Can Dialectical Behavior Therapy be Used to Treat Addiction and STOP Cravings?

Dan Pierce from Mentally Fit explains how to use Dialectical Behavior Therapy (DBT) to overcome addiction cravings.

Watch the full video, read responses from experts, then comment your response!

Addiction recovery experts respond

​Jennifer Hooper
Executive Director at Leesburg Treatment Services

I think Dan Pierce is an excellent example of someone showing the efficacy of sticking with treatment. I loved when he described how many modalities and treatments he tried, including DBT, and how it took time and his own understanding and practice of how to apply the treatment before it worked. I typically refrain from backing up over simplified step by step guides on how to manage complicated problems.

However, I feel as though Dan detailed a lot of concepts within his steps and shows that he has spent a lot of time and energy learning the skills, how they work and how to make them work for him. I agree with everything Dan said in relation to how to use the skills and I find DBT to be highly effective in treating cravings and ineffective and potentially harmful behaviors.

I would like to add the need to be mindful of varying audiences and skill training levels. This is very helpful for lower risk individuals, however, coping with harmful behaviors and use alone or without appropriate support and training can be dangerous for those in crisis or active addiction. It is especially dangerous if you are in a risk taking, emotionally dysregulated state and attempting to follow this list and "proceed mindfully" with use.

Proper education, skill building, treatment and stabilization are often needed for the skills to be effective, especially with individuals with progressed addictive and mental health diseases. My best advice would be to ask for help, share your urges with someone safe, get professional treatment that specializes in your needs and build your support and safety plans. This will help move a person from crisis to be able to follow through with and benefit from the skills much like Dan has.

I would caution with some phrasing Dan said such as "just alcohol", especially when referring to being at the bar and having a beer in the fridge. Normalizing this to people that may be struggling in the moment and looking for help with cravings may misunderstand the application. In early recovery, especially if still vacillating with use and abstinence, avoidance of triggers and reinforcers that create and enhance cravings and urges is still one of the most effective 1st steps to any means of abstinence. Replacing these with positive reinforcers for abstinence and getting help are usually your first and best lines of defense. 

Kevin Lee
Founder and CEO at JourneyPure

DBT is a useful tool that we teach our clients. The skills that Dan Pierce discusses are great ones that can be highly effective. Being mindful about thoughts before acting upon them is essential to staying sober. One of the most important aspects that Dan discusses about DBT is the pause and reflect method.

Addiction is a complex disease, and many people who suffer from it may believe that after some time sober, they will be able to drink or drug without consequences. They often forget the troubles and pain that their substance use caused in the past. When a person can feel a craving, pause before acting, and think through what the possible consequences may be, there's a good chance that the craving will go away. I agree with the statement that DBT is used to decrease or stop dangerous, addictive behaviors.

One thing I would like to add is that DBT is not the only way to treat addiction. At the end of the video, Dan says that if these DBT methods fail, a person can choose to carry out the negative behavior without judgment. I don't believe that anyone should encourage a person to go out and use drugs or alcohol if these methods fail. Today, addiction is a life and death matter.

While DBT is one tool used for treating addiction, an integrated approach that utilizes CBT, Medication-assisted treatment, life-skills training, recovery coaching, and aftercare can better support long-term sobriety rather than DBT alone.


MARTINJON

Author of the book 'Recover Yourself: Refocus Your Life Now That You're Sober'

I am a Recovery Mentor with 18 years clean and sober. Author of the upcoming book Recover Yourself: Refocus Your Life Now That You're Sober. I also host the Recover Yourself Podcast where I interview people in long term recovery.

I do a lot of work with treatment centers about getting people, with and without obvious addictions, to begin to recover themselves. One of our biggest problems is that we act and think with others in mind. Even in the Dan Pierce video, he states "you will look like a crazy person" (during the open hands half smile section) this is recognizing and normalizing the importance of the thoughts of others. Recovering yourself is about addressing the idea that we have run from, or to, others in order to define how we are to be.

I do agree with his techniques, they are wonderful, however, they take a certain amount of thinking clearly to be able to perform. It is important to be able to think clearly and to know what that really looks like. If a person has lived a decade where every action and every day has been dictated by a drug or mindset, a craving won't be as easy to dismiss because you want to be sober for a recording. This is where accountability comes into play.

For me, getting sober meant utilizing anything I could, from mindfulness to shame. As Dan mentioned calling family or a friend brings up a new sense, or feeling, I have to face my cravings, thoughts, or actions publicly, doing this often brings up feelings of shame or disappointment, it may even bring up new strength.

It doesn't seem like addiction, for Dan, is life or death. This is not the case for everyone, by hook or by crook there are people that have to stay sober and these activities may stave off a slight discomfort during a craving. Mindfulness is the key to long term recovery and each of Dan's activities are solid but are they achievable by someone new to recovery?

In order for these to work, we have to start from a place in which we respect ourselves enough to want to do them. This is not common amongst people who are new to recovery. I was the most suicidal during early sobriety, not active addiction.

Our addictions are symptoms of the things that Dan's exercises can help us further explore, the uncomfortableness, the feelings, and loneliness. Stepping away from the activities that we used to avoid those things will bring them back up, which is exactly what Dan touches upon in the beginning.. Doing this alone can be very difficult but it is not impossible of course..

I agree with Dan completely but it is probably not the solution to someone in active addiction, this is more an approach for someone who is sober curious. Now DBT can be used in conjunction with other therapies to help people in active addiction, but addicts have to come to sobriety on their own, I personally don't care how they do it so if this works I am 1000% behind them. if something else works all the more power to them. Once an addict is thinking clearly though, that is when the magic happens.

Elise Schiller​
Author of the book 'Even If Your Heart Would Listen: Losing My Daughter to Heroin'

My daughter, Giana Natali, died over a heroin overdose in January of 2014 at age 33. Her opioid use disorder was severe and compounded by major depressive disorder. For approximately 20 months she voluntarily attended residential and outpatient rehab programs to try to get well. I have used her letters, journals, and the progress and medical notes from her rehab stays to examine her illness and treatment, while writing a memoir about our family’s response to her illness and death.

I have become involved in advocating for evidence based treatment and harm reduction policies. I served on the Philadelphia Mayor’s Commission to Combat the Opioid Epidemic and currently serve on the City’s Behavioral Health Department Advisory Board.

As Dan himself says in the video, he is talking about “small behaviors.” He is talking about deciding not to smoke weed if you have a bust day and a lot to get done, or avoiding the desire to eat something sugary or fatty if you are trying to control your weight. Dan advises people to stop and “play the tape through,” examining the consequences of their behavior. The problem with this is that the definition of severe substance use disorder includes a person continuing the behavior despite being aware of the negative consequences.

DBT and other behavioral approaches have not been successful in treating severe opioid use disorder (OUD). People with severe OUD will do almost anything to avoid the extremely painful dopesickness that will be caused by not continuing their use. What has been successful is medication assisted treatment (MAT) with one of the three medications FDA approved for this purpose. The most current thinking is “medication first,” followed by therapy and immediate social services such as housing, and then recovery supports such as addiction counseling groups or support groups.

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