Table of Contents
- What is Dialectic Behavior Therapy (DBT)?
- How DBT Helps Treat Substance Use Disorders
- What Types of Addiction Can DBT Treat?
- Core Principles of DBT for Addiction Recovery
- DBT Skills Taught in Addiction Treatment
- DBT Skills Used in Addiction Recovery
- What Happens During DBT for Substance Use Treatment?
- Benefits of DBT for Addiction Recovery
- DBT Compared to Other Addiction Treatments
- How Long Is DBT for Substance Use Treatment?
- The House Of Life: Start Recovery with DBT for Substance Use
- Reference Sources:
Drug and alcohol use is rarely about the substance itself. For most people, drugs and alcohol become a way to cope with feelings and emotions that can feel too intense, painful, confusing, or overwhelming to handle alone. Someone may drink to calm anxiety, use opioids to numb grief, use stimulants to minimize depression or shame, or relapse during a conflict because they don’t have the tools to manage what they are feeling.
This is where DBT for substance use can be especially helpful. Dialectical Behavior Therapy, often referred to as DBT, is a structured form of therapy that teaches people how to better manage emotions, tolerate distress, improve their relationships, and make healthier choices when life feels unmanageable. DBT was originally developed by psychologist Dr. Marsha Linehan for people struggling with severe emotional dysregulation and chronic suicidal behaviors, and it has since been adapted for use with people struggling with substance use, relapse patterns, impulsivity, self-destructive behaviors, and co-occurring mental health conditions. Research has found that DBT adapted for substance use can help reduce substance use behaviors, improve emotional regulation, and support treatment engagement.
What is Dialectic Behavior Therapy (DBT)?
Dialectic Behavior Therapy is an evidence-based therapy that combines cognitive behavioral strategies with mindfulness, acceptance, emotional regulation, distress tolerance, and interpersonal effectiveness skills.
The word “dialectical” means that two opposing things can be true at once. In DBT the two truths are usually acceptance and change. A person can accept their current circumstances while also working towards meaningful change. Creating this balance is powerful in addiction treatment because many people entering recovery are carrying with them shame, guilt, fear, and self-criticism. DBT helps clients realize that they do not need to hate themselves into recovery. It allows clients to take accountability while also practicing compassion towards themselves.
DBT treatment often includes individual therapy, skills groups, mindfulness practice, relapse prevention planning, behavioral coaching, and practical homework assignments. In addition to talking about the problem, clients learn skills they can later use in real-world situations—during cravings, conflict, anxiety, anger, grief, loneliness, or moments of emotional overwhelm.
How DBT Helps Treat Substance Use Disorders
Addiction often develops as a means to escape emotional pain. While substance use may provide temporary relief, it usually creates lasting consequences: damaged relationships, health problems, legal issues, financial stress, guilt, shame, isolation, and worsening mental health symptoms.
DBT for addiction helps the clients slow down the cycle between emotion, urge, and action. An example of this would be when a person feels rejected and immediately goes to get drunk to deal with the rejection; instead, a client can learn to identify the emotion they are feeling, pause, use grounding skills, tolerate the discomfort, and choose a recovery-supportive response like going to an AA meeting or calling their sponsor.
DBT helps clients learn how to:
- Identify their emotional triggers before they escalate
- Manage cravings without acting on them
- Reduce impulsive reactions
- Cope with distress without the need for substances
- Communicate their needs more clearly
- Set healthier boundaries
- Repair relationship patterns
- Build a relapse prevention plan grounded in self-awareness
This can be especially beneficial for clients who are receiving dual diagnosis treatment, since substance use frequently overlaps with other mental health conditions such as depression, anxiety, trauma, PSD, bipolar disorder, and personality-related symptoms. SAMHA highlights the importance of coordinated treatment for persons with co-occuring mental health and substance use disorders.
What Types of Addiction Can DBT Treat?
Alcohol Addiction
DBT can facilitate alcohol addiction treatment by assisting the clients to understand their emotional patterns connected to their drinking behaviors. Some clients drink to manage anxiety symptoms. Others drink when they feel lonely, angry, ashamed, bored, or overwhelmed. DBT shows clients how to tolerate these feelings without the need for alcohol.
This is especially relevant in Los Angeles and California as a whole, where substance use remains a major public health concern. Los Angeles County reports that an estimated 1,482,000 residents currently struggle with substance use disorder, and California continues to track substance-related harms and overdoses through a statewide data tracking system.
