DBT Interpersonal Effectiveness Skills for Substance Abuse
Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future. Updates about mental health topics, including NIMH news, upcoming events, mental disorders, funding opportunities, and research. Read here for part 2 of this series, in which we will review how special treatment strategies are utilized by the DBT-SUD therapist to enhance the effectiveness of the treatment for co-occurring disorders.
Applying DBT to Related Conditions
Symptoms of substance abuse reflect the external consequences of problematic use such as failure to fulfill role obligations, legal problems, physically hazardous use, and interpersonal difficulty resulting from use. Symptoms of substance dependence reflect more internal consequences of use such as physical withdrawal upon discontinuation of a substance and difficulty with cutting down or controlling use of a substance. For example, some people attend one-on-one therapy sessions without participating in weekly skills groups.
Research Conducted at NIMH (Intramural Research Program)
Petry and Martin [15] examined the addition of CM to standard community based treatment (methadone maintenance and monthly individual counseling) for cocaine and opioid dependent patients. A couple of studies have examined DBT for women with BPD in community settings, such as a community mental health center and a VA hospital. In a community mental health setting, Turner6 compared a modified version of DBT that only included individual therapy to a client-centered therapy control condition. Patients in the DBT condition had greater https://sober-home.org/9-healthy-things-that-happen-to-your-body-when-you/ reductions in suicide attempts, deliberate self-harm, inpatient days, suicidal ideation, impulsivity, anger, and global mental health problems. In addition, a study of women veterans with BPD found that DBT patients had greater reductions in suicidal ideation, hopelessness, depression, and anger experienced than did TAU patients.7 Follow-up data for these two studies are not available. Dialectical behavior therapy (DBT)1 evolved from Marsha Linehan’s efforts to create a treatment for multiproblematic, suicidal women.
Effectiveness of DBT for Addiction Treatment
Additionally, some research has examined DBT-oriented treatments for other clinical problems, including eating disorders and depression in elderly patients. Telch and colleagues13 compared a 20-week DBT-based skills training group to a wait list control condition for women with binge-eating disorder and found that DBT patients had greater improvements drug withdrawal symptoms treatment and management in bingeing, body image, eating concerns, and anger. Although 86 percent of DBT participants had stopped bingeing by the end of treatment, this number declined to 56 percent during the six-month follow-up period. A second study compared a modified version of individual DBT that included skills training to a wait list condition.
This chapter explains the adaptation of DBT by Linehan and collaborators for the comorbidity of substance use and borderline personality disorder (titled DBT-SUD). We present the central principles of DBT and detail the elements that constitute DBT-SUD, both from the perspective of theory (biosocial model) and clinical practice (treatment stages, intervention techniques, and specific strategies for addictive behaviors). Dialectical behavior therapy is part of what is known as the third wave of psychological treatments, following behavioral therapies (1st wave) and cognitive behavioral therapy (2nd wave). Other third-wave therapies include acceptance and commitment therapy, and mindfulness-based cognitive therapy. Though none of these third-wave treatments were originally developed to address addiction, they are increasingly being used in their treatment or adapted for the treatment of substance use disorder. For instance, mindfulness-based cognitive therapy was adapted into mindfulness-based relapse prevention.
What Should You Expect During Dialectical Behavior Therapy?
Furthermore, it underscores the necessity of validation in therapy, explaining its role in developing a harmonized perspective that seamlessly integrates cognitive rationales with emotional acknowledgments. One outcome of the Blending Initiative was the inception of the Clinical Trials Network (CTN), a 17 site regional research and training center which collaborates with many community treatment programs to study the effectiveness of specific interventions in diverse community settings and patient populations. Other efforts to increase access to CBT and other evidence-based treatments for SUDs are also underway.[75-77] Future research focusing on methods to bridge the gap between theory and practice in a way that supports community clinicians so that systemic change can truly be effective is of particular importance.
As implied above, CBT for substance use disorders varies according to the particular protocol used and—given the variability in the nature and effects of different psychoactive substances—substance targeted. Consistent across interventions is the use of learning-based approaches to target maladaptive behavioral patterns, motivational and cognitive barriers to change, and skills deficits. For example, in a large effectiveness trial of motivational enhancement therapy for Spanish-speaking patients seeking treatment for substance use, Carroll et al [50] found small advantages for this treatment relative to TAU only among those in the sample seeking treatment for alcohol problems.
