Dialectical Behavior Therapy (DBT) for Addiction

What Is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy, or DBT, is a therapeutic approach used to treat borderline personality disorder (BPD) as well as co-occurring BPD and substance use disorders (SUDs). It has also shown promise as a therapy for eating disorders, PTSD,  and mood disorders.¹ DBT is based on cognitive-behavioral therapy (CBT) techniques as well as mindfulness and acceptance—acceptance of self, of uncomfortable thoughts and feelings, and of others.¹

Like CBT, DBT teaches skills to help recognize harmful thoughts and manage one’s thoughts and emotions so they don’t lead to unhealthy behaviors. DBT takes a similar approach but adds a component of mindfulness, that is, paying attention to thoughts and feelings in the present moment without judgment.¹ This focus on mindfulness is thought to help regulate the intense emotional states that someone with BPD experiences.¹  DBT believes that people function best when they have a good balance between acceptance and change.¹ DBT doesn’t shame or punish harmful behaviors such as drug or alcohol use; unhealthy behaviors are accepted and changed over time.

How Does DBT Work?

To understand DBT, it is important to understand what “dialectic” means. Dialectic refers to two things that seem like opposites existing at the same time.² The dialectical approach, where both acceptance and change skills are learned and applied in everyday life, is a fundamental principle of DBT.²

DBT operates off a biosocial theory of emotional vulnerability and reactivity. The biosocial theory states that we are each born with different levels of sensitivity to emotions; a person with higher emotional sensitivity may be more reactive and have a harder time returning to a healthy emotional baseline.¹ It’s like sensitive skin—some people can stay in the sun for hours without sunscreen and not get burned, while others get burned within a matter of minutes. Being emotionally sensitive isn’t a bad thing. But if you don’t have the right coping skills, it can contribute to emotional reactivity and dysregulation (an emotional response that falls outside the range of accepted norms).

DBT Goals

DBT serves 5 core functions, or goals:¹

• Enhancing capabilities, or learning skills to regulate your emotions, practice mindfulness, improve interpersonal relationships, and tolerate emotional distress.
• Generalizing skills. For DBT to be meaningful, you need to effectively apply the skills you learn to your everyday life. Through homework assignments, you learn how to generalize the skills you’ve learned to reach your treatment goals.
• Reducing harmful behaviors and strengthening motivation. You’ll learn how to decrease unhealthy behaviors that get you farther away from your goals and increase your motivation to act in healthy ways.
• Maintaining and enhancing therapist motivation and capabilities. DBT therapists attend regular team meetings for support, training, validation, and feedback. This helps reduce burnout and motivates them to stay engaged in the process.
• Structuring the environment. During DBT, your therapist works with you to ensure your environment supports your therapeutic goals, reduces harmful behaviors, and reinforces healthy decisions.

DBT Components

DBT is a comprehensive therapy approach that traditionally uses four core techniques to help and support both you and your therapist during outpatient treatment:⁴

• Group skills training. You meet weekly with a group to learn and practice healthy coping skills.
• Individual therapy. In one-on-one, weekly sessions with your therapist, you’ll review skills learned in group and apply the skills to specific challenges and events in your life.
• Phone check-ins and coaching. You can call your therapist when you need real-time support to help apply the skills you’re learning or to use if you’re having a crisis.
• Consultation team. Your therapist will also meet often with other DBT therapists for support, strength, motivation, and feedback.

How Effective Is DBT for Addiction Treatment?

DBT has helped improve outcomes in people with borderline personality disorder and co-occurring substance use disorder. A co-occurring disorder refers to the presence of both a mental health and substance use disorder.⁵

While more research is needed, studies show that DBT is a promising treatment for co-occurring borderline personality disorder and substance use disorder. In one study of women with co-occurring BPD and SUD, those who took part in a DBT treatment program were much more likely to stay in treatment, attend more individual therapy sessions, and reduce substance use than those who attended a community-based treatment program without DBT.²

Benefits of DBT for Addiction

The intended benefits of DBT in the addiction recovery process include:²

• Reducing substance misuse (for example, taking prescription drugs that don’t belong to you, using illegal drugs, or taking more of a drug or in different ways than prescribed).
• Fewer or less discomfort from withdrawal symptoms.
• Preventing relapse and avoiding triggers (the people, places, and things that support substance use).
• Increasing behaviors that promote and encourage abstinence (not using substances).
• Reducing substance cravings.
• Strengthening your social support system and developing community reinforcement of healthy behaviors that discourage substance use and encourage abstinence.

How to Find DBT for Substance Use

Many addiction treatment programs use aspects of DBT, including American Addiction Centers (AAC). AAC offers evidence-based substance use treatment at rehab centers across the nation. Substance misuse treatment can help you recover from substance use disorder. You deserve an addiction-free life. Call AAC at today or fill out the form below.