Dialectical Behavior Therapy & Substance Use Disorders

Substance use disorders (SUDs) impact many people across the country. Fortunately, SUDs are treatable. Professional addiction treatment programs offer a variety of interventions and services to help treat this condition, one of the most important being addiction therapy. Many evidence-based therapies exist that can effectively treat addiction, including dialectical behavioral therapy, or DBT.¹

This article will provide an in-depth explanation of what DBT is, including the foundations of DBT, goals, principles, and techniques of this specific therapy, and how it can help treat substance use disorders.

What is Dialectical Behavioral Therapy (DBT)?

DBT is an evidence-based therapy that merges principles pulled from behavior therapy, cognitive behavioral therapy (CBT), and mindfulness; however, DBT incorporates the concept of dialectics, or the idea that two seemingly opposite truths can exist at the same time.^1,2 DBT can help individuals with certain mental health conditions accept the reality of their problematic behaviors and help them modify those behaviors to invoke positive life changes.¹

Foundations of DBT

DBT was created by psychologist Marsha Linehan, who was looking to develop an effective treatment for highly suicidal patients.^1,3 While working with patients with borderline personality disorder (or BPD) who were chronically suicidal, Linehan recognized the invalidating feelings patients experienced when asked to make very difficult (although necessary) life changes.³ This inspired her to develop new strategies rooted in patients accepting themselves as they currently are while also working towards change, thus forming the basis of DBT.⁴

In this initial application, DBT showed tremendous efficacy in managing the symptoms of BPD.¹ Since then, DBT has evolved and may be effective in treating other psychiatric conditions, including posttraumatic stress disorder (PTSD), eating disorders, mood disorders, and substance use disorders.¹

Dialectical Behavioral Therapy Skills

A primary focus of DBT is helping patients learn new behaviors that can replace current maladaptive behaviors.³ This is done by practicing a set of behavioral skills that teach both change and acceptance.³ Through the guidance of a therapist, a patient can adopt these skills and utilize them to reduce symptoms of the condition they are experiencing.

The core skills that are taught in DBT are as follows:

• Mindfulness – Mindfulness is the practice of being aware of one’s internal states and surroundings.⁵ In DBT, practicing mindfulness helps patients learn how to observe, describe, and participate in the present moment with a nonjudgmental mindset.¹
• Emotion regulation – Emotion regulation skills help to provide strategies to manage one’s personal emotions.¹ Patients are taught to identify and label their emotions so that they can begin to understand how their emotions can influence behaviors that impact their ability to function.¹
• Distress tolerance – Distress tolerance teaches that pain is a part of life and refusing to accept that can lead to further distress.¹ Therefore, patients learn about crisis survival skills, which help them find ways to self-soothe and alter their thoughts during a crisis.¹ They also focus on acceptance skills, which show them how what may have once been perceived as intolerable might not actually need changing.¹
• Interpersonal effectiveness – Interpersonal effectiveness teaches social skills that help improve relationships with others.¹ This includes learning how to say “no” to people, how to get wants and needs met in healthy ways, and how to cope with interpersonal conflict.¹

Dialectical Behavior Therapy Techniques

Therapists who provide DBT to their patients can do so through a number of various techniques. As a means of offering a comprehensive course of care, DBT is traditionally structured with the following components:

• Skills group: Patients can engage in skills groups, where they will learn psychosocial skills (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness) and talk with others in the group about how they are utilizing these skills.¹
• Individual therapy: A patient can engage in a one-on-one DBT session with a therapist, where they will focus on various types of behaviors that can supplement what is being learned in group therapy.¹
• Telephone consultation: In its implementation for treating BPD, telephone consultation helps reduce parasuicidal behavior in patients. Therefore, when they are about to engage in this type of behavior or if they need in-the-moment guidance, patients are encouraged to call their therapist for a consult.¹ Of note, not all therapists utilize this technique, or may limit the time for telephone availability.
• Team consultation: As part of traditional DBT structure, a therapist consultation team may involve a collective weekly meeting between all of the DBT therapists.¹

DBT is a combination of various treatments provided by several professionals as opposed to one singular treatment conducted by a sole provider.⁴ Therefore, incorporation of the once-per-week meeting between practitioners can help them to problem-solve and better implement effective treatment plans related to their patient.⁴ This not only provides them a medium to ensure that the patient is receiving the best possible care, but also an opportunity for providers to offer support and encouragement to one another to help prevent treatment fatigue and burnout.⁴

Dialectical Behavioral Therapy for Addiction

Research has shown that DBT may be effective in treating SUD and co-occurring disorders, as well as treating patients who have not responded to other evidence-based treatments.¹

When being used in the treatment of SUDs, DBT targets specific behaviors that contribute to one’s substance misuse and modifies them in an effort to reduce the misuse. By doing so, DBT can be helpful in:⁶

• Reducing consumption of substances of misuse.
• Alleviating physical withdrawal symptoms.
• Reducing cravings, urges, and temptations to use substances.
• Avoiding triggers to use by making modifications in one’s environment.
• Decreasing behaviors that support drug use.
• Increasing community reinforcement of healthy behaviors.

Specific to abstinence and relapse, DBT stays true to its core feature of acceptance and change. For example, DBT encourages immediate cessation of drug and alcohol use with the understanding that relapse, should it occur, is not a sign of failure and does not prevent the client from achieving their goal of abstinence.⁶

Will Insurance Cover DBT?

Many major insurance companies typically offer some level of coverage for various types of therapies and/or substance use disorder treatment programs. The coverage you receive will be dependent on factors such as the insurance plan you have and the services you are looking to obtain. If you are unsure about your insurance coverage, talk to your insurance provider to obtain information about your specific plan, including your insurance coverage for rehab and other mental health services.

DBT and Addiction Treatment in Hollywood, FL

If you or someone you love is struggling with a SUD, addiction therapy can help. Recovery First, an inpatient rehab near Miami, offers a number of services (including DBT) that can help you learn how to live life without the use of drugs or alcohol. By contacting us right now at , you can speak to a trained admissions navigator who can help you start the admissions process, identify rehab payment options, and determine your insurance coverage for rehab. Our admissions navigators can also help you explore the various levels of addiction treatment that may be suitable for you.

Take the first step in your treatment by having your insurance verified with us. Simply fill out this secure online and get results in minutes.