Dialectical Behavior Therapy (DBT) for Addiction Recovery
Plain, fact-first answers about how care works here. Want to talk to a person? Call (888) 464-2144.
- The Archangel Centers is a licensed outpatient addiction treatment provider.
- The Archangel Centers operates clinics in Tinton Falls, NJ and Charlotte, NC.
- Dialectical behavior therapy (DBT) is part of the outpatient continuum at The Archangel Centers.
- Medication-assisted treatment (MAT) includes Suboxone, Vivitrol, and Sublocade.
- The Archangel Centers works with most major commercial insurance plans with free benefits verification.
Dialectical behavior therapy (DBT) was developed by Marsha Linehan in the 1980s for the treatment of borderline personality disorder and chronic suicidality. Over the following decades, the structured skill-based components of DBT were adapted for substance use disorder, eating disorders, post-traumatic stress, and other conditions where the central problem is dysregulated emotion driving destructive behavior. In addiction treatment, DBT is the right primary framework for clients whose use is heavily driven by emotional dysregulation, impulsivity, or self-harm patterns.
What DBT actually is
DBT integrates four skill modules with individual therapy and (in the full standard model) a phone consultation function:
Mindfulness
The foundation. Skills for paying attention on purpose, in the present moment, non-judgmentally. Specific skills include observing, describing, and participating; and a "wise mind" balance between emotional and rational thinking.
Distress tolerance
What to do when the moment is unbearable and you cannot fix it right now. Skills include TIPP (temperature, intense exercise, paced breathing, paired muscle relaxation), STOP (stop, take a step back, observe, proceed mindfully), self-soothing through the five senses, and radical acceptance.
Emotion regulation
Identifying and naming emotions, reducing vulnerability to emotional mind (sleep, food, exercise, mood medication if appropriate), increasing positive emotions, and opposite-action skills for emotions whose action urge is making things worse.
Interpersonal effectiveness
Asking for what you need, saying no, and maintaining self-respect, in specific structured forms (DEAR MAN, GIVE, FAST). For clients whose use is partly maintained by interpersonal conflict or by the absence of needed support, this module does heavy lifting.
The "dialectical" in DBT names the central tension the work holds: full acceptance of where the client is now, *and* commitment to change. Both at once. The work happens in the space between them.
Why DBT works in addiction treatment
The clinical evidence shows DBT is particularly effective when:
For these clinical pictures, DBT-informed treatment is associated with substantial reductions in self-harm, hospitalization, and substance use, with effects that often persist after treatment.
- Substance use is driven by emotion dysregulation more than habit
- The client has a co-occurring borderline personality disorder, post-traumatic stress, or chronic suicidality
- Self-harm patterns (cutting, restricting, purging, suicide attempts) are part of the picture
- Standard CBT has produced limited progress
- The clinical picture includes "I can't tolerate the feeling, so I use" more than "I can't break the habit"
DBT-S, the substance use adaptation
Linehan and colleagues developed a specific adaptation for substance use disorders (DBT-S) that includes:
DBT-S is the framework that informs DBT-influenced work at The Archangel Centers.
- Path to clear mind: the goal state in which the client is neither under the influence nor white-knuckling abstinence
- Dialectical abstinence: aiming for abstinence while preparing concretely for what to do if a slip occurs
- Burning bridges: structurally removing access to the substance and the people and places associated with it
- Building a life worth living: the explicit long-term goal that gives the skill work direction
DBT in practice at The Archangel Centers
DBT-informed work at The Archangel Centers is delivered through:
The depth of DBT work varies by level of care. The full DBT skill curriculum is most fully delivered in our Partial Care and PHP at Charlotte programs, with skill maintenance continuing through IOP and OP.
- DBT skill groups, focused on one module at a time, with structured handouts, in-session practice, and homework
- Individual therapy that integrates DBT skill coaching with the broader CBT and trauma work in the treatment plan
- Crisis planning built explicitly into the treatment plan for clients with suicidality or self-harm risk
- Coordination with the medical provider for medication that supports emotional stabilization where indicated
DBT alongside other modalities
DBT integrates with:
- **CBT** for the cognitive and behavioral work outside the emotional regulation domain
- **Trauma-informed care** for the trauma history that often underlies the dysregulation
- **Medication-assisted treatment** for the substance-specific pharmacological work
- **Family therapy** for the family system around the client
- **Group therapy** for peer-based skill practice
Who DBT is not for, or not the primary tool for
DBT is a high-investment treatment. It works best when the client is willing to engage in the skill practice and homework. For clients whose primary issue is habitual substance use without significant emotion dysregulation, CBT or contingency management may be the more efficient primary modality. The treatment team makes the call at intake and revisits it as the clinical picture clarifies.
DBT and co-occurring conditions
DBT has strong evidence for:
See PTSD and addiction and the broader dual diagnosis for how DBT fits the co-occurring picture.
- Borderline personality disorder, often with co-occurring SUD
- Chronic suicidality, with or without SUD
- Self-harm patterns
- PTSD, particularly in combination with trauma-focused work
- Eating disorders alongside SUD
Frequently Asked Questions
Is DBT just CBT with mindfulness added?
Do I need to have borderline personality disorder to benefit from DBT?
How long does DBT take?
Is DBT all about acceptance?
Can DBT be done virtually?
What if I have tried DBT before and it didn't work?
Which DBT skills do clients use most often in the first 30 days at Partial Care?
Does DBT pair with MAT for opioid use disorder?
Related Pages
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