Over the course of the next few months, I will be exploring the application of DBT skills in the context of addiction and substance use treatment. If you or someone you love is struggling with substance misuse and emotional dysregulation, learning these skills in the context of therapy may help.
One of the hallmarks of DBT therapy is the balanced approach we take to solving challenges. DBT is fundamentally comprised of many opposite yet equally valid beliefs that we simultaneously hold true, and DBT for addiction is no different.
“Dialectical abstinence” is the first DBT for addiction skill, and it exemplifies the synthesis of opposing views that characterizes DBT therapy. Classic “abstinence” is defined as a complete termination of use of the addictive behavior, and represents one perspective on addiction recovery. Programs are often rooted in the belief that abstinence is the route to recovering from addiction, and they maintain that a life permanently free from all addictive substances and behaviors is key to recovery. DBT for addiction embraces the concept of abstinence as well, though it does so while also acknowledging that slips happen. To this point, dialectical abstinence incorporates a harm reduction approach to recovering from addiction, where the demands for perfection are lifted. By infusing addiction recovery with harm reduction, dialectical abstinence seeks to minimize harm when missteps occur (i.e. “failing well”) and getting back on track to abstinence.
So how does that work, really? The idea is to set an intention to live addiction and substance-free while also being aware of challenges and areas of risk specific to you. It is important to recognize that craving, temptation and rebellion are normal parts of addiction recovery, as are intense emotions and interpersonal challenges, and that these experiences should be approached with curiosity and openness rather than fear or resistance. When a relapse occurs, remember to keep it in perspective and not catastrophize. Rather, take it as an opportunity to learn and grow, while at the same time fully recommitting to abstinence. The shame and guilt that often accompany a lapse are addressed from a perspective of self-compassion and non-judgment. And it is from this place of acceptance balanced with change that recovery grows and flourishes.