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