Treating Addiction with Dialectical Behavior Therapy

Group DBT session

Versatility of DBT

Dialectical Behavior Therapy (DBT) is an evidenced-based treatment approach most commonly utilized among patients with a diagnosis of Borderline Personality Disorder (BPD). DBT consists of a year-long commitment consisting of weekly individual and skills-based group sessions, telephone consultations as needed, and weekly team meetings for treating clinicians to better refine the interventions. Though designed for suicidal BPD patients, DBT has also had treatment impact on several other populations through its focus on group skills based sessions: Oppositional-defiant adolescents (Nelson-Gray, 2006), adult ADHD (Hesslinger, 2002), treatment-resistant major depressive disorder (Harley, Sprich, Safren, Jacobo, & Fava, 2008), binge-eating disorders (Telch, Agras, & Linehan, 2000), and families of suicidal patients (Rajalin, Wickholm-Pethrus, Hursti, & Jokinen, 2009). Addiction treatment can also benefit from the incorporation of DBT techniques, especially in the case of patients with co-occurring BPD and substance abuse.


Addiction Treatment and the Dialectical Approach

Roes (2008) reviewed the positive relationship between DBT and addiction treatment in an article for Addiction Professional. He writes that, historically, addiction treatment has emphasized the dialectical approach, meaning the combination of two seemingly opposing strategies. In the case of DBT, clinicians work to simultaneously confront clients’ distorted belief systems and maladaptive behaviors and also validate and promote self-acceptance with clients. Roes (2008) writes that the dialectical approach supports research in the addiction field, indicating that improvement in client’s self-esteem allows for better receptivity to constructive confrontation.


Prioritizing Maladaptive Behaviors Targeted by DBT

DBT strategies are aimed, first and foremost, to reduce suicidal and self-injurious behaviors, which are both especially common among individuals with BPD. When used with patients struggling with substance abuse, maladaptive behaviors are subsequently prioritized based on level of threat to individuals’ safety and quality of life; thus substance use is a close second to suicidal ideation/intent. The goal is to reduce use of substances and then to relieve the discomfort the client experiences in the absence of intoxication (Roes, 2008). Additionally, there are several strategies employed to help patients practice forecasting future struggles, problem-solving in advance of those situations, generating alternative behaviors to practice, and making necessary adjustments to their environment. Researchers are encouraged to conduct further research to better refine and support the relationship between DBT and its use in substance abuse patients.





Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills group for treatment-resistant depression. Journal of Nervous and Mental Disorders, 196(2), 136-143.


Hesslinger, B., Tebartz van Elst, L., Nyberg, E., Dykierek, P., Richter, H., & Berner, M. (2002). Psychotherapy of attention deficit hyperactivity disorder in adults--a pilot study using a structured skills training program. European Archives of Psychiatry Clinical Neuroscience, 252, 177-184.


Neacsiu, A., Rizvi, S., & Linehan, M. (2010). Dialectical Behavior Therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behavior Research and Therapy, 48, 832-839.


Nelson-Gray, R., Keane, S., Hurst, R., Mitchell, J., Warburton, J., & Chok, J. (2006). A modified DBT skills training program for opposition-defiant adolescents: promising preliminary findings. Behavior Research and Therapy, 44, 1811-1820.


Rajalin, M., Wickholm-Pethrus, L., Hursti, T., & Jokinen, J. (2009). Dialectical behavior therapy-based skills training for family members of suicide attempters. Archives of Suicide Research, 13, 257-263.


Roes, N. (2008) “DBT fits well in addiction treatment.” Addiction Professional Online.


Telch, C., Agras, W., & Linehan, M. (2000). Group dialectical behavior therapy for binge-eating disorder: A preliminary, uncontrolled trial. Behavior Therapy, 31, 569-582.