DBT For Substance Use Disorder: How It Works & Its Benefits

What is Dialectical Behavior Therapy? 

Dialectical behavior therapy (DBT) is a cognitive behavioral therapy (CBT) that focuses on accepting a person's experience. It's an effective addiction treatment and care for mental health problems like borderline personality disorder.

The main goal of DBT is to help people learn healthier ways to manage their emotions, thoughts, and behaviors. Using psychotherapy and skills-based training, dialectical behavior therapy teaches how to control impulses, regulate emotions, and develop coping skills for stress.

Who Benefits From DBT?

DBT has been successfully used to treat various mental health issues, including depression, anxiety, substance abuse, eating disorders, drug addiction, and alcohol abuse.

DBT is also useful in stopping self-harm behaviors and: 

• Suicidal thoughts: They often result from stress, depression, or anxiety. People with substance use disorders are at a higher risk of suicidal thoughts.
• Borderline personality disorder (BPD): It’s a mental health disorder marked by a constant pattern of mood swings and severe changes in self-image and behavior.
• Substance use disorders (SUD): These involve physical or psychological dependence on drugs or alcohol.
• Co-occurring disorders: These are conditions where a person is diagnosed with a mental health disorder and SUD, such as alcohol addiction. It's also known as a dual diagnosis.
• Binge-eating disorder (BED): This is a common eating disorder where a person habitually overeats to the point where it’s detrimental to their health.
• Depression in elderly people: It’s a serious mood disorder often ignored or misdiagnosed in elderly patients.  

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Dialectical Behavior Therapy (DBT) vs. Cognitive Behavioral Therapy (CBT)

CBT and DBT are both considered psychotherapy or talk therapy. CBT is structured, short-term, goal-oriented, and focuses on the present. It begins with education about the disorder and how it affects the person.

Next, a person learns and practices skills that change their thoughts, feelings, and behaviors. All of these help them learn how to deal with present problems and issues in the future.

With DBT, people learn to acknowledge their reality and develop the skills to accept their circumstances. This therapy also emphasizes the value of validation and strong relationships.

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What are the Techniques Used in DBT?

There are a couple of specific behavioral skills DBT therapists use to treat people. These include:

Mindfulness

Mindfulness is a technique adapted from meditation practices. It stresses focusing on breathing to "live in the present."

People use these breathing techniques to slow down the situation and separate their thoughts from their emotions.

This skill helps you regain control over a stressful situation or deal with painful emotions. It's particularly effective with adolescents. 

Distress Tolerance

Distress tolerance is about finding productive ways to distract oneself from difficult emotions, such as those related to substance abuse, until they pass. Some methods here include various coping skills like:

• Bringing down body temperature 
• Using intense exercise 
• Paired muscle relaxation
• Controlled breathing exercises

Emotional Regulation

Emotional dysregulation is the inability to control one's emotions and can contribute to substance abuse. It prevents painful emotions from bubbling up, unlike distress tolerance and mindfulness.

Programs teaching this skill educate people to label their feelings accurately, which can be particularly helpful for those with borderline personality disorder. 

A person also learns to distinguish between primary emotions and the harmful secondary reactions. In essence, emotional regulation is about learning not to give into primary emotional impulses.

Interpersonal Effectiveness

Improving interpersonal effectiveness involves constructively handling interpersonal conflicts. It’s about recognizing the need to stop unnecessary apologies and advocating for yourself while possessing essential social skills. 

By doing so, people can boost their self-esteem and develop valuable relationship-building abilities. Some interpersonal effectiveness examples include:

• Listening skills
• Empathy
• Conflict management
• Diplomacy
• Humor 
• Non-verbal communication (body language, tone of voice, etc.)
• Empathy
• Give and taking feedback

What Should You Expect During Dialectical Behavior Therapy?

DBT therapy, as a form of addiction treatment, usually involves individual therapy sessions and skills groups. Individual therapy meetings involve one-on-one contact with a professionally trained therapist to address your therapeutic needs.

Your therapist will help you: 

• Remain motivated
• Apply DBT skills to everyday life
• Address obstacles or problems that may occur during treatment

In skills groups, members learn and practice skills with others. One expert therapist leads and conducts exercises and teaching skills. Likewise, participants are encouraged to share their experiences and provide support. 

People are assigned homework, like practicing mindfulness exercises. Each group session lasts around two hours, and groups usually meet weekly for about six months. Groups can be shorter or longer, depending on the requirements of the members.

There are various ways DBT therapists can provide treatment. For example, some people attend one-on-one therapy sessions without participating in weekly skills groups. Others may decide to meet with the group without consistent one-on-one sessions.

Four Methods of Dialectical Behavior Therapy

To contribute to effective addiction treatment, therapists use four methods to administer dialectical behavioral therapy:

• One-on-one therapy sessions: An individual therapy where a therapist works with the person and focuses on their goals, such as developing healthier coping strategies, reducing suicidal behavior, or working through challenging relationships.
• Group counseling: In a group setting, people learn with their peers and practice their learning skills, including interpersonal effectiveness skills. It also helps people build relationships and create personal networks of support.
• A therapist consultation team: This team collaborates to discuss strategies and coordinate care for the person.
• Phone coaching: This is a form of reinforcement outside the therapy setting. It helps people practice new skills or receive encouragement and guidance when facing particular triggers.

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DBT For Substance Use Disorders

DBT addiction treatment, as substance abuse treatment, helps people become aware of their thoughts, emotions, and behaviors related to their addiction. It focuses on identifying and changing destructive behavior patterns, regulating emotions, and managing interpersonal relationships.

It also helps people learn to identify and handle triggers that lead to substance abuse and other high-risk behaviors. It teaches them how to handle emotional crises and maintain sobriety over time and:

• Decrease substance abuse
• Reduce physical discomfort from withdrawal
• Manage and lowers urges, cravings, and temptations to use
• Avoid triggers 
• Build community reinforcement and healthy relationships

Since SUD falls under the mental health conditions umbrella, its four main stages specifically target the most important treatment areas:

1. Out of control to in control

It focuses on decreasing reckless and dangerous behaviors while practicing valuable skills like distress tolerance and mindfulness.

2. Emotionally unavailable to emotionally engaged

In this stage, people practice experiencing emotions fully without using substances to cope.

3. Building a normal life and solving normal problems

This stage shifts from focusing on extreme symptoms to more common problems like relationship and work problems, life goals, and other emotional issues.

4. Feeling incomplete to feeling complete/connected

It focuses on building happiness by connecting the person with the world around them.

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