DBT for Substance Use Disorders
If emotion dysregulation and impulsiveness are a big component of your substance use, DBT for Substance Use Disorders (DBT-SUD) may help you STAY in recovery
The idea that either mental health disorders or addiction can be treated separately has long gone by the wayside in favor of a model that incorporates treating addiction and mental health at the same time. Substance use disorders commonly occur in the presence of one or more other disorders – anxiety, depression, post-traumatic stress disorder, borderline personality disorder, etc. A common co-occurrence is alcohol use disorder and borderline personality disorder. If you have been treated for substance use alone, without attention to overall mental health, it may be more difficult to remain sober.
When is DBT for substance use disorders appropriate treatment?
If you have been diagnosed with borderline personality disorder and a substance use disorder, DBT for substance use disorders (DBT-SUD) would be considered evidence-based and researched treatment.
If your substance use is accompanied by thoughts of suicide and/or self-harm behaviors, your therapist may recommend DBT-SUD.
If you have gone through other substance use disorder treatment programs and have continued to relapse, looking at how emotion regulation issues and high impulsivity may be contributing could be effective. DBT is effective at improving emotion regulation and reducing impulsiveness.
If your therapist has recommended DBT-SUD for increasing skills for tolerating distress in early recovery.
How is DBT-SUD different from regular DBT?
In DBT-SUD, you and your therapist will develop your diary card to reflect that substance use is one of your target behaviors and you will be working at determining what specific thoughts, emotions and cues in your environment lead to substance use or urges to use.
You will be making a commitment to not using substances, while also accepting that relapse is possible. You will have a solid plan for abstinence, as well as a solid plan to follow IF a slip to substances would happen.
You may be in a DBT skills group that consists of only other participants who are also working on substance use as a target behavior.
In addition to all four modules in DBT skills group, you will be learning the addiction-specific skills from DBT called “When the Crisis is Addiction.”
Regular drug testing is a part of a DBT-SUD program.
To learn more about substance use disorders, and how brain changes impact “willpower,” here is a portion of a talk given by Nora Volkow, the head of the National Institute on Drug Abuse:
In addition, an explanation of why behavioral based treatments may be effective:
How does community support fit into treatment?
One of the DBT skills for addiction is called Community Reinforcement! Another one is Building New Bridges. These skills relate to having more cues around you for recovery than you do for continued substance use.
Research supports that when individuals with substance use disorders engage in community supports OUTSIDE OF PROFESSIONAL TREATMENT, the likelihood of continued recovery is increased. Therapy can also assist you with ongoing mental health issues that can’t be addressed in a community support group. Remember though that treatment is short term – building up support for yourself while still engaging in therapy is crucial to long term outcomes.
Here is a link to important recent research that supports ongoing community support:
References supporting DBT for substance use disorders:
Dimeff, L., Sayrs, J., Wilks, C., & Linehan, M. (2021). DBT for Individuals with Borderline Personality Disorder and Substance Use Disorders. In S. McMain (Ed.), Dialectical Behavior Therapy in Clinical Practice (2nd ed., pp. 233–263). essay, Guilford Press.
Salsman, N. L. (2020). Dialectical behavior therapy for individuals with substance use problems: Theoretical adaptations and empirical evidence. In J. Bedics (Ed.), Handbook of dialectical behavior therapy. Amsterdam, the Netherrlands: Elsevier.
Trull, T. J., Freeman, L. K., Vebares, T. J., Choate, A. M., Helle, A. C., & Wycoff, A. M. (2018). Borderline personality disorder and substance use disorders: An updated review. Borderline Personality Disorder,5, 15.
Whiteside, U. (2010). A brief personalized feedback intervention integrating a motivational interviewing therapeutic style and dialectical behavioral therapy skills for depressed or anxious heavy drinking young adults. (dissertation). ProQuest. UMI. Retrieved 2022, from https://www.nowmattersnow.org/wp-content/uploads/2021/04/2010.Whiteside.Dissertation.A_Brief_Personalized_Feedback_Reduced-File-Size.pdf.