How to use Dialectical Behavior Therapy for Addiction Recovery

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

Thomas Mittelsteadt MS, CSAC, LPC-IT
Dual Diagnosis Therapist at Ascension NE Wisconsin-Mercy Hospital

I help those with both mental health and substance use issues create a better life for themselves by learning how to manage their psychological diseases. I’m a strong advocate for this population and educating the public, law makers and decision makers about these diseases and how best to work with and live with this population.

Dan put on a great presentation about how to use some DBT skills to overcome cravings and how to change habitual behaviors. He covered both complete sobriety and harm-reduction, which I think is very important for people to understand. Not everyone who has a problem with substance abuse are addicted so, harm-reduction would be a great way to handle the problem. If, however, harm-reduction isn’t working, then complete abstinence should be seriously considered.

I think it is very important that clients keep track of what and who triggers their cravings, discover what their automatic thoughts are and what feelings make them more vulnerable to a lapse or relapse so that they can become more mindful of these things in the first place. I agree with Dan that this is a process and no one should be expecting perfection immediately. This takes practice and dedication to the process. There is no magic pill, cure or counselor that will make it all go away instantly, and Dan’s first step, to make an agreement with yourself to be uncomfortable is a great way of starting this process. Getting used to occasional discomfort is part of life in general, it happens to everyone at times, it’s natural, it’s ok. The saying “this too shall pass” is a good to keep in mind, because it will.

Another important point that Dan brought up is for the client to be nonjudgmental about facts and about what is happening with the client. Don’t, figuratively, beat yourself up about a lapse or relapse, learn from it and keep moving forward. Relapses are nine times out of ten, a process that probably had been coming on for some period of time. The client should ask themselves, “What happened? What wasn’t I doing that I was doing to stay sober? How can I do better next time”? It’s a learning process, and no one learns overnight.

Distractions are great tools to use to get through a craving as well as “thinking through the drink” as they say. Keep in mind that when doing this think of not only the negative consequences, but also of the positive reasons to stay sober. Reward yourself for the small victories as well as the big ones. Both are important.

When it comes to harm-reduction and working with a dual diagnosis, if a client does lapse, I agree that it would be best to do it in a mindful way, non-judgmentally, and with intention. This also helps with breaking the triggers power. Triggers are thoughts that are tied to emotions and have certain chemicals in the brain that lock these together. To break this bond, one must be exposed to a trigger (not all, like going to a drug house or something dangerous like that) and then successfully get through the experience. New neurological pathways need to be created. Again progress, not perfection.

Finally, one important point that Dan glossed over, is breathing. This is very important while dealing with cravings. Deep slow breaths for the abdomen, NOT the chest, when doing any DBT skill will help slow the mind down and help relax the body. Getting more oxygen in a person’s body is also a good reward.

Founder at martinjon

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.