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Dialectical Behavioral Therapy (DBT) - Treatment for addiction

Dialectical Behavioral Therapy (DBT) - Treatment for Addiction

Impulsiveness, unstable relationships, dysregulated emotions, and suicidal thoughts are symptoms commonly associated with Borderline Personality Disorder—and are unmistakable for individuals who are affected by drug or alcohol abuse.

Navigating everyday life with these powerful struggles requires coping skills, and the goals of DBT (Dialectical Behavioral Therapy) are to give patients unique ways of handling challenging situations effectively and mindfully.

But can something as simple as counting the colors in a room, or running cold water over one’s hand, quell the intense moments of despair experienced by sufferers of mental illness and addiction?

Many studies reveal DBT to be an evidence-based treatment that requires practice and persistence—and, with determination, can change patterns that are highly damaging to addicts.

What Does “Dialectical Behavioral Therapy” Mean?

DBT was created by American psychologist and author Dr. Marsha M. Linehan in the late 1980s. Primarily designed to help individuals with Borderline Personality Disorder, it is also practiced by people who suffer from suicidal-ideation, eating-disorder, trauma, substance-abuse, and co-occurring symptoms.

On her website, Dr. Linehan describes the “dialectical” aspect of DBT as “the synthesis or integration of opposites,” meaning the treatment allows patients to find a middle ground between extreme emotions.

Some goals of DBT include helping patients become skilled in identifying the triggers of their unhealthy behaviors and complicated emotions, so that self-intervention is possible.

In treatment, which is administered by a therapist in individual or group sessions, DBT users are taught a vast array of skills built to help them find center during crisis.

Four Modules of DBT

  • Mindfulness
  • Distress Tolerance
  • Emotion Regulation
  • Interpersonal Effectiveness

Skills are often pneumonic devices that help DBT users remember them in moments of extreme stress. Examples include acronyms such as the “PLEASE” skill within the Emotion Regulation module, which addresses self-destructive habits.

The “PLEASE” acronym in DBT

  • Physical iLlness—If you are sick or injured, get proper treatment for it.
  • Eating—Make sure you eat a proper healthy diet, and eat in moderation.
  • Avoid mood-altering drugs—Do not take other non-prescribed medication or drugs.
  • Sleep—Do not sleep too much or too little.
  • Exercise—Make sure you get an effective amount of exercise.

“PLEASE” is just one skill that encourages DBT users to change their mindset through external, physical changes. Some skills are more of a mental exercise: “Wise Mind” helps DBT users combine emotional and logical reasoning, while “Participate” encourages users to distract themselves by becoming involved in an activity.

DBT therapists recognize the need to help clients integrate the sheer amount of skills into their daily lives. It is common to assign “homework” to help DBT users continue skills training outside of therapeutic sessions. Many DBT users also find it effective to develop their skills through smartphone apps such as “DBT Diary Card & Skills Coach” or “DBT Daily.”

DBT skills are partially based on Buddhist meditative practices, which are commonly taught in treatment programs. It is also a modified form of Cognitive Behavioral Therapy—though the two have marked differences.

What is the Difference Between Cognitive Behavioral Therapy and Dialectical Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) was invented in the 1960s by psychiatrist Aaron Beck. “Cognitive” is the operative word in the treatment, as it focuses on thinking and the relationship between thoughts and feelings. It is considered effective for individuals with anxiety and can change patterns of rumination.

An example of CBT therapy in practice would be if someone becomes concerned when a nearby group of people start laughing—it might be default for the individual to start worrying whether they are the butt of a joke told within the group.

But with effective CBT treatment, they could consider other possibilities (a change in thinking) and arrive at less anxiety-provoking conclusions.

Lessons like this are designed to help clients understand that events themselves aren’t always inherently negative, rather, the meanings we give them can sometimes lead to patterns of negative thinking.

Similar to DBT in terms of skills training within a therapist-and-client setting, CBT is also evidence-based and designed to help patients navigate problem-solving and change in mental and behavioral issues.

Though CBT treatment is short-term and requires five-to-ten months for most emotional problems, DBT was created to offer long-term (even lifetime) support to individuals with severe emotional and substance-abuse issues. Both intend to offer life skills, but DBT is a lifestyle change.

Referring back to the concept of DBT as a treatment requiring significant practice and memorization, individuals with Borderline Personality Disorder and Substance Use Disorder are encouraged to stay in treatment even as symptoms appear to wane—DBT users will need the practice once they’re back in crisis!

Addictive personalities tend to be hereditary, while economic, social, and other societal pressures can increase an individual’s access and desire to try mind-altering substances.