Drug Addiction
DBT therapy for addiction has been shown to be effective for individuals recovering from opioid addiction, methamphetamine addiction, cocaine addiction, prescription drug misuse, benzodiazepine dependence, and cannabis use disorder. DBT does not replace medical care, medically supervised detox, residential treatment, or medication-assisted therapy when those services are needed, but it can help clients develop the emotional and behavioral skills needed to support long-term, lasting recovery.
Behavioral Addictions and Compulsive Behaviors
Because DBT focuses on emotional regulation and impulse control, it is also useful for people struggling with compulsive behaviors such as gambling, eating disorders, self-harm, compulsive sexual behaviors, and other behaviors that function as a means of escaping emotional pain.
Core Principles of DBT for Addiction Recovery
Several core principles make DBT for addiction treatment especially helpful in recovery.
Acceptance and Change
DBT teaches clients that acceptance does not mean approval or giving up. Instead, it means seeing reality clearly enough to respond in a healthy way. In addiction recovery, this may mean accepting the consequences of addiction while also believing that change is possible.
Mindfulness
Mindfulness helps the clients notice and be more aware of what is happening in the present moment without the need to react immediately. This is helpful during cravings because cravings often feel urgent, but they generally rise, peak, and pass. Mindfulness assists the clients to be able to observe the urge without becoming controlled by it.
Distress Tolerance
Distress tolerance skills allow the clients to get through painful moments without making the situation worse. In early recovery, distress tolerance can be used when someone feels triggered, anxious, rejected, or emotionally overwhelmed.
Many people struggling with addiction have difficulty naming, understanding, and/or regulating their emotions. DBT teaches clients what causes emotions and how they work, how to reduce emotional vulnerability, and how to respond to their feelings in a healthier, more productive way.
Interpersonal Effectiveness
Relationships are often most impacted by addiction. DBT allows clients to practice assertive communication, boundary setting, self-respect, and conflict resolution.
DBT Skills Taught in Addiction Treatment
One of the reasons DBT treatment is so effective is that it gives clients practical, real-world tools they can use outside of therapy.
Mindfulness Skills
Mindfulness skills show clients how to slow down and observe their thoughts, feelings, urges, and body sensations. Instead of reacting on impulse, clients learn to pause and respond with intention.
Examples include deep breathing, grounding exercises, body scans, meditation, and present-moment awareness.
Distress Tolerance
Distress tolerance abilities help clients through hard moments without making things worse. Distress tolerance can be employed early in recovery when someone is feeling provoked, angry, frightened, rejected or emotionally saturated.
Emotional Regulation
A lot of people who have problems with substance use have trouble identifying, interpreting, or managing their emotions. DBT teaches clients about how emotions function, how to be less vulnerable to emotions, and how to respond to feelings in healthier ways.
Interpersonal Effectiveness
Addiction can frequently harm relationships. DBT supports clients in working on assertive communication, boundary establishing, self-respect and conflict resolution.
DBT Skills Used in Addiction Recovery
One of the reasons that makes DBT treatment so practical is that it gives clients tools to utilize in real life outside of therapy.
Mindfulness Techniques
Mindfulness skills help individuals learn how to slow down and notice their thoughts, feelings, urges, and physical sensations. Clients are taught to pause and reply with intention rather than responding automatically.
Examples include deep breathing, grounding exercises, body scans, meditation and present-moment awareness.
Distress Tolerance Techniques
Distress tolerance abilities are used when emotions seem powerful and immediate. These methods are designed to assist customers get through a crisis without narcotics, self-sabotage, or acting out.
Clients acquire self-soothing methods, urge surfing, diversion, radical acceptance, and crisis survival abilities.
Regulation of Emotions
A lot of people who have problems with substance use have trouble identifying, interpreting, or managing their emotions. DBT teaches clients about how emotions function, how to be less vulnerable to emotions, and how to respond to feelings in healthier ways.
Interpersonal Effectiveness
Addiction can frequently harm relationships. DBT supports clients in working on assertive communication, boundary establishing, self-respect and conflict resolution.
What Happens During DBT for Substance Use Treatment?
One of the beauties of DBT treatment is that it provides clients with real world tools that they may utilize outside of therapy.
One-on-One Therapy Sessions
In individual sessions, clients can address relapse patterns, emotional triggers, responses to trauma, interpersonal pressures, and habits that might impede recovery. The therapist helps the client apply DBT skills to real world problems.
