Can Dialectical Behavior Therapy Help with Substance Abuse?

For people looking for help with substance abuse, there are many options with various philosophies and approaches to treatment. One option that is often overlooked is dialectical behavior therapy (DBT). When might a person with substance abuse consider DBT as a useful option?

Dialectical behavior therapy is well established as an effective treatment for people with borderline personality as well as depression and anxiety. Less well known is DBT’s effectiveness in helping people overcome addiction.

How DBT Approaches Substance Abuse

DBT targets addiction as a symptom of emotion dysregulation. When a person experiences emotions as very intense, and has difficulty tolerating painful feelings, he or she may look to substances or other addictive behaviors as a strategy for coping. In other words, people whose substance abuse is related to managing emotions may benefit from DBT. Of course, those whose problems are less severe may do well with a less intensive treatment.

Because DBT offers a robust skills training program for people who have trouble managing intense emotions, it has been found to be useful in helping people replace addictive behaviors with healthy coping strategies.

DBT for substance abuse does have some differences compared to standard DBT. These differences in the treatment are designed to account for the unique needs of people with addictions.

DBT’s Use of Dialectical Abstinence

In treatment of addictions, there has long been a divide between those who promote abstinence and those who promote harm reduction. Rather than looking exclusively to either of these options, DBT’s approach is to support “dialectical abstinence.” This means that the therapist helps the person in therapy to do everything possible to achieve abstinence, while also supporting a harm-reduction approach when relapse happens. This dialectical stance allows the person to receive the benefits of both approaches.

DBT for substance abuse does have some differences compared to standard DBT. These differences in the treatment are designed to account for the unique needs of people with addictions.

Based on DBT’s balance of efforts toward change and efforts toward acceptance, people are supported in immediately and permanently stopping use of substances, all the while being encouraged to work toward desired goals even when relapse occurs. While many substance abuse treatments require complete abstinence in order to receive services, DBT takes a different approach. People must stay committed to the goal of abstinence, but also receive support to get back on track if relapse happens.

The DBT Treatment Structure

Individual DBT therapists can treat addiction through a targeted focus on substance-related behaviors. Because DBT sessions are highly structured around behaviorally specific targets, the therapist will specifically address behaviors that are linked to substance use-related outcomes. These targets often include decreasing use of illegal substances, alleviating physical discomfort, reducing cravings and urges to use, and avoiding opportunities and cues associated with drug use.

DBT also uses a set of strategies known as community reinforcement. Community reinforcement is a technique that increases social support for abstinence from substance use.

In the DBT skills training group, skills for overcoming addictions are included in the distress tolerance section. These include skills to plan for dialectical abstinence, an overview of behavior patterns that indicate when one is in “addict mind” or “clear mind,” the community reinforcement model, alternate rebellion, and more. These skills are intended to help people reinforce nonaddictive behaviors and end addiction-linked behaviors.

Considering DBT as a Treatment Option

Some questions to consider in evaluating DBT as a treatment option for substance abuse include:

• Is the addictive behavior linked to a problem managing emotional ups and downs?
• Is the person committed to complete and permanent abstinence as a goal, but in need of skills to work toward it?
• Would the person benefit from an intensive, structured treatment that includes weekly individual therapy and a skills group?

If the answers are affirmative, an evaluation for DBT may help.

In seeking DBT as a treatment option, it is important to find a licensed clinician who is intensively trained in the therapy he or she is offering, and who offers comprehensive DBT (individual therapy, skills training, phone coaching, and participation in a consultation team). After finding a provider, you can ask the therapist about his or her training and services offered.

Reference:

Dimeff, L. A., & Linehan, M. M. (2008). DBT for Substance Abusers. Addiction Science & Clinical Practice, 39-47.

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