Dialectical Behavior Therapy for Addiction

Dialectical behavior therapy (DBT) has proven to be one of the most effective treatments in helping people overcome substance abuse and achieve long-term sobriety. 

In addition to teaching valuable coping skills like mindfulness and emotion regulation, DBT also helps people reduce/eliminate alcohol and drug use and lead healthier lives with better relationships. 

Read on to learn more about how DBT can help you or a loved one with alcohol or drug addiction, and more about the DBT treatment programs that are offered at Otter House Wellness. 

About Dialectical Behavior Therapy for Addiction

Dialectical behavior therapy was first created in the 1980s by psychologist Marsha M. Linehan with the intention of helping patients with borderline personality disorder (BPD). 

Since its inception, DBT has grown to treat several other types of mental illness as well, and has proven to be quite effective in treating substance use disorders (SUD) in addition. 

It is a highly structured type of psychotherapy that is based on cognitive behavioral therapy (CBT) but which has been adapted to address specific mental health issues, such as intense emotions and impulsive behaviors. 

DBT can be an extremely effective type of therapy, however, it is essential that anyone participating in DBT be truly committed to their therapy and goals for change. 

It is usually recommended that people stay in a DBT program for a minimum of a year, though this will vary with each person. 

Key Facts on DBT

  • Disorders treated with DBT: borderline personality disorder, substance use disorders including alcohol use disorders and opioid use disorders, bipolar disorder, anxiety disorders, depressive disorders, eating disorders
  • Skills taught with DBT: mindfulness, emotional regulation, distress tolerance, interpersonal connectedness 
  • Benefits of DBT: improves personal relationships, helps people stop using drugs and alcohol, teaches valuable skills that can be used in all areas of life, teaches people how to control and manage their most difficult emotions, can help with withdrawal symptoms and reduce cravings
  • Consequences of untreated mental illness: worsening of mental health conditions or development of new ones, increased substance abuse, weakened immune system and more physical illness, financial and legal problems, poor performance at work or in school, increased risk for self-harm or suicide
  • How to pay for DBT: private or state-funded healthcare insurance, self-pay or cash, financial assistance, grants or donations

How Does DBT Work in Addiction Treatment?

DBT helps people to address the relationship between their thoughts, emotions, and behaviors, and can look at these relationships in terms of their addiction. 

In turn, it helps people address their impulsive and destructive behaviors, such as self-harm, suicidal ideation, and substance abuse. 

Because of this, DBT is often included in addiction treatment centers as a part of dual diagnosis treatment, which works to treat people with co-occurring disorders.

In these programs, people will work on their overall mental health and well-being to address any potential issues that may have led to their addiction. 

In this sense, people are less likely to relapse from alcohol or drug abuse in the future because their mental health is better and they no longer need substances to self-medicate. 

What Types of Programs Offer DBT?

DBT can be found in all levels of care and through several types of programs.

For this reason, people can continue to attend DBT sessions as they work their way through different levels of care as their situation improves.

Individual Therapy Sessions

The majority of DBT sessions will likely be in an individual format, allowing the patient to have one-on-one conversations with their therapist in which they address their own triggers as well as treatment goals. 

During these sessions, people will also work along with their therapists in order to apply the skills they have learned in DBT to real-life situations that apply directly to them. 

Group Therapy Sessions

Most DBT programs will include a group therapy component, though these groups will be small and consist of around four to eight people. 

These group sessions allow for peer support and are also likely to be where patients are taught new skills to work on through homework or group activities. 

Inpatient Programs 

DBT can also be offered as part of a larger inpatient or residential program, during which patients live onsite for an extended period of time and receive 24/7 care and support. 

Patients are likely to attend a mix of individual therapy and group therapy while in a residential program, while also using other types of interventions and treatment options geared toward addiction like medical detox, medication-assisted treatment (MAT), and family therapy

Outpatient Programs

DBT can also usually be found in multiple levels of outpatient care, including partial hospitalization programs (PHP) and intensive outpatient programs (IOP). 

