Dialectical Behavior Therapy for Addiction Treatment

Dialectical behavioral therapy (DBT) is a cognitive and mindfulness-based therapy focused on the patient’s experience and developing the skills to manage negative behaviors. Before the 1980s, therapists struggled to help people who were diagnosed with borderline personality disorder. Although cognitive-behavioral therapy (CBT) interventions could provide some assistance, therapists needed a more effective model to help treatment-resistant or emotionally complex individuals. In the 1980s, Dr. Marsha Linehan developed what would become the treatment of choice for people with personality disorders – dialectical behavioral therapy.

What is Dialectical Behavioral Therapy?

Dialectical behavioral therapy is built from the original concepts of CBT. The word “dialectic” stems from a form of intellectual thought used in philosophy. Dialectic means evaluating opposing viewpoints until the truth becomes clear. This idea—the process of thinking through a scenario or emotions—lies at the core of dialectical behavior therapy techniques.

The Principles of DBT

Through DBT, individuals are encouraged to acknowledge, confront, and analyze their disturbing thoughts and emotions and utilize coping skills to manage them. For example, people with borderline personality disorder may experience suicidal thoughts. These thoughts may stem from feelings of anxiety or guilt, which contradicts their desire to remain physically and mentally healthy. By acknowledging their emotions and thinking through their situation, DBT clients learn how to opt for healthy choices.

Dialectical behavioral therapy trains the mind to investigate these thoughts and emotions and decide on an appropriate choice. By incorporating mindfulness and daily skills practice, DBT techniques give individuals the skills necessary to make healthy choices. For people who struggle to make sense of their conflicting emotions, dialectical behavioral therapy skills offer a safe method to deconstruct their feelings and come to healthy conclusions.

Core Functions of DBT

• Encouraging individuals to change
• Teaching individuals the skills they need to make those changes
• Generalizing DBT skills to become effective in an individual’s natural environment
• Motivating and improving the skills of therapists providing DBT treatment
• Ensuring the five functions of DBT are met through time and practice

DBT Treatment Components

Individual Therapy

A bulk of dialectical behavioral therapy lies in the individual’s sessions and rapport with a therapist. Through these one-on-one sessions, a DBT client learns how to recognize their thoughts and emotions and manage them. These sessions also enable a client to discuss problems with their therapist, giving them the support they need to overcome them. Using dialectical behavior therapy techniques, clients move towards learning and improving positive coping skills. This is an essential component of substance abuse counseling and emotional regulation therapy.

Group Sessions

Dialectical behavioral therapy calls for group sessions about once or twice a week. These sessions provide a venue for clients to learn from their peers and practice their skills in a social setting. When working with a group, clients can put what they learn in their one-on-one meetings into action by practicing distress management, mindfulness, emotion management, and interpersonal skills. In these sessions, a therapist can observe a client’s progress and provide constructive feedback, facilitating improvement.

Therapist Consultation Team

Therapists are people too, and they need reinforcement. DBT therapists establish their avenues of support to be effective. A therapist consultation team provides much-needed support to the therapists providing the treatment, ensuring high-quality dialectical behavior therapy for all clients.

Phone Coaching

Questions can come up when patients start implementing their daily life DBT skills, and phone coaching allows therapists to support their clients through difficult situations. Phone coaching focuses on helping clients utilize their learned addiction recovery skills in real-world contexts.

Addiction Treatment with DBT Principles

Dialectical behavioral therapy works for drug and alcohol rehabilitation as well as emotional and personality disorders. Because DBT targets emotional responses and includes components not typical for other interventions, it is successful with individuals who haven’t responded to other addiction treatments. Individuals may turn towards substances as a way to self-regulate their emotions, which may lead to addiction. DBT techniques can help regulate the emotions that lead to substance use, while also building long-term addiction recovery skills.

Dual Diagnosis and DBT

It is common for people with substance abuse disorder to have a co-occurring mental illness, like bipolar disorder, PTSD, or depression. When a person has both, it is called a dual diagnosis. DBT allows clients and therapists to address both addiction and a mental health concern simultaneously. Clients gain emotional control, mindfulness, and practical addiction recovery skills, while participating in structured emotional regulation therapy and substance abuse counseling.

Evidence-Based Approach

DBT techniques are evidence-based, combining cognitive behavioral strategies with mindfulness. This approach empowers clients to manage emotional distress and develop the tools necessary for sustained sobriety. Whether applied as originally intended or adapted for substance abuse, DBT remains an effective form of addiction therapy for those seeking lasting recovery.

Resources

1. 1. https://dictionary.apa.org/dialectical-behavior-therapy

1. 1. https://www.facebook.com/LinehanInstitute/

1. 1. https://www.merriam-webster.com/dictionary/dialectic

1. 1. https://onlinelibrary.wiley.com/doi/10.1002/9781118957882.ch9

1. 1. https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/

1. 1. https://www.researchgate.net/publication/5351884_Dialectical_Behavior_Therapy_for_Substance_Abusers

1. 1. https://www.nami.org/NAMI/media/NAMI-Media/Images/FactSheets/Dual-Diagnosis-FS.pdf

1. https://www.ahrq.gov/topics/evidence-based-practice.html

If you are experiencing a mental health crisis or need immediate support, please visit SAMHSA’s National Helpline or call 988 for the Suicide and Crisis Lifeline.