Dialectical Behavior Therapy & Addiction Treatment

Several types of psychotherapy can be used to help people manage substance use disorders (SUDs). Dialectical behavioral therapy (DBT) is a therapeutic approach that can help patients to better accept and tolerate uncomfortable emotions while developing the necessary skills to change and improve their lives.¹

This page discusses DBT treatment for addiction, how DBT works, and options for addiction treatment in New England.

What Is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy (DBT) was initially developed to treat people with borderline personality disorder (BPD) who were chronically suicidal.¹ DBT has since been adapted to treat patients with a variety of mental illnesses and substance use disorders who contend with issues like emotional dysregulation and impulsivity.^1,2

In addition to BPD, dialectical behavior therapy is sometimes used to treat:^2,3

• Eating disorders.
• Anxiety disorder.
• Depressive disorders.
• Post-traumatic stress disorder (PTSD).

DBT has also been adapted to treat people with substance use disorder and co-occurring BPD or other mental illnesses.^3,4

Dialectical Behavior Therapy for Addiction

DBT for addiction focuses on improving patient motivation to change, enhancing patient capabilities, generalizing new behaviors (i.e., applying learned, therapeutic behaviors to various situations), structuring the environment, and enhancing therapist capability and motivation.⁴

The aims of DBT in drug addiction treatment are to:⁴

• Decrease continued substance use.
• Relieve the physical discomfort accompanying abstinence or withdrawal.
• Reduce cravings and desire to use substances.
• Help people avoid cues that could trigger relapse, like no longer associating with certain people, places, or things and destroying drug paraphernalia.
• Reduce behaviors that promote continued substance use.
• Increase healthy behaviors, such as developing friendships with sober people, seeking employment, and participating in positive leisure activities.

Studies have shown DBT’s efficacy in treating people with SUD and co-occurring BPD. In one study, women who received DBT while in treatment were significantly more likely to continue with treatment, achieved greater reductions in substance misuse, and attended more therapy sessions than those who did not receive DBT.⁴

Specific concepts of DBT (e.g., mindfulness, interpersonal effectiveness skill development, healing from interpersonal trauma) may also be successfully employed in addiction treatment, regardless of whether someone has a co-occurring disorder.

Effective addiction treatment typically employs not just DBT but a variety of therapeutic interventions, including cognitive behavioral therapy (CBT), motivational interviewing, contingency management, and more.

How Does DBT Work?

Dialectical behavior therapy helps people to find a balance between two seemingly opposite recovery concepts: change and acceptance.^1,2 In the context of addiction treatment, the change refers to the cessation of drug use and related behaviors. Acceptance is necessary for patients to understand that if relapse does occur, it does not mean that treatment cannot be successful.⁴

The therapist will often begin DBT therapy by asking the patient to commit to change by immediately ceasing their substance use. Because committing to a lifetime of sobriety may seem impossible, the therapist encourages the patient to determine a period of abstinence that seems realistic. At the end of that period, the patient renews their commitment. Eventually, by piecing together these short intervals of abstinence, the patient can achieve stable, lasting sobriety.⁴

The patient is also taught to “cope ahead” which means learning to better anticipate potential triggers and high-risk situations that may lead to relapse and developing a plan to cope with these triggers and situations.⁴

If a relapse should occur, the therapist helps the patient analyze events that lead to the relapse and determine what can be learned to prevent relapse from happening again. “Failing well,” as it is referred to in DBT, helps to alleviate powerful negative emotions and cognitions that many patients feel after a relapse that can potentially deter them from reestablishing abstinence.²

DBT Skills Training

One assumption of DBT is that patients either lack or would benefit from strengthening several essential life skills. Patients develop these skills through therapy sessions that may involve education, active practice, group discussion, as well as through homework assignments between sessions.²

The essential skills that are taught in DBT are:

• Mindfulness. Mindfulness is integral to DBT and is labeled one of the “core skills.” Mindfulness skills include non-judgmental observation, describing what is observed, and participation.⁵ Mindfulness emphasizes focusing attention on the experience of the present moment and learning to regulate attention.²
• Interpersonal effectiveness. Interpersonal effectiveness involves learning to successfully navigate interpersonal situations. Interpersonal effectiveness training teaches people to cope with interpersonal conflict, start new friendships, and end destructive ones.⁵
• Distress tolerance. Distress tolerance teaches people acceptance, to seek meaning, and to endure distress. Distress tolerance training teaches self-soothing techniques to survive difficult situations without making things worse.⁵
• Emotion regulation. Emotion regulation training teaches a range of strategies for reducing unwanted emotional reactions and increasing desired emotions. The training is focused on teaching patients how to recognize and describe emotions, modify emotional responses, lessen vulnerability to painful emotions, and cope with negative emotions.⁵

Benefits of Dialectical Behavior Therapy

DBT for addiction offers many potential benefits including:⁴

• A reduction in drug and alcohol use.
• A decrease in the physical and psychological discomfort associated with withdrawal symptoms.
• A decrease in the uncomfortable emotions often associated with abstinence.
• A reduction in cravings and urges to use.
• Awareness of triggers and high-risk situations that may lead to relapse.
• Development of healthy coping skills and relationships beneficial to recovery.

Does Insurance Cover DBT?

Yes, health insurance covers addiction treatment that,⁶ in most cases, will involve behavioral therapies such as DBT.⁷ The extent of coverage depends on the patient’s specific insurance policy.

Use the to verify whether your insurance covers treatment at AdCare.

DBT and Addiction Treatment at AdCare

If you or a loved one are struggling with addiction, AdCare inpatient drug rehab in Rhode Island or outpatient treatment centers in New England can help. AdCare provides a variety of evidence-based treatment services, including medical detox, behavioral therapies (including DBT), medications for substance use disorder, and more.

Contact to speak with our admission navigators who can answer your questions and help you begin the rehab admissions process.