember that getting involved with a pleasant activity is a 

great way to cope with cravings and urges.
65

Elective Session: Managing Negative 

Moods and Depression

Rationale 1. Negative moods and depression are common among alcoholics 

during the recovery process. Often, these moods are related to 

the actual depressant effects of alcohol or drugs or to the losses 

experienced in one’s life (e.g., family, job, finances) as a result of 

drinking. Depression and negative moods related to these factors 

often get better during the course of treatment without any specific 

attention, as one is sober longer and begins to deal more effectively 

with the remaining life problems. Some people, however, continue 

to experience problems with depression even after they have been 

clean and sober for fairly long periods of time. In such cases, it may 

be necessary to focus more directly on these negative moods.

2. Depression is a problem in its own right. However, it is a particular 

problem for the recovering alcoholic, since negative mood states, 

particularly depression, are a major reason for relapse and, thus, 

represent high-risk situations.

3. Returning to drinking is not an effective way to cope with depression and only serves to make the person more depressed in the long 

run.

4. There are many different ways to cope with depression and negative 

moods. Given the focus of the present therapy approach, negative moods can be dealt with effectively by changing the ways one 

thinks and behaves. As such, many of the skills that have been 

learned to manage negative thoughts, to solve problems, and to 

increase pleasant activities can be used to deal with depression and 

its symptoms.

5. The best way to beat depression is to consider each symptom as 

a separate problem to be solved. The symptoms of depression are 

interrelated; improvement in one area leads to improvement in 

other areas.

NOTE: Adapted from Emery 1981. © Simon and Schuster. Used with permission.
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Cognitive-Behavioral Coping Skills Therapy Manual

Skill

Guidelines

Depression has a number of causes and symptoms. Several different 

cognitive-behavioral approaches have been found helpful in dealing 

with depression of mild to moderate proportions.

1. Change your way of thinking about yourself and the world. One of 

the things that is most characteristic of depression is that the individual tends to view the world and the self through distorted and 

depressive perceptions. The way one thinks affects how one feels. 

As such, it is important to look at the way you think and see if this 

contributes to your feeling sad and depressed.

2. The steps to changing your thinking, while not easy, are simple. 

First, become aware of your self-defeating thoughts; second, 

answer these with more realistic ones; and third, act on the new 

thoughts. If you use these three A’s, you can overcome the symptoms and causes of your depression.

3. Awareness. The first step in the process is to recognize the 

symptoms of your depression. Depressed people often miss or misinterpret symptoms of depression. Below are some ways you can 

become more aware of your symptoms:

a. Pay attention to your mood changes. When you start to feel sad, 

gloomy, ashamed, bored, lonely, or rejected, tune into what’s 

going on, to how you’re feeling. These are important clues to your 

thinking.

b. Own your feelings. If you are having trouble recognizing your 

feelings, start talking about them. Tell people how you are honestly feeling at any given moment.

c. Be alert to your body. This is a clue to your emotions. Notice 

your posture, your facial expression, how you are walking and 

moving.

d. Label your avoidance. Keep a lookout for people, places, and 

activities that you once enjoyed but are now avoiding. Forget 

about the reasons why you are avoiding them, just see when you 

do.

e. Watch for times when your confidence disappears. Are there times 

and places when you ask others for help? Ask yourself whether 

you were able to handle this on your own before. Remember, this 

loss of confidence can be a symptom of depression.

 f. Look for activities that require great effort. Do you have to force 

yourself to make or return phone calls? Do you have trouble 

completing tasks around the house?
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Elective Session: Managing Negative Moods and Depression

g. Become aware of trouble concentrating or making decisions. Do 

you vacillate over simple decisions or second guess yourself? 

These can be symptoms of depression.

The second level of awareness is catching the thoughts that come 

before your symptoms. These are called automatic negative thoughts. 

During depression, these automatic negative thoughts become stronger 

and drown out more sensible thoughts. Thoughts are used to monitor 

feelings and behavior. They are used to initiate action and anticipate 

events. Your thoughts tell you what to do and how to feel. The chief 

characteristic of automatic negative thoughts is that they are generally 

wrong.

Automatic thoughts make you depressed; the more depressed you 

become, the more negative thoughts you will have and the more likely 

you are to believe them. Below is a list of thinking errors or methods of 

distortion characteristic of depressed thoughts.

Type of error Examples

Personalizing Thinking all situations and events revolve 

around you.”Everyone was looking at me and 

wondering why I was there.”

Magnifying Blowing negative events out of proportion. “This 

is the worst thing that could happen to me.”

Minimizing Glossing over the saving and positive factors. 

Overlooking the fact that “nothing really bad 

happened.”

Either/or Thinking “Either I’m a loser or a winner.” Not taking into 

account the full continuum.

Taking events out 

of context

After a successful interview, focusing on one or 

two tough questions. “I blew the interview.”

Jumping to 

conclusions

“I have a swollen gland. This must be cancer.”

Overgeneralizing “I always fail—I fail at everything I ever try.”

Self-blame “I’m no good.” Blaming total self rather than specific behaviors that can be changed.

Magical thinking “Everything is bad because of my bad past 

deeds.”

Thinking 

Errors
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Cognitive-Behavioral Coping Skills Therapy Manual

Mind reading “Everyone there thought I was fat and ugly.”

Comparing Comparing self with someone else and ignoring 

all of the basic differences. “Cher has a better 

figure than mine.”

Catastrophizing Putting the worst possible construction on events. 

“I know something terrible happened.”

In addition to becoming aware of the typical thoughts associated with 

depression noted above, it is important for you to become aware of your

characteristic automatic negative thoughts. A number of steps can be 

taken to help you do this.

a. One way to become more aware of your thoughts is simply to 

count them. This will help you realize that they just appear—they 

are automatic and not a reflection of reality.

b. Give yourself a goal of collecting 50 negative thoughts. It seems 

like an impossible task, but it will prompt you to think hard and 

you are likely to come up with 5 to 10 such thoughts, even if you 

don’t make it to 50!

c. Use an instant replay technique. If you have some negative feelings and cannot quite catch the thoughts, replay the feelings 

over and over until you catch the thoughts. If you can remember 

what happened, imagine the event as if it were happening right 

now.

d. Look for the meaning of the situation. Ask yourself, “What is the 

significance of the situation ... what are the consequences?” By 

doing this you can usually become aware of your thoughts.

