Substance misuse is a universal major problem with medical, psychological and forensic dimensions and consequences. Treatment approaches to substance misuse should address its complexity, with pharmacological, psychological and social interventions having an important role to play, either separately or in combination. This article focuses on the psychological approaches. There is a brief presentation of the models and the theory behind them as well as reference to research evidence supporting their efficacy. More detailed presentation of the theory and practice of cognitive behaviour therapy in substance misuse is given at the end of the chapter.