Cognitive-behavioral treatments are among the most well-defined and rigorously studied psychotherapeutic interventions for substance use disorders. In contrast to the previous edition of this textbook (Galanter and Kleber 2004), behavioral, cognitive-behavioral, and motivational approaches are now covered in separate chapters, reflecting the increasing use of these strategies in clinical practice as well as their accumulating levels of empirical support. Thus, while this chapter will focus almost primarily on cognitive-behavioral approaches, it should be noted that cognitive-behavioral therapy (CBT) shares several features with these other empirically supported behavioral approaches. First, cognitive, behavioral, and motivational therapies are applicable across a broad range of substance use disorders; that is, well-controlled trials have supported their efficacy across alcohol-, stimulant-, marijuana-, and opioid-dependent populations. Second, these approaches were developed from well-founded theoretical traditions with established theories and principles of human behavior. Third, these approaches are highly flexible and can be implemented in a wide range of clinical modalities and settings. Moreover, they are compatible with a variety of pharmacotherapies and, in many cases, foster compliance and enhance the effects of pharmacotherapies, including methadone, naltrexone, and disulfiram treatment. Finally, these approaches are relatively short-term and highly focused approaches that emphasize rapid, targeted change in substance use and related problems. In this manner, they are very compatible in a health care environment that is increasingly influenced by managed care, best clinical practice models, and professional accountability.