DBT, or dialectical behavior therapy, was first introduced to prevent people with borderline personality disorder (BPD) from harming themselves. Since then, DBT is now recognized as an effective therapy for treating various issues of mental health, including addiction. Within addiction treatment programs, DBT is beneficial because it promotes acceptance and change, is realistic about abstinence and motivates engagement in and completion of treatment.

What Is DBT?

Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment program that aims to help people achieve a life worth living. The program places an emphasis on building a sustainable quality of life, while also working to decrease behaviors that cause harm. DBT is effective for treating anyone with difficulty regulating emotions.

DBT is different from other forms of therapy because the principles of DBT hold that therapy should be a real relationship between two people. Both the therapist and the patient work hard to reach their goals. A common metaphor for DBT is rowing in a rowboat; both persons are rowing hard to make sure the boat is moving towards its destination. DBT is about patients and therapists working together to prevent substance abuse and manage addiction.


What Does Dialectical Mean?

The word “dialectical” is a philosophical term referring to two things that appear to be opposites, but can actually both exist at the same time. In the context of addiction treatment, DBT views two things as contradictory, but essential for recovery: acceptance and change.

To improve their lives, people must accept they struggle to control cravings and are addicted to drugs and alcohol. At the same time, they must balance this realization, or acceptance, with a strong willingness to change and work hard to stop using drugs or alcohol. DBT harnesses the power of behavioral change to move a person closer to the ultimate goal of sobriety.

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What Does DBT Consist Of?

An individual therapist usually takes the lead when working with someone who can benefit from treatment. The therapist takes responsibility for developing and maintaining an individual treatment plan for the person suffering from addiction or co-occurring disorders.

Within this framework, there are five essential functions of DBT:

  • improving patient motivation to change
  • enhancing patient capabilities
  • generalizing new behaviors
  • structuring the environment
  • enhancing therapist capability and motivation

These functions are incorporated into four modes of therapy, which involve different aspects of treatment to meet the specific needs of each function. The four modes of treatment include:

  • Structured Individual Therapy: Focuses on behaviors and striking a balance between acceptance and change.
  • Skills Group: A group meeting wherein people learn a behavioral skill to manage emotions, tolerate stress and have effective emotional relationships.
  • Skills Coaching: Individuals can call their therapist 24 hours a day to get help with coping skills or to avoid engaging in harmful behaviors. The coach can help a person learn to react in healthy ways.
  • Consultation Teams: DBT therapists work on a team that offers support and collaboration, which is essential to DBT.

Benefits Of DBT In Addiction Treatment

DBT is beneficial in addiction treatment because it addresses harmful behaviors that act as barriers to improving people’s lives. Within addiction treatment programs, DBT focuses on substance use and how it affects quality of life, while also promoting target behaviors essential for overcoming addiction. These behavioral targets include:

  • alleviating physical discomfort associated with withdrawal
  • avoiding triggers and cues related to substance abuse
  • community reinforcement of positive behaviors
  • decreasing substance use
  • reducing behaviors conducive to drug use, like momentarily giving up the goal to stop using drugs or alcohol, and instead functioning as if drug use can’t be avoided
  • reducing cravings and urges to use substances

Problematic behaviors often occur as a way to cope with a bad situation or feeling, like using substances to deal with depression, anxiety or other mental health issues. DBT can help those suffering from addiction develop effective ways to manage stress, regulate emotion and be mindful about themselves and others. Within addiction treatment programs, DBT is beneficial because of its unique approach to mental health and wellness, like promoting acceptance and change.


Promoting Acceptance And Change

For addiction treatment, DBT pushes the person to stop using drugs or alcohol immediately. At the same time, DBT also acknowledges that relapse can happen, which doesn’t mean the person can’t eventually achieve a fulfilling and substance-free life. This is the dialectic facet of DBT, or the union of the opposing forces of acceptance and change.

DBT constantly insists the person stop using drugs and alcohol, emphasizing the importance of abstinence. However, this approach is combined with non-judgemental, problem-solving responses to relapse. These responses include various techniques that work to reduce the dangers of infection and overdose and promote change.

Approach To Abstinence

Abstinence is encouraged from the first session onward but gives the person a reasonable time-frame for this commitment. For example, a lifetime of abstinence may be too difficult, so they may instead focus on whatever is attainable for that person. This could be a few hours, a full day, a month or whatever is reasonable. When this period is up, the patient renews this commitment over and over, with the hope of ultimately achieving long-term abstinence.

During this time, patients learn to “cope ahead.” This method helps them develop the behavioral skills needed to anticipate potential triggers and take preventative measures to be prepared for situations that risk substance use. While the therapist focuses on these issues, they are constantly reiterating the dangers of addiction and the need to stop use.

Using Relapse To “Fail Well”

While DBT therapists can help the person make a quick recovery, relapse is treated more as a problem that can be solved than as a personal weakness or failure of treatment. If relapse does occur, the therapist will often help the patient “fail well,” or guide them to evaluate their behaviors and determine what led to substance use. Then, they can apply strategies to avoid relapse in the future.

This is a benefit of DBT because it doesn’t punish the patient for slipping up and using drugs or alcohol. Instead, DBT uses relapse as a teaching moment for improvement. Within addiction treatment programs, many people feel a slip-up means recovery is hopeless, feeling intense negative emotions that can lead to further use.

DBT works to repair the harm caused by relapse, which involves increasing awareness of the harmful consequences brought on by substance abuse. The therapist will then reiterate abstinence, which is often better understood after a relapse.

Developing The “Clear Mind”

In many cases, those suffering from substance use disorders often begin addiction treatment in a certain mental and behavioral state of mind. Drugs or alcohol have taken over their actions, thoughts, beliefs and emotions. Once they have achieved abstinence promoted by DBT, their minds become more open to different possibilities, which can make them feel like they’re immune to future problems. This can trigger relapse because they may be ill-prepared for high-stress situations.

With the guidance of a DBT therapist, alternating between these two frames of mind can lead to the emergence of a new outlook that accepts their need to use substances, but also understands they have the power to change and take measures to cope with and avoid relapse. This balance is called the “clear mind,” which can help people achieve long-term abstinence.

Strategies To Complete Treatment

In the first session, the therapist directly addresses the likelihood of the patient falling out of treatment. To accept this possibility, the therapist and patient establish a “just in case” plan. This involves a list of places the patient may frequent during relapse as well as a list of supportive friends and family members who are willing to intervene if necessary.

Other strategies include continual contact with the patient during the early stages of therapy, shortening or lengthening therapy sessions (depending on their needs), and bringing therapy to the patient (going to their home or room in the rehab center).

Contact us today for more information on dialectical behavior therapy (DBT) and addiction treatment.