Dialectical Behavioral Therapy for Addiction

Dialectical Behavioral Therapy for Addiction 

Dialectical Behavioral Therapy for Addiction (DBT) is a comprehensive treatment program whose ultimate goal is to aid patients in their efforts to build a life worth living. It combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. Research indicates that DBT is effective in treating patients who present varied symptoms and behaviors associated with mood disorders, including self-injury. Recent work suggests its effectiveness for treating chemical dependency.

When dialectical behavioral therapy for addiction is successful, the patient learns to envision, articulate, pursue, and sustain goals that are independent of his or her history of out-of-control behavior, including substance abuse, and is better able to grapple with life’s ordinary problems. The fundamental principle of DBT is to create a dynamic that promotes two opposed goals for patients: change and acceptance.

The treatment includes five essential functions:

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

History of Dialectical Behavioral Therapy

DBT was initially used as the standard behavioral therapy of the 1970s to treat chronically suicidal individuals. Subsequently, Dialectical Behavioral Therapy for Addiction was adapted for use with individuals with both severe substance use disorder (SUD) and borderline personality disorder (BPD), one of the most common dual diagnoses in cases of addiction. DBT includes explicit strategies for overcoming some of the most difficult problems that complicate treatment of both conditions.

Dialectical Behavioral Therapy for Addiction

The ultimate goal in dialectical behavior therapy for addiction is to aid patients in their efforts to build a life worth living. When DBT is successful, the patient learns to envision, articulate, pursue, and sustain goals that are independent of his or her history of out-of-control behavior, including substance abuse, and is better able to grapple with life’s ordinary problems.

The all-encompassing embrace of both acceptance and change in dialectical behavior therapy for addiction is consistent with the philosophical approach found in Twelve-Step programs, expressed in the Serenity Prayer: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Like other behavioral approaches, DBT addresses the most detrimental to the least detrimental behaviors in that order. This is used to decrease behaviors that are imminently life-threatening (e.g., suicidal or homicidal); for substance-dependent individuals, substance abuse is considered the most important target within the category of behaviors that interfere with quality of life. Dialectical behavioral therapy for addiction targets include:

  • decreasing abuse of substances (both illicit drugs and legally prescribed drugs taken in a manner not prescribed);
  • alleviating physical discomfort associated with abstinence and/or withdrawal;
  • diminishing urges, cravings, and temptations to abuse;
  • avoiding people, places, and things associated with drug abuse, deleting the telephone numbers of drug contacts, getting a new phone number, and throwing away drug paraphernalia;
  • reducing behaviors that encourage drug abuse;
  • increasing reinforcement of healthy behaviors, such as making new friends, rekindling old friendships, pursuing social/vocational activities, and seeking environments that support abstinence






Dialectical Behavior Therapy

Dialectical Behavior Therapy

Dialectal behavior therapy was originally developed to treat people with borderline personality disorder. It emphasizes the psychosocial aspect behind treatment. The theory is that some people are more prone to react to certain situations in a more intense, highly emotional way than others and it takes them longer to return to a baseline mood level. It combines cognitive behavioral techniques with ideas from Eastern Religions like Buddhism (i.e. tolerance, acceptance, and, especially mindfulness).

What is the cognitive-behavioral portion of dialectal behavior therapy?

The cognitive behavior therapy aspect of dialectal behavior therapy is based on the idea that certain behavior is encouraged by reward and diminished by punishment. Dialectal behavior therapy focuses on changing a patient’s behavior can change the way they are feeling. Dialectal behavioral therapy concentrates on helping a person develop coping mechanisms. This type of therapy helps the patient develop tools that can help them deal with stressful or emotionally charged situations.

Dialectal behavior therapy also allows us to examine our cognition, which is the way we think. Often the way we think about certain behaviors or situation is influenced by our past and our environment. Certain family aspects play a part in how we think, as do experiences and trauma. Sometimes we have automatic thoughts that cause anxiety, fear, and other negative emotions. Dialectal behavior therapy works by having us examine the way we think and how we can change the way we think. It allows us to recognize negative cognitions and their effects, which can help us change them

What is mindfulness in the practice of dialectal behavior therapy?

Practicing awareness or mindfulness is a big part of why dialectal behavioral therapy works. The practice of mindfulness has been shown to increase overall happiness. It also allows the patient to recognize core experiences. An example of a core experience is a person that was not shown physical affection as a child. They may develop a core belief that it is not safe to allow physical intimacy. Mindfulness allows them to connect with the core experience and recognize the way that it has shaped their life in the present. When we are truly connected with a core experience, we begin to change the way we think about situations as a result of that core experience. Insight that comes from introspection allows you to change old patterns of behavior. Outside of therapy, few people take the time to really think about the way they behave.

Characteristics of dialectal behavior therapy

Support-oriented:  Dialectal behavior therapy focuses on your strength and allows you to build self-esteem through that process.

Cognitive-based:  Dialectal behavior therapy focuses on the process of cognition and the changing of long-held belief systems that are not helpful to us

Collaborative:  Dialectal behavior therapy aims to have you view and interact with your therapist in a cooperative, collaborative manner. It requires constant attention to the relationship between client and staff. The client and therapist must work together to make the necessary changes, and they must be on the same team.