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






Alcohol Abuse Therapy

One of the most important, difficult and intricate areas of mental health is in the field of alcoholism and addiction. Research has indicated that a vast majority of people who have alcohol abuse problems or drug abuse problems, have an underlying mental illness or significant emotional/psychological difficulty and about half of people with mental illness will be involved with drugs or alcohol at some point, usually as a form of self-medication. Alcohol abuse is difficult to treat, and there is still a good bit of controversy about causes and best approaches to alcohol abuse therapy. The goal of alcohol abuse therapy is to achieve lifelong abstinence. Among alcoholics with otherwise good health, social support and motivation the likelihood of recovery is very good with alcohol abuse therapy. Alcohol abuse therapy can begin only when the alcohol accepts that the problem exists and agrees to stop drinking. Alcohol abuse therapy has three stages of detoxification, rehabilitation and maintenance. Alcohol abuse therapy helps with all three stages; mainly rehabilitation and maintenance. Alcohol abuse therapy can include recommendations such as to avoid people places and things that make drinking seem fun etc, joining a self help group, enlisting the help of family and friends, replacing negative dependence on alcohol with a new hobby or work, and exercise. All of these are alcohol abuse therapy in order to help the alcoholic achieve permanent abstinence.

Alcohol abuse therapy is focused on modifying maladaptive behavior. People who misuse drugs and alcohol usually do so as a way of coping with experiences, memories or events that emotionally overwhelm them. Even if they had developed the proper coping strategies, people who have problems with alcohol abuse rely on the immediate gratification of the drugs and alcohol rather than facing the issues at hand. Alcohol abuse therapy which specializes in alcohol and addiction recovery will help a client set achievable short term goals in order to empower the client. Once sobriety from alcohol abuse is achieved, healthy and adaptive skills can be taught and developed and the client and the therapist can begin to explore the issues that led to the alcohol abuse and addiction, employing the new coping strategies. Together, the client and therapist will work to set longer term goals that include rebuilding damaged relationships, accepting responsibility and releasing guilt. A skilled therapist can help someone with alcohol abuse problems overcome their addiction or alcoholism and set them on the path of achieving the life they truly desire. This is what alcohol abuse therapy is all about. Quitting alcohol abuse can be extremely difficult and it can also be dangerous.