Dialectical Behavior Therapy (DBT) for Addiction Treatment

The DBT Approach

The DBT approach is multidimensional and comprehensive and relies on learning skills to change unhelpful thoughts and behaviors.

Therapists using DBT teach critical behavioral skills by modeling, providing instructions, telling stories, practicing, giving feedback, and coaching.¹ DBT uses a variety of strategies and techniques to do this including:¹

• Mindfulness. Central to all other skills in DBT, mindfulness is at the core of treatment. Individuals learn about and practice bringing awareness into the moment. By mastering the observation of what’s happening inside—feelings, thoughts, sensations, and impulses—and tuning into their senses and the environment around them, individuals can effectively slow down and focus on healthy coping skills during pain.
• Interpersonal effectiveness. Since many participants in DBT struggle with challenges in their relationships, interpersonal effectiveness works to repair, maintain, and establish healthy relationship behaviors, which also includes ending destructive ones. This strategy incorporates assertiveness training to help individuals create and enforce their boundaries with others and communicate effectively.
• Emotional regulation. This technique focuses on identifying, naming, and changing the negative effects of an emotional response. By helping an individual recognize and cope with intense negative emotions—and create an opposite action—therapists help them have more positive emotional experiences.
• Distress tolerance. This section of DBT discusses and teaches individuals to sit with discomfort and accept negative emotions. For individuals who experience distress or crisis, the implementation of learned techniques such as distraction and self-soothing skills empower them to cope with intense emotions with a more positive, long-term outlook.

DBT Treatment Components

Dialectical behavioral therapy is now used to treat other conditions and consists of four key components, including:^3,4

• Individual therapy. In these one-on-one, weekly sessions, individuals learn to apply DBT skills they’ve learned to real-life challenges. Homework encourages utilizing these new learned skills in everyday life situations.
• Group skills training. Individuals work on developing new, healthy coping skills during group skills sessions, where they actively practice the skills. Within the DBT group, the environment is supportive and reinforces positive behaviors. Outside of the group, the individual works to structure their environment to set them up for success.
• Phone coaching. For in-the-moment help when a difficult situation arises in between sessions, individuals can contact their therapist to get support when they need it the most.
• Consultation team for therapists. For therapists to be effective and the most helpful to an individual, they need to feel supported and validated. For this reason, a therapist consultation team meets weekly to help fellow therapists problem-solve and implement effective treatment in challenging situations—a suicidal individual or one who frequently misses sessions, for instance.

What Conditions Can DBT Help Treat?

Dialectical behavioral therapy was created with the intent to primarily treat women with suicidal tendencies.³ Since its development nearly 40 years ago, DBT has proven to be most effective for treating individuals with borderline personality disorder (BPD) when compared to other community-based behavioral therapy approaches.⁴ However, studies have shown that DBT is effective at treating other disorders. Researchers continue to investigate DBT’s effectiveness with other mental health conditions besides BPD. These include:^1,4-9

• Other personality disorders, such as antisocial personality disorder and narcissistic personality disorder.
• Anxiety disorders.
• Depression.
• Eating disorders.
• Bipolar disorder.
• Substance use disorders.
• Attention deficit hyperactivity disorder (ADHD).
• Post-traumatic stress disorder (PTSD).

DBT Uses for Veterans

Dialectical behavioral therapy can help Veterans—many of whom may be dealing with extreme emotions—reduce behaviors that interfere with their quality of life, regulate negative emotions without engaging in substance misuse or other dysfunctional behaviors, and develop healthy coping skills to improve their well-being and help them interact with the world.¹⁰

The Department of Veterans Affairs’ (VA) offers DBT programs at several VA sites across the country. The program helps Veterans work on the behaviors that threaten their life and teaches them skills such as interpersonal effectiveness, emotion regulation, distress tolerance, and mindfulness. The VA DBT programs may involve at least 6 months of treatment with individual therapy sessions, skills training groups, phone coaching, and a consultation with a therapist—all done weekly.¹⁰

