DBT for Substance Abuse

Substance abuse disorder is known to have profound mental and behavioral effects that only specific therapy could treat. Dialectical behavioral therapy (DBT) is one such therapy, and DBT for substance abuse has proven to be one of the more successful approaches ever used during treatment.

DBT is such an effective tool that it is also used in other concerns where there is a need for a focused approach to mental and behavioral issues, such as suicide and other forms of self-harm. DBT is a particularly effective approach because the person learns to envision, articulate, pursue, and sustain set goals, such as being sober or accepting and love of self to prevent self-harm.

While it does necessarily point out the potential root of the mental or behavioral issue(s), it does not affix the blame squarely on the person, but rather, on the situation itself, thus presenting a scenario where the person could improve and get well, instead of apportioning the blame on the person, which many tend to remember more than the solution.

What is Dialectical Behavioral Therapy (DBT)?

Dialectical behavioral therapy otherwise referred to as DBT is an evidence-based psychotherapeutic approach used to treat a variety of mental health conditions. This approach was developed by psychologist Dr. Marsha Linehan and a few of her colleagues in the 1980s and was largely based on the cognitive-behavioral therapy approach.

DBT is commonly used in individual and group therapy situations in the treatment of conditions such as anxiety disorders, depression, borderline personality disorder, depression, and substance use disorders. Therapists attribute the success of this approach to the fact that it comes with the addition of acceptance skills.

The addition of acceptance skills is a crucial part of DBT as many of the deep-seated and chronic issues that people deal with every day have to do with people not being able to accept certain facts related to the problem. This element of acceptance is critical to the success of the therapy because once there is acceptance on the part of the patient, it is only then that the positive changes could be affected.

It is important to note that positive change within the patient could only happen if the patient validates that the change is acceptable and that it is positive to them specifically. Validation in this context only comes with acceptance, and it is not just in one facet. The validations need to be in the form of the emotions the patient feels, their ideas about their issue, and the fact that no positive change will happen if they do not accept the fact that the current state they are in with their issue(s) is harming them and those around them.

How Does DBT Help in the Treatment of Substance Abuse?

Interviews with people who have gone through substance abuse reveal a stark commonality: all focus goes into the act of taking the substance and waiting for it to take effect. People in this state reach a level where no other conscious thought is given to anything else, which is why many are often discovered with their bad habit, as they already forgo any thought of hiding it.

dbt for substance abuseDBT helps in this manner because it brings back conscious thought and focuses on some aspects that will help a person not only manage their urges and cravings to take substances again, but also change their perception about certain aspects of their life that could harm them. These aspects include:

This concept is central to everything else in DBT, as it is at the core of treatment. Patients are taught the importance of bringing awareness into the moment. This aspect teaches how to focus, understand, and accept what is happening right now, at this exact moment, and how it affects the patient. By being able to consciously observe, understand, and relate what is happening at the moment to the patient, and how it affects what is inside of them, their feelings, thoughts, sensations, and impulses, the patient could then discern what the best course of action would be, and by “best course of action”, it would necessarily mean that the action will not harm them or others around them.

Mindfulness teaches people how to focus on the current situation, and not simply relate this to a painful experience. Focusing on the present also means not sifting through all the fearful and terrible things that might happen in the future due to the action. By dwelling on past painful experiences that might be related to the current situation, people only feed their anxieties and stress themselves to the point of indecision, confusion, and even panic. This goes the same for trying to overthink what a potential decision might result in moving forward. Considering if action is harmful is one thing, trying to figure out what repercussions it could have on a grand scale in the future is something else completely.

By being focused and grounded on what is currently happening, a patient is better able to recognize the impulsive behaviors and forceful emotions that often dictate their actions. Recognizing this allows them to consider better thoughts, decisions, and actions relevant to the situation.

Mental and behavioral issues often result in challenges in relationships, mostly due to the inability to communicate properly and appropriately. Nothing demonstrates this more than the behavior of people who have a substance abuse disorder. Certain substances could seriously affect a person’s ability to communicate properly, such as the slurred speech pattern resulting from too much alcohol, or the incoherent ramblings of someone high from drugs.

