The Role of Dialectical Behavior Therapy (DBT) in Substance Abuse Treatment

Dialectical Behavior Therapy (DBT) has emerged as a powerful instrument in mental health treatment, especially concerning substance abuse. Its amalgamation of cognitive-behavioral methods with mindfulness has shown efficacy in aiding individuals dealing with addiction to reclaim control over their lives.

DBT, developed by Dr. Marsha M. Linehan, was initially formulated to treat borderline personality disorder (BPD). It operates on the dialectical principle of balancing acceptance and change. It aims to encourage abstinence and diminish both the duration and negative consequences of relapses.

The therapy comprises four key modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Each module targets specific skills essential for managing emotions, relationships, and behaviors.

• Applying DBT in Substance Abuse Treatment: Substance abuse frequently intertwines with underlying emotional dysregulation and ineffective coping mechanisms. DBT's focus on emotional regulation and mindfulness renders it highly suitable for addressing addiction. Integrating DBT into substance abuse treatment enables therapists to assist individuals in identifying triggers, managing emotions without resorting to substances, and fostering the development of healthier coping strategies.

In the pursuit of abstinence, the DBT dialectic operates by advocating for both immediate and enduring cessation of drug abuse (the pursuit of change), while simultaneously instilling the understanding that a relapse, if it happens, doesn't indicate failure for the patient or the therapy to attain the intended goal (embracing acceptance). This dialectical approach combines a steadfast push for complete abstinence with nonjudgmental, problem-solving reactions to relapse, incorporating techniques to mitigate the risks associated with overdose, infection, and other adverse consequences.

The DBT approach is multidimensional and all-encompassing, relying on skill acquisition to alter unproductive thoughts and behaviors.

• Mindfulness: A therapist guides the client through a mindfulness exercise by asking them to focus on their breath. The client is encouraged to observe their thoughts, emotions, and bodily sensations without judgment. For instance, noticing the sensation of the breath entering and leaving the body, acknowledging thoughts without getting caught up in them, and becoming aware of any tension or relaxation in the body. For individuals grappling with addiction, mindfulness practices aid in increasing awareness of cravings, triggers, and emotional states. By fostering this awareness, individuals can respond to cravings more skillfully, reducing impulsive reactions and the likelihood of relapse.
• Interpersonal effectiveness: In a role-playing scenario, the therapist helps the client practice assertiveness by simulating a situation where the client needs to express their needs or boundaries to a friend or family member. The therapist would provide guidance on effective communication strategies and encourage the client to express themselves assertively while respecting the other person. Substance abuse can strain relationships and isolate individuals. DBT's interpersonal effectiveness module focuses on improving communication skills, setting boundaries, and building healthy relationships. Strengthening these skills aids in repairing relationships damaged by addiction and establishing a supportive network crucial for sustained recovery.
• Emotional regulation: An example could involve identifying triggers for anger. The therapist and client work together to recognize situations or thoughts that often lead to intense anger. Then, the therapist assists the client in creating an action plan, such as utilizing a timeout strategy or employing deep breathing exercises, to manage anger in a healthier manner when faced with triggering situations. By learning to tolerate and regulate emotions, individuals reduce the need to self-medicate with substances.
• Distress tolerance: During a distress tolerance session, the therapist might introduce distraction techniques, like engaging in a hobby or practicing relaxation exercises, to help the client manage intense emotions. The client could be encouraged to create a list of activities they find soothing or distracting to use during distressing moments. DBT's distress tolerance module equips individuals with techniques to tolerate distress without resorting to substance use. By learning crisis survival skills and distraction techniques, individuals can navigate challenging situations without turning to harmful substances.

By taking an addiction-focused approach to DBT, many individuals can benefit from treatment. Some of the benefits might include:

• Reduce substance use frequency or achieve abstinence
• Manage and alleviate withdrawal discomfort.
• Control impulsivity, cravings, and temptation linked to substance use.
• Establish and enforce boundaries essential for abstinence.
• Avoid triggers and situations that prompt substance use.
• Modify behaviors contributing to substance abuse.
• Foster healthy relationships and supportive environments for sustained recovery.

Incorporating DBT into substance abuse treatment programs can significantly contribute to achieving these goals by providing individuals with practical skills and strategies to navigate the challenges associated with addiction. The therapy's holistic approach addresses not only substance use behaviors but also the underlying emotional and interpersonal issues contributing to addiction.

DBT for addiction is most effective when used in conjunction with other addiction treatments, such as 12-step programme, individual therapy, and group therapy. DBT complements these other treatments by teaching you the necessary skills to effectively cope with your emotions and manage stress without turning to drugs or alcohol.

This is very important because the recovery journey can be a stressful and emotional time, and it is during these times that you are most likely to relapse. DBT provides you with the tools you need to deal with these difficult emotions and situations in a healthy way.

Why choose Samarpan?

Samarpan is a specialized international Substance Use Disorder (De-Addiction) and Process Addiction rehab in Pune, India that accepts a maximum of 26 clients. We only accept clients on a voluntary basis and have a highly structured program that encompasses the most effective approaches to Substance Use Disorder and addiction. The facility is set in the rolling hills Mulshi, with clients having either individual or shared rooms, in a modern resort like facility, staffed by Internationally Accredited Professionals. Samarpan is fully licensed under The MSMHA and is also an accredited GORSKI-CENAPS Centre of Excellence offering a program from 5 to 13 weeks.

If you or someone you care about is considering treatment for substance use disorder or process addictions, we can help. Contact us now on admissions@samarpan.in or phone/WhatsApp us on +91 81809 19090.

References

American Psychiatric Association. Gold Award: Integrating dialectical behavior therapy into a community mental health program. Psychiatric Services. 1998;49(10):1338–1340

Darke S, et al. Borderline personality disorder, antisocial personality disorder and risk-taking among heroin users: Findings from the Australian Treatment Outcome Study (ATOS) Drug and Alcohol Dependence. 2004;74(1):77–83.

Inman DJ, Bascue LD, Skoloda T: Identification of borderline personality disorder among substance abuse inpatients. J Subst Abuse Treat 1985

Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993a. [Google Scholar]

Linehan MM. Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press; 1993b. [Google Scholar]

Linehan MM. Skills Training Manual for Disordered Emotion Regulation. New York: Guilford Press; in press. [Google Scholar]