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Dialectical Behavior Therapy (DBT) for Drug and Alcohol Addiction Treatment

Dialectical behavior therapy (DBT) is a method of psychotherapy first developed by Marsha Linehan that has since proven effective in treating a variety of mental health disorders.1 In this article, you will get an in-depth look at DBT therapy techniques, including what DBT for substance use is, how and why it was developed, and similarities and differences between DBT and other therapeutic approaches. You will also gain an understanding of the techniques used in DBT, including skills taught, goals, and benefits.

What Is Dialectical Behavior Therapy (DBT) for Substance Abuse?

Dialectical behavior therapy for addiction is a complex treatment approach that encompasses many of the principles and skills found in cognitive behavioral therapy (CBT), with the addition of acceptance skills.1 It can be helpful to think of DBT as a modified version of CBT. Dialectical signifies the assimilation of 2 seemingly opposite truths that exist simultaneously.

In DBT for substance abuse, these 2 opposites integrated throughout therapy are the concepts of acceptance and change.2 Acceptance and change are the cornerstones of DBT. These concepts are broken down into 4 different modules: 2 acceptance and 2 change skills modules.2

Accepting your thoughts and feelings by validating the emotions you feel, even when they are painful, helps you to effectively manage and work through uncomfortable cognitions and emotions.1 The therapist’s role in DBT is largely collaborative. The therapist works with you to help you achieve stability by both accepting the things you can’t change and changing the things you can.1 The DBT therapist is constantly working with you to help you develop an awareness of what is within your power to change and what requires acceptance.

Linehan created DBT to help women who were struggling with suicidal thoughts and behaviors, as well as those who had been diagnosed with borderline personality disorder (BPD).1 However, DBT has been expanded to treat a variety of mental and behavioral health issues, including:3

Video: What Is Dialectical Behavior Therapy?

The following video will provide a short but comprehensive overview of DBT—what it means, its goals, and what to expect.

Credit: UC San Francisco (UCSF)

History and Development of Dialectical Behavior Therapy

DBT was created out of a need to treat individuals who struggled with some of the most severe symptoms of emotional dysregulation—primarily borderline personality disorder—and self-injuring and suicidal individuals.1 Marsha Linehan, the pioneer of DBT, was determined to find a treatment approach that worked. She conducted extensive research that led her to identify and incorporate CBT interventions that had proven effective in treating suicidal patients.4

Cognitive behavioral therapy has many benefits in treating individuals with mental health disorders. However, it largely focuses on the problematic thoughts and behaviors contributing to mental health disorders. Many of Linehan’s patients felt judged and disrespected, which contributed to patients terminating treatment prematurely.4

Linehan recognized that CBT was as comprehensive as it needed to be to treat her target population. This led to the inclusion of the skills of acceptance and validation: acceptance of one’s cognitions, emotions, and reality without trying to change them and without judging them as good or bad.4 The addition of acceptance and validation is what makes DBT unique from CBT.

DBT and CBT: Views, Beliefs, and Differences

As previously stated, DBT is based on CBT concepts and shares many of the same theories. However, there are differences between the 2 therapeutic approaches. It may be helpful to consider DBT as more optimistic due to the inclusion of acceptance and validation.

Similarities between CBT and DBT therapy techniques include:3

  • A patient speaks to a licensed therapist about their mental health challenges and current life problems.
  • A patient is taught skills and strategies by the therapist and asked to apply them in their daily lives.
  • Both teach strategies to change thoughts and feelings that are unhealthy and dysfunctional.
  • Individual skills are taught.

Differences between DBT and CBT include:3

  • CBT emphasizes changing dysfunctional ways of thinking, acting, and feeling through the learning of skills.
  • DBT emphasizes and teaches you how to accept dysfunctional thoughts, actions, and feelings in addition to teaching you the skills to change them.
  • DBT teaches interpersonal effectiveness skills in addition to individual skills, whereas CBT teaches individual skills alone.

For therapy to be considered DBT, several unique elements need to be incorporated into treatment, and these include:

  • Addressing both social and emotional wellness and developing skills in these areas to increase your quality of life.3
  • Teaching and adopting a dialectical perspective (that 2 opposite truths exist at the same time).4
  • Incorporating acceptance and mindfulness skills and interventions.4
  • Targeting emotions in therapy, as well as the biosocial theory of emotional regulation.4
  • Carrying out the 5 functions of DBT therapy (enhancing capabilities, generalizing capabilities, reducing dysfunctional behaviors and improving motivation, maintaining and enhancing therapist motivation and abilities, and structuring the environment).4

Dialectical Behavior Therapy Techniques

DBT is a comprehensive treatment program that incorporates several techniques or components, including individual therapy, group therapy, phone coaching, and therapist consultation.2 Each component of DBT for substance abuse plays a crucial role in helping a person accept and work through dysfunctional patterns of thinking, feeling, and behaving, as well as learn the skills necessary to improve their quality of life.

A DBT skills group:2

  • Is didactic in nature (like learning in a classroom).
  • Includes homework that is assigned at the end of each session.
  • Meets once a week for approximately 24 weeks.
  • Usually lasts 2–3 hours.

Individual therapy:2

  • Encourages the application of learned skills in your daily life.
  • Helps improve and strengthen motivation for change.
  • Is designed to occur at the same time as a DBT skills group.
  • Occurs once a week for about an hour.

Phone coaching:2

  • Allows you to call your therapist between sessions, especially when you are experiencing challenges in your daily life.
  • Gives your therapist an opportunity to provide coaching in real-time.
  • Is an opportunity for you and your therapist to identify appropriate skills that can be used in the moment to help you overcome your challenges.

