Dialectical Behavior Therapy (DBT) for Addiction

Medically reviewed by Dr. Eric Chegouri, MD, Medical Director · Last reviewed November 7, 2026

Some people drink or use because of habit or social pressure. Many others use because their feelings hit hard and fast, and a substance was the quickest way to turn the volume down. If that sounds familiar, dialectical behavior therapy, or DBT, was built with you in mind. It teaches concrete skills for getting through emotional storms without making things worse.

DBT holds two ideas together at once: you are doing the best you can right now, and you can learn to do things differently. That balance of acceptance and change is the "dialectic" in its name. For people who have felt judged, ashamed or out of control, it can be the first therapy that feels both kind and genuinely useful.

What is dialectical behavior therapy?

DBT was developed by psychologist Marsha M. Linehan at the University of Washington beginning in the late 1980s. She was working with people who had chronic suicidal thoughts and self-harm, many of whom met criteria for borderline personality disorder, and found that standard cognitive behavioral therapy alone often felt invalidating to them. Being told to change their thinking, without first being understood, led many to drop out.

Her answer was to blend CBT's focus on change with acceptance practices drawn from mindfulness traditions. The result was a therapy that teaches specific, learnable skills while also validating how hard things genuinely are. Researchers and clinicians later adapted DBT for people with substance use disorders, and today DBT skills are used widely in addiction treatment, mental health care and beyond.

The National Institute of Mental Health (NIMH) describes DBT as an evidence-based treatment for reducing suicidal behavior and self-harm, and it is one of the most studied therapies for emotion dysregulation.

How does DBT work for addiction?

DBT sees substance use as a behavior that often serves a purpose: escaping pain, numbing shame, calming panic or filling emptiness. The goal is not to shame that behavior but to replace it with skills that meet the same need without the damage.

Acceptance and change, together

In DBT, a therapist validates the reasons behind your behavior ("it makes sense that you drank after that phone call") while still being clear that the behavior has to change. This combination tends to lower defensiveness, which makes real change easier. You stop arguing with yourself about whether you are bad, and start working on what to do next.

Dialectical abstinence

DBT adaptations for substance use describe a stance sometimes called dialectical abstinence. It holds two goals at once: a firm, wholehearted commitment to not using, and a plan to respond quickly and without shame if a lapse happens. Rather than a slip becoming a reason to give up ("I've already blown it"), it becomes information to learn from and a signal to reach for support right away.

Chain analysis

When a problem behavior happens, such as a lapse, a self-harm urge or an explosive argument, DBT uses a detailed chain analysis to trace every link: the vulnerability that day, the trigger, the thoughts, feelings and body sensations, and the consequences. Each link is a place where a different skill could have changed the outcome, so the next time you have more options.

What are the four DBT skill modules?

DBT skills are organized into four groups. Each one targets a different part of what happens when emotions take over.

Skill names can sound like acronyms for their own sake, but they serve a purpose: in a crisis, a short memorable cue is far easier to recall than a paragraph of advice.

What does a DBT session look like?

DBT is usually delivered in two main formats that work together.

A diary card is a simple daily log where you rate cravings, emotions and urges, note whether you used, and record which skills you tried. It sounds small, but over a few weeks it shows patterns you might never notice otherwise, such as cravings that spike on poor-sleep days or after certain conversations.

In the original model, comprehensive DBT also includes between-session phone coaching and a consultation team for therapists. Many addiction programs, inpatient and outpatient alike, use DBT skills and principles without every component of that full model. If the specific format matters to you, ask your care team how DBT is delivered in your plan.

Is DBT effective for substance use?

DBT has a strong research record for reducing suicidal behavior and self-harm, which is why NIMH highlights it. Adaptations for substance use disorders have been studied as well, particularly for people who have both a substance use disorder and significant emotion dysregulation or borderline personality disorder. SAMHSA's resources on co-occurring disorders also describe DBT as one of the approaches used when mental health and substance use problems occur together.

The evidence is most robust for the full, comprehensive model with people who have complex emotional and behavioral difficulties. Research on DBT skills used on their own is promising but more limited. In practice, many people find DBT skills useful whatever their diagnosis, because almost everyone in early recovery deals with strong emotions and urges.

Who does DBT help?

DBT can be especially helpful if you:

• Feel emotions more intensely or more quickly than people around you, and take longer to come back down.
• Have used alcohol, benzodiazepines, opioids or stimulants to escape overwhelming feelings.
• Act on impulse when upset, then regret it later.
• Have a history of self-harm or suicidal thoughts.
• Find that relationships often feel chaotic, intense or unstable.
• Live with trauma, PTSD, depression, anxiety, bipolar disorder or ADHD alongside substance use.

Because DBT so often helps people with co-occurring conditions, it is a natural part of dual-diagnosis treatment, where mental health and addiction are treated together by one team.

How is DBT used at Reggie's?

At Reggie's Recovery Center, DBT is one of the evidence-based therapies used in individual and group sessions across residential and outpatient care. Your care team decides with you how central it is to your plan, based on assessment and what you want to work on.

In residential treatment at our Sun Valley campus, you have a protected setting to learn the skills while cravings and emotions are at their most intense. The structure of the day, with groups in the morning, individual work midday and yoga, meditation or other holistic activities in the afternoon, gives you natural chances to practice mindfulness and self-soothing.

In PHP and IOP at Reggie's Treatment Center in Los Angeles, the focus shifts to using skills in real life. You may be practicing DEAR MAN in a tense conversation at home, or using distress tolerance on a hard evening, then bringing what happened back to group and individual sessions.

How does DBT work with other therapies?

• CBT: DBT grew out of CBT and shares its structure and focus on practice. Many people use CBT tools for thoughts and DBT tools for emotions.
• EMDR: stabilization skills such as distress tolerance and grounding can help prepare you for trauma processing, which is introduced when you are stable enough to benefit.
• Relapse prevention: DBT's chain analysis and dialectical abstinence fit naturally into a written relapse prevention plan.
• Family therapy: interpersonal effectiveness and validation skills help families communicate with less conflict.
• Holistic therapies: yoga, meditation and breathwork reinforce the mindfulness and body-based skills DBT teaches.

What DBT is not (and its limits)

DBT is not only for people with borderline personality disorder, even though that is where it started. It is also not a quick fix: skills take repetition, and the first attempts often feel awkward or forced. That is normal. Most people need many weeks of practice before a skill shows up on its own in a hard moment.

DBT does not replace medical care. If you are physically dependent on alcohol or benzodiazepines, withdrawal can be life-threatening and needs medical detox. DBT also is not designed to process specific traumatic memories in depth; for that, trauma-focused therapies such as EMDR may be part of the plan. And it works best when combined with other supports rather than as a stand-alone answer.

How do you start DBT at Reggie's?

You do not need to know which therapy you want before you reach out. Call (818) 355-1200 any time to talk confidentially with admissions. A free insurance check usually takes 15 to 30 minutes, and many people begin treatment the same day. Most major PPO plans cover treatment at least in part, depending on your plan; you can learn more on our insurance page. If you are supporting someone who struggles with intense emotions and substance use, our family resources can help you know what to say.