Additionally, DBT can be helpful and effective for treating substance use disorders in Veterans, though studies on the uses and benefits of DBT use in the Veteran rehab for addiction have been limited.¹¹

Dialectical Behavioral Therapy and Addiction Treatment

Research indicates that dialectical behavioral therapy is effective in treating people with borderline personality disorder with co-occurring substance use disorders.¹ Several clinical trials suggest that DBT may also be effective in treating individuals with a substance use disorder and other co-occurring disorders, or individuals who have not responded to other evidence-based substance use disorder treatments.⁷

A substance use-focused DBT approach encourages individuals to commit to abstinence and work to bolster their motivation to change through the various activities and techniques.⁷ DBT for alcohol and drug addiction treats relapse as a problem to solve; therefore, therapists help the individual assess the events that led to the relapse and work to help them repair the harm they caused themselves and others as a result of the relapse.⁷ The idea is to increase the individual’s awareness surrounding the negative consequences associated with drug or alcohol use.⁷

Effectiveness of DBT for Addiction Treatment

While there is no conclusive evidence that DBT helps to treat a stand-alone substance use disorder, studies indicate that DBT can be a helpful component in a comprehensive treatment plan for an individual with a SUD and co-occurring mental health disorders, such as depression or borderline personality disorder (BPD).¹² In one study of women with BPD and co-occurring substance use disorders, individuals who received DBT showed reductions in substance misuse during a year of treatment (and in the 4-month follow-up) and dropped out of treatment less often than individuals who did not receive DBT as part of their treatment plan.³

For Veterans, the research is limited, as there is not yet conclusive data on the effectiveness of DBT for the treatment of substance use disorders in Veterans. However, studies indicate that DBT has been helpful in treating borderline personality disorder in Veterans. In fact, one study found that Veterans who received DBT for borderline personality disorder showed a decrease in the use of mental health services. In the year prior to DBT treatment, they had an average of 92.8 visits per year. In the year after DBT treatment, that number decreased to an average of 48.2 visits.¹³

Benefits of DBT in Addiction Treatment

By taking an addiction-focused approach to DBT, many individuals can benefit from treatment. Some of the benefits might include:⁷

• A decrease in substance use.
• A decrease in the physical discomfort associated with withdrawal symptoms.
• A drop in substance-related impulsivity, cravings, and temptations.
• Creating and enforcing boundaries necessary for abstinence.
• Avoiding triggers and precipitating events that could lead to substance use.
• Reducing problematic behaviors that contribute to substance use.
• Increasing healthy interpersonal relationships through community and other environments that support the individual’s success.

How to Find DBT Treatment

Therapists who facilitate DBT groups are specifically trained on providing effective treatment. The first step in finding if dialectical behavioral therapy is right for you is to talk with your doctor and mental health provider, who can evaluate your symptoms, treatment history, and therapy goals.

American Addiction Centers (AAC) offer DBT at select treatment facilities. If you’re unsure whether DBT might be appropriate for you, you can talk with your mental health professional or talk with a knowledgeable admissions navigator at AAC to find a treatment facility where you can be evaluated.

Does Insurance Cover the Cost of Dialectical Behavioral Therapy?

DBT may be covered by your insurance provider in conjunction with your inpatient or outpatient treatment plan. This depends on your specific health insurance plan. To see if your insurance provider covers all or at least part of the cost of rehab treatment, call us or use our online verification form below.

Is DBT Covered by the VA or Veterans Benefits?

Obviously, it depends on your needs and specific situation, but yes, DBT should be covered by the VA and your Veterans’ benefits.  As previously mentioned, DBT is offered at VA sites across the country. Visit the VA to understand your eligibility, the specifics of your coverage, and where you may be able to find a DBT program through the VA.

Thanks to the 2008 Mental Health parity and Addiction Act, health insurers are required to cover services for mental health, behavioral health, and substance use disorders similar to the coverage provided for other medical and surgical benefits.¹⁴ DBT is a mental health treatment and should be at least partially covered by many insurance plans, including TRICARE, Medicare, and Medicaid—all of which you may be able to use in conjunction with your VA benefits.¹⁵