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Dialectical Behavior Therapy (DBT) for Addiction Treatment

Overview of Dialectical Behavior Therapy

  • Adapted from cognitive behavioral therapy (CBT).

  • Teaches you skills to manage emotions and deal with cravings.

  • Shown to be effective at treating a variety of mental health disorders and addictions.

  • Used in many different settings, including mental health programs, hospitals and schools.

What Is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is a form of cognitive behavioral treatment that was initially established to help suicidal clients who were suffering from borderline personality disorder (BPD).

Due to its effectiveness, it was later expanded to treating substance abuse and several other mental health disorders. DBT therapy is based on four main components:

  • Skills training

  • Individual therapy

  • Phone coaching

  • Therapist consultations

Where It's Used

DBT is offered through:

  • Mental health programs

  • Community treatment centers

  • Inpatient rehab facilities

  • Hospitals

  • School systems and some workplaces4

Addictions and Mental Health Disorders Treated by DBT

  • Alcohol

  • Tobacco or nicotine

  • Prescription pain medication

  • Opiates

  • Stimulants (e.g., methamphetamine, ecstasy)

  • Depressants

  • Antidepressants

  • Hallucinogens (e.g., LSD)

  • Illegal drug addiction (e.g., cocaine, heroin)

  • Recreational drug addiction (e.g., marijuana)

  • Eating disorders

  • Depression

  • Post-traumatic stress disorder (PTSD)

How DBT Is Used to Treat Addiction

Dialectical behavior therapy focuses on:

  • Decreasing the abuse of different types of substances (e.g., alcohol and/or drugs).

  • Reducing painful withdrawal symptoms.

  • Diminishing cravings, temptations and urges to abuse substances.

  • Avoiding situations that cue substance abuse.

  • Increasing community support by helping you establish new friendships.

  • Encouraging you to engage in recreational or vocational activities that support abstinence.

Four Components of DBT

The four components of DBT therapy (skills training, individual therapy, phone coaching and therapist consultations) are conducted as follows:

Skills Training

Skills training includes group sessions that enhance your ability to change negative behaviors. A therapist leads the sessions and teaches you life skills. You are also required to complete homework assignments. The group meets weekly for about 2.5 hours for 24 weeks. The sessions may be periodically repeated if you need to be in the program for up to one year.

Individual Therapy

The individual therapy sessions emphasize helping you stay motivated to continue your treatment and teaching you how to apply the skills you are learning to actual events and daily challenges you face such as avoiding drug-seeking behavior. The individual sessions are once a week for the duration of the program and run simultaneously with the group meetings.

Phone Coaching

DBT therapists are available to offer you live coaching when you are facing a difficult situation, such as a relapse. More specifically, you can call your therapist outside of normal session time to receive coaching when you are in dire need of help.

Therapist Consultation

Therapist consultation is actually a platform for the therapists who are offering dialectical behavior therapy. The consultation team helps DBT therapists remain competent and stay motivated to work with clients who typically have difficult-to-treat disorders such as substance abuse. The support helps ensure that they will be able to provide the best possible treatment.

How Does DBT Differ From Cognitive Behavioral Therapy?

CBT also focused mainly on individual therapy. This strategy often failed to address the wide array of emotional and physical problems that people suffering from BPD or substance abuse generally presented.

The four components of DBT allow several therapists to work together. This makes it easier to provide multiple modes of therapy such as group sessions, individual sessions and phone coaching. These are critical aspects that help clients receive continuous support and at-the moment coaching, which improves their level of motivation to complete the program successfully.

DBT Effectiveness in Treating Addiction

Research shows that DBT is effective at:

  • Reducing substance abuse

  • Treatment dropout rates

  • Depression

  • Anger

  • Suicidal behavior

  • Psychiatric hospitalizations

  • Non-suicidal self-injuries

  • Improving social functioning

These same studies also show that DBT dramatically improved the outcomes of individuals who were suffering from co-occurring disorders such as borderline personality disorder and substance abuse or eating disorders and substance abuse. The effectiveness of this form of therapy is due to the development of behavioral skills such as:

  • Mindfulness - being aware of one's actions.

  • Interpersonal effectiveness - learning how to say no and still maintain self-respect as well as important relationships with other people.

  • Distress tolerance - learning how to cope with difficult situations.

  • Emotional regulation - gaining control over emotions that led to destructive decisions in the past.

The completion of a DBT program alone is showing promise in helping people successfully overcome addiction.

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