The complex challenge of substance use disorders (SUD) is a challenging mental health issues affecting millions of lives globally. These conditions lead to significant emotional, physical, and social consequences. Among the promising treatment options, DBT for treating substance use disorders has emerged as a powerful approach. Though initially created by Dr. Marsha Linehan to treat borderline personality disorder (BPD), has been successfully adapted to address addiction and substance use challenges. This article delves into how DBT’s unique strategies and methods offer effective pathways for treating substance use disorders and addiction.
Overview of Substance Use and Addiction
According to Various reports, substance use and addiction is a growing concern in India. About 160 million people consume alcohol in the country; and over 57 million individuals are affected by harmful or dependent alcohol consumption. What is perhaps more alarming is how 15 million children between the aged 10-17 are addicted to substance use with alcohol being the most prevalent followed by cannabis and opioid use.
Substance use disorders (SUD) and addiction affect various aspects of an individual’s life, disrupting both emotional and physical health. Addiction often begins with voluntary substance use, but over time, changes in brain function make it more challenging to stop, leading to chronic compulsive use. Substances such as alcohol, opioids, and stimulants can cause profound neurological effects that hijack the brain’s reward systems, making recovery a complex journey that typically requires structured therapeutic support.
Addiction is not solely a physical condition but is also deeply tied to psychological processes, including how individuals manage emotions, stress, and interpersonal relationships. The complexity of SUD requires multifaceted treatment approaches, like DBT, which target the underlying emotional dysregulation and behaviors that contribute to substance abuse.
How it Starts
Substance use disorders (SUD) and addiction have a range of underlying causes, including:
- Genetics: Studies suggest that genetics play a significant role in making individuals more susceptible to addiction.
- Mental Health Conditions: People with mental health disorders like depression, anxiety, or PTSD are at a higher risk to develop substance use disorders.
- Coping Mechanisms: For some, substance use starts as a way to manage stress, trauma, or emotional pain
- Peer Influence: Social environments and peer pressure, particularly during adolescence, can significantly influence substance use.
- Early Exposure: Individuals who exposed to drugs or alcohol at a young age are at a greater risk of addiction later in life.
- Trauma and Stress: Individuals who experience trauma, such as physical abuse, neglect, or significant loss, are at increased risk of turning to substances as a form of escape or relief.
- Tolerance and Dependence: As individuals continue using substances, their bodies build tolerance, meaning they need higher doses to achieve the same effects. This is especially in the cases of insomnia, stress relief and pain.
- Impulsivity and Risk-Taking: Certain personality traits, such as impulsivity or a tendency to seek novel experiences, are associated with a higher likelihood of substance experimentation and use.
How Substance Use and Addiction Impact Life
Substance use and addiction have far-reaching effects on an individual’s health and quality of life. Physically, addiction can result in overdose, chronic diseases, and organ damage. On an emotional level, it can lead to depression, anxiety, and feelings of isolation. Socially, addiction may destroy relationships and affect work performance. Moreover, individuals with addiction often experience legal and financial problems, exacerbating the stress and emotional burden that further perpetuate their substance use.
Various Substance Use Disorders
SUD manifests in different forms each carrying its own risk. These include:
- Alcohol abuse
- Opioid use disorder
- Stimulant abuse
- Cannabis use
- Medication abuse
While some individuals may engage in polysubstance use, making treatment more complex, DBT’s comprehensive framework addresses the wide range of behaviors associated with these disorders.
Overview of DBT
Dialectical Behavior Therapy is a cognitive-behavioral treatment that focuses on four key modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Initially developed to treat suicidal behavior in individuals with (borderline personality disorder) BPD, DBT has since been adapted to address a variety of mental health issues, including SUD and addiction. DBT’s unique blend of acceptance and change strategies makes it highly effective in treating disorders characterized by emotional dysregulation, including addiction.
How DBT Helps Substance Use and Addiction
DBT with its structured approach focusing on acceptance, mindfulness, and change helps individuals accept their current situation encouraging them to change maladaptive behaviors. Highly efficient with SUD, the various principles of DBT such as mindfulness, distress tolerance, and emotional regulation, directly combat the impulsivity and emotional triggers that drive substance use.