e. Set aside a specific time to collect negative thoughts. You may 

find that setting aside a regular time may be helpful. During 

a half hour period, for example, write out some of the negative 

thoughts you had during the day. You might want to limit the 

thoughts to specific problems or situations.

f. Write out your thoughts. Putting your thoughts down on paper 

is one of the best ways to become aware of them. When writing 

them out, force yourself to go beyond the obvious thoughts that 

first come to mind.

g. Use the excuses you come up with to avoid collecting negative 

thoughts as cues to swing into action. This way the excuse can 

become an early warning signal.
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Elective Session: Managing Negative Moods and Depression

4. Answering. Once you begin catching negative thoughts, you can 

begin answering them. The secret to answering negative thoughts is 

to realize there are different interpretations of any event and some 

are closer to reality than others. When answering your thoughts, 

try to consider a wide range of possible interpretations, not just 

the negative ones. If you are depressed, it is important to separate 

thoughts from facts, since you will have distorted thoughts, and 

when you believe and act on distorted thoughts, you become more 

depressed. You must begin to question the assumptions involved 

in the thoughts. A good way to do this is to ask some serious questions of yourself and your automatic thoughts.

Here are 20 questions that you can use to generate answers to your 

negative thoughts:

1. What’s the evidence? Ask yourself, “Would this thought hold 

up in a court of law or is it circumstantial?” Just because the 

newspaper is late one day doesn’t mean you can’t count on 

anything. Give yourself a fair trial before you convict yourself.

2. Am I making a mistake in assuming what causes what? Determining causes is rarely simple. Example: Many women think 

they’re fat because they have no willpower. Scientists have been 

studying obesity for years and they don’t know what causes 

it. They know the determinants are partly biological, social, 

cultural, psychological, familial, and economic. Saying lack of 

willpower causes obesity is an oversimplification. Specifics are 

difficult to pinpoint.

3. Am I confusing a thought with a fact? This can lead to trouble—

especially if you call yourself names and then believe them as 

gospel. There is an old story that makes this point: “How many 

legs would a dog have if you called the tail a leg? Five? Wrong. 

The answer is four. Calling a tail a leg doesn’t make it so.” 

Don’t be dogmatic about your thoughts—look for the facts.

4. Am I close enough to the situation to really know what’s happening? One woman said, “The bosses upstairs don’t like our 

department’s work and want to get rid of us.” Who knows what 

they’re thinking upstairs? You’re not up there with them. You 

have to rely on what you know as fact. The woman’s worry 

turned out to be a false rumor.

5. Am I thinking in all-or-none terms? Do you see the world in 

either/or terms (“I’m ugly and everyone else is beautiful”)? 

Just about everything is in degrees and on a continuum. Even 

a person’s gender is not always clear cut; some people’s hormonal makeup is such that it’s a tossup whether they’re male 

or female.
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Cognitive-Behavioral Coping Skills Therapy Manual

6. Am I using ultimatum words in my thinking? (“I always should 

be nice or no one will like me.”) You place unfair ultimatums 

on yourself with these words. This isn’t “just semantics,” but 

relates directly to how you feel and act.

7. Am I taking examples out of context? One student believed 

she’d been given a bad letter of recommendation. She thought 

the teacher said in the letter that she was narrow and rigid. 

When she reread the letter, she saw the teacher had written, 

“She has high principles.” It was really a positive letter, and 

she had taken this part out of context.

8. Am I being honest with myself? Am I trying to fool myself—

denying the truth, making excuses, and misplacing the blame? 

One depressed woman, speeding on the freeway, thought, “I 

hope they catch me and put me in jail.” When she thought 

about it for a moment, she realized she didn’t really mean this.

9. What is the source of my information? Consider your sources. 

People have their own reasons for what they tell you. “Am I 

depending on unreliable sources and spreaders of gloom to tell 

me how it is? Why let them define reality for me?”

10.Am I confusing a low probability (a rare occurrence) with a high 

probability? A mailman thought, “They’ll probably fire me for 

missing 3 days of work.” But after he reflected on it, he asked 

himself, “When was the last time they fired anyone at the post 

office?”

11.Am I assuming every situation is the same? Are you taking 

into consideration time, location, and subtle differences? “Just 

because I dropped out of school 20 years ago doesn’t mean I’ll 

fail this time.”

12.Am I focusing on irrelevant factors? Patients attempting to 

build a case for their depression have asked me, “What about 

Uganda, starving children, and Hitler?” It’s highly unfortunate 

that there is misery and evil in the world. But it’s irrelevant to 

being depressed. Do what you can to alleviate the suffering of 

others, but getting depressed over it won’t help.

13.Am I overlooking my strengths? When people become depressed, 

they overlook the problems they have solved in the past. I am 

continually amazed at people’s ability to handle adversity once 

they turn their thinking around. Ask yourself how you handled 

situations like these in the past.
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Elective Session: Managing Negative Moods and Depression

14.What do I want? What are my goals? Do I want to be happy and 

get the most out of life? Is this thinking (“Everything’s bad”) 

getting me what I want? Is it doing me any good?

15. How would I look at this if I weren’t depressed? Would I think 

a cold sore is the worst thing that could happen? How would 

others (nonpartisan viewers) interpret this situation? Imagine 

how you will react to it once you are over your depression.

16.What can I do to solve the problem? Are my thoughts leading 

to problem solving (generating solutions) or to problem blockage? If your kids are fighting and the plumbing is stopped up, 

thinking about the “unfairness of it all” doesn’t lead to any 

solutions.

17.Am I asking myself questions that have no answers? (“How can 

I redo the past?” “How can I be someone different?” “How can 

a relationship that’s ended not be over?”) Questions like these 

often can only be answered with questions. “Why should this 

happen to me?” Answer: “Why shouldn’t it?” “What if something terrible happens?” Answer: “So what if it does?” Asking 

yourself unanswerable questions is another way of demanding 

that the world be different than it is.

18.What are the distortions in my thinking? Once you pinpoint the 

errors, you can correct them. Are you jumping to conclusions? 

Painting everything black? Are you confusing your behavior 

with your worth?

19.What are the advantages and disadvantages of thinking this 

way? Ask if there are advantages in thinking, “I hate this house, 

I hate this neighborhood, and I hate this city and everything in 

it.” Probably few. The disadvantage is that this type of thinking 

can stop you from getting your share of pleasure.

20.What difference will this make in a week, a year, or 10 years? 

Will anyone remember (let alone care) in 10 years that I made 

a stupid remark at a party or had dandruff on my sweater? 

