This chapter focuses on current psychological approaches to drug and alcohol dependence, most notably learning theory and cognitive behavioural approaches. The role of motivation and readiness to change is discussed in some depth, due to its central place in initiating change, although it may be less important in sustaining change. The role of mental health factors both in instigating and sustaining addiction are explored and the question of how to tackle such comorbidity is discussed. Neuropsychological impediments most commonly evident in alcohol addiction are often either entirely neglected or mentioned only in passing when discussing psychological approaches. This is an important omission as the impact of mild-moderate impediments of executive functioning and memory clearly affect both initial learning, retention, recall and judgement. These areas are of crucial importance in terms of establishing self-regulation and monitoring and in terms of remembering to enact change. The critical role of relapse prevention in sustaining long-term change are then explored, before the chapter closes with some key pointers for those working in the field.