Dialectical Behavior Therapy for Drug Addiction

Dialectical behavior therapy (DBT) may seem like a complicated treatment approach at first but is based on one simple goal – helping to reduce destructive behavior. DBT is a relatively young derivative of cognitive behavioral therapy (CBT) which was used primarily in the treatment of addictions before DBT’s introduction. DBT combines the most effective and evidence-based methodologies of CBT along with holistic approaches such as meditation and mindfulness training. The outcome is a unique, modern and highly individualized therapy that is ideal for the treatment of both addiction and mental illness.

When addiction and mental illness occur at the same time, this is referred to as a co-occurring illness or dual diagnosis. The Substance Abuse and Mental Health Services Administration (SAMHSA) found that over seven million adults struggle with a dual diagnosis, and only a small fraction of them get the help they need. Learn more about how DBT works and discover what you can expect from a typical treatment plan to see if it could be a beneficial addition to your recovery.

History of DBT

Psychologist Marsha M. Linehan created DBT after pinpointing a need for it among patients diagnosed with borderline personality disorder. She realized that many individuals struggled with reacting in a healthy manner to extreme shifts in their emotions. Current therapies failed to fully address this area of coping, which is why DBT was born. This unique approach specifically teaches clients how to cope with surges in their emotion and stressful situations. After successful outcomes among Dr. Linehan’s patients, DBT was integrated into the treatment of other mental illnesses.

When it comes to addiction, this therapy is especially useful because it helps clients react appropriately to cravings, triggers and other things that may lead to relapse. DBT also focuses solely on the client and their personal goals, desires, and feelings which can increase morale and make their view of recovery more positive overall. Self-empowerment is at the core of DBT, which is helpful for anyone seeking help with a substance use disorder (SUD). Therapists specializing in DBT must complete intensive educational requirements in addition to ongoing training. Current DBT treatment consists of individual sessions with a therapist, group therapy, and phone coaching.

DBT Approach to Treatment

During DBT, you can look forward to participating in a few different activities, all of which are led under the supervision of a skilled therapist. This approach is much different than traditional individual counseling, which is a type of one-on-one therapy widely used for various purposes. While DBT still heavily relies on talk-therapy, it prioritizes establishing the need for change and acceptance in your life.

According to the National Center for Biotechnology Information (NCBI), DBT includes strategies designed to treat co-occurring disorders as effectively as possible. During treatment, the following five functions serve as guidelines for achieving this goal:

  • Increasing motivation to change
  • Enhancing capabilities
  • Generalizing healthy, new behaviors
  • Creating a structured environment
  • Improving capability and motivation of the therapist

 

These guidelines are expressed through four distinct phases of treatment. The first aims to identify behaviors that serve as obstacles in your course towards recovery. The second stage focuses on altering these behaviors to better serve your needs and goals as you work towards a healthier lifestyle. The third stage is about applying what you have learned in your everyday life and problem-solving as needed. The final stage allows you to put all your new skills together and reconnect with the world as a sober individual.

Length of Treatment

The length of treatment can vary from person to person, but most people spend at least six months in a standard DBT program. This amount of time is the minimum recommended to establish significant changes. Once you complete DBT, you may choose to continue therapy in the form of one-on-one counseling or become active in a community-based support group. Both options can be beneficial for long-term abstinence from alcohol and drugs.

DBT recommends immediate abstinence from substances such as alcohol, drugs, and prescription pills.During the first session, therapists typically ask a client to commit to stop using substances. Some people may find complete cessation overwhelming, but the process utilizes a day-by-day approach which many find achievable. The National Institute on Drug Abuse (NIH) found that an average of 40 to 60 percent of adults in treatment for addiction relapse at some point.

Dealing with Relapses

Should a relapse occur, DBT encourages a client to mentally accept the relapse, reroutes clients back to abstinence and addresses the underlying behaviors and triggers that led to relapse. By doing this, clients are able to prevent future substance abuse by learning skills that are individualized to their specific needs.

By developing new behavioral skills with a DBT therapist, you can learn how to anticipate cues and respond to high-risk situations without relapsing. Another way in which DBT prevents relapse is by encouraging clients to participate in healthy interests, community groups and to make new friendships.

All these options not only encourage recovery but also help to create long-term changes that provide benefit after treatment. Community groups such as 12 step programs serve as an excellent source of support. These groups provide the opportunity to socialize with like-minded individuals in an empowering setting. You can participate in community-based groups for as long as you feel you need to as well, making them a great option for both short and long-term use.

DBT Therapy in Practice

DBT consists of two primary formats: individual therapy and group therapy. During individual therapy, you will work with a therapist on a weekly basis in a private setting. This time is largely cognitive-based in the sense that it encourages you to talk about changes, challenging situations and other topics that may be on your mind. Individual therapy enables you to gain feedback from a therapist and learn skills to work through problems productively.

It is highly collaborative in the sense that you may complete homework assignments, participate in role-playing or engage in holistic strategies for managing stress to prevent relapse. Mindfulness exercise, meditation, and deep breathing are some of the methods taught by therapists that can reduce self-destructive patterns.

Group therapy typically occurs on a weekly basis as well and may last longer than individual therapy. During group, participants can socialize with others in recovery and share experiences. Group therapy focuses on four modules:

  • Emotion regulation
  • Distress tolerance
  • Interpersonal effectiveness
  • Mindfulness

Emotions play a key role in addiction. In fact, DrugAbuse.com refers to addiction as an emotional disease in addition to its current label as a chronic condition. Feelings such as guilt, shame, and hopelessness are common among those just starting out on the path to recovery. Unfortunately, these negative emotions can hinder the process and ultimately lead to relapse. DBT addresses the need for healthy emotion regulation by helping to identify and label emotions appropriately, react to them productively and prevent them in the future by building more positive thought patterns. DBT also equips you with the tools you need to fight against distress which is when many people feel most vulnerable to a relapse.

Crisis situations trigger relapse at such a high rate for several reasons. Firstly, many people lack the skills necessary to combat distress. Secondly, crises promote the need for an immediate resolution and in the case of individuals struggling with addiction, the solution may be to self-medicate with alcohol or drugs. Finally, many people struggling with addiction need help to slow down their thinking, which makes it difficult to find a way out of the throes of dependence other than through relapse. Fortunately, DBT combats these issues by teaching clients how to self-soothe, take their mind off of distressing situations and employ a more positive way of thinking.

Long-Term Benefits of DBT

All the skills taught during individual and group therapy aim to create permanent behavioral changes that will serve you for years to come should you continue to implement them. Similar to CBT treatment, DBT has been shown to reduce self-destructive behaviors and decision making which are common among individuals with co-occurring disorders. Like any other treatment method, you must actively participate in therapy and maintain a strong desire to recover in order for it to be most effective. Since DBT encourages clients to seek out new friendships, interests and social outings, it can reduce the likelihood of returning to old habits and environments associated with substance use disorder. DBT also emphasizes the need for active communication which can prevent individuals from bottling up emotions and feeling overwhelmed. Many relapse-prevention strategies are incorporated into DBT such as the use of mindfulness exercises, coping skill acquisition and responding to stress appropriately.