DBT for Recovery: How Dialectical Behaviour Therapy Helps Addiction
What dialectical behaviour therapy (DBT) is, how its four skill areas help people in addiction recovery manage emotions, cravings, and relationships, how DBT differs from CBT, and where it fits in treatment.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician and Addiction Medicine Specialist, Phuket Island Rehab.
Dialectical behaviour therapy (DBT) is an evidence-based therapy, originally developed for borderline personality disorder, that is now widely used in addiction recovery to help people manage the intense emotions, cravings, and difficulties that can drive substance use and relapse. DBT teaches practical skills in four areas: mindfulness, staying present and aware; distress tolerance, getting through crises and cravings without using; emotion regulation, understanding and managing intense emotions; and interpersonal effectiveness, handling relationships and conflict. These skills are directly useful in recovery because addiction often involves using substances to cope with overwhelming emotions, distress, and relationship problems, and DBT gives people healthier ways to handle these without turning to drugs or alcohol. It is delivered through individual therapy and skills-training groups where people learn and practise these skills together. DBT is related to cognitive behavioural therapy (CBT) but places greater emphasis on accepting and managing intense emotions and on balancing acceptance with change. It is especially valuable for people whose addiction co-occurs with emotional difficulties or conditions like BPD, and it works best as part of comprehensive treatment.
What DBT is
Dialectical behaviour therapy, usually shortened to DBT, is an evidence-based form of psychotherapy that has become widely used in addiction recovery. It was originally developed to treat borderline personality disorder, particularly for people with intense emotions and self-destructive behaviours, and it proved so effective at helping people manage overwhelming emotions and distress that its use has expanded to many other conditions, including substance use disorders. DBT is a skills-based, practical therapy: rather than only talking about problems, it teaches people concrete skills for managing their emotions, tolerating distress, and handling relationships, which they learn and practise and can apply in daily life.
The dialectical in DBT refers to a central principle of balancing two things that might seem opposed: acceptance and change. DBT helps people accept themselves, their emotions, and their current reality, while also working to change unhelpful patterns and behaviours, and finding the balance between these is part of its approach. In addiction recovery, DBT is valued because so much of addiction involves using substances to cope with intense emotions, distress, and difficulties that a person does not have other ways to handle, and DBT directly teaches those other ways. Understanding what DBT is, the skills it teaches, how it helps in recovery, and how it fits with other treatment shows why it has become such a valuable tool in addiction care.
The four skill areas
DBT is built around teaching skills in four main areas, each of which is directly relevant to recovery. The first is mindfulness, learning to stay present and aware, to observe one’s thoughts, feelings, and urges without immediately reacting to them, and to be grounded in the moment rather than swept away by emotion or impulse. The second is distress tolerance, a set of skills for getting through crises and intensely difficult moments, including cravings, without making things worse, that is, without turning to substances or other harmful behaviours to escape the distress. These two skill areas alone are powerfully useful in recovery.
The third skill area is emotion regulation, learning to understand, name, and manage intense emotions, to reduce vulnerability to overwhelming feelings, and to change emotional responses in healthier ways, which addresses the emotional turmoil that often drives substance use. The fourth is interpersonal effectiveness, skills for handling relationships, communicating needs, setting boundaries, and managing conflict, since relationship difficulties are a common source of the distress that fuels addiction. Together, these four areas, mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, give a person a comprehensive toolkit for managing the inner and relational challenges that recovery involves. The table below summarises them, and they are the practical core of what DBT offers.
| DBT skill area | What it helps with |
|---|---|
| Mindfulness | Staying present; observing thoughts and urges without reacting |
| Distress tolerance | Getting through crises and cravings without using |
| Emotion regulation | Understanding and managing intense emotions |
| Interpersonal effectiveness | Handling relationships, communication, and conflict |
| Core principle | Balancing acceptance and change (dialectics) |
How DBT helps in addiction recovery
DBT is particularly helpful in addiction recovery because of the close connection between its skills and the drivers of substance use. Addiction very often involves using alcohol or drugs to cope with overwhelming emotions, distress, cravings, and difficulties that a person does not otherwise know how to handle, and substances become a way, however destructive, of managing unbearable feelings or getting through hard moments. DBT directly addresses this by giving people healthier ways to do what they were using substances to do: to tolerate distress, manage intense emotions, ride out cravings, and handle relationship problems, without turning to drugs or alcohol. In this way, DBT helps remove the underlying reasons a person reaches for substances.
