What Is Dialectical Behavior Therapy (DBT) In Addiction Treatment?

Last Updated: July 6, 2020

Authored by Dr. Ahmed Zayed

Reviewed by Michael Espelin APRN

Dialectical behavior therapy (DBT) is based on principles rooted in psychotherapy. Derived from CBT techniques, DBT teaches skills to cope with cravings and manage strong emotions. For this reason, dialectical therapy is extremely effective in treating disorders such as addiction. DBT therapy techniques are practiced in a number of settings, including schools, hospitals, community treatment centers, and outpatient and inpatient mental health programs.
Dialectical therapy was initially developed to help people with borderline personality disorder and chronic suicidal ideation. However, DBT therapy was found to be effective in treating a number of other mental health problems. DBT for substance abuse is a well-established comprehensive treatment that is designed to encourage abstinence and reduce relapses. Several randomized clinical trials have shown that dialectic behavior therapy is effective in decreasing substance abuse.

What is DBT Therapy?

How to define dialectical behavior therapy? It is a type of psychotherapy that was modified and adapted from cognitive-behavioral therapy (CBT). Dialectical behavior therapy was developed by well-known psychologist Marsha M. Linehan in the 1980s and 1990s to treat people with borderline personality disorder. Dr. Linehan expanded upon the principles of CBT and added dialectics and acceptance to the original framework.

 DBT therapist writing in his notebook

What Kind Of Addictions Can Be Treated With DBT?

DBT techniques have proven to be effective in treating a number of mental health issues, including bipolar disorder, anxiety and depression, post-traumatic stress disorder (PTSD), eating disorders, and substance abuse. Addictions treated with dialectical behavior therapy include:

  • Alcohol
  • Tobacco
  • Opiates
  • Prescription pain medicines
  • Methamphetamines
  • Marijuana
  • Antidepressants
  • Cocaine
  • LSD

The word dialectical is a philosophical term which means two opposite things can be true at the same time. Based on this principle, DBT therapy encourages recovering addicts to balance two opposing goals – acceptance and change:

  • Acceptance refers to doing one’s best and accepting life as it is.
  • Change refers to working harder, being motivated, and altering behaviors to change one’s life.

What Happens During DBT Session?

On DBT therapy sessions, validation is used to help a recovering addict understand why they act in a particular way.

The fundamental idea is to help an individual understand three key notions:

  • Emotions, thoughts, and behaviors are all connected
  • Change is constant
  • Acceptance and change are opposites and can be balanced

DBT psychologist meeting patients at group therapy

What is dialectical behavior therapy? DBT is not a suicide prevention program. It does not prevent behaviors that bother other people.

DBT vs. CBT: Know The Differences Between DBT and CBT

DBT treatment and CBT share many beliefs and views. In fact, dialectical behavior therapy is an expansion of the basic principles of CBT. Both DBT vs. CBT relies on the underlying assumption that persistent mental health problems, such as addiction, are the result of two factors: emotional vulnerability and an invalidating environment. CBT emphasizes on change, whereas DBT includes validation in the process. Validation offers a recovering addict an understanding of why they act in a particular way.

Does Dialectical Behavior Therapy Work For Addiction Ttreatment?

Does DBT therapy show any results for addiction treatment? People with addictions are emotionally vulnerable due to past traumatic events or natural predisposition. This emotional vulnerability makes them react quickly and strongly to situations. When the environment is non-validating, the resultant feelings are perceived as wrong. DBT introduces optimism, which is lacking in CBT. The ideas conveyed during dialectical behavioral therapy are:

  • As a recovering addict, patients are doing their best, given the current circumstances
  • There is a desire to improve
  • New behaviors can bring about change
  • The addiction is not the personal fault, but it is patients duty to try and overcome it

Group DBT therapy session

CBT has higher dropout rates (patients discontinue treatment before it is completed). This is because CBT offers limited flexibility in allowing a recovering addict to come to terms with harmful behaviors. Also, CBT focuses on individual therapy, whereas dialectical behavior therapy is more comprehensive and includes group sessions, phone therapy, and consultation teams.

DBT for Substance Abuse: Is Dialectical Therapy More Effective?

Dialectical behavior therapy has been studied for several different clinical problems. All the psychological issues treated with DBT have one thing in common – they are the result of an individual’s inability to regulate emotions. Who can benefit from dialectical behavior therapy? DBT therapy works well for emotionally volatile people; for example, those who are easily disappointed, cry at the movies or frequently feel out of place. So, is DBT for substance abuse more effective than CBT? For substance abusers, life can feel like an emotional roller coaster. This is why dialectical therapy is so effective in addiction treatment.
Dialectical behavior therapy helps to:

  • Decrease the use of illicit substances
  • support abstinence
  • reduce withdrawal symptoms
  • diminish temptations and cravings
  • avoid situations that trigger abuse
  • improve support within the community
  • encourage positive and healthy vocational and recreational activities.

