Addiction is a serious and intricate condition that impacts the individual, as well as their family members and community. It is often intertwined with intense emotional pain, difficulty managing distressing situations, and/or strained interpersonal relationships.
Dialectical Behavioral Therapy (DBT), a comprehensive, evidence-based modality of therapy, is designed to equip individuals with practical skills to manage overwhelming emotions, reduce self-destructive behaviors like substance abuse, and ultimately build a “life worth living.”
What Is Dialectical Behavior Therapy (DBT)?
Dialectical Behavior Therapy (DBT) was originally developed in the late 1970s and 1980s by Dr. Marsha M. Linehan to treat individuals with Borderline Personality Disorder (BPD). This is a condition marked by pervasive emotional dysregulation and chronic suicidal behavior. Since then, DBT has been successfully adapted to address various other mental health conditions, including substance use disorders (SUDs), post-traumatic stress disorder (PTSD), depression, anxiety, and eating disorders.
The effectiveness of DBT lies in its unique approach of learning how to balance acceptance and change, helping individuals both accept themselves and their current realities while actively working toward positive behavioral change. DBT is a multifaceted treatment rooted in cognitive-behavioral principles, but stands out for its focus on “dialectics.” In philosophy, dialectics means exploring and reconciling opposing ideas. In DBT, this means balancing acceptance (validating a person’s current emotions and struggles without judgment) with change, by teaching and supporting new skills that promote healthier behaviors and improve quality of life.
Many people struggling with addiction and intense emotions feel invalidated or misunderstood. DBT for addiction can create a validating environment, recognizing that while behaviors such as substance abuse are destructive, they often develop as coping mechanisms for extreme emotional pain. This acceptance helps form a foundation for change, helping individuals feel understood and more willing to engage in the difficult work of changing long-standing patterns.
Goals of DBT
The overarching goal of DBT for addiction treatment is to help individuals build a life they experience as worth living. This is accomplished by addressing a structured set of treatment priorities.
This primary target includes reducing suicidal ideation and attempts, non-suicidal self-injury, and in the context of addiction, behaviors linked to high-risk substance use that pose immediate threats to life. Addressing these behaviors is critical to ensuring client safety and preventing fatal outcomes.
This involves addressing behaviors from the client or therapist that hinder the therapeutic process, such as missed sessions or reluctance to complete “homework” assigned by the therapist. Overcoming these barriers helps maintain consistent treatment progress and maximizes therapy effectiveness.
This broad category includes issues like substance abuse, severe mental health symptoms (such as those tied to depression and anxiety), relationship conflicts, unemployment, and homelessness. For addiction treatment, the focus is on substantially reducing or eliminating substance use and its related problems. Improving quality of life is essential for sustainable recovery and overall well-being.
Clients are taught specific skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness to manage emotions, cope with crises, and navigate relationships more effectively. These skills empower clients to handle daily challenges and reduce reliance on harmful coping mechanisms.
As individuals gain control over destructive behaviors and learn new coping mechanisms, DBT supports them in working toward personal aspirations and building a sense of self-efficacy and respect. Fostering self-respect and goal achievement promotes long-term growth and a fulfilling life beyond therapy.
The Four Core Skill Sets of DBT
DBT provides a toolkit of coping strategies grouped into four essential modules. They’re each designed to address underlying emotional vulnerabilities and behaviors, which can be vital for breaking the cycle of addiction.
Mindfulness
This practice cultivates acceptance and reduces automatic reactions, fostering greater emotional balance. Over time, mindfulness enhances self-awareness, allowing individuals to observe cravings or triggers without immediately acting on them. It encourages living in the present moment and helps reduce negative rumination, promoting calmness and focus in daily life.
Distress Tolerance
Distress tolerance provides individuals with practical tools to endure challenging moments without resorting to impulsive actions. Developing this skill helps people tolerate discomfort and uncertainty, lessening the urge to escape these feelings through harmful behaviors. Techniques such as distraction, grounding, and self-soothing are often used to manage crises safely.
Emotion Regulation
Strengthening emotion regulation skills helps prevent emotional overwhelm and support healthier decision-making. By recognizing and labeling emotions accurately, individuals can choose more adaptive responses rather than reacting impulsively. This skill also teaches individuals how to decrease sensitivity to strong emotions while enhancing their ability to experience and sustain positive feelings.
Interpersonal Effectiveness
Improving interpersonal effectiveness empowers individuals to assert their needs while maintaining respect and connection with others. Effective communication builds trust and fosters supportive relationships, which are vital skills for sustaining long-term recovery. It also teaches setting boundaries, negotiating conflicts, and maintaining self-respect during interactions.
How DBT Can Help with Addiction Treatment
Many individuals with addiction struggle with emotional dysregulation, sometimes leading to impulsive substance use as a means of coping. DBT's focus on emotional regulation helps individuals identify triggers, understand their own emotional responses, and develop healthier coping strategies. By improving emotional awareness and self-control, DBT helps to lower the chances that individuals will turn to substance use as a method of coping.
DBT for addiction treatment equips individuals with concrete skills to manage stress and cravings. Techniques such as self-soothing, distraction, and strategies that promote acceptance enable individuals to navigate challenging situations without resorting to substances. These skills can be particularly beneficial in preventing relapse during recovery.
Relationships with loved ones and colleagues are often negatively affected by substance use. DBT's interpersonal effectiveness module teaches individuals how to communicate effectively, assert their needs, and set healthy boundaries. Improved interpersonal skills foster supportive relationships that are vital for sustained recovery.
Many individuals with addiction also experience co-occurring mental health disorders, such as depression or anxiety. DBT is particularly effective for those with a dual diagnosis, as it addresses both substance use and underlying psychological conditions simultaneously. Integrated treatment approaches enhance overall outcomes and can help reduce the risk of relapse.
DBT emphasizes the development of a "life worth living," encouraging individuals to pursue meaningful goals and engage in activities that promote well-being. By focusing on long-term fulfillment rather than short-term relief, DBT can help support sustained recovery and reduce the likelihood of returning to substance use.
Modes of Treatment
Comprehensive DBT for addiction can be delivered through several modes. Each are designed to provide robust support and ensure that skills are learned, strengthened, and applied in daily life.
Individual Therapy
Group Therapy
Telehealth Services
Intensive Outpatient Programs (IOP) or Partial Hospitalization Programs (PHP)
DBT treatment can be offered as part of structured, intensive programs that combine multiple therapy modalities daily or several times per week. These programs can provide more frequent support for clients with severe symptoms or high risk.
Is DBT for Substance Abuse Covered by Insurance?
DBT for substance abuse is often covered under mental health and addiction benefits in many insurance plans, especially those complying with mental health parity laws. Coverage typically includes individual and group therapy sessions, but can vary by provider and policy. Limitations may also pertain to session limits, co-pays, and prior authorization requirements.
It’s important to contact your insurance provider directly to confirm coverage for DBT. Choosing an in-network DBT provider can also reduce out-of-pocket costs. Understanding insurance benefits can make treatment accessible and affordable in your time of need.
Recover from Addiction at Lennox CMHC
At Lennox Community Mental Health Center (CMHC), we offer DBT as a core part of our comprehensive addiction treatment programs. Through individual therapy, group sessions, and ongoing support, we empower individuals to overcome addiction and build fulfilling lives in recovery.
If you or a loved one is struggling with addiction and co-occurring mental health disorders, contact us today to learn how we can support your path to lasting recovery.
