Using Dialectical Behavioral Therapy for Addiction Treatment
Dialectical Behavioral Therapy (DBT) is a style of evidence-based psychotherapy that originated as a treatment for borderline personality disorder. However, there is now evidence that it can be useful in treating:
The word dialectic refers to the blending of two opposites. The basic principle of DBT is to create a process that promotes two opposed goals for patients–change and acceptance.
As it relates to the journey to abstinence, the dialectic takes the form of pushing for immediate and permanent abstinence (change), while at the same time instilling the fact that a relapse (if it happens) does not mean the person can’t achieve the goal of abstinence (acceptance). The dialectical therefore joins insistence on total abstinence with problem-solving, nonjudgmental responses to relapse.
“Life Worth Living” Goals
Many people who abuse alcohol and drugs do it as a way to deal with difficult and painful emotions. Most of these people don’t have the skills to manage life on “life’s terms.” DBT for SUDs (substance use disorders) teaches coping skills instead of turning to substances to numb out the intense emotions.
DBT requires a commitment to give up dysfunctional coping behaviors and replace them with more healthy and effective strategies, with the goal being to develop better ways to deal with uncomfortable emotions, thoughts, and behaviors. This is done with an eye on moving the individual toward their Life Worth Living goals.
What Is Dialectical Behavioral Therapy (DBT)?
DBT typically consists of individual therapy sessions and DBT skills groups. Your individual therapy sessions are one-on-one with a trained therapist. The therapist helps you stay motivated, apply the DBT skills to your daily life, and discuss problems that might come up while you’re in treatment. Participants in the skills groups learn and practice skills along with the other members of the group. Group members are invited to share their experiences and offer mutual support.
DBT also helps you develop new skills to manage emotions and decrease conflict in relationships. It focuses on providing skills in four main areas:
The 4 Core Elements of DBT
Mindfulness is one of the core concepts behind all the elements of DBT. It is considered the foundation because it helps people accept and tolerate the emotions they may feel when confronting their habits or exposing themselves to upsetting situations.
The concept of mindfulness and the meditation exercises that are used to teach thoughtful religious practice. Although the form taught in DBT does not involve any religious concepts. In DBT, it is the ability to pay attention, nonjudgmentally, in the present moment and experiencing your emotions and senses completely.
Mindfulness also relies on acceptance (sometimes called radical acceptance). Acceptance skills rely on the individuals to look at situations without judgment and to accept situations along with the emotions they produce. This lowers distress which can result in reduced discomfort and fewer symptoms.
Distress tolerance skills complete a natural development from DBT mindfulness skills. They have to do with the ability to accept both yourself and your current situation. The goal is to become able to calmly recognize negative situations and their possible effect, rather than becoming overwhelmed and hiding from them. This allows people to make wise decisions about how and whether to take action rather than falling into intense and often destructive emotional reactions.
People with borderline personality disorder and substance use disorder are frequently emotionally intense and easily aroused. They can be angry, frustrated, depressed, or anxious and benefit from learning to regulate their emotions.
Emotional regulation skills are based on the idea that intense emotions are a conditioned response to upsetting experiences. These skills can be put in 4 categories:
- Learning to understand and name emotions.–The individual focuses on recognizing their feelings. This relates to mindfulness.
- Changing unwanted emotions.–In this skill, the therapist highlights the use of opposite-reactions, problem-solving, and fact-checking to help regulate emotions.
- Reducing vulnerability.–The person learns to plan coping mechanisms in advance and to accumulate positive emotions to help handle difficult experiences better.
- Managing extreme conditions.–The patient focuses on consolidating the use of mindfulness skills to their current emotions, to help remain stable and alert in a crisis.
DBT skills training teaches interpersonal response patterns which are similar to those taught in assertiveness and interpersonal problem-solving classes. These skills include
- asking for what you need,
- saying no, and
- coping with interpersonal conflict.
The skills taught are meant to increase the chances that the person’s goals in a certain situation will be met, while at the same time, not damaging the relationship or the person’s self-respect.
How is DBT Used for Substance Abuse?
DBT is a well-established treatment for severe psychosocial disorders, including for people who are chronically suicidal. Because many of those patients have SUDs, the creators developed DBT for substance abusers. This includes illicit drugs and legally prescribed drugs taken in a manner that was not prescribed.