People often believe that their mistakes will be frozen forever in 

others’ minds.

5. Action. Just answering your thoughts won’t be enough to get you 

over your depression. You must act on your new thoughts and 

beliefs. By acting differently, you can change old thinking habits 

and strengthen the new ones. You have to do something to challenge 

your automatic thoughts. Listed below are a number of approaches 

that have been effective for many people in changing their behavior 

and overcoming depression.
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Cognitive-Behavioral Coping Skills Therapy Manual

a. Problem solving. As individuals’ drinking problems become more 

severe, a number of problems often develop in other areas of 

their lives. These may be in relationships with spouse, significant other, or family members; loss of job or a lack of vocational 

direction; financial difficulties; legal problems. Many times, the 

person feels overwhelmed by these problems, worries about 

them, begins to feel helpless over their outcomes, and starts to 

feel depressed.

NOTE: The following information is provided only as a review of 

general problem-solving strategies and may not be necessary to go 

over in detail, if at all, depending on the client’s level of demonstrated skill in this area from previous sessions.

One way to try to deal with this form of depression is to use the general 

problem-solving strategies outlined in a previous session:

1. Recognize the problem. Does a problem exist? What are some of the 

clues that one does exist?

2. Identify the problem. What is the problem? Define it as specifically 

and concretely as possible, including its smaller parts.

3. Consider various approaches. What can I do to possibly solve this 

problem? Try brainstorming, changing your point of view or frame 

of reference, or adapting a solution that has worked before as ways 

to generate alternative solutions.

4. Select the most promising approach. The solution that maximizes 

positive outcomes and minimizes negative ones is the one to implement first.

5. Assess the effectiveness of the selected approach. How well did it 

work? Do I need to try a different approach?

Using a systematic problem-solving approach lets people feel that they 

have an impact on and control over problems in their lives. As the problems are put in a different perspective and hopefully solved, depression 

begins to fade and they begin to feel better about themselves.

b. Change your activity level. One of the ways shown to improve 

mood and depression is to increase involvement in positive activities and reduce involvement in negative ones. (A more detailed 

focus of increasing positive activities is found in another session 

of this manual.)

Why focus on increasing positive activities? First, increasing 

your activity is a major way to change your thinking. When you 
73

Elective Session: Managing Negative Moods and Depression

are depressed, you do less, blame yourself for doing less, and 

become more depressed and apathetic; doing more challenges 

these stances. Second, studies show that even very depressed 

persons feel better when they become more active; activity 

improves mood. Third, activity counteracts the fatigue found in 

depression; you have to do more to get more energy. Fourth, 

activity increases one’s motivation; you have to do what you 

don’t feel like doing before you feel like doing it. Fifth, activity 

improves your mental ability; you not only change your situation 

by action, but you stimulate yourself to think. Solutions to what 

seem like unsolvable problems come to mind as you begin moving. Sixth, once you become more active, people will get off your 

back. Usually others will respond positively to your attempts to 

become more active, providing a secondary source of reinforcement for continued change.

NOTE: The following information is provided only as a review of 

strategies involved in increasing pleasant activities and may not 

be necessary to go over in detail, if at all, depending on the client’s 

level of demonstrated skill in this area from previous sessions.

Increasing Pleasant Activities: Positive Steps. People who are depressed 

often do not want to be involved in any activities and instead are inert. 

Developing a schedule of daily activities and following through with 

them is one way to help overcome depression. A number of steps have 

been found to help depressed individuals get going again:

a. Develop a schedule of activities that is flexible and allows for 

alternatives or contingencies if the activities you planned cannot 

be accomplished.

b. Stick with the general plan. If for some reason you cannot do the 

activity that you had planned, don’t try to go back and make it 

up; just go on with the schedule.

c. Schedule activities in one hour and half hour intervals. Do not 

plan activities that are too specific or too general.

d. Plan for quantity, not quality. When you are depressed, anything 

worth doing is even worth doing poorly!

e. Be task oriented. Remember that your primary goal is to follow 

the schedule you have established for yourself. The focus is on 

becoming more active; lessening of depression will follow.

f. After completing a planned day of activities, write down how 

you have done. Look at what you did right and where you can 

improve. Again, do not expect to follow the schedule perfectly.
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Cognitive-Behavioral Coping Skills Therapy Manual

Increasing Positive Activities: Blocks to Action. Despite good intentions, 

depressed people are often able to come up with a number of reasons 

(rationalizations?) that keep them from engaging in positive activities:

a. “I can’t think of any activities to schedule.” Is it that you cannot 

or just that you are having trouble? In general, you can schedule 

three types of activities: (1) things that you must do daily (eat, 

dress); (2) things that bring you pleasure (going to a movie, reading, shopping); and (3) things that bring a sense of satisfaction 

or mastery (answering letters, finishing projects).

b. “Practical problems stop me from carrying out activities.” Life is a 

series of practical problems that are more difficult to solve when 

exaggerated by depression; solving them often sets the stage for 

getting better. Use the general problem-solving approach to overcome these problems.

c. “I’m not a recordkeeper—I can’t keep a schedule.” While this may 

be a hassle, recordkeeping is not impossible! The key is to write 

down your activities in some form.

d. “I get distracted and sidetracked and don’t follow through on my 

schedule.” If this is a problem, see it as a challenge you can 

beat. Get rid of distractions; don’t lie down during the day if 

you’re depressed; use aids to help follow through on the schedule; reward yourself for following your schedule; plan activities 

for specific times, and make sure you follow through on time; 

develop cues to switch into your activity; start your plan with a 

success experience.

e. “I’m so overwhelmed with problems that I can’t get started.” 

Believing your problems are too much for you is part of depression; don’t be overwhelmed by this sense of being overwhelmed. 

The sense of being overwhelmed is nearly always worse than the 

reality of the situation.

f. Pace yourself. As you start to become more active, you may try to 

do too much, especially if you’ve been depressed for a while. The 

drawback to becoming overly ambitious is that it can backfire, 

especially if you run into difficulty; it is easy to become discouraged. So stick to your plan and increase your activities gradually.

Decreasing Unpleasant Activities. Another way to combat feelings of 

sadness and depression is to decrease unpleasant activities. The following are some methods you can use to decrease unpleasant activities:

a. Avoid the situation. Engaging in the opposite action often solves 

the problem. Many unpleasant activities can simply be avoided.
75

Elective Session: Managing Negative Moods and Depression

b. Change the situation. Do some “engineering” that modifies the 

situation to make it more manageable or less aversive.

c. Plan. Good planning can prevent many unpleasant activities.

d. Say “no.” Learn to say “no” to things that you do not want to do. 

