Medically Reviewed By

Brittany Kowalski, LCSW, ACS, CCS

Clinical Director, Speranza Behavioral Health · Last clinically reviewed June 2026

What Is Dialectical Behavior Therapy (DBT) and Why Is It Used in Addiction Treatment?

Dialectical Behavior Therapy (DBT) has become one of the most widely used therapeutic modalities in addiction treatment — and for good reason. Originally developed by Dr. Marsha Linehan at the University of Washington for patients with borderline personality disorder and chronic suicidality, DBT's core skills directly address the emotional dysregulation, impulsivity, and distress intolerance that drive substance use for many people.

This guide explains what DBT is, what its four skill modules involve, how it's applied specifically to addiction, and what DBT looks like in Speranza Behavioral Health's PHP and IOP programs.

What Is DBT?

DBT is a structured, skills-based psychotherapy that integrates cognitive-behavioral techniques with principles from Zen Buddhist mindfulness practice and dialectical philosophy. The word "dialectical" refers to the synthesis of opposites — in DBT, the central dialectic is:

Acceptance AND Change.

DBT teaches clients to fully accept themselves and their current reality and to work actively on changing behaviors that create suffering. This balance is why DBT is uniquely effective for people who have felt alienated by purely change-focused approaches: it validates their experience while still equipping them with skills to change their behavior.

The Four DBT Skill Modules

DBT is organized into four interconnected skill modules:

1. Mindfulness

Mindfulness is the foundation of DBT — the "how" that makes all other skills possible. DBT's mindfulness skills teach clients to:

• Observe thoughts, feelings, and sensations without immediately reacting to them
• Participate fully in the present moment rather than being hijacked by memories or anticipatory anxiety
• Adopt a non-judgmental stance toward their own experience
• Act from "Wise Mind" — the integration of rational thinking and emotional experience, rather than being controlled by either alone

For addiction specifically, mindfulness enables urge surfing — the ability to observe a craving as a temporary wave of sensation rather than an imperative to act. Research shows that urge surfing significantly reduces the behavioral response to cravings.

2. Distress Tolerance

Distress tolerance skills address one of the central engines of addictive behavior: the intolerance of negative emotional states. Many people use substances specifically because they cannot tolerate the distress of difficult emotions — anxiety, boredom, loneliness, pain, shame.

Distress tolerance skills in DBT include:

• TIPP: Temperature (cold water), Intense exercise, Paced breathing, Paired muscle relaxation — rapidly reduce physiological crisis states
• ACCEPTS: Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, Sensations — distract from overwhelming urges
• IMPROVE the moment: Imagery, Meaning, Prayer, Relaxation, One thing, Vacation, Encouragement — making a difficult moment more bearable
• Radical Acceptance: Accepting reality as it is without fighting or denying it — because resistance to painful reality typically increases suffering

3. Emotion Regulation

Emotion regulation skills address the underlying emotional vulnerability that makes distressing states so difficult to tolerate in the first place. Skills include:

• PLEASE: Treating Physical illness, Balanced eating, Avoiding mood-altering drugs, Balanced Sleep, Exercise — building a physiological foundation for emotional stability
• Opposite Action: Acting opposite to the action urge generated by a difficult emotion — engaging socially when isolation urge is strong, activating when depression-driven inertia sets in
• Check the Facts: Evaluating whether emotional reactions are proportionate to the actual situation
• Build Positive Experiences: Intentionally increasing experiences that generate positive emotions

4. Interpersonal Effectiveness

Interpersonal effectiveness skills teach clients to navigate relationships skillfully — particularly important in addiction recovery, where damaged relationships are both a consequence of addiction and a risk factor for relapse. Skills include:

• DEAR MAN: Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate — asking for what you need and saying no effectively
• GIVE: Gentle, Interested, Validate, Easy manner — maintaining relationships while managing conflict
• FAST: Fair, Apologies (don't make excessive ones), Stick to values, Truthful — maintaining self-respect in interactions

DBT's Application to Addiction Specifically

Substance use most commonly functions as a coping response to emotional states the person cannot tolerate — anxiety, boredom, loneliness, shame, anger, grief. DBT directly targets this functional relationship between emotional distress and substance use by:

1. Building awareness of the emotional states that trigger use (mindfulness)
2. Developing concrete, practiced alternatives to using as a coping response (distress tolerance, emotion regulation)
3. Repairing the relationships and life circumstances that create emotional instability (interpersonal effectiveness)
4. Reducing the biological vulnerability to emotional dysregulation (PLEASE skills)

Research demonstrates that DBT-adapted for substance use disorder (DBT-SUD) significantly reduces substance use, improves treatment retention, and reduces psychiatric symptoms compared to treatment as usual.

DBT at Speranza Behavioral Health in Woodbury, NJ

DBT skills groups and individually adapted DBT are core components of Speranza's PHP and IOP programs. Our clinicians are trained in DBT and its application to addiction and co-occurring conditions including BPD, depression, anxiety, PTSD, and emotion dysregulation disorders.

Call (866) 814-0126 for a free confidential assessment.

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Related Reading:

• What Is CBT and How Does It Treat Addiction?
• What Is Dual Diagnosis?
• Anxiety and Addiction

About the Author

Brittany Kowalski

Brittany Kowalski is a licensed clinical social worker (LCSW) and behavioral health advocate at Speranza Behavioral Health in Woodbury, NJ. With over a decade of experience in addiction recovery and mental health treatment, she specializes in dual diagnosis care, trauma-informed therapy, and evidence-based outpatient programs serving South Jersey communities.