How Dialectical Behavior Therapy Can Treat Addiction

In each of these circumstances, the use of functional analysis to arrive at strong case conceptualization and the flexibile utilization of treatment components is important. For example, among individuals with low levels of literacy, the use of written homework forms may need to be replaced by alternative means of monitoring home practice (e.g., using simplified forms or having the patient call to leave a phone message regarding completion of an assignment). Additionally, some research has examined DBT-oriented treatments for other clinical problems, including eating disorders and depression in elderly patients. Telch and colleagues13 compared a 20-week DBT-based skills training group to a wait list control condition for women with binge-eating disorder and found that DBT patients had greater improvements in bingeing, body image, eating concerns, and anger.

Dialectical Behavior Therapy (DBT) vs. Cognitive Behavioral Therapy (CBT)

In addition, the ability to reject offers for substances can be a limitation and serves a challenge to recovery. Rehearsal in session of socially-acceptable responses to offers for alcohol or drugs provides the patient with a stronger skill set for applying these refusals outside of the session. Where relevant, this rehearsal can be supplemented by imaginal exposure or emotional induction to increase the degree to which the rehearsal is similar to the patient’s high risk situations for drug use.

DBT For Addiction Treatment: Finding Therapy That Works

For example, during a conversation with his father, Michael encountered a triggering remark, which propelled him to verbally attack his father. To address this pattern, Dr. Petracek guided Michael to reassess the situation, encouraging him to respond instead of react. Dr. Petracek emphasized that responding involves expressing oneself without resorting to attacks. Michael was prompted to close his eyes and slowly chew a raisin, engaging in this with all of his senses.

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With DBT, people learn to acknowledge their reality and develop the skills to accept their circumstances. The process of dialectical abstinence can be compared to the actions of a quarterback in football. The quarterback focuses constantly on the ultimate goal of scoring a touchdown, even if only a few yards are gained in each play and even if ground is lost. The DBT therapist, likewise, always moves the patient toward the goal, stops only long enough to get the patient back on his or her feet after a fall, and is always ready with the next play that will eventually bring him or her to the goal line. Once the individual has resumed abstinence, the therapist moves back to the opposite (absolute abstinence) pole. Failing well may be particularly important for individuals who have BPD as well as SUD, given their susceptibility to dysregulated emotion.

Who does substance use disorder affect?

Dialectical behavioral therapy is an acceptance-based counseling approach that can be helpful for people who have not benefited from other therapeutic modalities. SUDs and other mental health conditions are caused by overlapping factors such as genetic vulnerabilities, issues with similar areas of your brain and environmental psilocybin magic mushrooms uses effects & hazards influences. CBT for SUDs encompasses a variety of interventions that emphasize different targets. Below we review individual and group treatments including motivational interventions, contingency management strategies, and Relapse Prevention and related interventions with a focus on functional analysis.

1. Because a lifetime of abstinence may seem out of reach, the therapist encourages the patient to commit to a length of abstinence that the patient feels certain is attainable—a day, a month, or just 5 minutes.
2. It prevents painful emotions from bubbling up, unlike distress tolerance and mindfulness.
3. Extensive individual and team homework is assigned upon completion of Part I and is intended to guide DBT teams in applying and building a DBT program within their unique settings.
4. Symptoms can be moderate to severe, with addiction being the most severe form of SUD.
5. Given the strength of current data on comprehensive DBT for patients with severe BPD, the absence of data supporting a “lighter” version of DBT, and the high-risk nature of the patient population, it is advisable to preserve the treatment’s integrity.

Relative Efficacy across Treatments

It’s important to go to all of your scheduled individual DBT therapy sessions and group skill training sessions. This isn’t to be confused with group therapy, in which you discuss your problems with others. Your therapist will likely ask you to keep a diary to track your emotions and actions and to look for patterns of behavior. You’ll bring this diary with you to your sessions so you and your therapist can decide what to work on for each session. Dialectical behavior therapy (DBT) is especially effective for people who have difficulty managing and regulating their emotions. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors.

Different tools work for different people, but ongoing therapy and self-help groups such as Narcotics Anonymous help many. In detoxification, you stop taking the substance(s), allowing them to leave your body. Depending on the severity of the SUD, the substance or an alternative may be tapered off to lessen the effects of withdrawal. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must have at least two signs in the symptoms section over 12 months to be diagnosed with substance use disorder.

DBT includes explicit strategies for overcoming some of the most difficult problems that complicate treatment of both conditions, including weak treatment engagement and retention. Dialectical behavior therapy is part of what is known as the third wave of psychological treatments, following behavioral therapies (1st wave) and cognitive behavioral therapy (2nd wave). Other third-wave therapies include acceptance and commitment therapy, and mindfulness-based cognitive therapy. Though none of these third-wave treatments were originally developed to address addiction, they are increasingly being used in their treatment or adapted for the treatment of substance use disorder. For instance, mindfulness-based cognitive therapy was adapted into mindfulness-based relapse prevention. In summary, DBT is a comprehensive, cognitive-behavioral treatment originally designed to help suicidal women.

Treatment is highly individualized — one person may need different types of treatment at different times. Mental health condition classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM), have become more sophisticated over time. SUD also recognizes a spectrum of problematic substance use, not just physiologic addiction. They also found that improvements in emotional avoidance (i.e., they became more willing and able to face difficult feelings) explained the relationship between difficulties with emotion regulation and food binging, food restriction, and shopping. In other words, being more able to face and address feelings subsequent to baseline levels of emotion dysregulation, largely drove reductions in food binging and restriction behaviors, and shopping. Additionally, reductions in emotional avoidance partially explained the relationship between difficulties with emotion regulation and compulsive shopping, meaning facing difficult feelings partially accounted for reductions in this behavior.

