Cue-exposure therapy

Domain II · Behavioural & cognitive · Monti, Rohsenow, Drummond · 1990 · Brown University

What it is

Cue-exposure therapy (CET) is a behavioural treatment for alcohol and other substance use disorders in which the client is repeatedly exposed, under controlled conditions, to the sights, smells, places, rituals and moods that have preceded their use, while use is prevented. The change model is…

Format

• Format across the trials: individual sessions in most protocols; inpatient (after detoxification) or outpatient; 6 to 16 sessions, typically 40 to 90 minutes; often several sessions per week. Examples: Monti et al. 1993, 6 sessions CET plus coping skills, inpatient; Drummond & Glautier 1994, 10…
• Phase 0. Assessment and preparation (1–2 sessions)

Who practises it, and how they are trained or regulated

• Phase 1. Urge-coping skills training (CET-USCS only; can overlap with Phase 2)
• Package elements around CET. In Rohsenow et al. (2001), CET-USCS was delivered alongside communication skills training; in Monti's model CET sits within broader coping skills training (drink refusal, managing thoughts about alcohol, coping with cravings, negative moods). D-cycloserine has been tested as a pharmacological enhancer of extinction in research only; it is outside a psychotherapist's role and not covered…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Low presence (no urge); add real smell cues if allowed in your setting.
• Shame spirals; keep it future-focused and motivating rather than punitive.
• Overreaching; increase difficulty only when the client is reliably coping.
• Skills used so early that the urge never builds; let the urge rise before prompting.
• Delayed craving later the same day; ask about it at the next session and adjust the plan.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.