This is probably the best way to ward off an unpleasant event.

e. Master the problem. Move toward an unpleasant activity instead 

of avoiding it. Embrace the activity and see if you can master it.

f. Limit the activity. If you just do not like some activity, “build a 

fence” around it. Give yourself a specific amount of time to work 

on it and no more.

g. Be careful of your thoughts. If you’re bothered by thoughts of certain activities, separate the reality from what you imagine.

h. Use the three A’s. Become aware of thoughts and images that are 

making events more unpleasant, answer them, then act on the 

new ones.

In-Session 

Exercise

Have clients describe their depression or an event that seems to contribute to their depression. Have them focus on the three A’s involved in 

overcoming depression. What cues are they aware of in mood, thought, 

and behavior. Explore with clients the automatic negative thoughts 

about self and the world that underlie the depression or are manifested 

in the situation. Have clients answer these thoughts. Have them ask 

questions of the thoughts or perceptions of self or situation that are 

outlined in the skill guidelines. Have clients outline the actions that 

they will use to help challenge their thoughts and behave in a more 

positive way. This may include active problem solving or modifying 

positive or negative behaviors.
Managing Negative Moods and Depression

Reminder Sheet

Use the Three A’s to help overcome your depression

■ Be AWARE of the symptoms of depression.

— Be aware of your moods and the situations that influence them.

— Be aware of your automatic negative thoughts.

■ ANSWER these thoughts.

— Ask questions, challenge the assumptions behind these thoughts.

— Replace the negative thoughts with positive ones.

■ ACT differently.

— Use your problem-solving skills to deal with issues that give you worries and concerns.

— Increase your positive activities.

— Decrease your involvement in unpleasant activities.

— Reward yourself for the positive steps you are making.

Practice Exercise

Use this worksheet to help you become more aware of the issues involved in your depression 

and the active steps you can take to change your moods.

1. What are the ways that I show my depression in my moods, attitudes, and actions? 

What are my symptoms? ___________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

2. What are the automatic negative thoughts that go along with my depression? What do

I think about myself, my current situation, and my world in general?________________

___________________________________________________________________________________

___________________________________________________________________________________

3. What questions can I ask myself to challenge these automatic negative thoughts?____

___________________________________________________________________________________

___________________________________________________________________________________

4. What steps am I going to take to act differently? What problem-solving strategies have 

I come up with to deal with my problems? What pleasant activities might I increase? 

What unpleasant activities might I avoid or minimize? ______________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________
77

Elective Session: Enhancing 

Social Support Networks

This session was taken from pages 72–76 of the Monti et al. book, with 

the following modifications.

Rationale Add to rationale item 1:

It is important for abstinent drinkers to work on building social 

support systems. Often, in the course of a drinking career, drinkers’ social circles narrow to include only other people who drink 

and who therefore will not be of much support in efforts to quit. 

Also, many drinkers find it hard to ask for help from family and 

friends because they feel they’ve disappointed those who have 

offered support many times in the past. If so, this might be a good 

time to hold a couples or family session, to go over how the family 

member can help you cope with situations that may be difficult 

for you.

Skill 

Guidelines

Add the following after item 2e:

f. Help with not drinking. Asking your spouse to talk with you or 

participate in a distracting activity when you are craving; asking a friend or coworker not to offer you drinks or talk about 

drinking when you are around; asking a parent to handle your 

money or paychecks for a few months so you don’t have a lot of 

money lying around; asking a roommate who drinks not to drink 

around you (have you considered that you might need to get a 

new roommate?).

In-Session

Exercise

The following exercise is added:

Make a diagram of your circle of social support. Put yourself in the 

center, the people who are already important in your life closest 

to you, people who are currently neutral a little farther away, and 
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Cognitive-Behavioral Coping Skills Therapy Manual

people you have not seen for a while or who are negative even farther away. Write in their roles (family, coworker, friend) and what 

kind of support they do (or could) offer. Circle the people who will 

be of most help in your efforts to not drink. What kind of support 

or help could you (or do you) provide them?

NOTE: In practice, one of the more convenient methods for 

enhancing a drinker’s social support network is through involvement in self-help groups. However, in Project MATCH, a self-help, 

12-Step facilitation approach is being contrasted with this cognitive-behavioral approach, so it is not permissible for a therapist 

to suggest or strongly encourage involvement in AA. If the patient 

suggests AA as a way of enhancing social supports, the therapist 

should not say anything more compelling than “That sounds like a 

good idea.” Let it go at that, and go on to help the patient develop 

some other, non-AA strategies for enhancing social supports.
79

Elective Session: Job-Seeking Skills

Rationale The Job Club is a disciplined approach to assist clients in obtaining 

satisfying employment. This approach to job finding uses behavioral 

principles.

A major premise of the Job Club is that finding a job is a full-time 

job, and all job seekers need to treat the problem as such. It must be 

emphasized that it is as important as therapy. The key elements to job 

finding are—

■ Development of a resume.

■ Instructions on how to fill out a job application.

■ Using relatives, friends, and the phone book to generate job leads.

■ Telephone techniques to secure interviews.

■ Rehearsal of the interview process.

■ Information on appropriate employment.

Skill Guidelines

The Resume Developing a positive resume is one of the first tasks. A resume should 

not leave large gaps between jobs, even if the client was not working 

due to drinking. These gaps can be handled by stating that the client 

was self-employed or rethinking his career goals during that period. 

The resume should be professionally typed and a good cover letter 

should be developed with counselor assistance. There are forms in the 

Job Club Counselor’s Manual (Azrin and Besalel 1980) to help clients 

develop resumes.
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Cognitive-Behavioral Coping Skills Therapy Manual

The Job 

Application

Filling out a job application correctly needs to be taught to many clients. They should learn how to emphasize positive personal attributes 

along with good job skills. Counselors need to work with the patients to 

make sure they understand how to correctly answer difficult questions.

Generating Job 

Leads

Job finding needs to be done in a matter of fact yet supportive manner. 

Clients will often take the easy way out and not comply with this critical aspect unless they are given a structure (e.g., the “Job Leads Log”) 

and are monitored.

