# ChatThero: An LLM-Supported Chatbot for Behavior Change and Therapeutic Support in Addiction Recovery

arXiv: https://arxiv.org/abs/2508.20996 · HTML: https://mlsanity.com/paper/2508.20996/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Builds on 34 of its 73 references that are in the map.
- First posted on arXiv 28 Aug 2025.

## Builds on (most cited first, 30 of 34)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [Generative Agents: Interactive Simulacra of Human Behavior](https://mlsanity.com/paper/2304.03442/) (2023)
- [G-Eval: NLG Evaluation using GPT-4 with Better Human Alignment](https://mlsanity.com/paper/2303.16634/) (2023)
- [A Survey on Large Language Model based Autonomous Agents](https://mlsanity.com/paper/2308.11432/) (2023)
- [A Survey on LLM-as-a-Judge](https://mlsanity.com/paper/2411.15594/) (2024)
- [From Generation to Judgment: Opportunities and Challenges of LLM-as-a-judge](https://mlsanity.com/paper/2411.16594/) (2024)
- [HealthBench: Evaluating Large Language Models Towards Improved Human Health](https://mlsanity.com/paper/2505.08775/) (2025)
- [Large Language Models Are State-of-the-Art Evaluators of Translation Quality](https://mlsanity.com/paper/2302.14520/) (2023)
- [GPTScore: Evaluate as You Desire](https://mlsanity.com/paper/2302.04166/) (2023)
- [Large Language Models Empowered Agent-based Modeling and Simulation: A Survey and Perspectives](https://mlsanity.com/paper/2312.11970/) (2023)
- [LLM Agents Grounded in Self-Reports Enable General-Purpose Simulation of Individuals](https://mlsanity.com/paper/2411.10109/) (2024)
- [AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments](https://mlsanity.com/paper/2405.07960/) (2024)
- [AI Hospital: Benchmarking Large Language Models in a Multi-agent Medical Interaction Simulator](https://mlsanity.com/paper/2402.09742/) (2024)
- [PsyQA: A Chinese Dataset for Generating Long Counseling Text for Mental Health Support](https://mlsanity.com/paper/2106.01702/) (2021)
- [CPsyCoun: A Report-based Multi-turn Dialogue Reconstruction and Evaluation Framework for Chinese Psychological Counseling](https://mlsanity.com/paper/2405.16433/) (2024)
- [Roleplay-doh: Enabling Domain-Experts to Create LLM-simulated Patients via Eliciting and Adhering to Principles](https://mlsanity.com/paper/2407.00870/) (2024)
- [Beyond Single-Turn: A Survey on Multi-Turn Interactions with Large Language Models](https://mlsanity.com/paper/2504.04717/) (2025)
- [Cactus: Towards Psychological Counseling Conversations using Cognitive Behavioral Theory](https://mlsanity.com/paper/2407.03103/) (2024)
- [HealMe: Harnessing Cognitive Reframing in Large Language Models for Psychotherapy](https://mlsanity.com/paper/2403.05574/) (2024)
- [SMILE: Single-turn to Multi-turn Inclusive Language Expansion via ChatGPT for Mental Health Support](https://mlsanity.com/paper/2305.00450/) (2023)
- [A Comprehensive Analysis of the Effectiveness of Large Language Models as Automatic Dialogue Evaluators](https://mlsanity.com/paper/2312.15407/) (2023)
- [CBT-LLM: A Chinese Large Language Model for Cognitive Behavioral Therapy-based Mental Health Question Answering](https://mlsanity.com/paper/2403.16008/) (2024)
- [Improving Medical Reasoning through Retrieval and Self-Reflection with Retrieval-Augmented Large Language Models](https://mlsanity.com/paper/2401.15269/) (2024)
- [PsycoLLM: Enhancing LLM for Psychological Understanding and Evaluation](https://mlsanity.com/paper/2407.05721/) (2024)
- [RARE: Retrieval-Augmented Reasoning Enhancement for Large Language Models](https://mlsanity.com/paper/2412.02830/) (2024)
- [LLMs Can Simulate Standardized Patients via Agent Coevolution](https://mlsanity.com/paper/2412.11716/) (2024)
- [StoryER: Automatic Story Evaluation via Ranking, Rating and Reasoning](https://mlsanity.com/paper/2210.08459/) (2022)
- [PaniniQA: Enhancing Patient Education Through Interactive Question Answering](https://mlsanity.com/paper/2308.03253/) (2023)
- [Comparing Two Model Designs for Clinical Note Generation; Is an LLM a Useful Evaluator of Consistency?](https://mlsanity.com/paper/2404.06503/) (2024)

## Built on by (most cited first, 4 of 4)

- [LLMs Should Incorporate Explicit Mechanisms for Human Empathy](https://mlsanity.com/paper/2604.10557/) (2026)
- [Rethinking Patient Education as Multi-turn Multi-modal Interaction](https://mlsanity.com/paper/2604.14656/) (2026)
- [DischargeBench: Pre-Deployment Evaluation of LLM Discharge Educators through Persona-Grounded Patient Simulation](https://mlsanity.com/paper/2609.20827/) (2026)
- [Multi-Objective Aligned Small Language Model Framework for SUD Patient Dialogue Generation](https://mlsanity.com/paper/2610.09209/) (2026)

## Abstract (arXiv)

Substance use disorders (SUDs) affect millions of people, and relapses are common, requiring multi-session treatments. Access to care is limited, which contributes to the challenge of recovery support. We present ChatThero, an innovative low-cost, multi-session, stressor-aware, and memory-persistent autonomous language agent designed to facilitate long-term behavior change and therapeutic support in addiction recovery. Unlike existing work that mostly finetuned large language models (LLMs) on patient-therapist conversation data, ChatThero was trained in a multi-agent simulated environment that mirrors real therapy. We created anonymized patient profiles from recovery communities (e.g., Reddit). We classify patients as texttteasy, textttmedium, and textttdifficult, three scales representing their resistance to recovery. We created an external environment by introducing stressors (e.g., social determinants of health) to simulate real-world situations. We dynamically inject clinically-grounded therapeutic strategies (motivational interview and cognitive behavioral therapy). Our evaluation, conducted by both human (blinded clinicians) and LLM-as-Judge, shows that ChatThero is superior in empathy and clinical relevance. We show that stressor simulation improves robustness of ChatThero. Explicit stressors increase relapse-like setbacks, matching real-world patterns. We evaluate ChatThero with behavioral change metrics. On a 1--5 scale, ChatThero raises textttmotivation by +1.71 points (from 2.39 to 4.10) and textttconfidence by +1.67 points (from 1.52 to 3.19), substantially outperforming GPT-5. On textttdifficult patients, ChatThero reaches the success milestone with 26% fewer turns than GPT-5.