Dialectical Behavioral Therapy for Addiction Treatment

Dialectical Behavioral Therapy

Managing thoughts and feelings when facing an active addiction or during rehab treatment can be very difficult for some individuals. While all types of addiction therapy are considered beneficial during rehab, dialectical behavioral therapy is designed for especially tough cases. Dialectical behavioral therapy (DBT) at drug and alcohol rehab contributes to developing a healthy mindset, and can even be lifesaving. 

The change necessary to establish and maintain sobriety can feel very sudden. Replacing addictive thoughts and actions that contribute to substance abuse, will often require several major alterations. Each person may react differently to receiving treatment, even sometimes behaving aggressively. 

This is particularly true for those who have been bound to addiction for long periods. Addiction takes time to develop, and adjusting to proper treatment, requires patience and understanding while remaining persistent. By opting into dialectical behavioral therapy, designed to assist addicts through tough times, you are adding immeasurable value to rehabilitation. Consequently, DBT reduces the risk of relapse after addiction care is completed.  

Dialectical Behavioral Therapy to Reinforce Rehab

Many recovering addicts experience uncomfortable thoughts and temptations, throughout the process of detox and beginning treatment. For some, the reaction to standard therapies and treatment sessions leads to increased stress until the adjustment has been made. DBT programs can intervene to address these feelings, to avoid potentially life-threatening hazards. 

The need for dialectical behavioral therapy can arise at any point during the recovery process. However, often this therapy is utilized if someone begins to show aggression, associated with emotional negativity, self-harm, or suicide. Circumstances can also include mental illness or addiction-related trauma. There can be many reasons as to why individuals suffer from such a response. 

Disconnecting the emotions and actions that led to the development of addiction typically requires changing one’s entire routine. The conflict of wants versus urges can make focusing on sobriety difficult. This is why DBT is a very necessary option to have as part of a rehab treatment plan for addiction.

Dialectical Behavioral Therapy and Dual Diagnosis

The necessary but strict requirements, that must be met to achieve sobriety, affect each person differently. For some, it is a welcoming process. For others, especially those that are suffering from a psychological illness along with an addiction disorder, this can be complex. 

Dual Diagnosis in the rehab setting is not uncommon. After establishing that a person has both a substance use disorder and a psychological illness co-occurring, treatment is adjusted. In severe cases, the response to classic treatment and therapy can inspire opposite reactions than desired. DBT has become an attractive alternative in these cases, showing significant rates of successful outcomes. 

To manage the pressure of relinquishing unorthodox means of self-medication, some may entertain the desire to relapse. Especially patients suffering from severe cases of personality disorders or depression, dialectical behavioral therapy can be applied within treatment immediately. DBT is occasionally applied as the primary course of treatment administered, radically reducing the risk of suicide. 

DBT Treatment Proven Beneficial for Psychological Disorders

Dialectical behavioral therapy, having such high rates of effectiveness, can be used to treat a host of psychological illnesses. Therapy requires that an addict delves deep into the root causes of their substance abuse. In doing so, additional assessments can be performed regarding mental health. This can lead to the discovery of mental illness that the addict was essentially unaware of. 

Some psychological illnesses that are treatable using dialectical behavioral therapy include:

  • Depression
  • Substance use disorders (that may be co-occurring)
  • Anxiety
  • Personality disorders such as Bipolar or Dissociative Identity Disorder
  • ADD, ADHD, or other attention-related disorders
  • Eating Disorders
  • PTSD
  • Obsessive-Compulsive Disorders

Because of the ability to adjust therapeutic measures to the needs of each individual, dialectical behavioral therapy is widely solicited. This includes the potential for the treatment of other stress-related illnesses, or even to assist those with a gambling addiction

Who Benefits Most From Dialectical Behavioral Therapy?

About half of those that seek substance abuse rehab are open to developing new routines that reinforce sobriety and recovery. These new habits are both physical and emotional and require practice and dedication. However the other half, after detox, can be much more reluctant and experience higher levels of stress. Dialectical behavioral therapy benefits those who may be having a particularly hard time, or begin to reject other therapy options.  

