Dialectical Behavior Therapy for Drug Addiction Treatment

There are a variety of evidence-based psychosocial interventions used to help people with addiction get sober and remain in recovery.¹ One of these addiction treatment therapy approaches is dialectical behavior therapy (DBT).²

This article will provide an in-depth look at what DBT is, how it works, and how it may be used in the treatment of drug and alcohol addiction.

What Is Dialectical Behavior Therapy?

Dialectical behavior therapy is a therapeutic approach with the goal of helping patients build a fulfilling life. It was originally developed to treat people with borderline personality disorder (BPD) who engage in self-harm or attempt suicide. People with BPD commonly struggle with emotional dysregulation and impulsivity, and DBT and its concepts have evolved and been adapted to treat people with a variety of mental and behavioral health disorders that are influenced by these characteristics such as:³

• Eating disorders.
• Anxiety disorder.
• Depressive disorders.
• Post-traumatic stress disorder.

It has also been adapted to treat patients with substance use disorder (SUD) and co-occurring BPD as well as other mental health issues.^3,4

DBT for Substance Use Disorder

DBT—in the context of addiction treatment—is primarily used to treat people with co-occurring disorders that are influenced by problems with emotional regulation. Emotional dysregulation can sometimes be seen in people with personality disorders, trauma survivors, PTSD, as well as certain anxiety or mood disorders.^4,5

DBT’s efficacy in treating co-occurring SUD and BPD is well established: One study found that women with SUD and BPD who received DBT interventions reported greater reductions in drug use throughout treatment and 4 months post-treatment as well as lower dropout rates than those who didn’t receive DBT interventions.³

In addition, specific principles of DBT (e.g., mindfulness, interpersonal effectiveness skill development, healing from interpersonal trauma) are often successfully employed in addiction treatment, regardless of whether someone suffers from a co-occurring disorder.

DBT is just one of several types of evidence-based therapies that may be used in addiction treatment.⁶ Often, treatment programs will utilize the principles of several different therapeutic approaches as needed.

How Does DBT Work?

DBT works by improving someone’s coping strategies and behaviors through 2 seemingly opposing principles: acceptance and change. Simply focusing on one or the other—proponents of DBT argue—would be an incomplete and ineffective strategy. To improve their lives, patients must make necessary changes to their behavior and surroundings but also be able to cope with the things they cannot change.³

Like many other therapeutic approaches, DBT stresses the importance of abstinence and cessation of drug and alcohol use.⁷ However, if and when relapse occurs, DBT views it as an opportunity to strengthen the patient’s acceptance skills as opposed to a failure of treatment.⁷

The 5 core functions of DBT include:³

1. Enhancing capabilities. Skills taught in DBT include: emotional regulation, attention regulation (being attentive in the present moment), interpersonal effectiveness, and distress tolerance (solving problems and not making them worse).
2. Generalizing the newly learned behaviors. The skills and behaviors learned in the previous function must be applied outside of the treatment sessions for them to be useful. The therapist may assign homework assignments or encourage the patient to troubleshoot ways to improve during therapy sessions.
3. Increasing the patient’s motivation to change. This involves getting feedback from the patient regarding treatment targets, which helps the therapist prioritize the sessions to better meet the patient’s needs.
4. Enhancing the therapist’s motivation and capabilities. It’s often important that a therapist practicing DBT meets with a team of other therapists to improve their approaches and ensure they maintain a compassionate and judgment-free attitude.
5. Structuring the environment. Patients often must learn to modify their surroundings; for example, avoid certain social situations that may trigger relapse. It also involves the therapist working to structure their sessions in a manner conducive to the patient’s progress.

DBT also emphasizes a hierarchy of behaviors that impact a person’s ability to create a life worth living. Starting with the most life-threatening behaviors, the substance-use target behaviors include:⁷

• Reducing substance use (including prescription medication that is taken for longer periods or in larger quantities than prescribed).
• Improving physical discomfort that is caused by withdrawal.
• Reducing or eliminating cravings.
• Avoiding triggers to relapse through the application of change strategies (ending relationships, changing phone numbers, getting rid of drug paraphernalia).
• Decreasing behaviors that support drug use.
• Increasing community support and reinforcement through the establishment of healthy interpersonal relationships.

DBT Therapy vs CBT

DBT includes many aspects of cognitive behavioral therapy (CBT), particularly the behavioral skills that are taught, such as problem-solving and stimulus control.³

However, DBT combines CBT with elements of other modalities to create a unique therapeutic approach marked by the incorporation of dialectical philosophy and the inclusion of acceptance and mindfulness skills.³

Dialectical philosophy is a cornerstone of DBT. At its core, dialectical philosophy assumes that opposite forces—in this case, change and acceptance—exist simultaneously and are in constant tension. Therapists using DBT attempt to balance the exploration of both change-based solutions (e.g., the ones described in the 5 core functions of treatment) and acceptance-based solutions.³

Acceptance practices are key elements that further differentiate DBT from CBT. One such practice—mindfulness—may involve:³

• Observing an experience in real time without judgement.
• Describing the facts of this experience.
• Participating fully in the experience.
• Focusing on and addressing one thing at a time.

Other acceptance practices found in DBT include:³

• “Radical acceptance,” which means accepting the experience of a given moment without resisting or trying to change it.
• Validating the truth of an experience, emotional response, thought, or opinion.

Addiction Treatment and Rehab near Laguna Hills, CA

Recovery from addiction is possible.⁷

Laguna Treatment—American Addiction Centers’ (AAC) Orange County rehab—offers different levels of care for substance use treatment and a variety of evidence-based interventions and therapies.

Call to start the rehab admissions process. Compassionate admissions navigators can also guide you through the process of using insurance to pay for rehab or help you explore other ways to pay for rehab.

You don’t have to live another day in active addiction. Call Laguna Treatment Hospital today or use the confidential to verify your insurance coverage.