Using Dialectical Behavioral Therapy In Addiction Treatment

Dialectical behavioral therapy (DBT) aids a person in developing the motivation to change harmful, substance-using behaviors so they can build a sober life.

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Dialectical behavioral therapy (DBT) is a versatile psychotherapy which treats both mental health and substance use disorders. Because of this, DBT is of great use within dual diagnosis treatment programs for addiction.

Addiction is fueled by dysfunctional behaviors and a person’s inability to manage stress and regulate their emotions in a healthy way. In addition, many individuals struggle to find the motivation to change substance-using behaviors.

Dialectical behavioral therapy recognizes these states and seeks to teach a person the importance of mindfulness, emotion regulation, interpersonal skills, and distress tolerance within recovery.

Which Disorders Can DBT Treat?

Dialectical behavioral therapy was developed as a treatment for borderline personality disorder and individuals who were struggling with suicidal thoughts. DBT has since been adapted as a treatment for substance use disorders (SUD).

Though dialectical behavioral therapy can be used to treat a substance use disorder alone, it offers great benefits to those in need of dual diagnosis treatment. A dual diagnosis, or co-occurring disorder, occurs when an individual struggles with both a substance use and mental health disorder.

Examples of dual diagnoses which may be treated with DBT include:

  • bipolar disorder
  • bulimia
  • binge-eating disorder
  • depression
  • post-traumatic stress disorder

While these conditions aren’t always related, in many cases they are. Either may have caused or aggravated the other. Frequently a person’s substance abuse is borne out of self-medication.

As the symptoms of the mental illness become unbearable, many people use drugs or alcohol to cope. A large part of dialectical behavioral therapy is teaching an individual healthy ways to cope with uncomfortable and negative thoughts and emotions so they don’t turn to substance abuse to numb the pain.

Dialectical Behavioral Therapy For Skill-Building

Building positive behaviors which support sobriety require a solid set of life and recovery skills. In order for these skills to be effective they must be individualized to fit each person’s life and circumstances.

To enhance each client’s capability for creating and maintaining a drug-free life, dialectical behavioral therapy focuses on building four main life skills:

  • emotion regulation: Negative emotions fuel substance abuse. Without the proper skills to cope with these feelings, a person is far more apt to try and manage them with drugs or alcohol. Learning how to regulate emotions in a healthy way reduces these instances of self-medication.
  • mindfulness skills: Mindfulness teaches a person to experience life in the present moment. This awareness helps a person become more accepting of their thoughts, emotions, and experiences so they don’t become ruled by them.
  • interpersonal effectiveness: Addictive behaviors tear relationships apart and make it difficult for the addicted individual to relate to other people in a healthy way. A large part of healing from addiction comes from the support of others. Being able to effectively communicate and relate to other people helps a person build a more solid recovery network.
  • distress tolerance: Stress is one of the biggest triggers of substance abuse and relapse. Learning to handle stress and process it in a healthy way helps make a person more resilient against relapse.

These skills aren’t static. In order for a person’s recovery to stay strong, they must continually evaluate these life skills and rebuild them as needed.

Dialectical Behavioral Therapy To Reduce Harmful Behaviors

When treating a person with a substance use disorder, the primary target of DBT is substance-using behaviors.

These substance-abuse-specific behavioral targets include:

  • reducing instances of drug abuse, including illicit drugs and the misuse of prescription drugs
  • relieving uncomfortable symptoms of withdrawal
  • decreasing cravings and thoughts of relapse
  • helping a person stay away from triggers and opportunities for drug abuse
  • helping a person cut ties with individuals and places which promote drug use
  • decreasing behaviors and mindsets which contribute to drug abuse and relapse
  • building access to community reinforcement and positive behaviors which support abstinence (e.g. making new friends or rebuilding old, healthy relationships)

Dialectical behavioral therapy targets also include building a person’s self-respect and achieving goals which enrich the client’s well-being and sense of personal fulfillment.

As a person works through these targets, their resolve for abstinence should grow and strengthen.

Dialectical Behavioral Therapy Promotes Abstinence

The DBT model pushes for immediate and long-lasting abstinence. As part of this initiative, treatment participants are cautioned that relapse is possible. However, therapists remind individuals that they can still find success within their sobriety and treatment goals if relapse does happen.

Should relapse occur, dialectical behavioral therapy encourages a non-judgmental approach which focuses on problem-solving techniques to regain an abstinent state. As part of relapse prevention, individuals are taught how to decrease the risks of infection, overdose, and other adverse health effects associated with continued drug abuse.

The thought of giving up drugs or alcohol can be overwhelming to a person newly in treatment. To make sobriety more attainable, DBT directs clients to set small, attainable abstinence goals.

For instance, instead of a person saying they’d like to be drug-free for life, a therapist might suggest setting a less intimidating goal. This could be as little as a day or up to a month. Once a person attains this goal, they’re directed to establish a new goal, and so forth.

To further prevent relapse and build confidence, a person is taught to “cope ahead.” This means that clients anticipate potential cues for relapse before they happen. Once these triggers are identified, a person is aided in developing a healthy response to these tempting situations.

The Structure Of Dialectical Behavioral Therapy

Dialectical behavioral therapy is delivered to clients by individual therapy and group skills training sessions. In standard therapy plans, individual sessions are offered once a week for about one hour. Group skills training sessions also occur once a week and last from one-and-a-half to two-and-a-half hours.

Individual sessions are conducted by a highly-trained therapist who helps the client stay focused and motivated within their recovery. The therapist also teaches each individual how to best use DBT skills to cope with challenges within their daily life.

Dialectical behavioral therapy group sessions provide a dynamic opportunity for participants to learn from each other’s experiences while receiving and providing mutual support. Each group is led by a trained therapist who teaches DBT skills and directs participants in exercises. During the session, homework is assigned. An example of homework would include working on mindfulness exercises between therapy sessions.

The best treatment programs are individualized to the specific needs of each person’s life and recovery journey. To support this, DBT is often used in conjunction with other behavioral therapies and treatment methods.

Healing takes time, especially when a person is facing a dual diagnosis. Because of this, inpatient drug rehabilitation programs are often the most optimal choice for treatment.

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Pennsylvania State University — Dialectical Behavior Therapy Implications for Substance Abuse
University of Washington — Dialectical Behavior Therapy
US National Library of Medicine — Dialectical Behavior Therapy for Substance Abusers

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