Dialectical Behavioral Therapy (DBT) for Addiction Treatment

A Guide to Dialectical Behavioral Therapy

Dialectical behavioral therapy, also called DBT, has helped people live in the moment, and it has successfully been used with addiction issues. It is a type of therapy that enables people to face the stresses of daily life with coping mechanisms that do not include drugs or alcohol. This type of behavioral therapy is a way to help with a substance use disorder or any other type of disorder.

Dialectical Behavioral Therapy

What Is DBT?

This type of dialectical therapy is a type of cognitive-behavioral therapy, with a focus on collaborative relationships and the development of skills for coping. Its origins come from its use as a treatment for borderline personality disorder (BPD). It was shown to be effective in treating issues that stem from emotional regulation. These include conditions such as eating disorders, PTSD, and substance use. Other types of self-destructive behaviors were further shown to benefit from this treatment.

This type of therapy teaches people to live in the moment as they find healthy ways to deal with stress. It has been found to be very helpful in treating drug dependence. The strategy may be used in individual treatment, group therapy, or phone coaching. Whatever the method, clients learn behavioral skills that will help them live with sobriety.

Techniques Used With This Type of Therapy

Clients will learn a host of ways to deal with emotional issues. These include mindfulness and dealing with stress. Mindfulness encourages living in the moment, not just thinking of what lies ahead in the future. You become aware of your thoughts, sensations, and possible impulses. What you see, touch, and smell is processed through a lens of non-judgment.


Any emotional pain that you are going through will be slowed down as a result of learning this therapy. Avoiding automatic responses, such as not thinking and acting on impulse, will be avoided, as you find ways to stay calm. Rather than going off, you will be able to look at yourself more objectively and not react as impulsively.

You may learn to pay more attention to your breath, using it to slow you down and avoid negative thinking. Taking a deep breath lets you pause and avoid errors in your thoughts by quieting your mind. It may also help to put things into perspective.

Tolerance to Distress

Living in the moment, you are taught several ways of handling distress. These may include self-soothing, distraction, improving the moment, and thinking of the reasons — whether good or bad — for not tolerating the feeling of distress. Coping with distress for the long term may be enhanced through this type of therapy.

Regulation of Emotions

Dialectic-behavioral therapy helps you to regulate those strong emotions that feel so powerful or even overwhelming. You will learn skills to help with naming and identifying the emotions as well as changing them.

For example, instead of reacting with a bout of anger, you recognize your emotional vulnerability, and you can react with a more positive approach. In some cases, you may then do the opposite of the reaction that you were first thinking of. Some emotional regulation skills include the following:

• Identifying emotions with labeling
• Identifying obstacles that prevent you from changing emotions
• Becoming less vulnerable to your “emotion mind”
• Increasing the emotions that are positive
• Increasing mindfulness to the emotions you are feeling
• Acting the opposite of your negative emotions
• Using distress tolerance techniques

Effectiveness in Relationships

You may become more assertive in your relationships. You may learn how to say “no” in order to maintain a healthy relationship with friends and family. This type of therapy can help you learn respect for others and yourself while listening to what others have to say. You will always deal with challenging people in your life; learning how to deal and communicate effectively with yourself as well as others will be very valuable.

Some people use the acronym GIVE to enhance relationships. This is spelled out as the following:

• G – Gentleness- not threatening
• I – Interest – show good listening skills
• V – Validate – acknowledge the thoughts and feelings of another
• E – Easy – an easy attitude with a lighthearted approach and a smile

Some Exercises to Try

These exercises are to help with mindfulness. You can practice mindfulness alone in your home, in a group setting, or even by imagining that you are walking down the street.

Paying Attention

Hold one raisin or small fruit, such as a strawberry, in your hand. It might have an unusual smell or texture. Paying careful attention, write down how it feels, how it looks, its taste, and the way that it smells. You have now taken a step towards mindfulness.

Observe a Leaf

Choose a leaf and hold it in your hand. Pay attention to it for five minutes. You will notice its texture, colors, patterns, and more.

Both of these exercises help you to be in the present moment. Your thoughts will align with your experience. Mindfulness can even be practiced while you are eating. When you eat, you concentrate on the experience of food’s taste and texture. Observing your thoughts plays a large role in learning to be mindful.