Experiencing sobriety may be a relatively new experience for those that have been suffering from addiction long-term. When the mind is left unaltered by the substances they have become dependent upon, some uncomfortable realities may be recalled. Recovering addicts who respond poorly to this realization, or are suffering from untreated psychological illnesses, experience higher risks for suicide. 

Incorporating DBT into Partial Hospitalization Rehab Programs 

Partial hospitalization programs do not require a complete stay within the facility, though, are more intensive than traditional rehab. For those that are more prone to rejecting a new approach, a more strict schedule that offers DBT is recommended. 

Partial hospitalization programs (PHP), utilizes DBT to reinforce new sober associations between one’s actions, emotions, thoughts, or attitudes during rehab. PHP allows for the time to disassociate any negative connotation to therapeutic assistance, and address aggressiveness during dialectical behavioral therapy. 

Restoring Focus on Sobriety: Dialectical Behavioral Therapy 

In an attempt to encourage a recovering addict to develop new habits, frustration may be expected along the way. While participating in intensive outpatient rehab, individuals may encounter some environmental triggers, as they work to incorporate effective coping mechanisms. The added stress upon themselves, matched with a desire to be clean and sober, can be a lot to handle. 

In some cases, the response to an uncertain internal dilemma can result in shutting down mentally and emotionally. When this occurs, dialectical behavioral therapists must contend a lack of willingness, encouraging effort to be put into the rehabilitation process. DBT is a delicate procedure, as it often requires treatment of those that tend to react with hostility toward rehabilitation.

In alternative therapies, opting for a new therapist could prolong the necessity for care. As opposed to switching, dialectical behavioral therapists strive to establish a working relationship with the individual, despite reluctance. DBT methods also drive down the number of those that give up on the program and return to active addiction. 

Understanding Why DBT Works

Dialectical behavioral therapy functions to help an individual sort through their emotions and behaviors on their rehabilitation journey. Recovering addicts are often conflicted with opposing feelings simultaneously, which if unaddressed, can lead to animosity or rejection of sobriety. 

These opposing internal positions and conflicts present in unique ways for each person. However, they typically include some combination of any of the following:

  • Desire to be free from substance abuse and addiction
  • Unwillingness to put forth effort, patience, and practice, into their rehab experience
  • Strong dislike or uncomfortability of change that prompts aggression or abuse
  • Development of apprehension, or what living sober will be like negatively
  • The fear associated with an uncomfortable or difficult detox
  • Lack of confidence in themselves to remain sober and healthy in recovery or to achieve it at all
  • Concern that being unable to self-medicate for psychological illness, such as depression or PTSD, by remaining sober will compromise their quality of life

Dialectical behavioral therapists will assess the emotional blocks that are hindering recovery efforts. Their training and experience with patients allow this to happen effectively, though it may take some time at first. By assimilating these driving concerns into a positive outlet, rehabilitation can resume simultaneously. Once hurdles are overcome, addicts recovering will be better able to face physical and emotional triggers on a united front. 

Methods Used in Dialectical Behavior Therapy

Dialectical behavioral therapists use specific and effective strategies to make strides. Because making changes to the way a person thinks, feels, and acts toward their addiction are essential, proactivity is the focus. However, to apply these methods, an addict must be aware of the need for change to occur. This process can begin during initial cognitive behavioral therapy and continue during DBT. Then dialectical behavioral therapists will approach rehabilitation using the following methods:

Work with their patients to properly categorize strengths and weaknesses. 

Guiding an addict to properly establish which attributes are beneficial and which are harmful, makes areas needing work more clear. Then, therapists and patients can work together to take a more proactive approach, harnessing the value within the stronger characteristics. 

