Addiction and Substance Use Therapy in Denver

Addiction & Substance Use

Published by CBT Denver | Clinically Reviewed by Dr. William Allen, Senior Clinical Psychology Fellow and Dr. Nicole Cross, Licensed Clinical Psychologist

Last updated: November 2026

Addiction can show up in many forms and is a common health concern worldwide. Approximately one in six adults in the United States experiences an addiction to alcohol or other substances in any given year, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Furthermore, when accounting for both substance and behavioral addictions, research published in Evaluation & the Health Professions suggests that nearly 47% of American adults experience signs of an addictive disorder annually.

Despite its prevalence, people often avoid disclosing their struggles because of social stigma and feelings of shame. However, addiction does not discriminate: it affects people from all walks of life, regardless of age, gender identity, sexual orientation, culture, or socioeconomic background.

Addiction develops through an interplay of multiple factors, including genetics, environment, trauma, and learned behaviors used to cope or "self-medicate." A person can experience addiction to a chemical substance or to a rewarding behavioral pattern.

Common Examples of Addictions

Addictions generally fall into two categories:

• Substances: Alcohol, cannabis, nicotine, cocaine, opioids, and prescription sedatives or stimulants.

• Behaviors: Gambling, video gaming, internet and social media use, pornography, and compulsive shopping.

Is Food an Addiction?

While "food addiction" is not currently an official diagnosis in the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders), many researchers and clinicians recognize compulsive eating patterns as behavioral addictions. Compulsive eating and binge eating involve the same neurological reward pathways and fulfill similar psychological functions as substance addictions—providing positive reinforcement (pleasure/reward) as well as negative reinforcement (temporary escape from emotional distress or discomfort).

Clinical note: It is important to distinguish food-related addictive behaviors from formal eating disorders. While binge-eating disorder and night eating syndrome share reward-driven features with addiction, conditions such as anorexia nervosa and bulimia nervosa are classified as distinct feeding and eating disorders with differing psychological mechanisms and specialized medical management needs.

A Disorder vs. An Addiction

While "addiction" is the term most commonly used in everyday conversation, healthcare providers and researchers utilize precise clinical terms, such as substance use disorder (SUD), alcohol use disorder (AUD), and gambling disorder.

Clinical diagnoses avoid an "all-or-nothing" label by rating severity across a continuum:

• Mild: Meeting 2–3 diagnostic criteria

• Moderate: Meeting 4–5 diagnostic criteria

• Severe: Meeting 6 or more criteria

This dimensional approach allows clinicians to tailor treatment plans directly to the severity of an individual's symptoms.

The Role of Dopamine in Addiction

Dopamine is a key neurotransmitter that regulates motivation, reward prediction, and reinforcement learning. In daily life, healthy dopamine surges reinforce adaptive behaviors—such as socializing, eating a nourishing meal, or listening to music—signaling to the brain, "This is rewarding; remember how to do this again."

When an individual engages with an addictive substance or behavior, the brain experiences an intense, unnatural flood of dopamine. This surge hyper-sensitizes the reward system, driving compulsive cravings for that stimulus. With repeated exposure, neuroadaptation occurs: the brain down-regulates dopamine receptors and releases less dopamine in response to the same input. This phenomenon, known as tolerance, compels the person to consume higher amounts of the substance or engage in more extreme behavior just to experience the previous reward or to feel normal.

Over time, tolerance blunts natural reward sensitivity, diminishing the pleasure derived from everyday activities and reinforcing reliance on the addictive cycle. A clear visual representation of this process can be seen in the Nuggets animated short film on addiction, which illustrates the cycle of tolerance and escalating use.

Recognizing the Signs of Addiction

Many individuals consume alcohol or engage in gaming and shopping without negative consequences. To assess whether a substance or behavior has crossed into an addictive disorder, consider whether the following DSM-5-TR diagnostic criteria apply over a 12-month period:

1. Loss of Control: Using the substance or engaging in the behavior in larger amounts or over a longer duration than originally intended.

2. Persistent Desire: Experiencing a persistent desire to cut back or making multiple unsuccessful attempts to stop.

3. Time Investment: Spending a significant amount of time obtaining, using, or recovering from the effects of the substance or behavior.

4. Cravings: Experiencing intense urges or intrusive desires to use the substance or engage in the behavior.

5. Role Failure: Failing to fulfill primary responsibilities at work, school, or home due to ongoing use or behavior.

6. Social Problems: Continuing use despite persistent social or interpersonal conflicts caused or exacerbated by the behavior.

7. Neglected Activities: Giving up or reducing vital recreational, occupational, or social activities in favor of use.

8. Hazardous Use: Engaging in the substance or behavior in physically hazardous situations (e.g., driving while intoxicated).

9. Physical or Psychological Consequences: Continuing use despite knowing that a physical or psychological problem is caused or worsened by it.

10. Tolerance: Requiring substantially increased amounts to achieve intoxication/satisfaction, or experiencing a diminished effect with continued use of the same amount.

11. Withdrawal: Experiencing characteristic physiological withdrawal symptoms when attempting to stop, or taking the substance/engaging in the behavior to relieve or avoid withdrawal.

Meeting two or more of these indicators suggests the presence of a disorder, while six or more indicates severe pathology. A comprehensive evaluation by a licensed mental health professional or physician is necessary to establish a formal diagnosis.

Evidence-Based Treatments for Addiction

Long-term recovery typically relies on a comprehensive continuum of care combining medical intervention, evidence-based psychotherapy, and peer support.

• Medical Detoxification and Levels of Care: Abruptly stopping certain substances (particularly alcohol, benzodiazepines, and high-dose sedatives) without medical supervision can produce severe, life-threatening withdrawal complications such as seizures and delirium tremens. Based on clinical assessment, care may range from medically monitored inpatient detoxification and residential treatment to intensive outpatient programs (IOP) and standard outpatient therapy.

• Pharmacotherapy (Medication-Assisted Treatment): Medications can reduce cravings and stabilize neurochemistry. Examples include naltrexone and acamprosate for alcohol use disorder, buprenorphine (Suboxone) and methadone for opioid use disorder, and varenicline (Chantix) or nicotine replacement therapies for nicotine dependence.

• Peer Support Communities: Mutual-help communities provide vital connection, accountability, and practical tools. Common secular and 12-step resources include SMART Recovery, Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Gamblers Anonymous (GA).

• Cognitive Behavioral Therapy (CBT): CBT is one of the most rigorously researched, gold-standard psychosocial interventions for substance use and behavioral disorders, as highlighted in a systematic review published in Clinical Psychology: Science and Practice.

How CBT Supports Recovery

CBT focuses on uncovering the bidirectional connections among thoughts, feelings, and behaviors:

• Navigating Ambivalence: Therapists provide a nonjudgmental space to explore mixed feelings about change, meeting clients wherever they are—whether their goal is harm reduction, moderation, or complete abstinence.

• Identifying Triggers: Clients learn to pinpoint external cues (people, places, environments) and internal cues (emotional distress, cognitive distortions) that trigger cravings.

• Coping & Relapse Prevention: CBT equips individuals with practical emotional regulation skills, craving-management strategies ("urge surfing"), and healthy substitute behaviors to navigate stress without returning to the addictive pattern.

Therapists at CBT Denver Specializing in Addiction

Dr. Will Allen and Dr. Nicole Cross both specialize in the assessment and treatment of substance use disorders and behavioral addictions. To learn more or schedule a consultation with our clinical team, please visit our contact page.