Dialectical Behavioral Therapy (DBT) for Alcoholism: An In-depth Look

Author: Thomas Roth

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy originally developed to treat individuals with borderline personality disorder. However, its application has broadened over time, and it has proven to be effective in treating a variety of mental health disorders, including substance use disorders such as alcoholism. This article delves into the specifics of how DBT works in treating alcoholism, its benefits, and its effectiveness.

What is Dialectical Behavioral Therapy?

DBT is a therapeutic approach that combines cognitive and behavioral therapies with mindful awareness and stress tolerance strategies. The term “dialectical” comes from the idea that two opposing ideas can coexist and that conflict between them can be resolved through balance and synthesis. In the context of DBT, this involves accepting one’s experiences while simultaneously working towards change.

DBT is a skills-based approach to therapy and focuses on four main areas that we list below.

• Mindfulness
• Distress tolerance
• Emotion regulation
• Interpersonal effectiveness
• Skills generalization

Mindfulness

DBT incorporates mindfulness techniques to help individuals stay present and aware, without judgment. This can help individuals recognize their cravings or urges to drink, and instead of acting on them impulsively, take a step back and make conscious, healthier decisions. Doing so will help recovering alcoholics maintain long-term sobriety.

Distress Tolerance

DBT is well-known for its emphasis on distress tolerance, which is the ability to accept and endure distressing situations without attempting to change them. This skill can be especially helpful for individuals battling alcoholism, as they often turn to alcohol to escape distress. Through DBT, individuals learn to tolerate distress without the use of alcohol. Healthy habits may even become a suitable replacement for alcoholism. For example, people may partake in hobbies like hiking, walking, or yoga.

Emotion Regulation

Alcohol is often used as a coping mechanism for managing intense or uncomfortable emotions. DBT provides clients with tools and techniques to recognize, understand, and regulate these emotions in a healthier manner. Through DBT, individuals learn to respond to emotional distress without resorting to alcohol. People learn how to become emotionally dependent on only themselves instead of substances as well. This forces people to address what’s wrong within them before using coping mechanisms.

Interpersonal Effectiveness 

Alcoholism often strains relationships and social interactions, contributing to isolation or conflicts. DBT helps individuals improve their interpersonal skills, promoting healthier communication, assertiveness, and relationship management. These skills can reduce the stress and emotional triggers often associated with drinking. Interpersonal effectiveness is also useful for people who need to build relationships because of the isolation that alcoholism causes. Therefore, people can begin to love again or make new friends.

Skills Generalization

DBT emphasizes transferring the skills learned in therapy to real-life situations. This includes practicing skills in diverse settings and situations, including those that might have previously triggered alcohol use. The aim is to equip individuals with the tools to maintain sobriety in the face of real-world challenges and triggers.

What Does a DBT Session for Alcoholism Look Like?

During a DBT skills group session, individuals learn about the four main modules of DBT (Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness) and how they can apply these skills to manage their alcohol use. For example, a session might involve learning about mindfulness techniques that can help to manage cravings, or interpersonal effectiveness skills that can be used to refuse offers of alcohol.

Individual therapy sessions in DBT for alcoholism are more personalized and focused on the individual’s specific challenges. The therapist might help the individual to explore situations that trigger their urge to drink, to develop strategies for managing these situations, or to work on improving their relationships.

How Does Dialectical Behavioral Therapy (DBT) Help for Alcoholism?

Dialectical Behavioral Therapy helps people recover from alcoholism by providing them with the tools and skills necessary to manage addiction. Everyone’s recovery journey is different, DBT may look different for everyone.

DBT aids individuals struggling with alcoholism in several ways that we list below.

• Building skills
• Balance, acceptance, and change
• Group therapy
• Individual therapy

Building Skills 

DBT helps individuals build important skills that are divided into four primary modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. We mentioned some of these skills briefly earlier but here we apply them to alcoholism.

• Mindfulness refers to the practice of being fully aware and present in the moment, which can help individuals avoid automatic reactions or unhealthy coping mechanisms like alcohol consumption.
• Distress tolerance equips individuals with skills to effectively manage and survive crises without resorting to harmful behaviors. This can be particularly beneficial in managing cravings or resisting the urge to drink.
• Emotion regulation includes strategies for understanding and managing emotional reactions. It can be especially useful for individuals who drink as a way to cope with difficult emotions.
• Interpersonal effectiveness teaches techniques for assertiveness and healthy communication. This can be helpful for individuals whose relationships have been strained or damaged by their alcohol use.

These are only some of the skills taught in DBT. Ultimately, it depends on your unique situation.

Balance, Acceptance, and Change 

One of the unique aspects of DBT is its focus on the concepts of balance, acceptance, and change. The therapy promotes a balanced lifestyle, which includes healthful living practices, adequate sleep, balanced diet, regular physical activity, and abstinence from alcohol.

At the same token, DBT places a significant emphasis on acceptance and change. Individuals are encouraged to accept their current situation and themselves as they are while also working towards making positive changes. This balance of acceptance and change can create a conducive environment for recovery.