Breaking the connection between negative thoughts that lead to addiction

The way a person thinks, or the feelings that are associated with thoughts, can have a real impact on behaviors. Breaking down the barriers between unrealistic expectations and achievable goals will lessen feelings of worry connected to presumed failure. An important step in this process, much like in cognitive behavioral therapy, is to develop a positive sense of self. Establishing self-awareness and self-confidence will greatly contribute toward moving forward and reaching new milestones in recovery. 

Developing healthy relationships in and out of therapy. 

It will be valuable to build a relationship between therapist and patient. Trust is a very important feature of the DBT program. It will also be worthy of having spent the time on relationships that will continue benefiting the individual after rehab. This may include peers, family members, other doctors, or even with themselves. During DBT they will have the opportunity to evaluate who and what is important. Then, how they can enhance their connection, and how to move past obstacles that cannot be undone or amended. 

Some areas in the life of a person in recovery will need to be left behind. This may be because they are contributing to addictive thoughts and behaviors. Or, this may be due to having sustained heavy damage to the relationship during active addiction. While it is not always easy, they must come to understand the reality of their situation. Meaning, to reconcile with the fact that the most important action to take, is to better themselves moving forward sober. 

The Objective of Dialectical Behavioral Therapy

The goal of dialectical therapy takes on more than one challenge. One is to promote a healthy lifestyle that revolves around sobriety. The other, to establish corresponding emotions about oneself, which will lead to confidence within the process. And last, how to take appropriate beneficial action, as opposed to harmful or threatening responses. 

Once DBT has begun to show improvements, the ability to make a constructive change will come more naturally.  Dialectical behavioral therapy works to add as many of the following attributes into a person’s rehab journey. Some of those that take priority include: 

  • Making the connection between what can be changed, and those that cannot be. 
  • Expanding on the capacity to accept where life is, and where it will go during rehab and after in recovery. 
  • Developing attitudes and behavior that will benefit a sober lifestyle, able to be used daily. 
  • Learning how to apply new coping skills into life after rehab with confidence and self-reliance.
  • Ensuring that focus on rehabilitation is maintained, and applying necessary pressure when applicable. 
  • Connecting each individual to additional addiction treatment and therapeutic programs, with necessary professionals, to maintain healthy sobriety. 

As each recovering person moves through the DBT process, new resources will become available to assist. Utilizing the groundwork that has been provided during dialectical behavioral therapy promotes necessary motivation throughout the entire rehab program. Which in turn, allows for better effectiveness in accommodating different requirements for care into treatment. 

Rehab Programs That Complement Dialectical Behavioral Therapy

Contrary to most outlined programs, dialectical behavioral therapy can be complete with many avenues to approach different requirements for care. This also includes adding additional programs that will benefit the individual’s overall quality of life after rehab. Thereby, ensuring that participants are given the same opportunities for care despite utilizing the necessary time in DBT. 

The additional rehab programs that complement the work done within dialectical behavioral therapy include:

  • individual therapy 
  • group therapy

Individual Therapy and DBT

Individual therapy also referred to as psychotherapy, will add to the development of coping skills. These coping skills will assist a recovering addict as they maneuver through rehab, and into their real-world experiences. During each session, individuals will have the opportunity to uncover essential thoughts and feelings associated with factors that encourage addiction. Once revealed, there is then an opportunity to discuss measures that can be taken to cope with these feelings and desires. Often, this type of therapy will continue throughout the program, and as needed beyond. 

Group Therapy and DBT

Taking part in group therapy offers each individual to learn about their addiction in an environment along with their peers. Most often, peer groups will consist of those with a similar psychological diagnosis, dual diagnosis, or type of addiction. While participating in group sessions, educational strategies can be discussed and shared on some of the most important topics. 

Typically, these will be specific to each designated diagnosis, however, in general, the list of topics will be consistent throughout. Some of the top coping skills include how to navigate through:

  • How to resolve or face conflict responsibly, respectfully, and effectively
  • Tips, tricks, and proven methods used for relaxation
  • How to address triggers when they arise suddenly, both emotionally and physically
  • How to manage anger and frustration while staying in control throughout any situation

While some of these may sound simple or more obvious to some, they can be especially difficult for others. During active addiction, drug, and alcohol rehab, and in recovery, life can feel overwhelming at times. This is why these issues are discussed and practiced during treatment while taking part in dialectical behavioral therapy. 