After completing the resume and learning how to fill out a job application, the patient needs to generate possible job leads. One way is to 

ask family and friends if they know of any possible employment opportunities. Another is to ask former employers and coworkers. If this fails 

to generate sufficient leads, advise the client to use the Yellow Pages of 

the phone book. For instance, if the client is looking for employment as 

a salesperson in a lumber yard, look in the Yellow Pages under lumber 

yards.

To document leads, have the client use the “Job Leads Log” included 

at the end of this section. It has a place for date, name of company 

and address, phone number, and space to jot down details during and 

after the phone call. There is also a place on this form for call backs if 

necessary. A minimum of 10 job leads are generated before the patient 

begins to make any phone calls. This list is checked by the counselor 

to assure that all leads are appropriate.

Telephone Skills 

Training

The next step is to rehearse telephone skills to make sure the client 

can use the telephone in a positive way. The following is a suggested 

outline:

■ Introduce yourself by giving your name and then asking for the 

person who does the hiring.

■ If you get this person on the line, again introduce yourself and 

make a statement like “I heard that ABC Lumber Company is a 

good place to work, and I would like to come down and discuss with 

you my qualifications as a lumber yard worker. When can I meet 

with you?”

■ If you do not get the person that does the hiring, ask for his or her 

name so you have it when you call back.
81

Elective Session: Job-Seeking Skills

Other scenarios will occur, and each one has to be discussed and 

rehearsed so mastery is achieved. Try to get the name of the person 

who does the hiring beforehand, if possible, so you can ask directly for 

that person. This may be possible if you get the name from a friend or 

former coworker.

Rehearsal of 

Interview Process

After job leads are generated and phone calls have secured interviews, 

train the client, using behavioral rehearsal, in the interviewing process. Reinforce the client at each step of the process. Once clients are 

ready for the interview, make sure they have proper transportation. 

Clients must also be prepared to be rejected for employment.

Goal Setting Each day, the client must get 10 new leads, make appropriate telephone calls, write necessary letters, and attend interviews. Success 

comes from making enough calls to secure enough interviews so the 

chances of getting a job increase to 100 percent.
Job-Seeking Skills

Reminder Sheet

1. Finding a job is a full-time job in itself, and you need to treat it as such.

2. The key elements include:

a. developing a resume,

b. knowing how to fill out a job application,

c. using relatives, friends, and the phone book to generate job leads,

d. using telephone techniques to secure interviews,

e. rehearsing the interview process, and

f. deciding what is appropriate employment.

Exercises

After this session, job finding should become a daily routine until you are successful in getting a job. Here is a suggested schedule:

1. Each evening, develop 10 job leads either through friends or with the Yellow Pages.

2. Get up at the same time each morning and begin making phone contacts at 8:00 a.m. 

Continue with this through the morning until the first scheduled job interview appointment in the afternoon. If unsuccessful in getting a job interview for the afternoon, spend 

the afternoon either making followup calls to companies contacted before or develop 

additional leads rather than waiting until the evening.

3. If you have the time, try to practice answering possible job interview questions with a 

friend or family member before going to an interview.

4. Spend the afternoon attending the job interview you scheduled that morning.

Continue with this daily schedule until you are successful. Remember that sticking with it 

is often the most important thing you can do to get a job.
Job Leads Log

Date Company Person’s name Telephone number Address Result of call Second call Third call Date Result Date Result
84

Elective Session: Couples/Family

Involvement I

This session is directed toward couples. Appropriate adjustments can 

be made for use with other family members or significant others.

Rationale 1. We have asked you to come as a couple. This is because, as you 

know, drinking affects other areas of your life, including marriage 

and the family. Spouses usually have some feelings and reactions 

to their partner’s drinking. Sometimes spouses try over and over 

to help their partners stop. Sometimes they give up or get angry. 

Sometimes their well-intentioned attempts to help are resented 

or make things worse in the long run. (Ask clients if any of these 

observations rings a bell in their lives and how they feel about the 

above).

2. We have also found that, in many couples, when one person has 

a drinking problem, there are also marital problems. For one reason or another, couples no longer get the positive rewards out of 

marriage and each other that they used to. Usually communication 

between partners is poor, nonexistent, or filled with negative emotions such as anger, withdrawal, heavy silence, or getting needs 

met outside the relationship (e.g., going out alone).

3. Another common marital difficulty is that small problems begin 

to get one down. It becomes harder to make even easy decisions. 

Eventually, they pile up so that essential tasks do not get done 

(shopping, paying bills, cleaning house, filling the car with gas). 

Couples begin to lose their ability to make decisions or solve problems. (Ask client if any of the above is relevant.)

4. Our goals are to—

NOTE: Adapted from Abrams et al. 1979, developed with support of NIAAA grant 

AA–07070, Barbara McCrady, Principal Investigator. The rationale section is taken 

directly from Session 1, pages 3–4. The Skill Guidelines #1 and the first two paragraphs of #2 are directly from Session 4, pages 31–32. Used with permission.
85

Elective Session: Couples/Family Involvement I

a. Help you work together to achieve sobriety of the drinking 

partner.

b. Increase the positive rewards in your marriage.

c. Learn how to solve problems when they come up.

d. Develop good communication skills.

Skill 

Guidelines

1. Stimulus Control. One type of situation that spouses are often concerned about is having alcohol in the house. Many times, a wife will 

feel that the stocked liquor cabinet, or beer in the refrigerator, is 

just too much of a trigger for drinking. Some problem drinkers feel 

similarly, while others find that alcohol in the house does not make 

much difference. (Ask couple: have the two of you thought about 

this? Have you discussed it with each other at all?)

Have the couple discuss this topic with each other for a few minutes, trying to come to a decision about how they will handle alcohol 

in the house. As the therapist, help them follow good listening and 

communication skills. Encourage both of them to express their own 

feelings about whether or not to keep alcohol in the house. You may 

have to get them to paraphrase what the other person is saying to 

assure that they understand each other. Work toward an initial 

agreement that they both can live with, and have them implement 

it during the week.

2. Reinforcing Sobriety. Besides the one plan already discussed, there 

are some other ways to view spouse involvement in sobriety. Explain 

to the spouse that sober behavior can be made more likely by looking at the short-term consequences of staying sober. If people are 

specifically complimented (rewarded) for staying sober, not just 

taken for granted, then these pleasant short-term consequences 

can help them stay sober in the future.

Have the couple come up with some desirable verbal statements 

that the spouse and drinker would like to hear, contingent on 

sobriety. Elicit from them an agreement on three or four verbal 

rewards that they would like to implement. Suggest that these be 

implemented for homework, at least one verbal reward per day contingent on sobriety.

