Dialectical Behavior Therapy (DBT) in Substance Abuse Treatment

A form of Cognitive-Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT) was developed by Dr. Marsha M. Linehan with a focus on building a meaningful life after treatment rather than merely eliminating the problem. It was initially applied to treat persons who are chronically suicidal but was adapted later to treat persons with substance abuse disorders, borderline personality disorders and other co-occurring disorders commonly associated with drug and alcohol abuse. In DBT, the client learns to articulate and pursue lifelong goals and is equipped with post-treatment stress-management tools that will help him achieve self-sufficiency.

The basis for DBT is striking a balance between two oppositions, namely, a client’s desire to eliminate pain and his concerted effort to accept inevitable pain. The addiction counselor utilizes DBT strategies to bring about change as the therapist and client discover new meanings that emerge from exploring various perspectives around a subject. For example, if a client clings to a belief as “absolute truth,” the counselor will help him explore other possible positions by asking questions like, “Have we considered [this possibility] or entertained [some other idea that may be equally truthful]?”

Why Dialectical Behavior Therapy (DBT)?

When an individual suffering from addiction is not responding to other types of evidence-based therapy (EBT), his attendance drops and the treatment outcome is minimized. Reasons for unresponsiveness may vary according to how the client feels about the therapist and family’s promptings for change. Due to the sensitive nature of the individual’s well-being, the client may feel that his emotions and experiences are not validated by those who are trying to help him. Rather than making the client feel like his absenteeism or relapse is his problem, the therapist will help the client “fail well.” Through guided behavioral analysis, the client will be able to evaluate the circumstances surrounding the event and diminish the acute feelings of failure or other negative emotions associated after the event. “Failing well” has helped clients recover faster from a relapse.

The Dialectical Approach to Abstinence vs. Harm Reduction

Rather than using one option exclusively over the other, Dialectical Behavior Therapy combines the best of both worlds. Abstinence refers to the absolute, complete avoidance of a substance or behavior. As a lifestyle change, the individual may avoid going to parties where friends will smoke or consume alcoholic beverages. He may go as far as asking his friends not to order an alcoholic beverage in his presence at a seemingly innocuous environment, such as a restaurant. Harm Reduction alludes to the gradual decrease of harm caused by the use of the substance. This approach eliminates the “cold turkey” effect; through the use of alternative substances, such as vaping instead of smoking, the client can eventually wean himself from his addictive cravings for the actual substance. In DBT, the addiction therapist will do everything in his power to help the client achieve abstinence, but in the event of a relapse, the therapist may switch to harm reduction to promote abstinence as the ultimate goal.

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