DBT for Substance Abusers

Because DBT skills can help substance abusers self-intervene when common symptoms arise—such as impulsivity, suicidal thoughts, and deep, painful emotions—DBT is highly effective during relapse prevention, bouts of irritability due to withdrawal, and feelings of hopelessness and emptiness common in substance-abuse recovery.

The comprehensiveness of DBT treatment within both inpatient and outpatient treatment settings can offer significant structure for substance abusers in their daily lives. Programs offer day-long activities and group sessions that reinforce coping skills, helping addicts deal with cravings, extreme mood swings, and replacement habits (such as overeating) commonly associated with rehabilitation.

The mindfulness aspect of DBT plays a significant role in substance-abuse recovery as well. DBT users learn grounding techniques such as breathing exercises, mindful meditation, and how to objectively observe their thoughts and feelings without judging themselves.

Guided by a therapist, clients learn these skills and discuss physical and mental changes they experience in practice. Over time, clients find themselves utilizing these techniques in times of crisis, and report their progress in therapeutic sessions.

Validation is a key component of DBT therapy, and is intended to convey empathy and understanding to sufferers while helping them feel heard. Once the client confirms feelings of validation, the therapist might ask if they can recall coping skills from treatment to help them weather their crisis.

However, a therapist may need to set healthy boundaries with clients who call in order to treat them effectively and not become overwhelmed themselves.

Community is essential for individuals recovering from substance abuse. Many find themselves cutting ties with past enablers and fellow abusers, and DBT groups help recovering addicts foster relationships built on healthy habits, acceptance, and crisis intervention.

Getting Help for Addiction

According to the National Institute for Drug Abuse, repeated drug use changes parts of the brain that give a person self-control. Many addicts are resistant to recovery and feel very isolated and alone with their addiction. They may have severed ties or had a falling out with exasperated friends and family members who feel powerless in the wake of their loved one’s destructive behavior.

But when someone suffering from substance abuse is ready to seek help, a good first step is to tell a loved one. It is certainly easier said than done, but with someone they trust, individuals who suffer from substance abuse can know they’re not alone when they talk to their primary care doctor or therapist about getting on the path to recovery.

If they do not currently see a healthcare professional, the addict’s loved one can help them locate a nearby physician or recovery facility through research on the internet or referral from other physicians.

It is important to help substance abusers understand that, despite harsh legal and criminal repercussions for drug use in some areas, addiction is a disease and public health issue that requires rehabilitation—not punishment.

Addicts seeking help may feel a sense of deep shame and worthlessness, but helping them understand they are biologically and mentally wired to crave mind-altering substances can get them steps closer to the realization that regaining control of their lives is possible.

With the right support, substance abusers can feel validated about their sometimes-daunting efforts toward reclaiming their physical, emotional, and mental health.


Can I afford addiction treatment?

Often times, your health insurance plan can cover a majority of the cost of your treatment. Not sure where to start? We can help verify your insurance plan and point you in the right direction, even if it’s not with us.

How can I communicate with my loved ones while in treatment?

Keep in mind that when you’re in treatment, you want to take the time to focus on yourself and your recovery. However, we understand that our patients have responsibilities outside of treatment and can make accommodations to comply with certain requests. To find out more, call and talk to our treatment specialists today.

Can someone help me stage an intervention?

Absolutely! Call our treatment specialists to discuss your specific situation. Often times we are able to send a certified interventionist to help assist in not only the intervention, but to also oversee your loved one’s transportation to rehab.

Can I force a loved one to go to rehab?

If you live in the state of Massachusetts, there is a law that passed, known as Section 35. Under this law, it “allows a qualified person to request a court order requiring someone to be civilly committed and treated involuntarily for an alcohol or substance use disorder”. Read more about Section 35 and speak with one of our treatment specialists today to help assist you through this process.

What does substance abuse treatment look like?

Substance abuse treatment often comes in multiple stages. The stages are dependent on what substance(s) an individual is using and how often. Typically, treatment consists of detox, inpatient/residential treatment and/or intensive outpatient treatment. This process usually takes on average 90 days. An individualized plan will be made for each patient by their clinician and therapist.

What will happen to my job while I’m in treatment?

The Americans with Disabilities Act (ADA) has given protected rights for people suffering from substance abuse. By filing for FMLA, you can help protect your job while you are in treatment. Our treatment specialists will go over different options with you and help you file the necessary paperwork you need to help protect your job. This process is discrete as we are HIPAA compliant.

Ready to make a change? Talk to a specialist now.