DBT: A way out of addiction?

Dialectical behavioural therapy, or DBT, aims to help develop new ways of managing very intense emotions. Often, we use substances to block out thoughts of these emotions, meaning as we get clean and in touch with our emotions, DBT can teach us the skills needed to manage this emotional intensity.

Experience shows that our thinking proceeds our behaviour. For example, you think about using a drug before you actually take the action to use it. This could be seen as a habit that consists of a cue, routine and reward. Therefore, if we can develop DBT skills to change the routine we implement, we can replace the need for drugs. This is effective because when we have a substance misuse problem, it can be because we are in some kind of distress (cue) then we go on to use a drug (routine), then we feel relieved (the reward). This is a complete set of behaviour that is effective, and it works, however using drugs causes massive cycles of shame and guilt. Therefore, when we learn DBT skills, we have a new set of tools in our toolbox to deal with our distress that can give us a new routine that is not damaging but adds great value to our lives.

DBT consists of four core modules, and these are;

• mindfulness
• interpersonal effectiveness 
• distress tolerance
• emotional regulation

When looking at DBT through the lens of addiction, we can dig deeper and understand how it can create a very clear way out of addiction. One of the first parts that stands out of the intersection between DBT and addiction is mindfulness. We have two parts of our mind; firstly, 'the addict mind', that is impulsive, one-minded, and will do anything to fulfil the need to relieve distress. The second part is the clean mind that is naive, risk-taking, and oblivious to danger.

Now neither of these extremes are helpful and both are dangerous, so the goal is to operate from a clear mind. This is the safest place to be because you are clean but conscious of your addiction and addict mind. In a clear mind, you enjoy your success but still expect urges, and ensure you plan for when you are tempted by having the DBT skills in place.

Another particularly useful part of DBT that can be helpful with addictions is to develop a peer group and a reinforcing community. One of the main outcomes of this peer group is to reinforce abstinence. There is the old saying that if you hang around with four addicts you will be the fifth, and if you spend your time with people who are working to become their best selves you will also become the fifth (as hard as it may be to hear, this includes family). Surrounding yourself with a high-level peer group pulls you up and discourages addictive behaviour. In turn, this helps you create a lifestyle that is more rewarding without this destructive behaviour, rather than one with it in your life.

This will ensure that behaviours that are incompatible with addiction will pay off and that you are rewarded by those around you. Once you have surrounded yourself with ethnocentric people, you will start to develop a new identity. For example, if you are a smoker (or any other substance abuse/destructive label) who has quit and that is your current identity, then, when someone asks if you want a cigarette, you may say 'I have quit smoking so I shouldn't'. The problem with this label is that it engages willpower, and you can have all the willpower in the world to hang on to a ledge but if someone comes back two days later, you won't be there; this means that willpower has a time limit. So, the goal is to change your identity to a non-smoker. Then if someone asks if you want to smoke, it is easy to say no because you are a non-smoker. With this new identity, you are not engaging in any willpower. Learning this DBT skill is a crucial step in changing your sense of identity and minimising the chance of relapse.

In DBT, we don't only focus on building new bridges, but also burning old ones. Many of the people in our old peer group will be our triggers and enablers. We have to walk into the garage of abstinence and slam the door shut. This is crucial because the tiniest slit of space can let an entire elephant in. As the saying goes, one is too many and a thousand is never enough.

The journey is not always plain sailing, and our addictive behaviours are also a way for us to rebel against authority, rules, conventions, and even the boredom of not breaking the law. This is where the DBT skill of an alternate rebellion comes in. In case you haven't noticed, DBT is all about developing tools to exchange one set of behaviours for new ones. The alternate rebellion replaces the destructive rebellions and keeps you on a path to your goals. Examples are things like shaving your head, going on holiday with your friends at a nudist colony, wearing clothes inside out, or printing a controversial slogan on a t-shirt. For me, it was getting a tattoo, because I was never allowed to have one. Take a moment to think of what your alternate rebellion would be.

It is important to note that DBT is very pragmatic and does not contradict other approaches, such as any 12-step programs, smart recovery, or any other beliefs or values you have. In fact, the skills can work alongside a lot of the tools you have developed in your life so far.

Ultimately, the goal of DBT is to give you some control over your behaviour and allow you space to deal with the trauma and underlying issues. Recovery is not just about trimming the weeds, but getting to the roots and ripping them out. The approach of DBT gives new meaning to an old tape that is playing.