Dialectical Behavioral Therapy in Addiction Rehab

Dialectical Behavioral Therapy in Addiction Rehab

Developed by Marsha Linehan, PhD, ABPP, Dialectical Behavior Therapy (or DBT) is a treatment that’s from the same Cognitive Behavioral Therapy (CBT) umbrella as Acceptance and Commitment Therapy (or ACT). Like CBT and ACT, DBT focuses on treatments that are based on acceptance, mindfulness, and self-awareness. However, unlike CBT and ACT, it specifically concentrates on group skills and individual psychotherapy classes in order to support people like addicts and dual diagnosis patients to learn new strategies and skills to develop a constructive and well-balanced life.

It’s a method of treatment to ensure sobriety by making the addict change the way he reacts to situations, feelings, and stimuli, which in turn consequently makes their lives more worth living. Training with DBT skills is all about instilling skills for interpersonal effectiveness, distress tolerance, emotion regulation, and mindfulness. On that note, here’s what you should expect when undergoing the DBT program in the context of getting over substance dependence such as drug addiction and alcoholism.

The Five Components of DBT

There are five components to a standard DBT program that work in tandem or harmony. They help differentiate DBT from many other psychotherapy programs, even similar ones under CBT such as ACT. Other psychotherapies focus on only one or two modes, cores, or aspects of treatment, as in the case of individual or group therapy. DBT is more holistic and complete, with each mode or component within its treatment paradigm intended to meet specific functions that cumulatively form a better person that can resist the temptations of drugs and alcohol when push comes to shove.

