How DBT Can Help With Substance Use Disorders
Read below why Dialectical Behavior Therapy isn’t just for borderline personality disorder—and how it supports real change in substance use recovery.
Substance use disorders are complex. They’re often tangled up in intense emotions, painful experiences, and overwhelming urges to escape. Many people I work with have tried to just stop using—only to find themselves caught in the same cycle again. This doesn’t mean you’re weak. It means you need more than just willpower.
That’s where Dialectical Behavior Therapy (DBT) comes in.
What is DBT?
Originally developed by Dr. Marsha Linehan to support people with borderline personality disorder, DBT has since been adapted for many mental health concerns, including substance use recovery. It's a skills-based therapy that combines acceptance and change, and it’s especially powerful for folks who feel stuck in emotional chaos or black-and-white thinking.
Why DBT Supports Substance Use Recovery
Substance use disorders aren’t just about the substance, it’s often about coping. Whether it’s anxiety, depression, trauma, or low self-worth underneath, DBT helps you develop the skills to manage those intense emotions without needing to numb out.
Here’s how DBT supports recovery from a substance use disorder:
1. Mindfulness – “What” Skills: Observe, Describe, Participate
🧠 Skill Example: Observe Without Judgment
In early recovery, urges can come fast and strong. Mindfulness teaches you to notice the craving without immediately reacting.
🔹 Try this: “I feel an urge to use. My chest feels tight, my mind is racing, and I’m telling myself I need relief.” No judgment—just awareness. The goal isn’t to stop the urge, but to watch it rise and fall like a wave.
2. Distress Tolerance – Crisis Survival Skills
💡 Skill Example: TIPP (Temperature, Intense Exercise, Paced Breathing, Progressive Muscle Relaxation)
When a craving hits or emotions feel unbearable, TIPP helps you reset your nervous system fast.
🔹 Try this: Splash your face with cold water or hold an ice cube. Do a quick set of jumping jacks. Then breathe in for 4, out for 6. Sometimes, just changing your body’s state is enough to ride out a craving without using.
3. Emotion Regulation – Understand & Change Emotions
💡 Skill Example: Check the Facts
Substance use is often driven by perceived threats or painful emotions that feel bigger than they are.
🔹 Try this: You think, “I messed up at work—I’m a failure. I need a drink.”
Now check the facts: “I made a mistake, but my boss didn’t say I’m getting fired. People make mistakes. I can repair this.”
Emotion regulation helps you stop reacting to intense feelings like they’re emergencies.
4. Interpersonal Effectiveness – Assert Your Needs & Maintain Relationships
💡 Skill Example: DEAR MAN
Substance use can strain relationships. This skill helps you repair trust and advocate for your needs without people-pleasing or blowing up.
🔹 Try this: “When you check in with me about my sobriety (Describe), I feel supported, but also pressured (Express). I’d like if we could set a time each week to talk about it instead of daily (Assert).”
5. Dialectics – Balance Acceptance & Change
💡 Skill Example: Both-And Thinking
Recovery is rarely black and white. You’ll have good days and rough ones. Dialectical thinking helps you hold compassion and accountability at the same time.
🔹 Try this: “I had a slip today and I’m still committed to recovery. I can feel disappointed in myself and keep moving forward.”
What DBT Looks Like in Therapy
In my work with teens, young adults, and adults navigating complex mental health concerns and substance use recovery, I integrate DBT skills into sessions in a way that’s personalized, honest, and nonjudgmental. It’s not about perfection. It’s about building a life that feels worth staying present for.
If you’re tired of white-knuckling your way through recovery, DBT might be the missing piece. You don’t have to do it alone.
Interested in learning more or starting therapy?
Reach out today to schedule a free 15-minute consultation.