Is DBT effective for substance abuse?

Dialectical Behavioral Therapy shows promise for substance abuse, although the focus of most research so far is those with the dual diagnosis of Substance Use Disorder and Borderline Personality Disorder. DBT is formulated to help you tolerate distress healthily and effectively, without resorting to coping mechanisms such as substance abuse. The therapy also helps develop Emotion Regulation skills to help keep you in a place where you don’t feel you need to use substances. Beyond this standard DBT approach, at the DBT Center of Marin, we also offer Informed DBT which integrates other modalities into DBT to create a multidimensional treatment to optimally address your substance abuse. Such modalities are evidence-based, cognitive-behavioral interventions specifically for the treatment of substance abuse.  

What is Substance Abuse?

Substance Abuse is defined as a pattern of harmful use of any substance for mood-altering purposes. Substance use crosses the line into abuse when it interferes with your work, health, and relationships or otherwise causes harm to your life. The associated stigma and shame can both contribute to that harm. Substance abuse can be mild or debilitating and harm your quality of life. 

How does DBT support this diagnosis?

There are many reasons why one might abuse substances. Sometimes people use substances to get through distressing situations or emotions rather than less destructive coping mechanisms. DBT can help clients learn to concentrate on the present moment, modify ineffective behaviors, and reduce the triggers leading to substance abuse. DBT support for these symptoms extends beyond the therapy session through phone coaching as a crisis intervention tool in addition to individual weekly psychotherapy and skills groups. DBT provides clients with structure and skills to better tolerate distress and the guidance on how to apply these skills to the unique situations in their lives. 

Which DBT modules are most relevant for substance abuse?

Learn how to manage substance abuse through the 4 components of DBT: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.

Mindfulness: Learn how to be truly present.

Mindfulness skills teach you how to focus on your current situations, stopping rumination on painful past experiences or future uncertainty. Regular mindfulness practice can help keep you grounded in the present moment and increase your mental stability. By being grounded, you are better able to recognize your impulsive behaviors and vacillating emotions and to cope ahead for future stressors.

Emotion Regulation: Learn to manage, change, and accept the different emotions, so that your emotions don’t control you. 

Dysregulated emotions and irregular self-care can be exacerbated by substance abuse. DBT teaches Emotion Regulation skills to stop unwanted emotions from starting in the first place, regulate or change such emotions once they start, and learn to accept and become comfortable with unavoidable emotions. Many of the skills meant to regulate emotions also prioritize balanced sleep, eating, exercise, and prescription medication usage, all of which can help reduce urges to use.

Distress Tolerance: Learn to tolerate painful emotions and situations that seem unbearable, and avoid behavior that can make things worse.

Emotions often seem unbearable or intolerable, which can lead you to choose the coping method that provides the fastest relief, no matter the consequences. Distress Tolerance offers tangible skills to use in place of ineffective, impulsive behaviors that can make things worse. These techniques range from guided self-soothing skills, to easy to use methods that activate the parasympathetic nervous system, using your own body’s chemistry to reduce distress. Distress Tolerance skills like TIPP and Wise Mind ACCEPTS can help you tolerate the moment instead of resorting to substance use. 

Interpersonal Effectiveness: Learn to communicate with others in respectful ways while maintaining healthy boundaries and upholding positive self-respect. 

Substance abuse can place strain on relationships. DBT guides you in both being a good friend or partner and getting your needs met. Interpersonal effectiveness skills provide clear instruction on how to maintain relationships with others, ask for what you want, and uphold your self-respect. Interpersonal Effectiveness skills also provide tools to head off problems and better resolve conflicts before they become overwhelming.

References to research that demonstrate the efficacy of the treatment for the diagnosis

1. This study found that ACT and DBT treatments had positive effects on substance use disorders.

Stotts, A. L., Northrup, T. F. The promise of third-wave behavioral therapies in the treatment of substance use disorders. Current Opinion in Psychology 2, 75–81 (2015). https://doi.org/10.1016/j.copsyc.2014.12.028.

2. This article summarizes several clinical trials that found DBT decreased substance abuse in patients with BPD. It also explains the overlap between the two conditions.  

Dimeff, L. A., Linehan, M. M. Dialectical behavior therapy for substance abusers. Addiction science & clinical practice 4, 39–47 (2008). https://doi.org/10.1151/ascp084239.

3. This study presents an analysis of how mindfulness can help prevent relapse in substance use disorders.

Breslin, F. C., Zack, M., McMain, S. An Information‐Processing Analysis of Mindfulness: Implications for Relapse Prevention in the Treatment of Substance Abuse. Clinical Psychology: Science and Practice, 9, 275-299 (2006). https://doi.org/10.1093/clipsy.9.3.275.