  • 1. Enhance Capabilities with DBT Skills Training: Skills training under DBT is all about dealing with and improving the patient’s innate capabilities and talents by teaching them behavioral skills. To be more specific, going through all that DBT skills training involves training your social skills or rebuilding them in case the rigors of alcohol and drug dependence have made you socially tone-deaf or acclimated to more abusive, codependent, enabling, and toxic relationships.
  • The skills training course is usually taught in groups that are run like classes with group leaders that assign homework and teach on a blackboard or whiteboard. The skills homework in question assists and supports addicts in using the skills in a practical way during their everyday lives. They can apply the skills they’ve learned on daily situations. Groups can meet weekly for 2.5 hours and then it takes about 24 weeks in order to fulfill the whole curriculum.
  • A 1 year program can repeat those 24 weeks of training in order to check your progress, really drill in those skills, get into the more advanced lessons after the fundamentals have been established, and instill a sense of habit when it comes to applying the training. Briefer schedules that only test a skill subset can also be used for those attending school or working a job. The skills training program of DBT includes the following modules.
    1. Emotion Regulation: It’s important for addiction patients to learn how to change your emotions that you wish to change rather than simply going on impulse on everything, such that your emotional wellbeing is dependent on outside stimuli.
    2. Interpersonal Effectiveness: You’re trained on how to ask for what you want properly and say no when called for while still maintaining your relationship with others and upholding your self-respect. You will learn to become more assertive without being a bully.
    3. Distress Tolerance: You’re also taught how to tolerate negative emotion and pain in difficult circumstances. You’re supposed to acknowledge the aching feelings instead of attempt to change it with drugs and alcohol.
    4. Mindfulness: Mindfulness as seen in mindfulness meditation is the practice of being self-aware and not letting your mind go on autopilot so that you can be present and in the moment. This will keep you from living in denial.
  • 2. Enhance Motivation with Individual Therapy: Individual therapy is important because addiction is a personal issue that should be approached on a case-by-case basis depending on the kind of person who’s being addicted to drugs or alcohol. DBT is better applied to the needs of the individual if it takes into account the person’s personality, strengths, flaws, and environmental circumstances, resulting in a custom-fit tactics that uses your abilities to the fullest when applying CBT skills training.
  • In turn, you can enhance your motivation through individual therapy of the DBT kind, which in turn helps patients to apply the skills they’ve learned to specific challenges in their everyday lives, whether it’s dealing with job loss or the loss of a loved one as well as difficulties in romance. Using the fundamental DBT paradigm, individual therapy can happen every week or for as long as required. It works best when it runs simultaneously with DBT-type skills training.
  • 3. Ensure Generalization with Coaching: Telephone coaching is also used in DBT along with other in vivo coaching techniques in order to offer in-the-moment support every time. The intention behind this is to coach patients in order to use their skills from DBT to effectively cope with difficult circumstances, stressors, problems, and situations that happen to them daily instead of having to recall what skills to apply later on after classes are over.
  • Patients undergoing DBT treatment can call their individual therapist even after sessions are over in order to get coaching advice at times when they need such recommendations the most and in the moment. Treatment, therapy, and counseling can happen and become applicable even when it’s outside the scheduled program, allowing for greater flexibility and real-time DBT-type advice from professional therapists or counselors.
  • 4. Structure the Environment with Case Management: The patient can also be assisted and supported by case management strategies in his own life, such as dealing with their social and physical environments. This typically involves the therapist applying the same problem-solving, validation, and dialectal strategies for the sake of teaching the recovering addict to become his own case manager, which lets him in turn solve his own problems by himself. As the saying goes, “Feed a man a fish he eats for a day. Teach him how to fish and he eats for a lifetime.”
  • In other words, it’s better for the therapist to at first serve as the patient’s case manager before teaching him how to become his own case manager instead of simply spoonfeeding him the answer to his issues every time. This way, the therapist can consult the client on what to do and let him figure things out for himself, allowing him a measure of independence when, for example, dealing with cravings and the mental side to addiction. The therapist will only have to intervene on the recovering client’s behalf when it’s absolutely required.
  • 5. Support Therapists with the DBT Consultation Team: The DBT consultation team is typically concentrated on specialists on DBT, which includes case managers, skills training group leaders, individual therapists, and counselors as well as others who assist the addiction treatment of the patient. The team is supposed to support DBT service providers in their therapeutic work since, as another saying goes, “Who will watch the watchmen?” The team offers therapy for the therapist. Therapists are only human and can also experience burnout.
  • The consultation team exists for the sake of supporting therapists in keeping them competent and motivated themselves, because if the therapists are themselves bogged down, they won’t be able to help out the patients either. They work in tandem in order to tag-team the patients with the best rehab treatment possible. It’s especially crucial when treating recovering addicts with dual diagnosis issues and complex, difficult-to-treat disorders along with their addiction.

Why Does DBT Teach Skills?


Problematic behaviors leading to drug addiction and alcoholism can be a manifestation or coping mechanism for an unresolved situation. It can also be the way for someone to solve a problem even though the destructive solution might seem to defeat the purpose of fixing said problem. The behaviors might offer temporary relief or a short-term solution for the stressors, stimuli, or issues you may face in various situations they’re oftentimes ineffective as long-term solutions.

Indulging in negative acts and behavior is you treating pain with painkillers instead of finding ways to constructively cope with the pain or solve the source of the pain. DBT is a program that acknowledges many addicts are doing the best that they can do deal with their situation and they still need to learn new behaviors in relevant contexts in order to truly find a resolution or closure for the problems in their life.

DBT assist’s a patient’s ability to solve problems like addiction or the underlying cause on why they became addicted in the first place through behavioral skills in areas like interpersonal effectiveness, emotion regulation, distress tolerance, and mindfulness. It’s through these skills taught by DBT that you can effectively navigate through situations without relying on self-destructive coping mechanisms like retreating to your shell or using substance abuse as a crutch to better deal with or survive life’s many challenges.

How Does DBT Prioritize Treatment Targets?

Patients receiving DBT usually have multiple problems requiring treatment, like addiction compounded by other underlying mental issues like PTSD or depression. This might mean they have a dual diagnosis or they might have problem behaviors that full under a single diagnosis. How does a DBT therapist figure out where to begin treatment and rehab then? The good doctor uses a hierarchy to determine which problems should be priorities.

