DBT for Addictions & Substance Abuse

DBT has been found to be very successful for the treatment of addictions and substance abuse. The Dialectic element helps people to accept their addiction and also accept the need for change, while the Behavioral Therapy element gives people them the tools to handle situations that tend to trigger their addictive behaviors, by teaching them to react in different ways.

Understanding Dialectical Behavior Therapy

Dr. Marsha Linehan developed the technique of DBT (Dialectical Behavior Therapy) because she found the principles of Cognitive Behavioral Therapy (CBT) to be too limiting. When treating clients who were engaged in self-harming behavior, she realized that CBT was focused on helping them to change their behavior. She wanted to balance this desire for change with an element of acceptance or validation, and this led to the addition of dialectics to the therapeutic formula.

Rather than validating and encouraging negative behaviors, DBT helps people to understand why they want to act in certain ways.  By explaining that everything is connected and that change is constant, DBT teaches clients to use opposing forces in their lives to find a balance. This can help them to both accept the situation in which they find themselves and to take action to make changes, by demonstrating that these are not contradictory goals.

Understanding Addiction

Dr. Marsha Linehan recognizes substance abuse and other addictions as types of self-harming behaviour. Many addicts experience social, financial, personal, legal and health problems as a result of their addiction, but they continue to indulge in these behaviors because it gives them a temporary break from the pain. Acknowledging their pain is a crucial first step in DBT.

The treatment process starts with encouraging the client to accept himself or herself, and to accept their life as it is, rather than as it is supposed to be. The next stage is recognizing that they need to change themselves in order to survive, because their self-harming behavior is destroying their life. This is the seemingly contradictory dialectic that DBT helps the addict to confront: the need for acceptance of self and the importance of changing their behavior.

Modifying Addictive Behaviors

It can be incredibly difficult to overcome addictive behaviors, so DBT therapists work with their clients to find the motivation to quit their substance abuse. By accepting their addiction and taking action to make changes, DBT is somewhat similar to the “12 Steps” approach of Alcoholics Anonymous. However, one major difference is that the group therapy element of DBT does not encourage clients to discuss their addiction or their recovery process with one another, but rather to work together on alternative behavior strategies.

The DBT behavior modification element is based on teaching four skill sets: mindfulness, interpersonal relations, emotion regulation, and distress tolerance. Mindfulness is about living in the moment and not thinking about your past or your future. Distress tolerance means accepting a difficult situation and not resorting to substances to escape from it. Interpersonal skills can help addicts to focus on their relationships and resolving conflicts through communication, and emotional regulation is about learning to identify and change negative feelings. All of these skills can help addicts to resist the temptation to drink or take drugs, by learning to manage their emotions and avoid trigger situations without turning to these substances.

One of Dr. Linehan’s other recommendations is to encourage addicts to find different and less dangerous ways to ‘act out’ their need to rebel – she calls it “alternate rebellion”. Engaging in competitive or extreme sports, for example, can replace the buzz of getting high and provide a distraction from social settings where drugs and alcohol are on offer.

Abstinence and Relapse

Most DBT therapists will require their clients to sign strict abstinence agreements while participating in therapy , but the agreement will specify a short period of time which can be renewed, rather than setting an unattainable goal of life-long abstinence. Helping clients to set realistic and achievable goals for themselves is a key element of DBT treatment.

At the same time as encouraging change, the dialectic approach also accepts the reality of failure. If a client relapses into substance abuse, they are not told that they have failed. The therapist will offer problem-solving responses in a non-judgmental way, such as encouraging the client to minimize the self-harm involved in their relapse, and to come back to therapy quickly. It is important that the client does not feel disheartened by their relapse, and that their re-commitment to abstinence is accepted and encouraged.

Following a relapse, the therapist will talk with the client to help them understand the behavior that led to and followed their return to substance abuse. From this analysis they can increase their understanding of the trigger events and devise coping strategies for use in future situations. DBT also teaches addicts that recognizing the negative consequences of their substance abuse can help them to accept their guilt and regret, and that these feelings can then be used to reinforce their desire to change.

Helping Addicts to “Do Teshuva”            

Although DBT was developed as a technique for helping people with borderline personality disorder, a number of research studies have found evidence of its effectiveness in substance abuse treatment. Many addiction treatment centers around the world have begun implementing DBT programming. At Machon Dvir in Jerusalem, we recognize the importance of accepting onto our program individuals who struggle with substance abuse and addictive behaviors. The dialectic approach of helping them to accept their addiction while recognizing the need for change, is consistent with the Jewish principles of Teshuva – repentance. Feel free to contact us if you or a friend could benefit from Dialectical Behavioral Therapy.