Dbt substance abuse presentation

DIALECTICAL BEHAVIOR THERAPY
FOR SUBSTANCE ABUSE
Skills for Recovery and Relapse Prevention
Alicia Lawson, Psy.D.

Dr. Alicia Lawson – www.dbtmarin.com

What we’ll cover
• What is Dialectical Behavioral Therapy (DBT)?
• What is the dialectical approach to treating substance abuse?
• Why skills?
• What makes a great skill?
• How do you choose the right skills at the right time?


What is DBT?

Cognitive Behavioral Therapy
+
Validation
(acceptance)
+
Dialectics


What is DBT?
Cognitive Behavioral Therapy

Four main change strategies
1. Skills Training
2. Exposure Therapy
3. Cognitive Therapy
4. Contingency Management


What is DBT?
Validation


What is DBT?
Dialectics
1. Everything is connected to everything else

1. Change is constant and inevitable

1. Opposites can be integrated to form a closer approximation to the
truth (which is always evolving).


What is DBT?
Dialectics

Balancing

Change/Problem Acceptance
Solving Validation


What Is The Dialectical Approach?
Polarities in Substance Abuse Treatment

Abstinence Only Model
vs.
Harm Reduction Model


The Abstinence Model

Never using again

Pro:
People who commit to abstinence stay off longer

Con:
It takes longer for people to get back on the wagon once they fall off


Harm Reduction Model

Acknowledging there will be slips; minimizing the damage but not
demanding perfection

Pro:
When a slip does happen, people can get back on wagon faster

Con:
People who commit to harm reduction relapse quicker



HARM
ABSTINENCE vs.
REDUCTION

SYNTHESIS: DIALECTICAL ABSTINENCE


Dialectical Abstinence

The goals is not to use drugs again. Complete abstinence. However, if
there is a slip, the goal is to minimize harm and get back to abstinence
as soon as possible.

Pro:
It works!

Con:
It is work!
You don’t get a vacation (you’re either abstinent or working to get back
to abstinence at all times)


Why Skills?
• Pain and distress are a part of life (inability to accept pain can
increase suffering)

• Prevents impulsive actions (i.e. drug use) that can make things
worse.

• Replaces old behaviors that work in short term yet can cause
problems in the long term.


What makes for a GREAT skill?

• People have to actually use it

• It has to be measurable

• It has to work in stopping the problematic behavior without causing
new problems

• It allows the individual to build mastery (self – reinforcing)


What makes a Great skill?
People have to actually use it

1. UNDERSTAND THE PROBLEM

Conducting a Behavioral Chain Analysis

Trigger Link

Vulnerabilities Link Link Self-Destructive Behavior Consequences


People have to actually us it

2. FIGURE OUT WHAT TO DO

PROBLEM
CUE CONSEQUENCES
BEHAVIOR

CUE SKILL REWARD


People have to actually us it

3. ADDRESS FACTORS THAT GET IN THE WAY

“Yes, but”
“Just one
more time”

“I can’t do
this”
“It’s not
my fault”


It has to be measurable

Pre/Post measures of SUDs
(subjective units of distress)


D B T D i a measurable
has to be r y Ca r d
ItName:__________________________________ Date Started:_____________________

Urges 0 - 5 Em otions 0 - 5 Behaviors
sucide alcohol drugs binge skip Pain Sad Shame Anger Fear/ Joy alcohol drugs binge meds study Sleep Exercise self Diary
Date: therapy Anx. reienforce Card
Mon.

Tue.

Wed.

Thurs.

Fri.

Sat.

Sun.

Homework / Notes:

* 0=Not thought about or used 2=Thought about, not used, wanted to 4=Tried, could do, but didn't help 6=Didn't try, used, didn't help
1=Thought about, not used, didn't want to 3=Tried, but couldn't use 5=Tried, could use, helped 7=Didn't try, helped


It has to work without causing problematic side effects

Behaviors to Increase Behaviors to Decrease

Mindfulness Skills • Identity confusion
• Emptiness
• Cognitive dsyregulation
Distress Tolerance Skills • Impulsive behaviors
• Suicide threats
• Intentional self harm
Emotion Regulation Skills • Libile Affect
• Excessive Anger

Interpersonal Skills • Interpersonal Chaos
• Fears of Abandonment


It allows the individual to build mastery


The right skills at the right time?
DBT skills for substance abuse disorders

1. Avoiding Cues & Triggers
2. TIP
3. Urge Surfing
4. Pros and Cons
5. Alternative Rebellion



Avoiding Cues & Triggers



TIP

T Temperature

I Intense Exercise

P Progressive Muscle Relaxation



Urge Surfing



Pros and Cons
Pros Cons

Using
Drugs

Using
Skills



Alternative rebellion


Case #1: Party Crisis

Options for skills
1. Avoiding Cues & Triggers - Leaving the party immediately!
2. TIP – Go dance intensely to the music
3. Urge surfing – acknowledged the desire for a cigarette and remind
yourself it’s a wave and will pass
4. Think about the pros and cons of smoking
5. Use alternative rebellion (double dip, leave the toilet seat up, …)



• Cognitive – Review the data; what has been measured pre/post
scores after skills use, diary cards, etc.
• Behavioral - Know the situation; what are the cues, triggers,
emotions, vulnerability factors, etc.
• Validation – Build on any past successes
• Dialectic – Accepting the moment and current situation completely
while focusing on skills to create change and build a life worth living.


References
• Dimeff, L., & Linehan, M.M., (2008). Dialectical Behavior Therapy for
Substance Abusers. Addiction Science & Clinical Practice 4(2)39-47.

• Dimeff, L., et. Al., (2000). Dialectical behavior therapy for substance
abuse: A pilot application to methamphetamine-dependent women
with borderline personality disorder. Cognitive and Behavioral
Practice. 7(4) 457-468

• Linehan, M.M., (1993). Cognitive-Behavioral Treatment of Borderline
Personality Disorder. New York: Guilford Press.
Linehan, M.M., in press. Skills Training Manual for Disordered
Emotion Regulation. New York: Guilford Press.

• Marlatt, G.A., and Donovan, D.M., (2005). Relapse Prevention:
Maintenance Strategies in the Treatment of Relapse Prevention. New
York: Guilford Press.


How you can learn more

Books
Koerner, K. (2011). Doing dialectical behavior therapy: A practical guide.
New York: Guilford Press.
Linehan, M.M., 1993. Skills Training Manual for Treating Borderline
Personality Disorder. New York: Guilford Press.
Marlatt, G.A. & Gordon, J.R. (1995). Relapse Prevention. New York:
Guilford Press.
Pryor, K. (1999). Don’t shoot the Dog: The New Art of Teaching and
Training. New York: Bantam Doubleday Dell Pub.

Websites
http://www.dbtselfhelp.com/
http://behavioraltech.org/
http://www.addictionpro.com/article/dbt-meets-12-steps


Thank you!

Dr. Alicia Lawson
Clinical Psychologist
Owner DBT Center of Marin
www.dbtmarin.com


Dbt substance abuse presentation

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