The emotional dysregulation that drives addictive behavior needs a specific type of therapeutic intervention to teach the skills needed to live everyday life without drugs or alcohol.
That’s where dialectical behavior therapy (DBT) comes in. DBT was designed to address exactly this challenge. At All In Solutions, DBT forms a major part of client treatment for those who need more than insight— they need the right set of tools.
What Is Dialectical Behavior Therapy?
DBT is a comprehensive, evidence-based form of psychotherapy developed by Marsha Linehan in the late 1980s, primarily to treat Borderline Personality Disorder.[1]
The term “dialectical” refers to the synthesis of two opposing ideas central to DBT: acceptance and change. DBT holds that a client must be accepted exactly where they are, while at the same time being supported to change the behaviors that are making their life unworkable. This balance between validation without enabling and challenge without rejection is what distinguishes DBT from most other approaches to psychotherapy.
DBT is grounded in cognitive behavioral therapy (CBT) but expands on it by incorporating mindfulness practices, a comprehensive skills training curriculum, and a structured approach to crisis intervention. In its full format, DBT consists of four components: individual therapy, DBT skills group, phone coaching between sessions, and a therapist consultation team. In addiction treatment settings like All In Solutions, DBT is often delivered in an adapted form where the core skills training is retained and integrated within the client’s larger treatment plan.
DBT is appropriate for adults and adolescents across all levels of care and is particularly well-suited to those with co-occurring mental health disorders characterized by emotional dysregulation — such as borderline personality disorder, mood disorders, and trauma-related disorders — alongside their addiction.
How Dialectical Behavior Therapy Works
The Four Core Skill Modules
As mentioned above, DBT consists of four modules of skill training. Each of these four modules addresses the emotional and behavioral challenges that underlie addiction and interfere with recovery.
Below, we’ll explore each module in more detail:
Mindfulness — The foundational skill of DBT. Mindfulness teaches clients to pay attention to the thoughts, feelings, and sensations in their bodies without judgment and without reacting instinctively to them. When clients develop their mindfulness skills in DBT, it enables them to observe cravings and urges for substances as just passing mental events rather than absolute needs. By developing mindfulness, clients can create space between a craving and the action they take in response to it, allowing them to consciously choose their actions.
Distress Tolerance Distress tolerance skills teach clients how to manage crisis situations and extreme levels of emotional discomfort without making a bad situation worse. Distress tolerance skills do not eliminate emotional distress, but they provide clients with specific tools to manage it without using substances or engaging in other self-destructive behaviors. Examples include self-soothing, radical acceptance, and crisis survival strategies. Clients can use these skills at the peak of their emotional instability while developing a greater ability to manage their emotional states.
Emotion Regulation Emotion regulation is very important for people in recovery because it allows them to understand and manage the intense emotions that drive addictive behavior. This module helps clients identify their emotions, understand the reasons for their emotions, manage and decrease negative moods, and build positive experiences that counteract chronic negative feelings.
Interpersonal Effectiveness Interpersonal effectiveness skills help improve the relationship difficulties that both contribute to addiction and hinder recovery. The skills clients learn in this module will help them ask for what they want, set and maintain boundaries, resolve conflicts, and maintain their self-respect in their relationships. This will help restore relationships broken due to addiction and enable clients to build new relationships that support their recovery.
The Dialectical Principles of DBT
The DBT framework, the synthesis of acceptance and change, gives structure and purpose to the recovery process. By integrating both acceptance and change into therapy, clinicians validate clients’ emotions and the reasons for their actions while at the same time insisting that they must and can change. This balance helps maintain the therapeutic relationship without becoming either too enabling or too shaming, both of which tend to derail the treatment process.
Dialectical principles enable clients to develop a more flexible frame of reference about themselves and their situations. It moves them away from the black-and-white, all-or-nothing thinking associated with emotional dysregulation toward a more balanced view that incorporates both acceptance of reality and a commitment to change.[2]
The Efficacy of Dialectical Behavior Therapy
The evidence of DBT’s effectiveness spans various clinical conditions and populations. While it was originally validated by randomized controlled trials for people with borderline personality disorder, it has also been studied for a variety of addiction issues.
Research has shown that DBT is an effective treatment modality for those suffering from substance use disorders, particularly those with conditions related to emotion regulation, with clients showing a reduction in drug use, greater improvement in emotional regulation, and better treatment retention [3].
DBT has also demonstrated a high level of efficacy for the treatment of co-occurring disorders that frequently occur with substance use disorder and greatly complicate the treatment process.[4] Studies have shown DBT to be successful with PTSD, eating disorders, mood disorders, OCD, and ADHD.
DBT is a well-established, evidence-based treatment for borderline personality disorder and is widely used in clinical settings for individuals with complex and co-occurring conditions.[5]
What to Expect From DBT
Clients receiving DBT therapy can expect a structured, skills-based treatment that is significantly different from traditional open-ended talk therapy.
The therapeutic process includes:
- One-on-one sessions with a clinician trained in DBT, focusing on diary card completion, identifying target behaviors, applying DBT skills to real-life situations, and moving through the DBT treatment hierarchy.
- Structured group sessions focused on the four skill modules in sequence, with clinicians teaching and practicing specific skills with group members each week
- Each client completes a diary card to document feelings and urges to use substances, along with documenting skills used, to share during the following week’s individual session.
- Full DBT programs use phone coaching to provide clients with access to their therapist during crisis situations, decreasing reliance on third-party crisis services by reinforcing in-the-moment use of skills.
Most clients find DBT to be demanding but purposeful. New DBT clients consistently report that they are able to effectively use the DBT skills taught in group sessions within 1-2 weeks of completing each week’s skills-based group.
Dialectical Behavior Therapy at All In Solutions
At All In Solutions, DBT is offered by licensed clinicians throughout all levels of care and in both group and individual settings. Each All In Solutions facility offers DBT skills groups in its programming schedule and uses a structured format that covers the four modules while allowing for real-life application of skills and appropriate troubleshooting to help clients master those skills.
DBT individual sessions are used to apply the model to each client’s specific emotional patterns, interpersonal challenges, and high-risk situations, with the treating clinician adapting the approach to the client’s unique needs and co-occurring conditions. As part of a comprehensive treatment plan, DBT is used in conjunction with other evidence-based therapy models such as CBT and EMDR, as determined by the clinical treatment team. The clinical teams at each facility coordinate their work together to ensure that the skills developed in DBT support and enhance all aspects of each client’s treatment plan.