In addition to rewarding sobriety, the couple should also make 

plans to reward each other for some of the favors they do. Too often, 

alcohol-involved marriages slip into a cycle of mutual criticism and 

recriminations. This can be reversed by having each spouse make 

an effort to praise the other daily for some satisfaction or favor 

provided. To paraphrase a slogan from Parent Effectiveness Train-
86

Cognitive-Behavioral Coping Skills Therapy Manual

ing, they should “catch each other being good.” Have the spouses role 

play appropriate ways of giving verbal praise.

3. Problem Solving. The process by which problems are dealt with in 

a close relationship is a very important aspect of that relationship. 

Problem-solving skills have already been presented to the identified patient in an earlier session. The steps of that process should 

be reviewed at this time: (1) recognize that there is a problem, (2) 

identify the problem, (3) consider various approaches, (4) select the 

most promising approach, and (5) assess the effectiveness of the 

selected approach. Discuss each step in some detail with the couple to verify their understanding.

In-Session 

Exercise

Have the couple identify a problem situation they are presently coping 

with, or one they can anticipate in the near future. Have them work 

through each of the first four steps of the problem-solving process 

together. The therapist may serve as a resource to answer questions, 

provide suggestions if they get stuck, or keep them on track, but otherwise should let the couple work it through by themselves as much 

as possible. For the fifth step of the process, the couple should specify acceptable outcomes as well as outcomes that would necessitate a 

reworking of their approach.

Introducing 

the Practice 

Exercise

The assignment has several elements. Go over each one with the couple to make sure they understand what is to be done and how their 

behavior is to be recorded. Suggest that they continue practicing each 

element of the assignment regularly until the next conjoint session.

Schedule the next couples session in several weeks.
Couples/Family Involvement I

Reminder Sheet

1. The nonusing spouse should provide at least one verbal reward (praise) each day to the 

recovering drinker for continuing to be sober.

2. Both partners should praise each other at least once daily for satisfactions given to each 

other.

3. As problems are encountered, they should be dealt with by both spouses together, using 

the five-step problem-solving process:

a. Recognize that a problem exists.

b. Identify the problem as accurately as you can.

c. Consider various approaches to solving the problem.

d. Select the most promising approach.

e. Assess the effectiveness of the selected approach.

Practice Exercises

1. Implement the plan you came up with during the treatment session regarding alcohol in 

the home.

2. The nonusing spouse should reward abstinent behavior verbally at least once each day.

3. Use the problem-solving process together at least once every week. Write a brief summary of what you did and how it worked. Bring these summaries to the next couples 

session.
88

Elective Session: Couples/Family

Involvement II

Review of

Practice

Exercises

Review the couple’s progress on their plans regarding alcohol in the 

house, the praise given for sobriety, and their summaries of problemsolving efforts, as assigned at the previous couples session. Provide 

as much praise as possible for their efforts and accomplishments. 

Trouble-shoot problem areas or reasons for non-compliance.

Rationale1 1. There are any number of possible barriers to closeness or intimacy 

in relationships. Can you generate some examples? These might 

include distrust, anger, poor self-esteem, fear of failure, withdrawal/isolation, or sex role typing.

2. Effective communication within close/intimate relationships is 

important for several reasons. Among them are the following:

a. It helps you and your partner to feel closer to each other.

b. It promotes better understanding of each other’s point of view 

and increases your ability to solve difficulties and conflicts.

c. It decreases the likelihood that resentment and bad feelings over 

something will build up and affect other areas of your life (e.g., 

daily bickering over finances or the in-laws may lead to more 

pervasive negative feelings).

d. Drinking and relapse are less likely to occur when you have an 

effective way to respond to difficulties in a relationship.

1 The rationale and skill guidelines are taken directly from selected sections of 

the Monti et al. session on “Close and Intimate Relationships,” pages 68–70.
89

Elective Session: Couples/Family Involvement II

Skill 

Guidelines2

1. Do not expect your partner to read your mind. That is, don’t expect 

him/her to know what you think, want, or feel without your expressing it.

2. Do not let things build up. Frequent contact with a person increases 

the chance that some of his/her behaviors may bother you. Since 

the cumulative negative impact of saying nothing about a repeated 

annoyance can be great, it is important to give constructive criticism

at an early point.

When giving constructive criticism, calmly state the criticism in 

terms of your own feelings, focusing on the impact that the situation has on you. Criticize specific behavior (e.g., “I feel angry when 

you leave dirty dishes all over the kitchen”) not the person, and 

request a change in that behavior (e.g., “I’d appreciate it if you’d 

remember to rinse your dishes off and put them in the sink when 

you’re done with them”). Finally, offer to compromise, so that both 

of you can come away from the discussion feeling that you have 

gained something (e.g., “I’ll wash the dishes if you leave them rinsed 

and in the sink”).

No matter how adept you are at giving criticism appropriately, you 

must be selective. Stop and think before commenting on irritations. 

Do not bring them up unless they seem important to you. Bringing 

up every minor annoyance can put your partner permanently on 

the defensive.

3. Express your positive feelings. Many couples have difficulty expressing positive feelings within their relationship, particularly if the 

level of criticism has been increasing. When criticism occurs in the 

absence of any expression of positive affect, good feelings get overlooked, and negative feelings become more salient.

One reason people become reluctant to express positive feelings 

is the fear that doing so would contradict the criticisms they have 

made. For example, one partner may refrain from saying that a 

dinner is good if he/she has criticized the other partner for serving 

it an hour later than expected. However, it is not inconsistent to 

verbalize both of these aspects of our reactions to another person’s 

behavior. A problem arises when we assume that positive verbalizations are not important because “he knows how I feel even if I don’t 

say it.”

2 The last two paragraphs of the skill guidelines (4 and 5) are taken directly from 

Abrams et al. 1979, page 58.
90

Cognitive-Behavioral Coping Skills Therapy Manual

4. Couples may negotiate fun activities by using quid pro quos. (“I’ll 

do what you want today in exchange for you doing what I want over 

the weekend.”)

5. Go out of your way to offer to do necessary but irksome tasks 

around the house. Offer to do tasks that one’s partner usually does 

or complains about. Give to the other without expecting anything 

back and without saying, I’ll do it only if you do something for me.

Behavioral 

Rehearsal 

Role Plays

Ask the couple to identify some situations that are problematic for 

them. Select one for role playing now and one for the practice exercise. 

