Although originally developed for borderline personality disorder (BPD), Dialectical Behavior Therapy (DBT) has turned out to be helpful for far more people than it was originally intended. Clinicians now use the same skills—mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness—with people who are struggling with drug and alcohol abuse to prevent relapse.
Many people who are recovering from drugs or alcohol have strong emotional triggers, such as stress, anger, shame, or anxiety, that can quickly lead them back to their old ways. DBT gives people real tools to slow down those reactions, notice the urge to use drugs, and choose a healthier response.
At Trinity Wellness Group, our program structure is based on a four-week cycle, with each week focusing on one of the four DBT skill sets to help those in recovery significantly reduce the risk of relapse.
What is DBT?
Dialectical Behavior Therapy (DBT) is a structured psychotherapy that teaches people how to manage intense emotions, cope with stress, and build healthier relationships.
Psychologist Marsha Linehan at the University of Washington developed it in the late 1980s while working with people who had long-term emotional instability and self-destructive behaviors, particularly those with borderline personality disorder (BPD) [1].
Linehan combined Cognitive Behavioral Therapy with mindfulness techniques to build a framework that teaches people how to stop, think about their thoughts and feelings, and overcome stressful or triggering situations intentionally instead of acting on impulse.
Who Can Benefit from DBT?
DBT has grown into a highly effective therapy for a range of substance use disorders and co-occurring mental health conditions. Anyone struggling with emotional regulation, cravings for drugs and alcohol, or strained relationships due to mental health and addiction can benefit from DBT.
Conditions DBT Skills Can Help Address
- Substance use disorders and relapse risk
- Alcohol dependence
- Chronic stress and emotional dysregulation
- Anxiety disorders and panic attacks
- Depression and mood instability
- Post-traumatic stress and trauma-related symptoms
- Impulsivity and high-risk behaviors
- Anger and difficulty managing intense emotions
- Relationship conflict and interpersonal difficulties
How DBT Skills Help Prevent Relapse in Recovery
DBT is used in many addiction treatment programs because it helps people deal with one of the main reasons they relapse: having trouble controlling strong emotions. DBT doesn’t just help people stop using drugs; it helps them understand the patterns that lead to drug use [2].
Some of the most important ways that DBT skills help people stay sober are:
- Recognizing emotional triggers early on, before they turn into cravings or acting on impulse
- Learning how to deal with strong emotions without using drugs or alcohol
- Making it easier to deal with stress, anger, or anxiety by improving emotional regulation
- Being mindful to stay in the moment and aware during triggering situations
- Better communication and setting better boundaries can help lower relationship stress that can lead to relapse.
- Finding better ways to deal with boredom, loneliness, or anger
- Learning to stop and think before acting
DBT Skills That Strengthen Long-Term Sobriety
Skill #1 Mindfulness
DBT is based on mindfulness, which is the practice of being aware of and present in the moment. During recovery, people often have cravings and relapse when they feel stressed, feel bad about the past, or are afraid of the future.
People who practice mindfulness can slow down, notice how they feel without judgment, and put distance between an urge and their reaction. That pause can help them choose a healthier response instead of acting on a craving.
Activities may include:
- Daily breathing exercises to stay grounded and present when you have a craving or are stressed
- Writing in a journal or thinking about your thoughts and feelings without judging them
- Walking or moving with awareness to pay attention to your body and the things around you
Skill #2 Distress Tolerance
People often feel waves of stress, frustration, or emotional pain that are too much to handle in the early stages of recovery. In DBT, they learn how to get through those tough times safely with distress tolerance techniques such as grounding exercises, healthy distractions, or calming strategies until the intensity passes.
One of the most important things you can do to avoid relapsing is to learn how to deal with pain instead of using drugs and alcohol to escape it.
Activities may include:
- Using grounding techniques such as holding an ice cube or noticing five things you can see, hear, feel, taste, and touch
- Healthy distraction activities, such as exercising, reading, or creative hobbies, during high-stress moments
- Crisis coping plans, including phone lists, safe spaces, or brief meditations for immediate relief
Skill #3 Emotional Regulation
DBT helps people understand their emotional patterns, figure out what makes them react in certain ways, and learn better ways to deal with intense feelings of anger, shame, sadness, or anxiety. People are less likely to use drugs or alcohol to numb or escape their feelings when they are more aware of them.
Activities may include:
- Keeping a journal of your triggers and reactions can help you find emotional patterns.
- Listening to music, taking a warm shower, or using guided imagery to calm strong feelings are all ways to soothe yourself.
Skill #3 Interpersonal Effectiveness
Addiction can destroy relationships, and rebuilding and repairing them during recovery can cause stress, shame, or other social pressures that may lead to relapse. Many people also go back to using drugs or alcohol because of triggering relationships or a lack of boundaries.
This skillset teaches individuals how to set strong boundaries, communicate clearly, and handle conflict in healthier ways. It also helps individuals build stronger support systems, an important part of long-term sobriety.
Activities may include:
- Practicing assertive communication by role-playing tough talks with a therapist or friend
- Setting and keeping healthy limits with friends, family, or coworkers
- Using DEAR MAN strategies (Describe, Express, Assert, Reinforce, Mindful, Appear Confident, Negotiate) to ask for what you need while keeping the peace
Our Approach to DBT at Trinity Wellness Group
Week 1
Focus is on mindfulness, distress tolerance, and foundational psychoeducation topics, including understanding how mental health challenges drive addiction, co-occurring disorders, common challenges in early sobriety, identifying triggers, and stages of change.
Week 2
Focus is on emotional regulation, interpersonal effectiveness, and the exploration of the importance of community and relationships in sustaining recovery, as well as the ability to start over in the face of lapse and relapse.
Week 3
Integration of advanced DBT skills, trauma processing, and coping strategies for personality-specific challenges in recovery.
Week 4
Consolidation and implementation of skills with support from clinicians and recovery coaches with lived experience in preparation for transition to aftercare.
Manage Cravings and Intense Emotions with DBT Therapy in Massachusetts
At Trinity Wellness Group, we offer personalized day treatment programs for those recovering from substance use and co-occurring mental health disorders. Through evidence-based approaches such as DBT and CBT, you’ll learn strategies to manage stress, prevent relapse, and support your long-term recovery.
Our flexible scheduling makes it easy for students and working adults to get the support they need without disrupting their lives. With options designed to fit your schedule, our team is here to provide the tools, guidance, and support you need to thrive both at work and in life.
Contact us today to find support and begin treatment.
Sources
[1] Barth, S. et al. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The mental health clinician, 6(2), 62–67.
[2] Linehan, M. M. (2008). Dialectical behavior therapy for substance abusers. Addiction science & clinical practice, 4(2), 39–47.