The distress tolerance skills are especially valuable for managing cravings, teaching a person to get through the intense urge to use without acting on it, recognising that a craving will pass. The emotion regulation and mindfulness skills help with the emotional turmoil and reactivity that fuel relapse, and the interpersonal skills help with the relationship stresses that often trigger use. By building these capacities, DBT helps people stay in recovery through the very situations, intense emotions, cravings, crises, and conflicts, that would otherwise lead to relapse. This is why DBT is so well suited to addiction recovery and why it has been adapted specifically for substance use, giving people concrete, practisable skills that directly support staying sober.
How DBT differs from CBT
DBT is related to cognitive behavioural therapy, or CBT, and shares some of its foundations, but there are meaningful differences worth understanding. CBT focuses primarily on identifying and changing unhelpful thoughts and behaviours, on the basis that how we think affects how we feel and act, and it is highly effective for many conditions including addiction. DBT grew out of CBT but developed in response to people for whom a pure focus on change was not enough, particularly those with very intense emotions, and it places greater emphasis on accepting and managing intense emotions, on tolerating distress, and on the balance between acceptance and change.
In practice, this means DBT puts particular weight on emotional skills, distress tolerance, mindfulness, and the dialectic of accepting oneself while changing, which makes it especially suited to people whose difficulties centre on overwhelming emotions and emotional dysregulation. CBT and DBT are not rivals, and both are valuable in addiction treatment; the choice or combination depends on the person and their needs. For someone whose addiction is closely bound up with intense, hard-to-manage emotions, or with a condition like borderline personality disorder, DBT’s particular strengths may be especially helpful, while CBT’s focus on thoughts and behaviours suits others, and many treatment programs draw on both. Understanding the difference helps clarify what DBT distinctively offers.
Where DBT fits and who it helps
DBT is typically delivered through a combination of individual therapy, where a person works one to one with a therapist to apply the skills to their own life, and skills-training groups, where people learn and practise the DBT skills together, which is both efficient and supportive, as members learn alongside others working on the same skills. In addiction treatment, DBT is used as part of comprehensive care, alongside other elements such as detox where needed, other therapies, support, and treatment of any co-occurring conditions, rather than as a standalone solution. It fits naturally into treatment programs that address the whole person and is often one component of a broader, individualised approach to recovery.
DBT is especially valuable for certain people in recovery. It is particularly helpful for those whose addiction co-occurs with intense emotional difficulties, emotional dysregulation, self-harm, or conditions like borderline personality disorder, for which DBT was originally developed and remains a leading treatment, and which very commonly co-occur with substance use. For these people, DBT’s combined focus on managing emotions and on addiction can be transformative, treating both the emotional difficulties and the substance use that is often a way of coping with them. More broadly, the skills DBT teaches are useful to many people in recovery, since managing emotions, distress, cravings, and relationships is part of everyone’s recovery. Where it is a good fit, DBT is a powerful, evidence-based tool that helps people build the inner and relational skills that sustain lasting recovery.
Getting help that includes the right therapy
If you are seeking treatment for addiction, particularly if your substance use is bound up with intense emotions, distress, or a condition like BPD, it is worth looking for treatment that includes evidence-based therapies such as DBT, delivered by trained professionals, as part of comprehensive care. And if you are at an earlier stage, recognising that substance use has become a problem and seeking help, the right treatment for you can be determined with professional guidance. The signs that substance use has become a disorder include being unable to cut down despite wanting to, needing more for the same effect, and continuing to use despite harm, and recognising these is the step toward getting help.
If you or someone you love is struggling with addiction, reaching out for help is the most important step, and treatment incorporating effective therapies like DBT can be part of the support. A crucial safety point comes first: anyone who is physically dependent on alcohol or benzodiazepines should not stop suddenly on their own, because withdrawal can cause seizures and be life-threatening, so stopping should be done with medical support through a supervised detox. From there, comprehensive treatment, which may include DBT, CBT, and other approaches, along with treatment of any co-occurring conditions and ongoing support, gives a strong foundation for recovery. Addiction is treatable, recovery is genuinely possible, and therapies like DBT can help people build the skills to manage emotions, cravings, and relationships and to sustain a lasting recovery, so reaching out for help is a worthwhile step.
