Dialectical Behavior Therapy and Substance Abuse

DBT GROUP THERAPYAccording to the United Nations 2016 World Drug Report there are approximately a quarter-billion drug users worldwide. Over 29 million of those people are estimated to suffer from drug use disorders.

Although use of some drugs like cocaine has declined over the past few years, use of other drugs such as heroin and “club drugs” are on the rise. Other than tobacco and alcohol, the 2016 Global Drug Survey lists the most frequently used drugs as marijuana, MDMA, cocaine, amphetamines, LSD, psilocybin, opioid medications, nitrous oxide, and ketamine.

Those struggling with overuse of any one or a combination of these drugs are prone to developing dependence syndrome – an assortment of maladaptive cognitive, physiological, and behavioral symptoms that develop after repeated substance use. Despite the harmful health and social consequences that result from using the drugs, dependent users typically demonstrate an overwhelming desire to continue taking them. They’re also likely to prioritize their drug use as the day’s most important activity, and will develop an increased tolerance to the drugs over time, often requiring higher dosages to achieve the same desired effect.

Finding effective treatments for those in the powerful grip of drug dependency is extremely challenging. However, recent research has provided greater insight toward understanding the behavior of those struggling with addiction. Armed with new knowledge, clinicians are seeking innovative ways to better treat those with substance use disorder.

In a number of studies, Dialectical Behavioral Therapy (DBT) is one of the treatment strategies showing favorable results among the substance abuse population. For example, in a recently conducted randomized clinical trial, researchers set out to evaluate whether DBT would be effective for drug-dependent women with Borderline Personality Disorder (BPD).

In the study, subjects were assigned to either DBT or Treatment as Usual (TAU) for one year of care with results measured by both interviews and urinalyses throughout the clinical trial.

Findings were definitive in this study. Those who received DBT showed considerably greater reductions in drug abuse than those receiving TAU. In addition, individuals within the DBT group demonstrated significantly greater gains in global and social adjustment at follow-up than did those assigned to TAU. Clearly, within this population of women with co-occurring BPD and drug addiction, DBT was shown to be a superior treatment option.

In another study, DBT was compared to comprehensive validation therapy plus 12-step (CVT+12S) for the treatment of heroin addicted women meeting criteria for BPD. Here again, the findings for the implementation of DBT were compelling. While both treatment conditions were effective in reducing opiate use relative to baseline, DBT participants maintained reductions in opiate use through 12 months of treatment, while those assigned CVT+12S showed an increase in opioid use during the treatment’s final 4 months. An important additional finding was that DBT participants were notably more accurate in their self-report of opiate use than those assigned to CVT+12S treatment.

Finally, in a study, examining the relationship between improvements in emotion regulation and substance use problems, DBT treatment once again proved effective. Here, 27 women with substance dependence and BPD received 20 weeks of DBT in an academic community outpatient substance abuse treatment program. Participants exhibited improved emotion regulation, improved mood, and decreased substance use frequency.

Conquering drug addiction requires developing specific skills to manage destructive, repetitive behaviors. Studies like these provide encouraging statistics that demonstrate incorporating DBT into addiction treatment can support both recovery and prevent relapse.