Have the couple discuss how the application of some of the communications skills discussed could help them cope more effectively with the 

situation selected for role playing. Then have the couple role play the 

situation, trying to employ those skills. The therapist should provide 

feedback regarding both the verbal and nonverbal aspects of the role 

play.

Wrap-Up Ask the couple to summarize what was most salient and useful from 

these two couples sessions. What do they plan to practice/apply in the 

future?

Introducing 

the Practice 

Exercise

Although the couple will not have an opportunity to turn in the 

completed exercise, they should be urged to complete it as a way of 

continuing the practice they began in the role playing. They should 

also be urged to make an effort to apply these principles in their relationship on an ongoing basis.
Couples/Family Involvement II3

Reminder Sheet 

The following points can be of assistance to you within a close relationship:

■ Do not expect your partner to read your mind.

■ Do not let things build up: Give constructive criticism.

■ Calm down.

■ Stop and think before expressing irritation.

■ State the criticism in terms of your own feelings.

■ Criticize specific behavior, not the person.

■ Request specific behavior change.

■ Offer to compromise.

■ Express your positive feelings.

■ Offer to go along with a fun activity in exchange for doing one that you choose at a 

later time.

■ Offer to do necessary but irksome tasks around the house. 

Practice Exercise

Use the practice exercise in Monti et al., pages 207–208.

3 The Reminder Sheet is adapted from Monti et al., page 207.

93

 Appendix A: Bibliography

This manual represents a compilation of materials from a number of 

sources. Peter Monti, David Abrams, Ronald Kadden and Ned Cooney’s 

Treating Alcohol Dependence: A Coping Skills Training Guide, © Guilford 

Press, 1989, served as the primary source for the Project MATCH CBT 

therapists’ manual and the introduction of this volume. Other sources 

are listed by chapter.

Introduction to Coping Skills Training

Litt, M. “Introduction to Coping Skills Training.” Unpublished manuscript, University of Connecticut Health Center, Farmington, CT, 

1990.

Jaffe, A.; Brown, J.; Korner, P.; and Witte, G. “Relapse Prevention 

for the Treatment of Problem Drinking: A Manual for Therapists 

and Patients.” Unpublished manuscript, Yale University School 

of Medicine, New Haven, CT; University of Connecticut Health 

Center, Farmington, CT, 1988.

Coping With Cravings and Urges to Drink

Carroll, K. “Manual for Relapse Prevention in the Treatment of Cocaine 

Abuse.” Unpublished manuscript, Yale University School of 

Medicine, New Haven, CT, 1987.

Ito, J.R.; McNair, L.; Donovan, D.M.; and Marlatt, G.A. “Relapse 

Prevention for Alcoholism Aftercare: Treatment Manual.” 

Unpublished manuscript, Health Services Research and 

Development Service, VA Medical Center, Seattle, WA, 1984.

Jaffe, A.; Brown, J.; Korner, P.; and Witte, G. “Relapse Prevention 

for the Treatment of Problem Drinking: A Manual for Therapists 

and Patients.” Unpublished manuscript, Yale University School 

of Medicine, New Haven, CT; University of Connecticut Health 

Center, Farmington, CT, 1988.

Managing Thoughts About Alcohol and Drinking

Ito, J.R.; McNair, L.; Donovan, D.M.; and Marlatt, G.A. “Relapse 

Prevention for Alcoholism Aftercare: Treatment Manual.”
94

Cognitive-Behavioral Coping Skills Therapy Manual

Unpublished manuscript, Health Services Research and Development 

Service, VA Medical Center, Seattle, Washington, 1984.

Ludwig, A.M. Understanding the Alcoholic’s Mind: The Nature of Craving 

and How to Control It. New York: Oxford University Press, 1988.

Problem Solving

Bedell, J.R.; Archer, R.P.; and Marlowe, H.A. A description and evaluation of a problem solving skills training program. In: Upper, 

D., and Ross, S.M., eds. Behavioral Group Therapy: An Annual 

Review. Champaign, IL: Research Press, 1980.

D’Zurilla, T.J., and Goldfried, M.R. Problem solving and behavior modification. Journal of Abnormal Psychology 78:107–126,1971.

Sanchez-Craig, M. “A Therapist’s Manual for Secondary Prevention 

of Alcohol Problems.” Unpublished manual. Addiction Research 

Foundation, Toronto, Canada, 1983.

Planning for Emergencies and Coping With a Lapse

Jaffe, A.; Brown, J.; Korner, P.; and Witte, G. “Relapse Prevention 

for the Treatment of Problem Drinking: A Manual for Therapists 

and Patients.” Unpublished manuscript, Yale University School 

of Medicine, New Haven, CT; University of Connecticut Health 

Center, Farmington, CT, 1988.

Seemingly Irrelevant Decisions

Marlatt, G.A., and Gordon, J.R. Relapse Prevention: Maintenance 

Strategies in the Treatment of Addictive Behaviors. New York: 

Guilford Press, 1985.

Managing Negative Moods and Depression

Emery, G. A New Beginning: How to Change Your Life Through Cognitive 

Therapy. New York: Simon and Schuster, 1981.

Enhancing Social Support Networks

Depue, J. Getting a little help from your friends. In: Depue, J. ed. 

Managing Stress (Pawtucket Heart Health Program treatment 

manual). Pawtucket, RI: The Memorial Hospital, 1982. pp. 1–9.

Marlatt, G.A., and Gordon, J.R. Relapse Prevention: Maintenance 

Strategies in the Treatment of Addictive Behaviors. New York: 

Guilford Press, 1985.
95

 Appendix A: Bibliography

Job Seeking Skills

Azrin, N.H., and Besalel, V.A. Job Club Counselor’s Manual. Baltimore, 

MD: University Park Press, 1980.

Meyers, R.J.; Smith, J.E.; and Mallams, J.H. “The Community 

Reinforcement Approach Manual.” Unpublished manuscript, 

University of New Mexico, Albuquerque, NM, 1992.

Couples/Family Involvement

Abrams, D.B.; McCrady, B.S.; and Hay, W. “Treatment Manual: SelfControl Treatment With Spouse Involved and Marital Therapy.” 

Unpublished manual, Butler Hospital/Brown University, 1979.

General Background Materials

Annis, H.M., and Davis, C.S. Relapse prevention. In: Hester, R.K., and 

Miller, W.R., eds. Handbook of Alcoholism Treatment Approaches. 

New York: Pergamon, 1989. pp. 170–182.