Group Therapy

Group therapy is a core component of DBT. In group sessions, individuals learn and practice the skills taught in DBT. They also have the opportunity to share experiences and give and receive support from others who are dealing with similar issues. This shared experience can reduce feelings of isolation, build a sense of community, and enhance motivation for change.

Individual Therapy

In individual DBT sessions, the therapist and individual work together to address specific problems and challenges. The therapist provides validation and acceptance while also pushing for change. They use a variety of strategies, including behavior analysis, which involves examining problematic behaviors (like alcohol use) and their triggers and consequences. The goal of these sessions is to provide tailored strategies and support to help the individual apply the skills they’ve learned in their everyday life.

Overall, DBT offers a comprehensive and multi-faceted approach to treatment, providing individuals with the skills, strategies, and support necessary to overcome alcoholism and build a healthier, more balanced life.

Effectiveness of DBT in Treating Alcoholism

Research has shown that DBT can be effective in treating alcoholism. A study published in the “Addictive Behaviors” journal found that individuals who underwent DBT for substance use reduced their substance abuse and were more likely to stay in treatment compared to those who received other forms of therapy. 

Other research has highlighted the effectiveness of DBT in reducing self-destructive behaviors, including self-harm and suicide attempts, both of which can be higher among individuals with alcoholism.

We summarize the findings of the research about DBT for alcoholism below.

Reduction in Substance Abuse

DBT has been found to help reduce the severity and frequency of alcohol abuse. A study published in the journal “Addictive Behaviors” found that individuals undergoing DBT reported a significant reduction in their substance use. These participants exhibited lower frequency and quantity of alcohol consumption, indicating that DBT can assist individuals in managing their drinking behavior more effectively.

Improved Treatment Retention

Treatment retention, or staying in treatment for the recommended duration, is a critical factor in recovery from alcoholism. Interestingly, studies indicate that individuals undergoing DBT are more likely to stay in treatment compared to those receiving other forms of therapy. This is likely because DBT focuses on building a trusting and accepting therapist-client relationship, and it equips individuals with practical skills that they can see working in their everyday lives.

Reduction in Self-Destructive Behaviors

Alcoholism is often accompanied by self-destructive behaviors, including self-harm and suicide attempts. Research has demonstrated DBT’s effectiveness in addressing and reducing these behaviors. DBT, with its focus on emotional regulation, distress tolerance, and mindfulness, helps individuals develop healthier ways to cope with emotional pain, thereby reducing their reliance on self-destructive actions.

Addressing Co-Occurring Disorders

Alcoholism frequently co-occurs with other mental health disorders such as depression, anxiety, and borderline personality disorder. DBT was originally developed to treat borderline personality disorder and has since been adapted for other conditions, making it particularly suitable for individuals with alcoholism and co-occurring mental health issues. By addressing these co-occurring disorders, DBT can help reduce the overall distress that often leads to alcohol use.

Long-Term Benefits

DBT’s benefits extend beyond the period of active therapy. Studies have shown that individuals maintain gains made during DBT, such as reduced substance use and improved emotional coping skills, even after therapy has concluded. This suggests that DBT equips individuals with durable skills and resources that they can continue to use long-term, supporting ongoing recovery and resilience

What Are the Other Treatments for Alcoholism

Several treatment modalities are available for alcoholism. Below we list the most common alcoholism treatment options.

• Cognitive Behavioral Therapy (CBT)
• Family Therapy
• Group Therapy
• Equine Therapy
• Faith-Based Healing
• Medications for Alcoholism
• Adventure Therapy
• Inpatient Alcohol Rehab
• Outpatient Alcohol Rehab
• Intensive Outpatient Programs (IOPs)
• Acupuncture for alcoholism
• Co-Occurring Disorders
• Sober Living
• Residential Inpatient
• Yoga for alcoholism
• Partial Hospitalization (PHP)
• Alcohol Detox

Depending on your needs, you may need some or all of these treatments for alcoholism. Always consult with a medical professional before trying anything at home.

Get Treatment for Alcoholism Today

DBT offers a comprehensive and flexible approach to alcoholism treatment, with strategies that can be adapted to fit each individual’s needs and stage of change. While it requires commitment and effort, it offers a robust set of tools that can support individuals on their journey to recovery.

When it comes to alcoholism it’s important to get treatment sooner rather than later. If you don’t wait, you may end up with liver damage and other health conditions. The good news is that there are plenty of alcohol rehabs that can help. Check out our network or give us a call to find treatment for alcoholism. We have plenty of verified alcohol rehab centers that can help with Dialectical Behavioral Therapy and other types of treatment.

Sources

• Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, NY: Guilford Press.
• Dimeff, L. A., & Linehan, M. M. (2008). Dialectical behavior therapy for substance abusers. Addiction Science & Clinical Practice, 4(2), 39–47.
• “Addictive Behaviors” Journal
• “The American Journal of Psychiatry”
• “Journal of Clinical Psychology”
• “Journal of Behavioral Health Services & Research”