DBT can help you cut back on substance use and stay in treatment longer. The strongest evidence comes from people who also live with borderline personality disorder. In one trial, 64% of DBT participants stayed in treatment, compared with 27% in usual care. DBT targets the overwhelming emotions that often drive use and teaches you to tolerate distress without a drink or drug. Studies are still small, though, so it’s worth knowing which skills matter most.
Key Takeaways
- DBT can help some people reduce substance use, with the strongest evidence among those with co-occurring borderline personality disorder.
- In one trial, 64% of DBT participants stayed in treatment versus 27% receiving usual care, with greater drug use reductions.
- DBT targets addiction’s emotional roots, building distress tolerance and emotion regulation skills to cope without drinking or using drugs.
- DBT aims for abstinence while planning for relapse, working to shorten lapses and limit harm without framing slips as failure.
- Evidence remains preliminary, with small studies, varied DBT formats, and no clear advantage over 12-step programs in head-to-head comparisons.
Can dialectical behavior therapy help treat substance use disorder
Dialectical behavior therapy (DBT) may help some people reduce substance use, according to early research, even though it wasn’t originally designed for addiction. If you’re considering DBT for substance use disorder, you’ll find the most evidence for people who also have borderline personality disorder (BPD). In one randomized trial, 64% of DBT participants stayed in treatment, compared with 27% receiving usual care, and they showed greater reductions in drug use. A systematic review also found DBT skills training feasible and linked to less substance use and better emotion regulation.
Still, you should weigh these findings carefully. Studies are small, DBT formats vary, and DBT for addiction hasn’t outperformed 12-step programs. It’s a promising option, not a proven replacement for established, evidence-based care. Talk with your provider.
How does DBT work on the roots of addiction
DBT works on the roots of addiction by targeting the overwhelming emotions that many people use substances to cope with, instead of focusing only on the substance itself. If you’ve wondered what is DBT used for, its core aim is building skills that help you tolerate distress without reaching for a drink or drug.
| DBT element | How it helps you |
|---|---|
| Emotion regulation | Lowers emotional intensity that fuels use |
| Distress tolerance | Helps you ride out urges safely |
| Abstinence strategies | Support your commitment to stopping use |
| Relapse planning | Limits a lapse’s length and harm |
Research links DBT treatment with improved emotion regulation in people with SUD, though studies are small and varied. Much of the evidence comes from people with co-occurring BPD, so your results may differ. It’s a promising tool, not a replacement.
Why does DBT treat addiction and co-occurring conditions together
DBT treats addiction and co-occurring conditions like borderline personality disorder (BPD) together because they often share a common driver: intense emotions that feel impossible to manage.
If you treat only the substance use, that underlying distress can keep pulling you back. DBT-SUD addresses both at once, and trials in people with BPD and SUD suggest why that matters:
- In one trial, 64% of DBT participants stayed in treatment, compared with 27% receiving treatment as usual.
- That trial found greater reductions in drug use, measured with structured interviews and urine tests.
- DBT’s skills training targets emotion regulation, and a review found preliminary improvements in it among people with SUD.
These findings come from small trials in people with BPD, so you can’t assume they apply universally.
Which DBT skills target cravings and relapse
DBT targets cravings and relapse through a combination of skills, with emotion regulation at the center, rather than a single anti-craving technique. These strategies are meant to help you stay abstinent and, if you do relapse, to shorten the lapse and limit its harm. That dual focus matters: you’re not treated as a failure for slipping, but the goal you’re working toward still remains abstinence.
If painful emotions often drive your cravings, learning to manage them gives you options besides using. A systematic review found preliminary support for improved emotion regulation and reduced substance use among people with SUD.
Programs differ, however. Some studies tested full DBT, others standalone or adapted skills groups, so researchers can’t yet clearly say which specific skills best prevent relapse.
What does the evidence say about DBT for addiction outcomes
The evidence shows DBT is promising for addiction outcomes but does not yet prove it works for substance use disorder broadly. Early results look encouraging, but most studies are small, use different versions of DBT, and often focus on people who also have borderline personality disorder (BPD), so you can’t assume the findings apply to everyone.