Dialectical Behavioral Therapy (DBT): Skills and Goals

Behaviors can be reinforced and rewarded. Reinforcers are things that increase the likelihood of a behavior occurring again. For example, if a dog gets a treat for sitting down, the treat is the reinforcer. DBT treatment harnesses the power of reinforcers and behavior change to move a recovering addict closer to their goals.  Dialectical behavior therapy specialist works to establish target behaviors – actions that an addict wants to increase or decrease. For example, someone with a substance abuse problem may have an initial target of reducing thoughts about using drugs or alcohol.

DBT Therapist listening to his patient's confession

Other goals of dialectical behavior therapy include:

  • Reducing dangerous and reckless behaviors, increasing positive emotions, and learning to manage stress
  • Fully experiencing feelings and avoiding escapism from strong emotions
  • Building healthy relationships and working on life goals
  • Moving towards a happy future by feeling complete and connected

DBT Therapy Techniques: An Overview

Dialectical behavior therapy techniques are research-backed and include four modes of treatment:

Structured Individual Therapy

The focus is on the individual’s past and present behavior and dialectics (balance of acceptance and change). Recovering addicts are asked to track their emotions and behaviors outside sessions. The focus is on dealing with everyday challenges such as avoiding drug-seeking behavior. Addicts are taught to stay motivated and apply the skills to practical daily life. DBT drug addiction counseling sessions are usually weekly and last for an hour. Family therapy may be included as part of the program.

Weekly Group Meetings

DBT meetings are about 2 to 2.5 hours in duration and are usually conducted for 24 weeks. The focus is on a different behavioral skill each week. Skills include changing negative behaviors, coping with stress, managing emotions, and developing healthy relationships. Teens and young adults attend sessions with family members so they can learn the same life skills.

Dialectical Behavior Group Therapy

Skills Coaching

Recovering addicts have 24-hour live phone access to the therapist to help with coping skills and target behaviors. The DBT therapist acts as a personal coach to change the addict’s reaction at stressful times. If a recovering addict is in dire need of help, they can call the therapist outside of regular session hours. Unlike a sober coach, DBT therapist does not tell the addict what to do. Rather, they guide the addict on the options and aid in decision-making.

Consultation Team

Many DBT therapists work in collaboration to ensure the recovering addict receives the best treatment possible. Changing life-threatening behaviors is a stressful process. Teamwork ensures that therapists can discuss their client’s progress and remain competent to treat serious disorders such as substance abuse. This support ensures the patient receives high-quality care.

DBT Treatment: Finding Therapy That Works

DBT therapists have a lot of specialized training and follow a number of guidelines that are different from other psychotherapies. A good DBT therapist understands where the recovering addict is coming from while also pushing them to make the changes that will make their life better. The relationship between a DBT therapist and a recovering addict is one of the equals. Both work in collaboration to achieve the client’s goals.

Addict having DBT therapy session

How To Choose A Good Dialectical Behavior Therapy Specialist?

A recovering addict should ensure the addiction therapist has a master’s or doctoral degree from an accredited university and specialized training in dialectical behavior treatment. Most states require therapists to pass licensure examinations, and the degree is typically displayed in the counselor’s office. Recovering addicts may also inquire about the number of years a therapist has practiced dialectical behavior therapy as an indication of their experience.

Page Sources

  1. Linda A. Dimeff, Marsha M. Linehan, Dialectical Behavior Therapy for Substance Abusers, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797106/
  2. Dialectical Behavior Therapy for Treatment of Borderline Personality Disorder: Implications for the Treatment of Substance Abuse, http://citeseerx.ist.psu.edu/viewdoc/download?doi=
  3. Eric Spagenski, DBT for Co-Occurring Mental Health & Substance Use Disorders, https://sophia.stkate.edu/cgi/viewcontent.cgi?article=1678&context=msw_papers

Published on: April 18th, 2018

Updated on: July 6th, 2020

About Author

Dr. Ahmed Zayed

Dr. Ahmed Zayed is a Bachelor of Medicine and Surgery. He is graduated from the University of Alexandria, Egypt. Dr. Ahmed Zayed has a passion for writing medical and health care articles and focuses on providing engaging and trustworthy information to readers.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.


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