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Dialectical Behavior Therapy (DBT) is a well-established and evidence-based treatment approach for individuals with multiple severe psychosocial disorders. Due to the prevalence in overlap between psychosocial distress and Substance Use Disorders (SUD), psychologists have developed DBT for Substance Abusers. This targeted system incorporates concepts and modalities designed to promote stable abstinence and to reduce both the length and adverse impact of relapses. Among these are dialectical abstinence and “clear mind.”
Beginning DBT in an outpatient setting allows clients to engage with treatment-related goals while also integrating their daily experiences and challenges into their treatment. This allows for a more genuine and comprehensive identification of needs that may not be seen or experienced in an inpatient or residential setting. Furthermore, individuals who learn the skills and techniques taught during outpatient treatment can utilize them both in the community and as part of their support network at the moment.
Clients entering treatment for SUD typically begin DBT in the mental and behavioral state known as “addict mind.” During this state, their thoughts, beliefs, actions, and emotions are under the control of one or many substances.
As they achieve increasingly longer periods of sobriety, they typically develop an outlook identified as “clean mind.” In this state, sobriety is there but clients may also feel immune from future problems. This potential lack of vigilance can set the stage for both mental and physical lapses.
The interplay between addict mind and clean mind constitutes a dialectic that leads to the identification, during the process of dialectical abstinence, of a third state called “clear mind.” During this phase, the individual enjoys sobriety while remaining fully aware of the presence and characteristics of addict mind. With a clear mind, they are aware and take measures to avoid or cope with circumstances that can restore addict mind and place their recovery in jeopardy.
The word dialectical refers to the synthesis of two opposites and the mindset that there is always more than one point of view. This translates to two opposite goals for clients: change and acceptance.
The parallel process of acceptance and change in Dialectical Behavior Therapy is consistent with the philosophical approach found in 12-step programs, as seen in the Serenity Prayer: “God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
This synthesis also makes DBT unique in its ability, as a clinical approach, to complement a system of recovery. In the quest for maintaining stable and long-standing recovery, the DBT dialectic guides clients to push for immediate and permanent termination of use (Change), while also holding the belief that relapse, should it occur, does not mean that the client or the treatment cannot achieve the desired result (Acceptance).
The dialectical approach joins concrete insistence on recovery with nonjudgmental, problem-solving responses to relapse that include techniques to reduce the negative outcomes associated with overdose, infection, and other personally identified risks. The 12-step concept, “Just for Today”, invokes the same strategy to reach the same goal: a lifetime of recovery achieved moment by moment all while engaged in a worthwhile life.
DBT’s ultimate goal is to aid clients in their efforts to build a life worth living. The concept of a life worth living is open ended and client-centered. This allows for clients to take on a more active part in treatment, including determining the life they are looking to live and developing the skills required to achieve this life.
When Dialectical Behavior Therapy is successful, the client learns to envision, convey, pursue, and maintain goals that are independent of their history of problematic behaviors, including substance abuse. As a result, clients are better able to navigate life’s typical problems. DBT’s emphasis on building a life worth living is a broader therapeutic goal than a reduction in problem behaviors, symptom management, or reduction of negative outcomes. As a result, this process can be more meaningful to the patient, which in turn, allows for more concrete and genuine client participation and connection.