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Dialectical Behavior Therapy (DBT) for Substance Abuse

The skills that help you stay sober are often the same skills that help you build a better life.

Dialectical behavioral therapy (DBT) was designed especially for people who experience intense emotions and have been unable to find a way to manage them. This is especially beneficial when helping people living with struggles that cause them to turn to substances find healthier ways to cope.

At Agape Detox Center, DBT is a core component of our addiction treatment program. Our trained therapists are ready to work with you and deliver the necessary practical skills and emotional coping mechanisms to ensure that long-term recovery is not just possible, but sustainable.

What Is DBT?

DBT is an evidence-based form of therapy originally created by Dr. Marsha Linehan in the late 1980s to treat borderline personality disorder (BPD).[1] Since its development, DBT has undergone extensive research and has been modified and applied for use with a variety of mental health disorders and substance use disorders. DBT is one of the most extensively researched and clinically supported treatments for borderline personality disorder and emotional dysregulation.[2]

DBT is intended for those who experience intense emotions that seem difficult, if not impossible, to control and who have found other forms of therapy to be insufficient. It is particularly suited for people dealing with emotional dysregulation issues, self-harm behavior, co-occurring disorders, eating disorders, post-traumatic stress disorder (PTSD), bipolar disorder, and addiction.[3] Each session is facilitated by a licensed clinician or therapist who specializes in providing DBT services.

Our staff at Agape Detox Center uses DBT in both our detox and inpatient treatment programs as part of individually tailored treatment plans. Our clinical team delivers the emotional and behavioral foundation required to facilitate recovery from both addiction and co-occurring mental health conditions.

How DBT Works

DBT is based on dialectics — the belief that two opposing ideas can both exist at the same time. The primary concept of DBT is acceptance and change: being able to accept yourself and your current situation while still having the willingness to engage in activities to improve oneself and change. This balance sets DBT apart from other types of therapeutic models and is especially helpful for people who have felt judged or criticized, giving them an environment where they feel accepted.

DBT is structured into four distinct skill modules. Each module is designed to provide skills related to improving aspects of emotional and behavioral functioning:

  • Mindfulness: The foundation for all DBT skills. Mindfulness enables the person to recognize their thoughts, feelings, and sensations at any given point without judgment, establishing a gap between receiving an emotional cue and reacting impulsively. In terms of substance dependence, mindfulness helps develop an awareness of craving without automatically responding to it.
  • Distress Tolerance: These skills help the person develop methods to survive emotional crisis situations without making the situation worse or resorting to substances as an attempt to escape the emotional pain. Instead of reducing the level of distress, these techniques give a person tools to get through difficult situations intact.
  • Emotion Regulation: These skills enable the person to identify their emotional responses, minimize susceptibility to intense emotional reactions, and ultimately build a life that produces more positive emotional experiences over time. For people whose substance use and addiction have been influenced by negative emotions, this module addresses the cause of their behavior directly.
  • Interpersonal Effectiveness: Developing healthy interpersonal relationships is critical for maintaining long-term sobriety. Interpersonal effectiveness skills help the person develop the ability to communicate their own needs effectively, set boundaries, respect themselves, and navigate relationships without jeopardizing either their sobriety or their overall wellness.

At Agape, DBT is delivered through therapy sessions focused on applying skills to personal challenges, group skills training where clients learn and practice the four modules together, and ongoing support as clients integrate DBT techniques into their daily lives.

Who Is DBT Right For?

DBT was created for people who have extreme emotional reactions and have had trouble keeping their emotional responses under control without resorting to harmful behaviors. With this definition of DBT applied to addictions, it can apply to many people.

DBT is particularly well-suited for people who:

  • Experience strong, rapidly shifting emotions that they cannot seem to control
  • Have a history of self-harm, suicidal ideation, or impulsive behavior driven by their emotions
  • Are managing co-occurring mental health issues in addition to an addiction, particularly those with BPD, PTSD, eating disorders, or bipolar disorder
  • Have tried other types of therapies, but did not find them to be enough
  • Struggle with establishing and maintaining relationships due to ongoing conflict, abandonment fears, and inability to express their own needs
  • Are using substances to deal with negative emotions, emotional pain, or to alleviate internal distress

While DBT was developed for people with borderline personality disorder (BPD), it has been researched extensively and proven successful across a wide range of presentations.[4] The clinical staff at Agape evaluates potential clients through an intake process to determine whether DBT is the best treatment option for each person. Many times in addiction treatment, DBT is not just helpful — it is the missing piece.

Efficacy of DBT for Substance Abuse and Co-Occurring Disorders

DBT consistently shows positive outcomes for individuals with substance abuse and co-occurring mental health issues.

Randomized controlled studies conducted with people with borderline personality disorder have demonstrated a consistent reduction in self-harm and suicidal behavior, as well as a reduction in substance use and hospitalizations when compared to treatment-as-usual controls.[5] Since BPD so frequently co-occurs with substance use disorder (nearly 80% of those with BPD will develop a substance abuse disorder at some point in their lives), these findings have direct relevance to addiction treatment.[6]

Studies focusing on DBT in substance use disorder have demonstrated meaningful reductions in drug use, cravings, and relapse rates. Research conducted by Dr. Marsha Linehan and colleagues found that DBT resulted in a greater reduction in substance use than standard treatment among women with BPD and a substance abuse disorder, with results that were sustained at follow-up.[7] Similar findings have been replicated with varying populations since that time.