The treatment targets come in the following order of priority, from first priority to last priority:

  • Life-Threatening Behaviors: Any self-destructive behaviors that can lead to life-threatening situations or the death of the patient, like suicidal thoughts from depression or extreme drug abuse leading to overdose, should be prioritized first. Self-injury whether non-suicidal or suicidal should be addressed along with suicide communications, suicidal ideation, or any other behaviors meant to threaten the life of the patient in question or cause himself bodily harm.
  • Therapy-Interfering Behaviors: The next on the list of top priority behaviors that should be addressed and changed are behaviors that interrupt the therapy. Obviously, such behaviors will keep the patient from receiving DBT skills training or any other therapy like individual, group, CBT, or ACT. Any behavior that interferes with the client receiving effective treatment should be dealt with post-haste. These behaviors can be on the part of the therapist or client, such as being non-collaborative in working towards treatment goals, canceling appointments, and coming late to sessions.
  • Quality-of-Life Behaviors: Any behaviors that interfere with the quality of life of the patient, which includes having a housing or financial crises, relationship problems, drug addiction, alcoholism, gambling addiction, and mental disorders, should then be addressed after the life-threatening and therapy-interfering behaviors have been resolved. A recovering addict should stop self-destructive behavior and have enough motivation to continue therapy in order to resolve his behaviors that lead to the destruction of his quality of life.
  • Skills Acquisition: Once the patient has dealt with his suicidal tendencies, behaviors that interrupted his therapy sessions, and any behaviors that deal a blow to his quality of life then he can rebuild his life from scratch. He can now learn new skillful behaviors under the DBT banner that replace his bad habits and horrible coping or defense mechanism behaviors like drug addiction and alcoholism in order to help achieve his goals of sobriety, financial solvency, and having healthy familial and romantic relationships.

Presentation of problems should be done in the order as expressed above when undergoing a DBT session. For instance, if the recovering addict is expressing a wish to end his life and reports drug cravings that led to him becoming in debt such that his parents are the ones paying for his addiction rehab, the therapist should prioritize his suicidal behavior first then work his way down the list. DBT is ineffective on a dead client or someone who refuses treatment in the first place.

What Are The Stages of Treatment in DBT?

DBT is divided into four treatment stages. They are defined by how severe the client’s behavior is and don’t come in any particular timeframe. Here they are below:

  • Stage 1: During the first stage of DBT treatment, the patient has out-of-control, self-destructive behavior that serves as a manifestation of how miserable he is. He might be suicidal or attempting to kill himself, or at the very least engaging in self-harming. Many recovering addicts might start off in this stage, with them using alcohol and drugs until they’ve gotten an intervention or they themselves have decided to enter rehab. When starting DBT treatment, patients often describe their mental illness experience as being “in hell”. The goal of the first stage is to move the client from this miserable state and achieve a modicum of behavioral control.
  • Stage 2: It’s during this stage that the patient might be living a life of quiet desperation. He hasn’t been pushed to the threshold of being suicidal yet or he has gone back to controlling this urge, but he is still suffering due to feelings of invalidation and past trauma. He might have an inhibited emotional experience as a result. It’s the goal of the second stage of DBT treatment to assist the recovering addict from moving to this quiet desperation state to someone who can normally experience the full range of their emotions. PTSD is usually treated during this particular DBT stage.
  • Stage 3: The third stage of DBT is helping the recovering patient to learn how to live life. He has already gotten past the two thresholds of self-destruction but he might be at a loss on how it is to live sober. He might have forgotten what it’s like not use drinking alcohol or taking drugs as a crutch to cope with his difficult life. It’s during this stage that he can find peace and happiness while at the same time building his self-respect or self-esteem and defining his goals in life. The end goal during this stage is to teach the patient to lead a life of ordinary happiness while dealing with unhappiness.
  • Stage 4: In rehab terms, this is aftercare after the main rehab program has finished. Some people might need it and some might not but most recovering addicts use this because it’s better to be safe than to be sorry. It involves taking care of yourself to prevent yourself from relapse and going under the rabbit hole again. It can also involve finding deeper meaning in your life through spirituality or religion. In secular terms, it involves living your life or ordinary happiness and unhappiness then going a step further in fulfilling your human potential. This should move the patient from a sense of incompleteness to a journey towards completion, thus maximizing his capacity for experiencing freedom and joy.

