Dialectical behavior therapy (DBT) is a type of cognitive behavioral psychotherapy that was specifically developed to better treat individuals with severe borderline personality disorder (BPD). In instances of BPD with a co-occurring substance use disorder, the use of a modified version of DBT (“DBT-S”) has been shown to help manage stressful or painful affects, maladaptive cognition, and self-injurious behavior in individuals with BPD who use drugs or alcohol in an effort to cope with these thoughts and emotions.1, 2
DBT-S employs the pillars of dialectical behavior therapy with added focus on the patient’s struggle to reach abstinence, increasing the patient’s motivation to change their behavior and thinking, and strengthening the therapist’s skills and abilities to connect with “easily lost” patients.1
It can be difficult to connect and communicate with patients who have BPD and a substance use disorder; some of these patients might even leave therapy after a short period of time because they can’t or won’t change their thinking patterns. DBT-S helps therapists meet their patients where they are, accept the patient for their faults, and help the patient accept themselves through changing mindsets and skills. It also works to help the patient grow their motivation for change.
Keep reading to learn more about:
- How dialectical behavior therapy works.
- The skills patients and therapists learn through using DBT.
- How DBT-S is used to help patients who have both a BPD and struggle with addiction.
What Are DBT Techniques?
Dialectical behavior therapy combines numerous cognitive-behavioral approaches, known as cognitive behavioral therapy or CBT, including contingency management and exposure therapy. Therapists commonly use techniques of CBT as part of addiction treatment.
Through DBT, therapists are able to show their patients the inconsistencies in their behavior vs. responses to standard approaches to therapy—“dialectical,” in short, means opposing forces—and help them work toward both acceptance and change in their behavior and thinking. Thus, the major focus of DBT is to bring together opposing beliefs, behaviors, or styles of interacting in such a way that makes these opposites functional. It can help patients experience a gradual transformation, continually working on creating this balance. Once patients find that balance, they can develop the coping skills needed to combat the symptoms of their illness that are most disabling.2
DBT-S specifically promotes cessation from and abstinence of substances. A combination of off-site counseling, attachment strategies, attempting to lower the risk or time spent of relapsing, and spending time locating patients who miss therapy sessions exemplify this dialectical abstinence approach.2
Some of the techniques used in dialectical behavioral therapy include:3, 4
- Enhancing an individual’s capabilities and life skills, including but not limited to improving emotional regulation, practicing mindfulness strategies, and enhancing distress tolerance skills.
- Practical application of new or modified skills, often addressed through homework assignments from the therapist.
- Improving a patient’s motivation to change and reducing behaviors inconsistent with a recovery and maintaining abstinence.
- Biosocial theory, which details that mental and personality disorders caused by environmental factors influence personality traits that are biologically determined.
How Long Does DBT Therapy Take to Work?
Applying DBT therapy in the treatment of a patient with borderline personality disorder can be an intensive and long-term process. Results from trials of DBT-S being administered for over 12 months of treatment in patients with borderline personality disorder and co-occurring substance use disorders, showed generally improved results over the standard treatment.
Behavioral Skills Taught in DBT
In dialectical behavior therapy, therapists focus on teaching four sets of behavioral skills:4
- Distress tolerance.
- Interpersonal effectiveness.
- Emotion regulation.
Mindfulness helps patients focus on the present and remain fully aware of each moment. Patients working on mindfulness skills learn how to participate fully in their present activity and to observe their current experience in a nonjudgmental way.4
Through distress tolerance, individuals learn how to tolerate pain rather than attempt to change it. Distress tolerance is especially important for individuals who are struggling with substance abuse because it helps them accept uncomfortable withdrawal symptoms, cravings, and triggers rather than attempt to eliminate those symptoms by using again.4
Interpersonal effectiveness refers to the skills that individuals need in order to ask for what they want and to decline what they do not want while maintaining healthy relationships with others.4
Emotional regulation skills help patients learn how to identify and address emotions they want to change.4
Using Dialectical Behavior Therapy to Treat Addiction
For someone with borderline personality disorder (BPD) and co-occurring substance use disorder (SUD), DBT modified for patients with SUD (DBT-S) may help a patient accept who they are and change their thinking patterns to guide them to reach a healthier, more positive approach to life that doesn’t include using drugs or abusing alcohol.
The foremost goal of DBT-S is immediate cessation of the substance, and an understanding that should relapse occur, it doesn’t mean that the patient cannot reach sustained sobriety in the future.2
With DBT-S, patients are taught additional new behaviors, including how to:2
- Avoid returning to substance abuse. This could comprise of ending contact with people who encourage or use those substances or throwing away drug paraphernalia.
- Reduce and get rid of behaviors that lead the patient back to drug abuse. This could include helping the patient change their mindset from using drugs is inevitable to teaching that even if relapses occur, sobriety and recovery are possible.
- Encourage the patient to build a healthy community of support around them, such as reconnecting with old friends or developing new friends that do not abuse substances.
As well as abstinence from drugs or alcohol, DBT-S also focuses on planning ahead by giving patients the tools and skills to deal with high-risk situations that might have once led them to relapse.2
If you or a loved one are struggling with drugs or alcohol and think you might benefit from treatment like dialectical behavior therapy, help is available. Call 662-638-0015 to reach one of our knowledgeable and compassionate Admissions Navigators for help today.
- American Society of Addiction Medicine. (2019). The ASAM principles of addiction medicine. Philadelphia, PA: Welters Kluwer.
- Dimeff, L.A. & Linehan, M.M. (2008). Dialectical behavior therapy for substance abusers. Addiction Science & Clinical Practice 4(2), 39-47.
- Lynch, T.R., Morse, J.Q., Mendelson, T., et al. (2003). Dialectical behavior therapy for depressed older adults: A randomized pilot study.American Journal of Geriatric Psychiatry. 11, 33–45.
- Chapman, A.L. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry MMC 3(9), 62-68.