In treating addiction, DBT emphasizes dialectical abstinence, which combines abstinence-based treatment with harm reduction strategies. This approach helps individuals stay committed while preparing for the possibility of relapses. DBT also reinforces positive perception and self-esteem to reduce the shame and emotional fallout which usually leads to further substance use after a relapse.
DBT for Treating Substance Use Disorders
When discussing the dialectics of SUD, a common situation is the conflict of mind in individuals involving justification of substance use and its benefits against a cleaner mindset that pushes away from the consequences of usage. Without help, the clean mind might just act too harshly against the addict mind creating unmanageable abstinence paving the way for relapse. This is where DBT can help.
The core of DBT lies in the concept of dialectics—the balancing of opposites. In the case of SUD treatment, this involves balancing the goal of complete abstinence with the understanding that lapses can occur. DBT introduces the concept of clear mind, which helps clients find a balance between “addict mind” (where addiction dominates) and “clean mind” (where individuals feel invulnerable to relapse). By preparing clients to navigate between these two extremes, DBT helps them remain focused on long-term commitment while managing the setbacks they may encounter along the way.
Benefits of DBT in SUD and Addiction Treatment
DBT helps SUD and addiction in several ways to help individuals manage the emotional triggers that often precede substance use. DBT’s core skills help in the following ways:
- Mindfulness: Allows individuals to remain present and better manage cravings
- Emotional Regulation: ER techniques help them cope with negative emotions in healthier ways, reducing the reliance on substances as an escape.
- Distress Tolerance: Skills taught in DBT are particularly useful during the early stages of recovery helping individuals tolerate the discomfort associated with withdrawal and sobriety.
- Interpersonal Effectiveness: Improves communication and relationship essential for building a supportive network, a critical component of successful recovery.
Another major benefit is DBT’s structure and its use of both individual therapy and skills training groups, providing individuals with a support network that fosters accountability and community reinforcement. DBT also emphasizes validation, encouraging individuals to accept their struggles while working toward positive change.
Effectiveness of DBT for Addiction Treatment
Research has shown that DBT is effective in reducing substance use and promoting long-term sobriety, especially in individuals with co-occurring BPD. Several randomized controlled trials (RCTs) have supported the efficacy of DBT for reducing substance use compared to treatment-as-usual (TAU) or other manualized SUD treatments. DBT teaches addiction afflicted individuals to:
- Identify emotions.
- Recognize obstacles
- Reduce vulnerability to emotional Conflict.
- Increase positivity.
- Change destructive behaviors.
- Practice distress tolerance techniques
- Increase self confidence
- Improve interaction with people
DBT has also been shown to reduce suicidal behavior, another critical factor in individuals with severe SUD. The skills learned through DBT not only help individuals manage their substance use but also improve their overall emotional stability and well-being.
Various DBT Approaches to Addiction and SUD
DBT for SUD integrates several specific strategies that address the challenges of addiction. One key approach
Dialectical abstinence: This combines abstinence-based treatment with harm-reduction techniques. This helps clients commit to sobriety while preparing for lapses, reducing the emotional dysregulation that often follows a relapse.
Alternate Rebellion: Helps individuals develop skillful non-destructive ways to rebel against society without turning to substance abuse. This is especially helpful for addicts trying to be unique or different.
EG: Instead of addiction as rebellion, you could dye your hair blue, wear a weird jacket or place a standout contradictory bumper sticker on your car
Burning bridges and building new ones: This involves cutting ties with individuals and environments that promote substance use and establishing healthier, supportive relationships.
Community reinforcement: Encourages individuals to reshape their environment to support sobriety,
Adaptive denial: Helps them resist cravings by reframing thoughts around their addiction.
Action Item: Angela is craving a drink. Instead of denying it outright, she tells herself, she is craving for a soft drink or a glass of mineral water or a walk. Angela’s turns self-deception into an asset.
DBT also emphasizes the importance of ancillary treatments, such as medication-assisted treatment (MAT) for opioid use disorders and participation in 12-step programs, to complement the therapeutic process.
Conclusion
Dialectical Behavior Therapy provides a comprehensive and effective approach to treating substance use disorders and addiction. Its integration of acceptance and change strategies, combined with its specific focus on emotional regulation and mindfulness, make it uniquely suited to addressing the complexities of addiction. By helping individuals navigate the dialectic between abstinence and relapse, DBT equips them with the tools needed for long-term recovery.