Help With a Range of Issues

While first developed with borderline personality disorder in mind during the 1980s, dialectic-behavioral therapy has helped with a whole range of issues in addition to substance use. Some of these include bipolar disorder, ADHD, self-injury, general anxiety disorder, obsessive-compulsive disorder, PTSD, suicidal behavior, and more.

What Are Its Benefits?

Some of its benefits include a reduction in suicidal behavior that is self-harming. It can also challenge your assumptions and give you the ability to look at things from several perspectives. It aids in accepting things as they are while helping you to create new perspectives from which to see them. You can then move forward with a life that is happier and more fulfilling.

Some of the challenges that can be overcome, in addition to substance use, include the following:

• Impulsive behavior
• Emotions that overwhelm
• Suicidal thoughts
• Eating disorders
• Challenging relationships filled with conflict
• Trauma

You may have abused substances as a result of another issue. In the past, it has helped you to cope with that issue. Now, you will have a new way of coping with stress and your emotions, and it will involve sobriety.

Benefits You May Receive

You may learn strategies for acceptance and strategies to make permanent lifestyle changes. Learning about acceptance, you can be more tolerant of yourself and your emotions. Making positive changes will be easier.

You’ll learn about the analysis of problems. You will recognize destructive behavior patterns, replacing them with new, positive ones. You’ll be able to focus on changing thoughts and patterns that are not working for you. At the same time, you’ll be able to communicate effectively with your therapist in a group or individual sessions. You’ll learn new skills to give you greater capabilities. By growing to recognize positive thoughts, you’ll have new strengths that you can further develop.

Effectiveness in Stopping Substance Use

Studies have shown that a dialectical approach may help those with substance use disorders. It pushes for the immediate cessation of use on a permanent basis. This is the highest priority of the therapist who employs this treatment within the group or with the individual.

Studies have also found that there is a decrease in the use of illicit drugs and legally prescribed drugs. Even prescription drugs may be taken in a manner not prescribed.

This therapy results in cravings being diminished and helps with the burning of old bridges to drugs, such as friends who helped you obtain illegal substances. Things associated with a drug past get tossed out, and old phone numbers are deleted.

Behaviors related to drug use are altered: Clients no longer feel that drug use is unavoidable, thinking which may lead to a relapse.

The therapy also helps foster better behavior through a community of new sober friends and old friends that you had before drugs, through new activities, and through better social interactions. Support through abstinence receives reinforcement as the person seeks new environments in which to grow.

This type of therapy is effective no matter the client’s age, gender identity, race, ethnicity, or sexual orientation. Clients now have a way to express strong emotions and have gained new coping skills. Although the beginning studies were on people with borderline personality disorder, uses have grown as it works on substance use disorders as well as other disorders.

What the Therapist May Do

Therapists may ask clients to commit to stopping drug use in the first session. Committing to a period of abstinence is the first step in lifelong recovery. Clients then commit to being free of drugs for a period of time. This time lengthens as it becomes a moment-by-moment change towards lifelong abstinence. This therapy is in some ways like a 12-step program, with each day as a new goal.

The therapist helps clients anticipate any cues or high-risk situations that might put threaten abstinence. The promotion of change is the goal of the therapist and then becomes the goal of the client. The dialectic gives the message that drug use is disastrous and must be avoided.

What does dialectic mean? According to the dictionary, dialectic is the art of investigating or discussing the truth of opinions. It helps determine the truth by a logical exchange of ideas as well as opinions. It might expose false beliefs while finding the truth. Dialectics comes from the methods of Socrates and dates far back in history.

The therapist will decide how this therapy will be used with each client. It works most effectively for those whose emotions play a strong role in their use of drugs. It has been proven successful for people who have been hard to treat.

The dialectical path requires a significant amount of time and a commitment to its use. You may receive “homework” and must realize that there may be challenges in practicing the skills and exploring experiences that are in the past. However, success may follow, and the commitment pays off and can give promising results.

You now have a better understanding of this type of therapy and how it is used in substance use treatment. We offer this therapy alongside other types of therapy, and we invite you to contact us to learn more about our treatment center and the road to lifelong sobriety. You can overcome substance use and start aiming for a happier and more fulfilling life.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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