A DBT consultation team is a group of DBT therapists who:2

  • Function as a source of support for practicing DBT therapists.
  • Seek to strengthen motivation in the DBT therapists.
  • Aim to improve competency among the DBT clinicians.
  • Usually meet on a weekly basis.

Goals of Dialectical Behavior Therapy

DBT has 4 main goals or stages of treatment. These goals are characterized by the severity of the behaviors that are present.3

Stage 1: Transitioning from out of control to in control:

  • You are experiencing behaviors that are erratic, reckless, and out of control.
  • Your emotional distress is high.
  • The goal is to develop the ability to gain control over your behaviors.

Stage 2: Transitioning from emotional unavailability to emotional engagement:

  • Your dangerous behaviors are now under control.
  • Your emotional distress may still be high and you experience feelings of misery and suffering.
  • The goal is to learn how to move through feelings of misery and be able to experience a wide range of emotions in a healthy and productive way.

Stage 3: Building an ordinary life and solving ordinary problems:

  • During this phase, you work to build and sustain self-respect.
  • You work on identifying short-term and long-term goals for yourself.
  • You aim to create a life that supports feelings of happiness, joy, and contentment.

Stage 4: Transitioning from feeling incomplete to feeling complete and connected:

  • You work to strengthen your spirituality.
  • The goal is to find profound value in your life through the development of your spiritual being.

What Are the Skills Addressed in DBT for Addiction?

The DBT substance abuse treatment skills taught are based on the 2 main components of DBT: acceptance and change. 2 change-based skills and 2 acceptance-based skills are woven into the fabric of DBT programs.2

Change skills include:2

  • Interpersonal Effectiveness Skills. Learning how to get your wants and needs met in relationships, maintain your self-respect, and set healthy boundaries so that you can build and maintain healthy relationships.
  • Emotional Regulation Skills. Learning how to change painful or negative emotions into healthy ones, increase protective factors against negative emotions, and reduce your susceptibility to negative emotions.

Acceptance skills include:2

  • Distress Tolerance Skills. Learning how to endure and accept painful feelings without reacting to them and making the situation worse.
  • Mindfulness Skills. Learning how to fully participate in the present moment without judging it and without trying to change it.

Benefits of Dialectical Behavior Therapy

DBT is effective in treating individuals with substance use disorders (SUDs). Research shows that women with co-occurring SUDs and BPD who received abridged versions of DBT for addiction (interventions were only acceptance-based) showed a substantial decrease in opioid use over the following 12 months. They also had higher abstinence rates (16 months) compared to those who did not receive the DBT interventions.4

Learning acceptance is what makes DBT a beneficial part of an addiction treatment plan. When you think of substance misuse, you probably consider change the highest priority. However, due to the nature of DBT and its constant effort to synthesize acceptance and change, acceptance is just as important as change in treating addiction.5

DBT recognizes that relapse does not hinder your goals and recovery (acceptance).5 It simply calls for a commitment to end substance use now with the intention of long-term sobriety (change).5

Change is encouraged and supported with positive reinforcements, contingencies, and problem-solving skills.4 Strategies that are taught include preventing relapse through the development of problem-solving skills and techniques that reduce the risks of overdose, health problems, and other dangers associated with drug use.5

DBT assumes that people are doing the best they can.5 This assumption helps encourage those struggling with SUDs as opposed to punishing or judging them. Relapse isn’t judged or shunned. It is accepted as part of the process.

DBT for addiction doesn’t view a relapse as a failure on your part. Instead, relapse is seen as a problem that needs a solution. The therapist supports you in analyzing the relapse to teach you the skills you need to prevent it from occurring again.5

The 4 treatment targets (in order of priority) are:2

  1. Life-threatening behaviors. Behaviors that threaten your safety, including self-harm and suicidal behaviors or thoughts.
  2. Therapy-interfering behaviors. Behaviors that prevent you from obtaining the treatment you need. They can include showing up late to a session and showing resistance to treatment.
  3. Quality of life behaviors. Behaviors that prevent you from creating a life worth living for yourself. These can include mental health disorders, financial challenges, and interpersonal conflict.
  4. Skills acquisition. Learning healthy behaviors and skills to help you achieve your goals while reducing the presence of maladaptive behaviors.

DBT is solution-focused and recognizes that change takes time. It is evidence-based and can help you learn the skills necessary to create a happy and healthy life for yourself.3 DBT treatment targets help organize and prioritize the focus of therapy based on the severity of a person’s symptoms.

Find a DBT Therapist Near Me

Addiction treatment can start anyone battling a substance use problem on the path to a happier and healthier life. Rehab programs are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. You can use SAMHSA’s Behavioral Services Locator to search for facilities. Many state government websites will also provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.

American Addiction Centers (AAC) offers evidence-based treatment approaches in a variety of treatment settings, including inpatient treatment, outpatient treatment, and aftercare. Addiction is treatable and substance abuse treatment is effective when it is tailored to your unique needs, incorporates evidence-based therapies (such as DBT), and provides a variety of interventions and treatment settings to help you achieve your recovery goals.6

DBT for alcoholism or drug abuse can be an effective component of your addiction treatment plan. At AAC, we recognize the importance of using evidence-based treatments such as DBT to help you overcome your mental health and substance abuse challenges.

Call American Addiction Centers today free at to speak with an admissions navigator. We can answer questions about treatment and accepted insurance providers, offer advice, and help you begin the recovery process. You can also verify your insurance coverage and locate a rehab center near you.

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