Depending on the intensity of outpatient treatment that a person chooses, they may attend therapy sessions on a weekly or bi-weekly basis, or even several times a week if necessary. 

Types of DBT Techniques 

There are four main techniques taught in DBT skills training that separate this type of therapy from others. 


Mindfulness teaches a focus on the present moment, as opposed to dwelling on the past or anxiously anticipating future events that may or may not happen. 

It can be helpful in DBT and when treating addiction, as it can help people to accept their emotions and manage them instead of leaning on substances to escape or forget. 

Interpersonal Effectiveness

DBT teaches numerous skills for interpersonal effectiveness that are directed toward helping people to build better relationships through healthier communications styles. 

This is an important skill for people who are living with substance abuse issues or borderline personality disorder, as people in these groups often have problems in relationships with their friends, family members, and intimate partners. 

Stress Management

Stress management, sometimes referred to as distress tolerance in DBT, is a skill that focuses on effectively managing any stressful or challenging situations that come up in life. 

Part of this skillset is learning how to self-soothe, distract oneself if necessary, and accept and acknowledge emotions without judging them. 

Emotional Regulation

Emotion regulation in DBT is one of the biggest focuses of this kind of therapy, teaching patients to identify and manage their emotions while reducing the intensity of these emotions as well. 

This DBT skill is especially vital in treating people who are exhibiting behaviors of self-harm or suicidal ideation, to help keep them from acting impulsively when they are experiencing intense emotions. 

Elements of DBT in Addiction Recovery Programs

While DBT definitely shares some characteristics with other types of therapy, there are some key elements that separate DBT and make it a great choice for treating addiction. 

DBT is often used in addiction recovery programs for people who have tried other therapy modalities and found them ineffective. 

Elements of DBT in addiction recovery programs include:

  • Mindfulness and living within the present moment
  • Effective communication and respecting the boundaries of others
  • Coping with conflicts in healthy and appropriate ways
  • Acceptance of life conflict and difficult emotions
  • Finding a healthy balance between acceptance and change
  • Having the ability to label emotions and describe experiences appropriately

Furthermore, one of the largest benefits of DBT as a therapy is that it teaches concrete skills that can be applied to any area of life and can extend beyond its original applications. 

How Effective Is DBT in Drug and Alcohol Treatment?

Multiple studies have confirmed DBT to be an effective treatment for drug and alcohol addiction, including one study that found patients who received DBT were more likely to stay in and complete treatment. 

Still, DBT is by no means a cure for substance abuse or any mental health disorder, though it has helped many to improve their quality of life. 

Benefits of DBT in a drug and alcohol treatment program include:

  • DBT promotes and encourages people to make positive changes in their lives, such as achieving and maintaining sobriety
  • DBT can help people to better understand the negative consequences of their drug and alcohol use
  • Can address addiction at the same time as other mental health disorders 
  • Can reduce a person’s risks of relapse by arming them with healthy coping mechanisms
  • Can foster better interpersonal relationships, and in turn a larger support network 


RO-DBT stands for Radically Open Dialectical Behavior Therapy, a type of therapy that was developed for people who have problems with overcontrol and which emphasizes the idea of “radical openness.”

Radical openness is the idea of people learning to be flexible, open, and socially connected. In fact, it is this idea of social connectedness that sets RO-DBT apart from other types of therapy. 

RO-DBT is a type of DBT therapy. Yet there are differences between these two behavioral health therapies, including:

  • DBT treats people with emotional dysregulation, while RO-DBT treats people with overcontrol issues, which are essentially opposite problems.
  • DBT is an internal therapy approach that teaches skills like emotion regulation and distress tolerance, whereace RO-DBT is an external therapy approach that teaches skills like social-signaling and social connectedness.
  • DBT works best on mental health disorders that involve lack of control such as borderline personality disorder and antisocial personality disorder, whereas RO-DBT works best on disorders that involve overcontrol like obsessive compulsive disorder and certain eating disorders.

