Marsha Linehan, the woman who created dialectical behavior therapy, or DBT, was once a patient herself who had a profound desire to end her life.

In what could only be described as a relentless quest to heal herself and the people around her, Linehan developed DBT for those with borderline personality disorder, a mental illness marked by mood instability, warped self-image, impulsiveness, and intense but unstable relationships.

DBT would be employed for patients afflicted with substance abuse disorders. In fact, DBT has become a staple in the treatment of addiction. Its principles are just as applicable to people with drug or alcohol addictions as those who have BPD and other mental issues. DBT especially possesses great utility in an addiction treatment context because patients with substance abuse disorders often have co-occurring mental health issues.

Read on to learn about the principles that undergird DBT and how it is used to treat substance abuse.

The Core Principles of DBT

Dialectical behavior therapy is support-oriented in that it helps patients identify and build on their strengths to increase self-confidence. It is cognitive-based, in that it helps people identify patterns — their beliefs, thoughts, and assumptions — that make their lives more difficult. DBT is also collaborative, in that it encourages patients to work out their issues in collaboration with therapists.

DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.

There are four modules of DBT, which include: 

  • Mindfulness: At its core, all of the skills in DBT are centered on mindfulness. This aspect helps patients accept and tolerate the emotions they may be feeling when they are challenging habits or beliefs or confronting upsetting or uncomfortable situations. Though mindfulness derives from Buddhist practice, in DBT it does not contain religious or metaphysical elements. Instead, therapists urge patients to practice mindfulness in a way that they become more aware of their environments via the five senses of touch, taste, sight, smell, and sound.
  • Interpersonal Effectiveness: This involves how patients interact with the people around them and in their relationships. Specifically, they are taught how to ask for what they need, how to say “no,” and how to deal with interpersonal conflict.
  • Distress Tolerance: This component involves tolerating, accepting, and finding meaning in the distress that occurs in their lives. Those include distressing events such as the death of a relative or friend, the loss of a job, or illness. Patients are taught to accept a distressing event without imposing judgment on the situation. The object of distress tolerance is to develop the capability to recognize a negative event and its impact without becoming overwhelmed or cowed by it.
  • Emotion Regulation: This DBT aspect teaches people in recovery how to identify, regulate, and feel emotion without it overwhelming them to the point that it triggers impulsive behavior.

In the context of people who are suicidal or have borderline personality disorder, this component teaches them to regulate the intense and labile emotions they tend to experience like being frequently angry, intensely frustrated, depressed, and anxious.

How DBT Treats Addiction

Unlike medication-assisted treatment (MAT), DBT is abstinence-based. An article in The Fix sums up the goal of DBT in

Dialectical Behavior Group Therapy session

an addiction treatment context: “…DBT pushes for immediate and permanent cessation of drug abuse (change) while also offering the idea that a relapse, should it occur, does not mean that the individual cannot achieve the desired result (acceptance).”

While the dialectical approach mandates abstinence, it also provides nonjudgmental, problem-solving solutions to relapse.

This passage from The Fix encapsulates this approach:

DBT treats a lapse into substance abuse as a problem to solve, rather than as evidence of patient inadequacy or treatment failure. When a patient does slip, the therapist shifts rapidly to helping the patient fail well—that is, the therapist guides the patient in making a behavioral analysis of the events that led to and followed drug use and gleaning all that can be learned and applied to future situations.

The therapist is also tasked with helping a patient recover quickly from a relapse episode.

Alternatives to DBT

Studies support DBT as an effective treatment option for people with substance abuse disorders. People enrolled in a professional addiction treatment program have access to services beyond DBT.

Those include the following treatment modalities:

  • Cognitive Behavioral Therapy: Treatment that addresses the negative thoughts and actions associated with addiction.
  • Group Therapy: A program that provides patients with a supportive recovery community.
  • Family Therapy: This form of therapy focuses on the elimination of addiction and its impact on the family unit as a whole.
  • Dual Diagnosis Treatment: A program that addresses a substance abuse disorder and an accompanying mental health issue in a patient.
  • 12-Step Fellowship Groups: A therapy model based on the groundbreaking 12-Step program that was pioneered by Alcoholics Anonymous founder Bill Wilson and Bob Smith.
  • Holistic Therapy: A treatment model that focuses on the whole person, from the addiction to diet and mental health.
  • Pharmacotherapy: A treatment program that involves the use of medications to help someone cycle off of an addiction.
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