Dialectical Behavior Therapy (DBT) for Addiction

Many people with an addiction can experience intense emotions suddenly and frequently. These strong emotions can contribute to drug use and can even act as a barrier to seeking treatment. One of the most effective ways to help people with unregulated emotions is dialectical behavior therapy (DBT).

DBT is a form of psychotherapy that teaches emotion regulation.¹ It’s beneficial for patients with substance use disorder, borderline personality disorder, and other mental health conditions, particularly for people who have not connected with other forms of therapy.  

What is Dialectical Behavior Therapy (DBT)?

DBT is founded on the principles of the popular form of talk therapy called cognitive behavioral therapy (CBT). CBT empowers patients by helping them identify negative or unhelpful thoughts. A CBT practitioner will then teach a patient how to replace that negative thought with a more productive one. While this is effective for many, people with strong emotional responses can feel invalidated by being told their thoughts are “wrong.”²

This is where DBT therapy comes in. Instead of trying to replace their thoughts, DBT patients are taught to accept their thoughts, feelings, and behaviors. They are then taught new ways to cope with those emotions and thought patterns. This is where the name “dialectical” comes in, which refers to the combination of two opposites: change and acceptance.¹

Therapists use DBT to treat a variety of mental health disorders, including:¹  

• Substance use disorder
• Borderline personality disorder (BPD)
• Self-harm and suicidal behavior
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Depression
• Anxiety

How Does Dialectical Behavior Therapy Work?

DBT revolves around two opposing forces—acceptance and change—and helping a patient find a balance between the two.¹ Accepting their authentic selves and accepting their current reality are powerful forms of validation for the patient. With this validation, they can embrace healthier ways to cope, including emotional regulation. These new skills then lead to change in many areas of their life. 

Mental health professionals facilitate this progress through four different types of DBT sessions. These include:¹

DBT pre-assessment

The initial meeting with a therapist will educate the patient on this form of talk therapy, ensuring the patient is a good fit. Then, the patient will agree to the length of treatment (which is typically six months to a year). 

Individual therapy

In these sessions, the therapist will help a patient apply DBT to their life. The patient is often asked to keep a diary that tracks their feelings and actions for the week, which the therapist refers back to in the session.

Skills training in groups

During a skills training, the patient doesn’t share, instead taking on a student role. In the classroom setting, the therapist will teach the fundamental skills of DBT.

Telephone crisis coaching

The brief calls are either at agreed-upon times between sessions or in times of crisis. Over the phone, the therapist will help the patient use DBT in the present moment with whatever situation they’re struggling with. 

Four Components of Dialectical Behavior Therapy

In dialectical behavior therapy sessions, patients are taught to not see situations as all-or-nothing. Instead, they’re taught that there is more than one way to respond, and they’re invited to find the middle ground. Therapists often teach their DBT patients to use the mantra, “I’m doing the best that I can in this moment, and I want to and can do better.”²

Additionally in these DBT addiction treatment sessions, there are typically four goals that the therapist is trying to achieve. These DBT for addiction treatment objectives include:

• Keeping the patient safe by minimizing self-harming behaviors 
• Limiting any behaviors that take away from the therapeutic process
• Helping improve the patient’s quality of life by addressing any roadblocks
• Teaching new skills to offer a healthier way to respond to life’s challenges.

Four Dialectical Behavior Therapy Skills

DBT’s approach to mental health is holistic and practical. The DBT professional equips the patient with multidimensional tools they can use to address many issues, from self-harming behavior to symptoms of depression to healing from past trauma⁴—all of which can impact a person’s addiction. This type of therapy prioritizes cultivating compassion towards oneself, which can be incredibly powerful for someone with low self-esteem or a patient who harbors a lot of shame.

There are four main skills that DBT teaches:^1,2,3

Mindfulness

Being fully in the present moment (rather than thinking about the past or future) and acknowledging the thoughts and feelings that arise without trying to change them.

Distress tolerance

Managing emotions during challenging situations while accepting the situation as it is. 

Interpersonal effectiveness

Building boundaries for yourself while respecting those of others to strengthen relationships and communicate more effectively.

Emotion regulation

Recognizing, accepting, and regulating intense emotions.

How DBT Treats Addiction & Co-occurring Disorders

DBT has become an increasingly proven treatment method for patients with substance use disorders (SUDs) and co-occurring disorders, particularly those who have not responded to other evidence-based approaches.^5,6 Part of DBT’s effectiveness in treating addiction comes from its nonjudgmental approach. Using the dialectal approach, the patient is asked to make a commitment to themselves to stop using or drinking (the “change” aspect) while also being reminded that if a relapse can’t be avoided, hope is not lost, and they can still become sober one day (the “acceptance” aspect).⁵ This offers a “middle road” to recovery that can feel more attainable for people with severe emotional instability.  

