Dialectical behavior therapy (DBT) represents an evidence-based approach for treating substance use disorders and behavioral addictions. Originally developed to treat borderline personality disorder, DBT has evolved into an effective treatment for addiction by addressing the emotional dysregulation and impulsivity that often drive substance use.
The term “dialectical” refers to the balance between two seemingly opposite concepts: acceptance and change. This balance forms the foundation of DBT’s approach to addiction recovery, allowing individuals to accept themselves while working toward positive change in their relationship with substances.
At Addiction Treatment Center of New England in the Brighton neighborhood of Boston, MA, we incorporate evidence-based approaches like DBT into our comprehensive treatment programs. These programs address the complex nature of addiction by combining behavioral therapies, medical care, and community support.
Dialectical behavior therapy (DBT) is a type of cognitive-behavioral therapy developed by psychologist Marsha Linehan in the 1980s. While initially created to treat borderline personality disorder, clinicians have successfully adapted DBT to address substance use disorders and other forms of addiction.
DBT combines traditional cognitive-behavioral techniques with mindfulness practices derived from Eastern meditation traditions. This integration helps individuals become more aware of their thoughts, feelings, and behaviors, particularly those that contribute to substance use.
DBT for addiction focuses on both acceptance and change, teaching people to accept themselves as they are while working to change harmful behaviors related to addiction.
How Does DBT Work?
Dialectical behavior therapy offers a powerful, evidence-based framework for individuals working to overcome addiction. By combining mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, DBT helps people build the skills needed to navigate triggers, manage cravings, and respond to challenges without turning to substances. It not only supports sobriety but also strengthens overall mental wellness, self-awareness, and resilience. For many, DBT becomes more than a treatment method; it becomes a practical, compassionate way of living that empowers long-term recovery and healthier relationships with oneself and others.
Core DBT Modules: How They Help Treat Addiction
Mindfulness is the practice of paying attention to the present moment without judgment. This foundational skill helps individuals develop awareness of their internal experiences and external environment.
In addiction treatment, mindfulness helps people recognize cravings and triggers as they arise, allowing them to pause and choose how to respond rather than acting automatically on urges to use substances. Mindfulness techniques for substance use disorders, including:
- Observing urges: Noticing cravings without acting on them, creating space between feeling and behavior.
- Describing experiences: Putting feelings and thoughts into words, which helps reduce their power and intensity.
- Participating fully: Engaging completely in healthy activities to build positive experiences and distract from cravings.
Substance use often serves as a way to cope with distressing emotions or situations. Distress tolerance skills provide healthier alternatives for managing these difficult moments without turning to substances. Distress Tolerance Techniques (including TIPP skills):
- Temperature change: Using cold water or ice to quickly shift your emotional state during intense cravings.
- Intense exercise: Engaging in short bursts of physical activity to release tension and reduce urges.
- Paced breathing: Slowing your breath to calm the nervous system when feeling overwhelmed.
- Progressive muscle relaxation: Tensing and relaxing muscle groups to reduce stress that might trigger substance use.
- Crisis survival strategies: Using distraction, self-soothing, and improving the moment to get through difficult situations without substances.
Emotional dysregulation is a common trigger for substance use. Many people use drugs or alcohol to manage painful emotions or to create positive emotional states. DBT teaches skills for identifying, naming, and managing difficult emotions without substances. Key emotional regulation strategies:
- Identifying emotions: Learning to recognize and label feelings, which is the first step in managing them effectively.
- Opposite action: Doing the opposite of what an emotion urges you to do when that urge is unhelpful (e.g., reaching out to a friend when depression makes you want to isolate).
- Building positive experiences: Increasing activities that bring joy or satisfaction to create natural emotional rewards.
- Reducing vulnerability: Taking care of physical health through proper sleep, nutrition, and exercise to stabilize mood.
Relationship difficulties can trigger substance use or make recovery harder. Conflicts, isolation, and boundary issues often contribute to relapse. Interpersonal skills taught in DBT include:
- Assertiveness: Expressing needs and saying no without guilt or aggression.
- Asking for help: Reaching out for support when needed instead of turning to substances.
- Repairing relationships: Making amends and rebuilding trust damaged during active addiction.
- Maintaining self-respect: Standing up for personal values and boundaries in relationships.
DBT teaches communication skills to help individuals maintain healthy boundaries and repair relationships damaged by addiction.
DBT for Addiction
DBT for substance abuse addresses relapse as an issue to be resolved; consequently, therapists assist the individual in evaluating the circumstances that contributed to the relapse. Life skills learned in DBT are designed to be used long after formal treatment ends, supporting ongoing recovery and relapse prevention. Unlike some treatments that focus primarily on the period of active addiction, DBT teaches lifelong skills that help individuals manage emotions, relationships, and stress. These skills continue to support recovery even after formal treatment has ended.
Success after DBT for addiction means greater emotional stability, healthier relationships, and the ability to manage cravings and stress without substances. Research in the Journal of Clinical Psychology indicates that individuals who complete DBT for addiction report improvements in quality of life beyond just reduced substance use. They describe better relationships, increased ability to handle stress, and greater overall life satisfaction.
How the Dialectical Principle Guides Addiction Recovery
The core dialectical principle in DBT is the balance between acceptance and change. In addiction recovery, this means accepting the person as they are, including their struggles with substances, while also working to change behaviors related to addiction.
Key concept: “Dialectical abstinence” is a unique DBT concept that balances the goal of complete abstinence with a non-judgmental approach to relapse.
How DBT’s Approach Differs from Traditional Addiction Treatment
- Acceptance of setbacks: Relapse is seen as a learning opportunity, not a failure or moral weakness. This reduces shame and helps people stay engaged in treatment.
- Focus on both abstinence and harm reduction: DBT encourages striving for abstinence while preparing for and managing lapses in a way that minimizes harm.
- Non-judgmental support: Therapists maintain a compassionate, non-shaming stance, even when clients continue to struggle with substance use.
For example, someone in recovery who experiences a relapse after three months of sobriety might typically feel intense shame and consider abandoning treatment altogether. In DBT, the therapist helps the person accept the relapse without self-blame, analyze what led to it, and develop new strategies for the future, all while maintaining the goal of abstinence.
DBT For Addiction FAQs
DBT builds upon CBT by adding mindfulness practices and dialectical thinking, while emphasizing emotional regulation and distress tolerance skills specifically designed to address the impulsivity and emotional triggers common in addiction.
Yes, DBT works well alongside medication-assisted treatment, providing the behavioral skills needed to support recovery while medications address physical dependence and cravings.
A comprehensive DBT program for addiction typically runs 6-12 months, with weekly individual therapy and group skills training sessions, though the format may be adapted based on individual needs and treatment setting.
No, research shows DBT is effective across various substances and behavioral addictions because it addresses the underlying emotional regulation issues common to all addictive behaviors.
People who struggle with emotional regulation, have a history of relapse, experience intense cravings, or have difficulty maintaining relationships often benefit most from DBT’s comprehensive skill-building approach.
Mindfulness creates awareness of triggers and cravings without automatic reactions, helping individuals pause between feeling an urge and acting on it, which creates space for making healthier choices.
DBT therapists serve as coaches who teach skills, validate experiences, and help clients apply DBT principles to real-life situations while maintaining a balance between acceptance and change.
We’re Here to Support You Every Step of the Way
If you or someone you love is struggling with addiction, now is the time to take the next step. Reach out today to learn how DBT-focused treatment can help you regain control, find balance, and move forward with confidence.