Trials report the following:
- Better retention: In one randomized trial, 64% of DBT participants stayed in treatment, versus 27% with usual care.
- Lasting reductions: Among opioid-dependent people with BPD, only the DBT group maintained reduced opioid use through the final four months.
- No clear edge over 12-step: A review of three trials with 75 women found no significant advantage for DBT.
If you’re considering DBT, treat it as promising, not a replacement for proven SUD care.
What does a DBT-based addiction program include
A DBT-based addiction program typically teaches DBT skills, with a strong emphasis on emotion regulation, an area where studies have reported improvements among people with SUD. Programs differ from study to study, so there’s no single standard package, but most share a few core elements.
Your program will also likely use strategies that promote abstinence while planning for setbacks. If you relapse, the aim is to limit how long it lasts and how much harm it causes.
Some programs offer complete DBT, while others provide standalone or adapted skills training. Much of the published research involves people with co-occurring borderline personality disorder, so ask how a program fits your needs. Remember, the evidence doesn’t support DBT as a replacement for other evidence-based addiction care.
How does someone begin DBT for substance use disorder
Begin DBT for substance use disorder by talking with a doctor, therapist, or addiction specialist who can assess your needs and help you decide whether DBT fits alongside other evidence-based care.
Start DBT for substance use disorder with a professional who can assess your needs and see how it fits with other evidence-based care.
Ask any program you contact questions that clarify what you’ll receive:
- Does it offer thorough DBT or skills training only? Studies use different formats, so results may vary.
- Has it treated people with co-occurring BPD? Most DBT-SUD research comes from this group.
- How does it handle relapse? DBT aims to promote abstinence and limit relapse’s harm.
Remember that DBT’s evidence is promising but preliminary, and it hasn’t outperformed 12-step programs in small comparisons. You don’t have to choose one path. Many people combine approaches that support their recovery.
Frequently Asked Questions
Is DBT for Substance Use Disorder Usually Covered by Health Insurance?
DBT is often covered, but coverage varies, and the research here doesn’t address insurance directly. In the U.S., parity laws generally require your plan to cover substance use treatment comparably to medical care. Still, you may find that extensive DBT programs aren’t in-network or need prior authorization. Call your insurer, ask about specific billing codes, and check whether your DBT provider accepts your plan before you begin.
How Long Does a Typical DBT Program for Addiction Last?
There isn’t one fixed length you can count on. Standard thorough DBT often runs about a year, but the addiction research doesn’t define a typical program, and studies use different formats, from full DBT to adapted skills groups. One opioid trial tracked results through its final four months. If you’re weighing options, ask providers how long their program lasts and how they’ll support you if relapse happens along the way.
Can DBT Be Combined With Medication-Assisted Treatment for Opioid Use?
Yes, you can likely combine them, though the evidence here doesn’t directly test that pairing. In a small trial of 23 opioid-dependent people with BPD, DBT participants kept their reductions in opioid use steady through the final four months. DBT isn’t proven to replace evidence-based SUD care, so you’d use it as a complement, not a substitute. Ask your care team how DBT’s emotion-regulation skills could support your medication plan.
Is DBT Effective for Teenagers Struggling With Substance Use?
You can’t count on a clear answer yet. The evidence doesn’t include trials testing DBT with teenagers who use substances. Most studies involved adults, often women with borderline personality disorder, so you shouldn’t assume their results fit your teen. Still, DBT shows early promise for reducing substance use and strengthening emotion regulation. If you’re considering it, ask providers how they’ve adapted it for adolescents, and pair it with established care.
Can DBT Be Done Online or Through Telehealth for Addiction?
Possibly, yes, but the research summarized here doesn’t test online or telehealth DBT for addiction, so you can’t assume it works the same way. What studies do show is that the DBT-SUD trials, mostly in people with co-occurring BPD, found promising but preliminary reductions in substance use. If you try virtual DBT, ask your provider how they’ll adapt the program and coordinate it with other evidence-based addiction care you’re receiving.