- A patient with co-occurring panic disorder and alcohol dependence may be experiencing cycles of withdrawal, alcohol use, and panic symptoms that serve as a barrier to both reduction of alcohol consumption and amelioration of panic symptoms.
- There also are some promising data on DBT for women with BPD who struggle with substance use problems.
- DBT can teach communication skills, coping techniques, self-confidence and other qualities important to overcoming drug addiction.
- That SUD and BPD should frequently co-occur stands to reason, because substance abuse is one of the potentially self-damaging impulsive behaviors that constitute diagnostic criteria for the personality disorder.
DBT was originally developed to treat borderline personality disorder (BPD) and for people with suicidal thoughts or engaging in self-harm behaviors. In all, it takes around six months to complete the skills training modules following the standard DBT schedule. The modules are often repeated, however, meaning that many people spend a year or longer in a DBT program. Dialectical behavior therapy is used to treat several mental illnesses in addition to substance abuse and addiction. DBT can help individuals to recognize intense emotions, how to accept some of them as a part of life, and how to change ones that lead to negative actions. Through DBT, individuals learn how to accept themselves for who they are and develop tools for dealing with difficult emotions and managing stress.
A person’s self-image is assessed and improved upon through a working therapeutic relationship between the therapist and individual. Clients are encouraged to understand that their thoughts and feelings are valid, to accept themselves as worthwhile, and to find the motivation to modify negative thoughts and behaviors. Emotional pain is part of life, and individuals are taught through DBT to accept this and learn how to work through it.
Three RCTs supported DBT-SUD for reducing substance use relative to treatment as usual (TAU; Linehan et al., 1999) or for reducing use over time in a way that was comparable to somewhat stronger than comparison manualized SUD treatments (Linehan et al., 2002; Linehan et al., 2009). Two RCTs found that standard DBT without SUD modifications outperformed TAU and treatment by experts in substance use outcomes (Harned et al., 2008; van den Bosch et al., 2002). Harned and colleagues (2008) found that 87.5% of those with substance dependence who received DBT achieved full remission for at least 4 weeks, as compared to only 33.3% of those who received comparison treatment by experts. DBT-SUD findings were recently generalized in three important ways within a large pre-post effectiveness trial of primary SUD (i.e., no BPD inclusion criterion), Native-American clients, and adolescents (Beckstead et al., 2015). In studies published between 1986 and 1997, reported rates of borderline personality disorder (BPD) among patients seeking treatment for substance use disorders (SUDs) ranged widely, from 5 to 65 percent (Trull et al., 2000). More recently, Darke and colleagues (2004) documented a 42 percent prevalence of BPD among 615 heroin abusers in Sydney, Australia.
This group is often a step-down for youth and caregivers completing the Adolescent DBT IOP track, though patients may be admitted to this group directly, depending on needs. People who may benefit from DBT include those struggling with emotional regulation, self-destructive behaviors, and interpersonal alcohol withdrawal difficulties, and those who have not found success with other therapeutic approaches. To clarify key terms used in this manuscript, the term substance use is defined as taking any illicit psychoactive substance or improper use Pof any prescribed or over the counter medication.
Dialectical behavioral therapy is a type of therapy that was developed by Dr. Marsha Linehan in the 1980’s. The conceptual basis of DBT is inconsistent with making the benefits of treatment (e.g., receipt of prescribed anti-craving medications, attendance at sessions, continued participation in treatment) contingent on abstinence. Rather than punishing patients for the very problems that brought them into treatment, DBT assumes that patients are doing the best they can and must continue working to achieve their goals.
On the one hand, the most conservative clinical choice would be to limit DBT to women with BPD. On the other hand, DBT is a comprehensive treatment that includes elements of several evidence-based, cognitive-behavioral interventions for other clinical problems. As such, DBT often is applied in clinical settings to multiproblematic patients in general, including those patients who have comorbid Axis I and II disorders, and/or who are suicidal or self-injurious; however, caution is important in applying a treatment beyond the patients with whom it has been evaluated in the research.