The main goal of DBT for substance use disorder is to eliminate substance abuse and dependence and any other related severely defective behaviors. This is accomplished while increasing behavioral control through the use of functional, skillful behavior at the same time.
For people with substance dependence, SUD is the most important target for DBT within the category of behaviors that interfere with a person’s quality of life. After learning the basic skills, a special set of six addiction skills are addressed.
DBT Addiction Skills
Specific behavioral goals in DBT for substance abuse include:
Dialectical abstinence combines the need for behavioral change, such as abstinence, and the need for radical self-acceptance. Work toward abstinence while being prepared for occasional relapses
“Clear mind” is a combination of “addict mind” and “clean mind.” Addict mind is fully engaging in addictive behavior and includes thoughts and actions that occur under the influence. A clean mind pretends that addiction is not a problem, a self-deceiving feeling of immunity to relapse. While a clear mind is being completely aware that you can slip back into addiction, even during abstinence.
Community reinforcement includes how to purposefully seek out people, places, and activities that reinforce non-addictive behavior. This skill could involve learning how to spend time with friends, family members, and others who will reinforce the decision not to use it.
Burning bridges and building new ones
This is done by burning bridges to people, places, and things connected to your drug use. Also, by destroying telephone numbers of drug contacts, getting a new phone number, and disposing of drug paraphernalia. It is also a set of plans to manage cravings, such as urge-surfing (using the image of a wave ride out the urge). This is also an important skill for managing cravings.
This skill helps addicts find skillful and non-destructive ways to rebel against a society that don’t involve substance abuse. It’s especially useful for individuals who use their identity as an addict as a way to be different or special.
Deny the cravings. Deal with cravings and urges to use by telling yourself that you are craving something harmless like lemonade or a good workout. Adaptive denial essentially turns self-deception into an asset.
How Effective is DBT for Substance Use Disorders?
Researchers constantly look for real evidence to back up treatment claims. Several random clinical trials (RCTs) for dialectical behavioral therapy for SUDs were completed on patients with treatment-resistant polysubstance dependence (dependence on more than one substance at the same time).
The study found that those patients who were treated with DBT:
- were more likely to attend a higher number of treatment sessions,
- to stay in treatment (64% v. 27%), and
- achieved greater reductions in drug abuse throughout treatment.
In another study, patients with opioid use disorder and co-occurring borderline personality disorder received DBT and methadone replacement therapy. This group was found to have maintained more confirmed reductions in opiate use during the last 4 months of treatment than the control group who received methadone therapy and treatment as usual.
Who Can DBT Help?
Anyone can be helped by DBT. Dialectical behavioral therapy wasn’t designed for any single diagnosis. Instead, its intent is to be used across many diagnoses and effective for patients who have a problem regulating emotions and behavior. This applies to most addicts. Plus, it’s a good choice for people with substance use disorders and a comorbid (co-existing) mood or behavioral problem. Or for patients who don’t respond to more traditional addiction treatment.
However, there are some questions to consider when thinking about DBT for addiction treatment:
- Is the addictive behavior connected to a problem managing emotional ups and downs?
- Are you committed to permanent, complete abstinence as a goal but lack the skills to accomplish it?
- Would you benefit from an intensive, structured treatment that includes individual therapy and a skills group?
If you answered “yes,” then DBT is a very good treatment option for you. It’s important to find a licensed medical professional trained in dialectical behavioral therapy.
How Can Miracles Recovery Center Help?
Miracles Recovery Center can help you find your way to lifelong sobriety. We have several levels of care:
- Partial Hospitalization Program (PHP) where you will live at your home, but you will attend individual and group therapy sessions five days a week for about 5 hours a day.
- Intensive Outpatient Program (IOP). In this program, you attend sessions at the facility during the day or evenings. You will attend 12 hours of group therapy per week with one individual therapy session per week. This allows plenty of flexibility to fit around your schedule.
- Outpatient Program (OP). The outpatient program is an excellent step-down level of care after completing PHP or IOP if you’re just not confident enough to handle life without some continuing care. Studies show that the longer you continue some type of therapy, the better your chances at long-term sobriety and relapse prevention. In the OP, you attend counseling sessions for 9 hours a week and receive individual therapy once a week.
You will have a say in your treatment and when you move on. Our licensed medical professionals are experienced in addiction treatment and therapy. And their only job is to help you succeed. Contact us now. Whether for you or a loved one we are here to answer your questions, and we’re sure you have many.