Therapists who specialize in dialectical behavioral therapy for addiction treatment help their patients achieve lasting sobriety by asking them to commit to a length of abstinence that feels doable to them, whether that’s a day, a week, or a month.⁶ When that period of time is up, they ask them to commit again, and the cycle restarts. This seemingly short-term process helps the patient begin to make changes in their life while accepting where their current abilities are. As they build their recovery toolkit, they can build up how long they commit to abstinence at a time, until they are confident to commit to long-term sobriety. 

Additionally, using dialectical behavioral therapy for substance use can help patients:⁶

• Decrease abuse of drugs
• Alleviate physical discomfort from withdrawals
• Lessen cravings and urges to use
• Foster healthy relationships and seek out healthy connection

Benefits of DBT for Addiction Treatment

DBT therapies have many functional benefits that patients can apply to everyday challenging moments. For example, a therapist specializing in DBT for substance use disorders will help a patient learn how to “cope ahead.”⁶ This technique helps a patient visualize potential triggers at stress-inducing events and prepare how to handle these situations calmly and without turning to drugs or alcohol. 

While the DBT therapist is nonjudgmental about the patient’s choices, they hammer home the point that using drugs should be avoided at all costs. To maintain sobriety, the patient is instructed to cut ties with any bad influences, destroy drug paraphernalia, and even get a new phone number to control who can contact them.⁶ 

There are also proven long-term benefits for DBT and SUD patients. A study found that patients who were taught DBT continued to benefit from the therapy for several years after completing treatment.⁷ They cited that DBT helped them gain control over their lives and taught them how to manage setbacks. They also attributed the ability to form healthy relationships to their DBT experience.⁷ 

Is DBT Covered by Insurance?

Yes, DBT for co-occurring SUD is typically covered by insurance. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that health insurance policies cover mental health and substance use disorders in a similar way to medical and surgical benefits.⁸ 

Psychotherapy treatments like DBT for comorbid SUD are an important aspect of treating mental health disorders and substance use disorders, so it should be covered by major insurance companies. However, coverage will vary depending on the specific policy. 

DBT and Addiction Treatment in Kansas City 

The acceptance-led DBT approach can be the ideal method for emotionally-charged patients to overcome their addiction and co-occurring disorders. However, DBT is only one part of an effective treatment plan. At Empowered Recovery Center in Kansas City, our mental health professionals will build a comprehensive treatment protocol that integrates all aspects of an effective recovery plan.

Whether you’re looking at a medical detox, partial hospitalization, intensive outpatient, or standard outpatient, our experienced team will develop a holistic treatment plan that addresses your addiction from all angles. They’ll work with you to help you build a healthier mind and body and give you all the tools you need to achieve long-term sobriety. 

Curious what a DBT treatment plan could look like? Reach out to one of our rehab admissions specialists to learn more about how we utilize DBT. They’ll be able to answer any other questions you may have, such as using insurance for your program, what payment plans we offer, and what it looks like to be admitted into one of our programs. 

Call us or fill out our contact form today to find out how DBT could be the missing piece in your recovery.

References 

1. Professional, C. C. M. (2025, June 30). Dialectical Behavior Therapy (DBT). Cleveland Clinic. Retrieved July 24, 2025, from https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt
2. Corliss, J. (2024, January 22). Dialectical behavior therapy: What is it and who can it help? Harvard Health. Retrieved July 24, 2025, from https://www.health.harvard.edu/blog/dialectical-behavior-therapy-what-is-it-and-who-can-it-help-202401223009
3. Dialectical Behavioural therapy. (n.d.). CAMH. Retrieved July 24, 2025, from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/dialectical-behaviour-therapy
4. Corliss, J. (2024, January 22). Dialectical behavior therapy: What is it and who can it help? Harvard Health. Retrieved July 24, 2025, fromhttps://www.health.harvard.edu/blog/dialectical-behavior-therapy-what-is-it-and-who-can-it-help-202401223009
5. Haktanir, A., Callender, K. A., & Marquette University. (2020, April). Meta-Analysis of Dialectical Behavior therapy (DBT) for treating substance use. Retrieved July 24, 2025, from https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1601&context=edu_fac
6. Dimeff, L. (2008). Dialectical Behavior therapy for Substance Abusers. Addiction Science & Clinical Practice, 4(2), 39–47. Retrieved July 27, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC2797106/
7. Gillespie, C., Murphy, M., Kells, M., & Flynn, D. (2022). Individuals who report having benefitted from dialectical behaviour therapy (DBT): a qualitative exploration of processes and experiences at long-term follow-up. Borderline Personality Disorder and Emotion Dysregulation, 9(1). Retrieved July 24, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC8885141/
8. Mental Health and Substance use Disorder parity. (n.d.). DOL. Retrieved July 27, 2025, from https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-and-substance-use-disorder-parity