DBT has also been successful in reducing symptoms associated with co-occurring disorders commonly seen with substance use disorders, including PTSD, eating disorders, bipolar disorder, and depression, making it a valuable treatment option in a dual diagnosis setting.[8] For clients managing multiple co-occurring conditions alongside addiction, DBT’s broad applicability makes it one of the most versatile and impactful therapies available.

The evidence overwhelmingly shows that DBT provides valuable and powerful tools for persons with emotional dysregulation that feeds addiction and provides individuals with the ability to build a life of wellness and stability.

What to Expect From DBT

DBT is a unique combination of structured interventions combined with a focus on the person’s individual experiences. While working within the structure provided by the therapist and program, participants develop skills and strategies to manage their thoughts, emotions, and behaviors.

While it may differ based on the facility and therapist, here is generally what you can expect from DBT:

01

Individual therapy sessions

One-on-one meetings with a trained clinician to integrate DBT skills in daily life for the specific recovery challenges you’ll face, such as managing cravings and developing and maintaining healthy relationships. As with all DBT sessions, validation is present throughout to ensure you are heard as we continue to develop skills to change your responses to your experiences.

02

Group skills training

Learning and practicing the four DBT modules alongside others in recovery. Structurally, groups resemble classroom settings instead of group therapy the primary focus is teaching and developing practical skills related to mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

03

Real-world application

Applying the skills learned in DBT sessions to real-life situations helping to reinforce knowledge and build confidence in applying the skills learned.

Agape Wide Range of Treatment

DBT at Agape Detox Center

At Agape Detox Center, DBT is not merely a supplementary add-on; it is central to Agape’s multidisciplinary treatment program.

Our licensed clinicians are trained in DBT principles and provide this therapeutic approach throughout each level of care, from medical detox to the residential program and aftercare. Clients who experience emotional dysregulation, have co-occurring mental health issues, or a history of self-harm related to their addiction will find the DBT treatment provided by Agape provides a solid structure with skills-based tools that allow for recovery to be long-lasting — not just during treatment, but in real life.

The Skills You Need Are Within Reach

DBT has helped countless people move from surviving their emotions to managing them — and from managing them to building a life they don’t need to escape. At Agape Detox Center, our admissions team is available around the clock to answer your questions and help you take the first step.

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FAQ

Frequently Asked Questions About DBT for Substance Abuse

What does DBT stand for?

The primary principles of DBT include dialectics (acceptance and change), behavioral science, and mindfulness. Treatment involves teaching clients skills in four areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness — delivered through a combination of individual therapy and group skills training.

Is DBT effective for substance abuse?

Yes. Research has repeatedly shown that DBT results in substantial decreases in substance use, cravings, and relapse rates — especially for people who experience intense emotional dysregulation and borderline personality disorder. It is considered one of the most empirically supported forms of psychotherapy currently being used for co-occurring addiction and mental health disorders.

What are the principles of DBT?

CBT primarily addresses the identification and modification of distorted thought processes and maladaptive behaviors. While DBT uses many of the same cognitive behavioral techniques as CBT, it places a stronger focus on acceptance, validation, and teaching the client the four skill modules. This allows DBT to better serve people experiencing extreme emotional responses that other therapies may be unable to address using solely change-oriented approaches.

What is the difference between DBT and CBT?

CBT primarily addresses the identification and modification of distorted thought processes and maladaptive behaviors. While DBT uses many of the same cognitive behavioral techniques as CBT, it places a stronger focus on acceptance, validation, and teaching the client the four skill modules. This allows DBT to better serve people experiencing extreme emotional responses that other therapies may be unable to address using solely change-oriented approaches.

Is DBT used for OCD and eating disorders?

Yes. DBT has been modified and adapted for numerous conditions beyond addiction, including OCD, eating disorders, PTSD, and bipolar disorder. Many of these conditions frequently co-exist with substance use disorder. When appropriate, we use DBT as part of our integrated dual diagnosis program for patients experiencing these conditions alongside substance use disorder.

Sources

[1] [3] [4] [8] Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry (Edgmont), 3(9), 62–68. https://pmc.ncbi.nlm.nih.gov/articles/PMC2963469/

[2] Flynn, D., Kells, M., Joyce, M., et al. (2021). Dialectical behaviour therapy: Implementation of an evidence-based intervention for borderline personality disorder in public health systems. Current Opinion in Psychology, 37, 14–19. https://doi.org/10.1016/j.copsyc.2021.01.002

[5] Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/209726

[6] Substance Abuse and Mental Health Services Administration. (2014). An introduction to co-occurring borderline personality disorder and substance use disorders. https://library.samhsa.gov/sites/default/files/sma14-4879.pdf

[7] Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal of Addiction, 8(4), 279–292. https://doi.org/10.1080/105504999305686