Substance Misuse Formulation
A cognitive formulation of substance misuse based on Beck et al.'s (1993) model. Maps the pathway from early experiences through beliefs and automatic thoughts to substance use and its maintaining cycle.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Substance Misuse Formulation
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Early Experiences & Developmental Context
What life experiences contributed to the development of substance use?
Core Beliefs
What fundamental beliefs about self, others, and the world developed from these experiences?
Rules & Assumptions
What conditional rules link beliefs to behaviour?
Activating Situation
What triggers the substance use cycle?
Automatic Thoughts
What thoughts arise in response to the activating situation?
Permission-Giving Beliefs
What thoughts give permission to use?
Urge & Craving
Facilitating Beliefs & Action
What beliefs facilitate the final step to use?
Maintaining Cycle
How does continued use maintain the problem?
Protective Factors & Strengths
What resources, strengths, and supports might help in recovery?
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When to use the Substance Misuse Formulation
The Substance Misuse Formulation is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for substance misuse.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device — or download it as a print-ready PDF.
How it works
Most people work through it in around 25 minutes. It moves through six short steps:
- Early Experiences & Developmental Context — What life experiences contributed to the development of substance use?
- Core Beliefs — What fundamental beliefs about self, others, and the world developed from these experiences?
- Rules & Assumptions — What conditional rules link beliefs to behaviour?
- Activating Situation — What triggers the substance use cycle?
- Automatic Thoughts — What thoughts arise in response to the activating situation?
- Permission-Giving Beliefs — What thoughts give permission to use?
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, the Substance Misuse Formulation works by mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going — and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Marlatt, G.A. & Donovan, D.M. (2005). Relapse Prevention (2nd ed.). New York: Guilford Press.
- Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing (3rd ed.). New York: Guilford Press.
- Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive Therapy of Depression. New York: Guilford Press.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- Samaritans: 116 123 — free, day or night, 365 days a year
- SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day
More Substance Misuse worksheets
View all Substance Misuse worksheets →Substance Misuse
Functional Analysis of Substance Use
Explore the triggers, thoughts, feelings, and consequences associated with substance use to understand its function in your life.
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Decisional Balance
Weigh up the pros and cons of continuing to use substances versus making a change. A core motivational interviewing technique.
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Urge Surfing Record
Track urges to use substances without acting on them. Practice the skill of riding the wave of craving until it passes.
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Substance Use Diary
Track your substance use day by day to identify patterns, triggers, and the relationship between mood and use.
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Pros and Cons of Change
A simplified motivational tool to explore your reasons for and against changing your substance use.
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