Interpersonal effectiveness also extends into how a person behaves around other people. Certain substances can induce irritability, belligerence, indifference, or a great desire for isolation in the people who take them. These behaviors are, of course, not things that would work well if a person desires to be socially acceptable. Interpersonal effectiveness dictates that a person should observe and recognize if their behavior is something that would push people away from them, and if so, what could they do to improve the situation.

People necessarily have different opinions and ways of accepting things. While the difference is typically acceptable and normal, there are also certain responses that others find to be offensive and unacceptable. This is particularly true with certain emotional responses that come off as negative or intense.

Managing one’s emotions, even for people who don’t have a substance abuse disorder, could be quite challenging. Anyone who has ever been in anger management will attest to this, which is why this is an important aspect of DBT. It has been said time and again, but it remains true: a person must learn to control their emotions, and not let their emotions control them. On top of this, substance abuse could exacerbate a person’s negative emotional response. DBT seeks to correct this right from the root, by preventing negative or unwanted emotions from escalating in the first place. This discipline takes time because emotions are extremely powerful drivers of human thought and action, but it is an essential component of treatment.

This aspect of DBT is tied in with emotional regulation. Life is naturally stressful, and there are many stressful instances where the option a person has is to experience it and hope to come out alive and well. A person in distress is quite likely to react blindly, in the attempt to remove themself from the stressful situation. Others are likely to take a negative action after a stressful situation, such as going on an alcohol binge.

Distress tolerance involves learning techniques that implement distraction and self-soothing skills to prevent the mind from focusing on the stress and induce a mindset not conducive to constructive thought. This aspect teaches people coping skills that will be crucial while in a crisis or in instances that are likely to cause a person to react blindly.

What Are the Treatment Goals of DBT?

DBT operates on the principle that given an opportunity, a person could either take control of a situation that would cause them great distress and ensure that it does not or at the very least, maintain enough internal determination and control so that the situation does not become one where a person is left with no choice in their response or action.

The four main goals of DBT include:

This situation is a pitfall that practically everyone is sure to go through at some point in their life. It is important to note that while it might be possible to be in a situation where a person has no control, a person will always have control over how they react to the situation.

In the context of substance abuse, there are situations in life that could be emotionally devastating, but this does not necessarily mean that a person should go on excessive alcohol intake or drug use. DBT helps a person focus on what is happening at the moment, understand how they feel about that moment, and decide on a non-harmful way to respond to it.

Anger, sorrow, and hate could push a person to take action that they will most certainly regret later on. These are intense emotions that are difficult to handle, but they are not impossible to handle. It is this mindset that DBT seeks to develop in a person.

Emotional regulation is not the denial of how a person feels, since being a human being also means having emotions. Emotional regulation means knowing how intense the emotion is, and understanding how much of it is manageable. This also means that if the emotion is beyond a person’s threshold, asking for support from others is also an option, rather than reacting to the intense emotion blindly and unconsciously.

While this type of therapy teaches a person to focus on the here and now, it also teaches a person to veer away from overthinking the future, and from dwelling on past mistakes. The last two scenarios are known to create problems for people because it induces unnecessary stress, worry, and even outright fear.

DBT for substance abuse instead focuses more on the things that a person could fix and affect a positive change on, such as a person’s reaction to stressful situations, better communication skills, and choosing courses of action that do not involve self-harm or harming others.

DBT helps in knowing the massive negative impacts of substance abuse and in ways to avoid them. This is not, however, the end-all and be-all target of DBT. This therapeutic approach seeks to improve the overall quality of life by understanding the current situation one is in and making informed decisions.

Find the Most Effective Approach For You at LUNA Recovery

Therapy is not about fixing what needs fixing right now. It’s also about seeing what caused it in the first place, and what else could be affected by it. This is something we here at LUNA Recovery learned early on as we helped people in their journey to recovery.

The beginning of the journey to recovery is all about understanding. We know that quite well, and that is what we practice in treatment here. Talk to us now.