DBT for Substance Use Disorders

Many people use substances to cope with strong emotions and stress, often using it to escape from problems, emotions such as fear or pain, and anger. DBT is a promising therapy used to treat addiction by helping users to find healthy coping mechanisms for emotions, trauma, stress, and cravings.

DBT or Dialectical Behavior Therapy is a type of Cognitive Behavioral Therapy (CBT) developed in the 1980s at the same time CBT was developed. The therapy emphasizes the psychosocial aspects of substance abuse and substance use, and works to help substance dependent persons to cope with the emotional and social reasons behind their addiction.

What is DBT

Dialectical Behavioral Therapy was developed to treat borderline personality disorder (BPD), focusing on the extremes of emotions often experienced by people with BPD. It was later adapted to meet the needs of substance use disorder, because many people who are addicted to substances also experience a great deal of black and white emotions, dialectical choices, and situations. DBT suggests that some people experience emotions much more quickly and strongly than others, and many never learn to cope with changing emotions in the face of stress, trauma, or even romance, family, or friendships.

DBT focuses on helping you to build the tools to cope with the emotional and social aspects behind addiction, allowing you to cope in a healthier way.

What is Dialectical

Dialectics represent how we understand concepts through their polar opposites. For example, “love and hate” are dialectics. In most cases, dialectics are concepts that are poorly defined on their own, but are defined very well in the presence of their opposites. In psychology and therapy, dialectics can include self-esteem (ego), courage, anger, impulsiveness, inhibition, guilt, risk taking behavior, and so on. In most cases, you cannot fully understand these concepts without comparing them to their opposite. Inhibition cannot be fully understood without uninhibited behavior, you cannot understand risk without understanding safe behavior, and so on. This is important in some recovery, because opposites and extremes often dominate addiction. For example:

  • You use because you are stressed, which makes your life worse, causing you to stress more
  • You choose to use as an escape route, and need an escape route from your substance use
  • Forbidding yourself from something makes you want it more
  • You’re sad or lonely so you use which makes you more sad or lonely
  • You’re angry because people are mad at you for using so you use more to deal with it, and they become more angry with you.

DBT for Substance Abuse

Dialectical behavior therapy works to help you to recognize and cope with the emotional and social reasons behind your addiction. This means that it helps you to understand why you respond in a certain way to emotions, what you are feeling before and after you use, and how to manage those emotions so that you no longer feel the need to use. DBT focuses on improving your motivation to change, giving you the capability to change, helping you to generalize behavior while ensuring that your therapist has the capability and motivation to provide you with the support you need.

Components of DBT

DBT is broken down into four primary components; Group Therapy, Individual Therapy, Phone Coaching, and Therapist Consultation.


Individual Therapy

Individual therapy allows the therapist to interact with you in a one-on-one environment to learn your emotional responses, identify your self-destructive behavior, and work towards identifying why you have those responses. In most cases, individual sessions are 60 minutes but may be longer if the therapist identifies a special need.

Group Therapy

DBT heavily involves group therapy, where the therapist meets with a group of people who all show similar destructive behaviors. Here, the therapist creates a classroom-like environment, where each session is focused on learning a new skill or topic focused on correcting this behavior. In most cases, group therapy includes 24 weeks of 2.5 hour classes, with each skill broken into four to six sessions.

Phone Coaching

DBT ensures that you have a full support system, even outside of therapy. Phone coaching allows you to call your therapist at almost any time to talk about issues and cravings as they happen. Here, the therapist will help you to make the best decision by guiding you through your options and helping you to decide to make the best decision for you.

Therapist Coaching

DBT provides a strong support system for the therapist with intensive meetings and supervision from other therapists. This helps the therapist to stay on the right track, get insight from their peers, and ensure that they maintain a high standard of quality support and advice throughout your therapy.

Prioritization

DBT therapists typically create a prioritization schedule for creating a treatment plan, by developing a hierarchical treatment prioritization around your specific issues. In most cases, people with substance use disorders have multiple problems, and DBT focuses on them in a way that allows you to tackle problems as they become most important.


Life-Threatening Behaviors

DBT focuses on life threatening behaviors such as relapse, potential overdose, potential suicide, and other similar problems first. This means that the first step of DBT is to ensure that you are safe and do not have pressing problems before tackling your mental problems. Here, decreasing or stopping your use of substances is the primary goal of the therapy.

Therapy-Interference

In most cases, patients come to DBT with anger, aggression, and a lack of motivation. DBT works to correct these to solve denial issues, reduce discomfort brought on by withdrawal, reduce cravings, help you to avoid substances, help you with issues like coming late to meetings or not showing up at all, solving problems behind failing to collaborate in group meetings or refusing to learn new skills, etc.

Quality of Life

DBT focuses directly on working to solve issues that affect quality of life. For example, stress, anxiety, financial crisis, persistent nightmares, strong cravings, triggers, etc. This often includes specific focus on reducing substance abuse behaviors.

Skills

Here, DBT helps you to learn new skills that will help you to achieve your life goals such as staying clean, working towards a happy life, and finding healthy coping mechanisms. These skills include increasing community support by meeting new friends, following through on old friendships, experimenting with new hobbies, seeking out positive environments, working towards life goals, and involving yourself in social activities.

DBT directly incorporates:

Mindfulness
Distress Tolerance
Interpersonal Effectiveness
Emotional Regulation

DBT focuses on the most pressing issues first, with the underlying assumption that if your worst problems aren’t fixed, you won’t care about the reasoning behind those problems.

Stages of Treatment

DBT works to build you up through multiple stages designed to walk you slowly away from substance use and towards a new life.

  • Stage 1 – You are transitioned away from reckless behavior such as drug or alcohol use and towards building skills that will help you to improve relationships, manage distress, and increase your attention.
  • Stage 2 – Here, you learn to recognize your emotions and accurately experience them without relying on an escape mechanism such as drinking or using drugs.
  • Stage 3 – Your therapist helps you to recognize everyday struggles and conflicts such as stress, relationship problems, arguments, work problems, and other ‘small’ issues so that you can learn how to cope with them in a healthy way.
  • Stage 4 – DBT helps you to focus on creating happiness for yourself and building a good future.

DBT offers a number of benefits to patients.

Benefits of DBT

  • It’s nonjudgmental. The premise of DBT is that every person is doing the best they can at any given moment.
  • It’s tailored to the patient. If you need more focus and more time, DBT gives that to you.
  • It focuses on the worst issues first, so you can get rid of problems that make your situation worse. DBT may not focus on substance use right way if you are displaying suicidal behavior or have a comorbid problem that might make it difficult for you to quit.
  • DBT encourages personal growth and mindfulness but recognizes that each person moves forward at their own pace.
  • DBT actively works to build skills that improve every part of your life.
  • DBT recognizes that most substance use is based on emotional and social problems, and works to correct them.
  • DBT is highly effective, comparative to CBT, and more effective for patients with emotional distress or comorbid disorders.

Is DBT Right for You?

DBT is a form of CBT that is highly effective in treating many forms of addiction. For example, if your addictive behavior is linked to managing emotions, stress, or escapism, DBT may be a very good solution for you. DBT is also highly suited to treating comorbid disorders including depression, PTSD, and anxiety. However, you must commit to complete and permanent abstinence from substance use, commit to learning new skills, and commit to an intensive treatment process.

DBT is an evidence based substance use dependence therapy and it can help you to develop the skills to detox and stay clean to permanently improve your life.