Cost of Dialectical Behavior Therapy

The average cost of a DBT program without insurance can be between $150 and $300 per week and around $6,000 per year or more.

For the average person, the cost of DBT can be out of reach, especially if they are also in need of other treatments at the same time. 

Fortunately, DBT can often be paid for mostly by insurance, though this will vary with each person. 

Factors that can affect the cost of DBT include:

  • Whether it is through outpatient treatment or part of a larger inpatient program
  • The duration and frequency of therapy, as well as the length of the program as a whole
  • Whether the treatment facility accepts insurance and is in the patient’s network
  • Whether the patient’s insurance is private or state-funded

Many facilities also offer financial assistance, such as sliding fee scales and payment plans, in order to make their services more accessible to a wider range of people. 

Contact us at Otter House Wellness if you have concerns about paying for addiction treatment, as we often work with individuals and their families if they need help accessing treatment. 

Find Custom DBT Programs in North Carolina

DBT is a valuable part of substance abuse treatment and can be what many people need to change their lives and start living in more positive and healthy ways.

At Otter House Wellness, we offer multiple levels of outpatient care to serve people with varying levels of addiction, including multiple types of behavioral therapy. 

Contact us today to learn more about DBT in our comprehensive treatment programs and how we can help you or your loved one live without substances and mental illness symptoms. 

Frequently Asked Questions

What is DBT and how does it work?

DBT is a type of psychotherapy and behavior therapy most commonly used for people with borderline personality disorder and which teaches strategies for emotion regulation. It is often performed through both individual and group sessions, with the therapist teaching valuable skills and coping mechanisms to help people deal with their emotions in healthier ways.

What mental illnesses does DBT treat?

DBT can be used to treat a variety of mental illnesses, however, it was originally created as a means of treating borderline personality disorder. It is also especially effective in treating substance use disorders, eating disorders, post-traumatic stress disorder, and self-harm and suicidal behaviors.

How is DBT different from CBT?

There are several differences between DBT and CBT, including that DBT often includes a group therapy component and tends to be more long-term than CBT, which usually only lasts a few months at the most. DBT also has more of an emphasis on certain skills like mindfulness and emotion regulation that help people deal with difficult emotions and impulsive behaviors. 

Who is not a good candidate for DBT?

DBT can be a great therapy for a variety of people and disorders, but anyone taking part needs to be comfortable with group therapy and also committed to their mental health goals. For this reason, DBT is often not recommended for mood disorders or behavior disorders where the patient may lack a commitment to or be resistant to their therapy.

Is DBT or CBT better for anxiety?

While DBT and CBT can both be used for treating anxiety, CBT is considered to be the better option for mental health issues like anxiety and depression. On the other hand, DBT is considered to be better for people with borderline personality disorder and behaviors that go along with it like self-harm and suicidal behaviors.

Can you recover from mental health issues for good with DBT?

Many types of mental health issues are considered chronic, including addiction, so DBT cannot offer a complete cure. With DBT, however, many people are able to see their symptoms of mental health issues improve greatly and even enter remission for the long-term.


Association for Cognitive and Behavioral Therapies (ACBT). “Radically Open Dialectical Behavior Therapy.” Retrieved from: https://www.abct.org/fact-sheets/radically-open-dialectical-behavior-therapy/. Accessed on May 7, 2024. 

Cleveland Clinic. “Dialectical Behavior Therapy (DBT)” Retrieved from: https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt. Accessed on May 3, 2024. 

National Library of Medicine. “Dialectical Behavior Therapy.” Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/. Accessed on May 3, 2024. 

National Library of Medicine. “Dialectical Behavior Therapy for Substance Abusers.” Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797106/. Accessed on May 7, 2024. 

Psychology Today. “Dialectical Behavior Therapy.” Retrieved from: https://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapy. Accessed on May 3, 2024. 

Yale Medicine. “Dialectical Behavior Therapy (DBT).” Retrieved from: https://www.yalemedicine.org/conditions/dialectical-behavior-therapy-dbt. Accessed on May 4, 2024. 

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