The Reason for the Development of DBT


DBT was developed in the beginning to treat individuals who are chronically suicidal and diagnosed with borderline personality disorder or BPD. It’s presently acknowledged as the gold standard psychotherapy technique for this demographic. Additionally, research has uncovered that it’s effectiveness is most apparent when treating a wide range of disorders such as drug and alcohol addiction or substance dependence, eating disorders, Post-Traumatic Stress Disorder or PTSD, depression, and the like.

It is DBT’s goal to assist patients in building a constructive life where they feel like it’s worth living every day because they’re able to fulfill their fullest potential as human beings. When undergoing the DBT program, the therapist and the client work together in order to set meaningful goals that personally impact the client himself in bettering his life. This oftentimes entails working in ways to decrease destructive or harmful behaviors and replacing them with more constructive and life-boosting ones.

The Dialectical Behavioral Therapy of Lanna Rehab


By contacting Lanna Rehabilitation in Thailand for all your addiction therapy needs that go beyond clinical or hospice care, pharmaceutical addiction treatment, and detoxification, you can avail of many different Cognitive Behavioral Therapy (CBT) services and sessions from certified internationally trained psychotherapists, including the Acceptance and Commitment Therapy (ACT) Dialectical Behavioral Therapy (DBT) variants of CBT that focus on mindfulness and accepting stressful feelings and emotions objectively to avoid overreacting to them.

The DBT therapy in a nutshell involves the combination of group skills training and individual psychotherapy in order to teach the recovering addict some useful strategies and life skills that will help substitute their drug dependence with more constructive activities. Acquire free consultation from the Lanna Rehab Center through its 24/7 toll-free number and inquire more about its CBT and DBT offerings.

Martin Peters

Martin Peters has a BA (Hons) Dip HE Dip RN CSAT III and is the Group Program Director Lanna Healthcare. He is a Registered Nurse and Certified Substance Abuse Therapist working in the mental health field since 1994; Martin has had a wide range of experience in management and supervisory roles within established healthcare systems, and has provided consultancy services to a number of private and public sector organizations in the UK and Asia in terms of management, policy writing, accreditation and recruitment. Martin’s addictions experience has been in developing inpatient services in Thailand since 2009, both clinical and operational. He has been instrumental in expanding and developing a non 12 step inpatient treatment centre and opening a further inpatient centre with a 12 step approach, implementing KIPU Electronic Records, strengthening hospital partnerships, introducing a Scholarship for students under the Masters in Addiction Studies Program at The ASEAN Institute for Health Development and working with an international accreditation body. Martin has also been a speaker at several international conferences on addiction, including ASEAN conferences and has also guest lectured at Mahidol University (Thailand), University of Sarghoda (Pakistan) Institute of Medical Sciences (Pakistan) and has been a representative on the CARF Standards Advisory Committee for 2016.In 2015. Martin became a Co-Founder of Lanna Healthcare, launching Lanna Rehab in March 2016 and opening Jintra in January 2018. In June of 2018, Martin was involved in the merger of Lanna and DARA, becoming Thailand's biggest private licensed operator. Martin is currently a Joint and Asia Health Co Ltd Owner Operator of Lanna Healthcare Co Ltd, which under its umbrella manages Lanna Rehab in Chiang Mai, Jintra Rehab in Chiang Mai and DARA Rehab in Koh Chang - all Thailand MoPH Licensed Addiction Facilities providing world-class treatment in Thailand.