DBT Requirements During Rehab

In dialectical behavioral therapy, many concerns will be addressed. This may include diagnosing and treating psychological illness, or even addiction-related trauma that affects a person’s mental state. It is important to evaluate all possibilities that hinder recovery efforts while ensuring that each course of treatment is individualized. This means that what is incorporated into DBT for one person may vary from what is useful for the next. 

DBT will be organized by priority for each patient exclusively during outpatient rehab treatment. This will be done while following the legal and necessary guidelines, put in place for safety and consistency. Some of the evaluations that can alter what is deemed as a crucial necessity for each individual are the following: 

  • Having or being at risk of a chronic or life-threatening illness
  • Having a substance use disorder, which may have to be treated initially
  • Suicidal thoughts, desires, or behaviors requiring further intervention
  • The dedication to other additional programs or therapies, including showing up late, skipping programs, or uncompleted mandatory assignments
  • Elements that contribute to the development or restoration of an addict’s quality of life. Examples include: 
    • Family and peer communication
    • Psychological disorders
    • The quality of romantic or intimate relationships
    • Work-related inconsistencies

Though all are going to be essential to address at some point throughout the rehabilitation from addiction journey, order matters. Some pose a more prominent threat immediately, and others can be postponed to revisit later. 

It is important to note that in some cases, the immediate and mandatory intervention will supersede any other treatment. This is in the event of suicide or self-harming tendencies, which may include some personality disorders where arbitration is impassable. Left untreated, certain illnesses can work against recovery efforts, or produce life-threatening results. 

Multiple Approaches to Recovery

The combination of several different programs designed for those suffering from addiction and possibly with a dual diagnosis proves a success. Some of these options that can be designated to an individual are mandatory, yet performed in no specific order. Other regiments are more strict. The rest, very diverse. 

Of the less structured rehabilitation programs that can be utilized while participating in DBT, are those used in stress management. Holistic treatment options that are available at rehab are highly encouraged and can reduce distress undergone during downtime. 

Some of the programs that are available to utilize include meditation and fitness, or even acupuncture and massage therapies. Having a way to fill in the time and divert frustration or excess energy can reduce agitation and provide enjoyment. Rehab and DBT are not only about the work that must be put in to achieve mandatory requirements. It is also about finding new ways to enjoy sobriety while promoting a fulfilling life in recovery. 

Finding Rehab Treatment with DBT for Addiction

Getting treatment for addiction while fearing the repercussions of a psychological disorder should never stop you from getting help. Rehab facilities that offer dialectical behavioral therapy can be utilized in even the toughest situations to achieve a better tomorrow. Don’t wait until these illnesses have driven everything beyond repair. Remember, there is always hope.

Contact our addiction resources today to find out which programs are available for you. You have the power to make changes in your life, and DBT during rehab offers just the motivation needed. Work on getting sober, starting now. 

References

https://www.verywellmind.com/dialectical-behavior-therapy-1067402#:~:text=Dialectical%20behavior%20therapy%20(DBT)%20is,improve%20their%20relationships%20with%20others.

https://psycnet.apa.org/record/1990-10352-001

https://www.researchgate.net/publication/319216663_Dialectical_Behaviour_Therapy_and_Pathological_Gambling

 

 

Article Reviewed by Gregory Struve

Gregory StruveGreg received a Master’s in Counseling from the Adler Graduate School in 2006. He trained at one of the top trauma and anxiety treatment centers in the world until 2008 when he became a faculty member at Grand Canyon University. From 2011 to 2016 he directed a program that leads the field in terms of innovative treatment of anxiety and trauma. During that time he even made several appearances on A&E’s intervention.