Chaney, E.F. Social skills training. In: Hester, R.K., and Miller, W.R., 

eds. Handbook of Alcoholism Treatment Approaches. New York: 

Pergamon, 1989. pp. 206–221.

Daley, D.C. Relapse: A Guide to Successful Recovery. Bradenton, FL: 

Human Services Institute, 1987.

Donovan, D.M., and Chaney, E.F. Alcoholic relapse prevention and 

intervention: Models and methods. In: Marlatt, G.A., and Gordon, 

J.R., eds. Relapse Prevention: Maintenance Strategies in the 

Treatment of Addictive Behaviors. New York: Guilford Press, 1985. 

pp. 351–416.

Ito, J.R., and Donovan, D.M. Aftercare in alcoholism treatment: A 

review. In: Miller, W.R., and Heather, N., eds. Treating Addictive 

Behaviors: Processes of Change. New York: Plenum, 1986. pp. 

435–456.

Ito, J.R.; Donovan, D.M.: and Hall, J.J. Relapse prevention in alcohol 

aftercare: Effects on drinking outcome, change process, and aftercare attendance. British Journal of Addiction 83:171–181, 1988.

Kadden, R.M.; Cooney, N.L.; Getter, H.; and Litt, M.D. Matching 

alcoholics to coping skills or interactional therapies: Posttreatment results. Journal of Consulting and Clinical Psychology 

57:698–704,1989.

Marlatt, G.A., and Gordon, J.R. Relapse Prevention: Maintenance 

Strategies in the Treatment of Addictive Behaviors. New York: 

Guilford Press, 1985.

97

Appendix B: Therapist Selection, 

Training, and Supervision in 

Project MATCH

Specifications of treatment in manuals is intended to define and differentiate psychotherapies, to standardize therapist technique, and to 

permit replication by other investigators. However, it is essential that 

manual-guided therapies be implemented by qualified therapists who 

are trained to perform them effectively. Project MATCH uses extensive 

procedures to select, train, and monitor therapists in order to promote 

delivery of study treatments that are specific, discriminable, and delivered at a consistently high level of quality. These include (1) selection 

of experienced therapists committed to the type of therapy they would 

be performing, (2) extensive training to help therapists modify their 

repertoire to meet manual guidelines and to standardize performance 

across therapists and across sites, and (3) ongoing monitoring and 

supervision of each therapist’s delivery of treatment during the main 

phase of the study to assure implementation of study treatments at a 

high and consistent level.

Therapist

Selection

All MATCH therapist candidates are required to meet the following selection criteria: (1) completion of a master’s degree or above in 

counseling, psychology, social work, or a closely related field (some 

exceptions to this requirement were made in individual cases), (2) at 

least 2 years of clinical experience after completion of degree or certification, (3) appropriate therapist technique, based on a videotaped 

example of a therapy session with an actual client submitted to the 

principal investigator at each site and to the Yale Coordinating Center, 

and (4) experience in conducting a type of treatment consistent with 

the MATCH treatment they would be conducting and experience treating alcoholics or a closely related clinical population.

These criteria are intended to facilitate (1) selection of appropriate therapists for the training program, as training is not intended to train 

novice therapists, but to familiarize experienced therapists with man-
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Cognitive-Behavioral Coping Skills Therapy Manual

ual-guided therapy, and (2) implementation of MATCH treatments by 

experienced and credible therapists. For example, therapists selected 

for the Cognitive-Behavioral Coping Skills Therapy (CB) are experienced in cognitive and behavioral techniques; thus, the CB therapists 

are predominantly doctoral or masters-level psychologists. Therapists 

for the Twelve-Step Facilitation Program are predominantly individuals who have gone through 12-step recovery themselves, have been 

abstinent for several years, and are typically masters-level or certified 

alcoholism counselors. Therapists selected for the recently developed 

Motivation Enhancement Therapy (MET) have worked extensively with 

alcoholics and typically have experience in systems theory, family therapy, and motivational counseling.

Therapist 

Training

Training, supervision, and certification of therapists was centralized 

at the Yale Coordinating Center to facilitate consistency of treatment 

delivery across sites. Each therapist came to New Haven for a 3-day 

intensive training seminar, which included background and rationale 

for Project MATCH, extensive review of the treatment manual, review of 

taped examples of MATCH sessions, and practice exercises. Each therapist then returned to their clinical site and was assigned a minimum 

of two training cases, which were conducted following the MATCH protocol (e.g., weekly individual sessions, a maximum of two emergency 

and two conjoint sessions, truncated sessions for patients who arrived 

for a treatment session intoxicated).

All sessions from training cases were videotaped and sent to the 

Coordinating Center for review of the therapists’ (1) adherence to 

manual guidelines, (2) level of skillfulness in treatment delivery, (3) 

appropriate structure and focus, (4) empathy and facilitation of the 

therapeutic alliance, and (5) nonverbal behavior. Yale Coordinating 

Center supervisors review all training sessions and provide weekly 

individual supervision to each therapist via telephone. Supplemental 

onsite supervision is delivered weekly by the project coordinator at 

each Clinical Research Unit.

Therapists were certified by the Yale Coordinating Center supervisors 

following successful completion of training cases. Therapists whose 

performance on initial cases was inadequate were assigned additional 

training cases until their performance improved. The average number 

of training cases was three, and therapists completed an average of 26 

supervised sessions before certification.

Ongoing 

Monitoring

To monitor implementation of Project MATCH treatments, facilitate 

consistency of treatment quality and delivery across sites, and prevent 

therapist “drift” during the main phase of the study, all sessions are 

videotaped and sent to the Coordinating Center, where a proportion 

of each subject’s sessions (one-third of all sessions for Cognitive-
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Appendix B: Therapist Selection, Training, and Supervision in Project MATCH

Behavioral and Twelve-Step Facilitation, one half of all MET sessions) 

are reviewed by the supervisors. Telephone supervision is provided on 

a monthly basis by the Coordinating Center supervisors and supplemented with weekly onsite group supervision at each Clinical Research 

Unit.

All sessions viewed are rated for therapist skillfulness, adherence to 

manual guidelines, and delivery of manual-specified active ingredients unique to each approach. These ratings are sent monthly to the 

project coordinators at each site to alert local supervisors to therapist 

drift. Therapists whose performance deviates in quality or adherence 

to the manual are “redlined” by the Coordinating Center, and the frequency of sessions monitored and supervision are increased until the 

therapist’s performance returns to acceptable levels.

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