Dialectical thinking influences many aspects of the therapist’s approach and style. For instance, the therapist continually seeks to balance and synthesize acceptance and change-oriented strategies in the most effective possible manner. Within each session, the therapist works to provide a balance of acceptance and validation with problem solving/behavior change strategies. When the therapist and patient lock horns on particular issues, dialectical thinking allows the therapist to let go of the desire to be “right” and focus on ways to synthesize his or her perspective or opinion with that of the patient (based on the idea that each position is likely to be incomplete on its own). Finally, in DBT, there is an emphasis on movement, speed, and flow within therapy sessions. Therapists use a variety of therapy strategies and also vary their style and intensity from lively and energetic, to slow and methodical, and from reciprocal and validating to irreverent and off-beat.

This improvement might be linked to the learning and practice of dialectical behavior therapy behavioral and cognitive skills, as demonstrated in the treatment of substance-related behaviors. At the same time, there were no mediation effects for gambling, and compulsive sexual and shopping behaviors, which undercuts this hypothesis. Individuals with alcohol use disorder sometimes also struggle with behavioral issues like gambling problems, compulsive shopping and sexual behavior, and restrictive or binge eating. The authors of this paper explored whether dialectical behavior therapy treatment for alcohol use disorder may also lead to reductions in commonly co-occurring behavioral issues. As mentioned previously, an essential aspect of dialectical behavioral therapy is fostering healthy interpersonal relationships and social skills. It includes things such as conflict resolution, communication skills, and balancing your priorities with the demands of others.

Particular challenges to the field include the determination of the most effective combination treatment strategies and improving the dissemination of CBT to service provision settings. Novel treatment strategies including more scalable modalities (such as computer-based programs) and combination strategies to improve rates or speed of treatment response (such as DCS) medication for alcohol use disorder may aid in the transportability of treatments outside of research settings. A study on dialectical behavioral counseling showed that it effectively treats parasuicidal patients with borderline personality disorder. It has been proven to reduce the incidence and severity of parasuicidal behavior, hospitalizations, trait anger, and improving social functioning.

Distress tolerance trains individuals to deal with stressful situations in a more manageable manner and seek a more peaceful way of dealing with stress instead of escaping it. In addiction treatment, this is important because substance abuse disorders may not only be caused by chronic stress but may lead to excessive worrying over both major and minor details. In DBT, the patient and therapist work to symptoms of alcohol withdrawal resolve the apparent contradiction between self-acceptance and change to bring about positive changes in the individual in treatment. Part of this process involves offering validation, which helps people become more likely to cooperate and less likely to experience distress at the idea of change. Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers.

As implied above, CBT for substance use disorders varies according to the particular protocol used and—given the variability in the nature and effects of different psychoactive substances—substance targeted. Consistent across interventions is the use of learning-based approaches to target maladaptive behavioral patterns, motivational and cognitive barriers to change, and skills deficits. Consistently with other DBT for substance use disorder programs, the intervention did not present interpersonal effectiveness skills because the goal is to present the most relevant skills for addressing substances in a relatively short period. DBT was developed in the late 1980s by Dr. Marsha Linehan and colleagues when they discovered that cognitive behavioral therapy (CBT) alone did not work as well as expected in patients with BPD. Dr. Linehan and her team added techniques and developed a treatment to meet the unique needs of these individuals. Taught in the distress tolerance module of skills training, another acceptance intervention in DBT is called radical acceptance, which essentially involves accepting the experience of the present moment for what it is, without struggling to change it or willfully resisting it.

Therefore, all of these factors must be considered before embarking upon treatment. CBT for substance use disorders includes several distinct interventions, either combined or used in isolation, many of which can be administered in both individual and group formats. Specific behavioral and cognitive-behavioral interventions administered to individuals are reviewed below, followed by a review of family-based treatments.

Researchers have also found that DBT is effective regardless of a person’s age, sex, gender identity, sexual orientation, and race/ethnicity. While DBT isn’t appropriate for every substance abuser, there is emerging evidence to suggest that most components of DBT are efficacious for most alcoholics and addicts, and when the patient struggles with a co-occurring condition, DBT is therapeutic and effective. Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people understand how thoughts affect emotions and behaviors. To date, no clinical trials have evaluated DBT for patients with SUD but not BPD. However, we believe that certain circumstances and considerations may justify its use for the treatment of SUD patients who have other severe co-occurring psychosocial problems and/or have failed to respond to other SUD therapies (see Is DBT Appropriate for Patients With SUD But Not BPD?). Dialectical behavioral therapy can be helpful for treating a range of psychiatric conditions in both adolescent and adult populations.

Information about workshops, intensive training, online training, and other educational products for patients and therapists can be obtained through Behavioral Tech, LLC (). The adaptation of DBT to patients with SUD and BPD represents a natural extension of the therapy, in light of the comorbidity’s frequent and often synergistic threat to life (see Prevalence and Consequences of SUD-BPD Comorbidity). The adaptation was designed for a population of individuals with SUD that is largely heterogeneous across drugs of abuse and demographic variables.

In addition, therapists modify their approach based on what is working/not working in the moment. In summary, the patients for whom DBT has the strongest and most consistent empirical support include parasuicidal women with BPD. There also are some promising data on DBT for women with BPD who struggle with substance use problems. Preliminary data suggest that DBT may have promise in reducing binge-eating and other eating-disordered behaviors. On the one hand, the most conservative clinical choice would be to limit DBT to women with BPD. On the other hand, DBT is a comprehensive treatment that includes elements of several evidence-based, cognitive-behavioral interventions for other clinical problems.