Skills Training Groups
DBT skills groups offer practical tools in a supportive group format. Clients may learn to exercise mindfulness, role-play boundary setting, address cravings, identify triggers and learn from peers.
Homework and Practice
Skills improve with repetition therefore DBT often involves practice assignments. They might engage in journaling activities, emotion logs, mindfulness practice, relapse prevention workbooks, or behavior tracking.
Benefits of DBT for Addiction Recovery
DBT for substance use has a number of recovery benefits:
- More efficient emotion management
- More control over impulses
- Less guilt, less self-destructive thoughts
- Better relapse prevention skills
- Improved communication
- Better restrictions
- Increased tolerance to cravings and distress
- Greater self-knowledge
- Better engagement with treatment
NIDA says addiction behavioral therapy can assist clients:
- Strengthen motivation
- Develop ability to resist substance use
- Substitute substance use with healthier activities
- Improve problem solving
- Support better interpersonal functioning
DBT Compared to Other Addiction Treatments
DBT is commonly used alongside other evidence-based therapies rather than instead of them.
DBT vs. CBT
Cognitive Behavioral Therapy, or CBT, is a form of therapy that focuses on identifying and modifying harmful ideas and behaviors. There is significant evidence that CBT is effective for substance use disorders.
DBT borrows many ideas from CBT but places more focus on mindfulness, acceptance, emotion regulation, and distress tolerance.
DBT vs. Motivational Enhancement Therapy
Motivational enhancement therapy is designed to increase the person’s own motivation to change. SAMHSA characterizes motivation-enhancing approaches as techniques that help increase involvement and retention in substance use treatment.
DBT focuses less on moving people toward change, and more on helping them regulate emotions and behaviors as they move toward change. These approaches might be quite compatible with each other.
DBT vs. Traditional Talk Therapy
Traditional talk therapy could assist people develop understanding, process emotions and explore prior experiences. DBT also promotes insight, although it is more structured and skills-based. This can be particularly useful for individuals who require practical skills for addictions, conflict, impulsivity and emotional stress.
How Long Is DBT for Substance Use Treatment?
Some clients are offered DBT-informed treatment during detox or residential treatment, and others may continue on with DBT for several months in PHP, IOP, outpatient therapy, or ongoing aftercare.
How long it takes will depend on the severity of the addiction, the history of relapses, co-occurring mental health symptoms, emotional regulation needs, and treatment goals. Since DBT skills are abilities that need to be practiced, many clients continue to use DBT techniques well after formal therapy is over.
The House Of Life: Start Recovery with DBT for Substance Use
At The House of Life, we know addiction rehabilitation is more than merely abstaining from substance use. It’s about learning how to live differently, cope differently, communicate differently, and respond to grief without falling back into damaging patterns – and that’s exactly the approach we take as our luxury rehab in Los Angeles.
We offer evidence-based therapies in our therapeutic program, including DBT for substance use, CBT, trauma-informed care, and motivational approaches. Individualized treatment planning and compassionate support help clients develop practical methods for regulating emotions, minimizing the risk of relapse, enhancing relationships, and building a stronger foundation for long-term recovery.
DBT for Substance Use FAQs
Does DBT Help With Substance Abuse?
CBT vs. DBT: Which Is Better for Substance Abuse?
Who Should Not Take DBT?
What Is the 24 Hour Rule in DBT?
Reference Sources:
- Dimeff, L. A., & Linehan, M. M. “Dialectical Behavior Therapy for Substance Abusers.” Addiction Science & Clinical Practice. https://pmc.ncbi.nlm.nih.gov/articles/PMC2797106/
- SAMHSA. “Substance Use Disorder Treatment for People with Co-Occurring Disorders.” https://library.samhsa.gov/sites/default/files/pep20-06-04-006.pdf
- National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide. https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf
- SAMHSA. TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment. https://library.samhsa.gov/sites/default/files/tip-35-pep19-02-01-003.pdf
- California Department of Public Health. Substance and Addiction Prevention Branch Data Products. https://www.cdph.ca.gov/Programs/CCDPHP/sapb/Pages/Data.aspx
- Los Angeles County Department of Public Health / Recover LA. “Substance Use in Los Angeles County.” https://www.recoverla.org/sud_101/substance-use-in-la-county/
- McHugh, R. K., Hearon, B. A., & Otto, M. W. “Cognitive Behavioral Therapy for Substance Use Disorders.” https://pmc.ncbi.nlm.nih.gov/articles/PMC2897895/