Summary
Dialectical behaviour therapy (DBT) is an evidence-based therapy, originally developed for borderline personality disorder, that is now widely used in addiction recovery to help people manage the intense emotions, cravings, and difficulties that can drive substance use and relapse. DBT teaches practical skills in four areas: mindfulness, staying present and aware; distress tolerance, getting through crises and cravings without using; emotion regulation, understanding and managing intense emotions; and interpersonal effectiveness, handling relationships and conflict. These skills are directly useful in recovery because addiction often involves using substances to cope with overwhelming emotions, distress, and relationship problems, and DBT gives people healthier ways to handle these without turning to drugs or alcohol. It is delivered through individual therapy and skills-training groups. DBT is related to cognitive behavioural therapy (CBT) but places greater emphasis on accepting and managing intense emotions and on balancing acceptance with change. It is especially valuable for people whose addiction co-occurs with emotional difficulties or conditions like BPD, and it works best as part of comprehensive treatment.
As Dr. Ponlawat Pitsuwan, addiction medicine specialist at Phuket Island Rehab, puts it, “So many of the people I work with were never using because they loved the drug, they were using because they had no other way to survive their own emotions, and that is exactly the gap DBT fills. It teaches someone how to ride out a craving, how to get through a wave of unbearable feeling without picking up, how to handle the relationships that set them off. For people whose addiction is tangled up with intense emotions or BPD, it can be life-changing, because it finally gives them the skills they were missing.”
Frequently asked questions
What is DBT?
Dialectical behaviour therapy (DBT) is an evidence-based, skills-based form of psychotherapy originally developed for borderline personality disorder and now widely used in addiction recovery and other conditions. Rather than only talking about problems, it teaches concrete skills for managing emotions, tolerating distress, and handling relationships. The dialectical principle refers to balancing acceptance, of oneself and one’s emotions, with change of unhelpful patterns. It is valued in recovery because addiction often involves using substances to cope with difficulties that DBT teaches healthier ways to handle.
What are the four skills of DBT?
DBT teaches skills in four areas: mindfulness, staying present and aware and observing thoughts and urges without immediately reacting; distress tolerance, getting through crises and intense moments, including cravings, without making things worse; emotion regulation, understanding, naming, and managing intense emotions; and interpersonal effectiveness, handling relationships, communicating needs, setting boundaries, and managing conflict. Together these give a person a comprehensive toolkit for managing the inner and relational challenges of recovery, and they are the practical core of what DBT offers.
How does DBT help with addiction?
DBT helps because addiction often involves using substances to cope with overwhelming emotions, distress, cravings, and difficulties, and DBT gives people healthier ways to do what they were using substances to do. The distress tolerance skills help with riding out cravings without acting on them, the emotion regulation and mindfulness skills help with the emotional turmoil that fuels relapse, and the interpersonal skills help with relationship stresses that trigger use. By building these capacities, DBT helps people stay in recovery through the very situations that would otherwise lead to relapse.
What is the difference between DBT and CBT?
CBT focuses primarily on identifying and changing unhelpful thoughts and behaviours and is highly effective for many conditions including addiction. DBT grew out of CBT but places greater emphasis on accepting and managing intense emotions, tolerating distress, and the balance between acceptance and change, making it especially suited to people whose difficulties centre on overwhelming emotions and emotional dysregulation. They are not rivals; both are valuable in addiction treatment, and the choice or combination depends on the person and their needs, with many programs drawing on both.
Who benefits most from DBT in recovery?
DBT is especially valuable for people whose addiction co-occurs with intense emotional difficulties, emotional dysregulation, self-harm, or conditions like borderline personality disorder, for which DBT was originally developed and which commonly co-occur with substance use. For these people, its combined focus on managing emotions and on addiction can be transformative. More broadly, the skills DBT teaches, managing emotions, distress, cravings, and relationships, are useful to many people in recovery, since these are part of everyone’s recovery, so DBT helps a wide range of people, with particular strengths for those with emotional difficulties.
How is DBT delivered in treatment?
DBT is typically delivered through a combination of individual therapy, where a person applies the skills to their own life one to one with a therapist, and skills-training groups, where people learn and practise the DBT skills together, which is both efficient and supportive. In addiction treatment, it is used as part of comprehensive care, alongside elements such as detox where needed, other therapies, support, and treatment of any co-occurring conditions, rather than as a standalone solution. It fits naturally into treatment programs that address the whole person as one component of an individualised approach.
Sources
National Institute of Mental Health (NIMH). Psychotherapies. https://www.nimh.nih.gov/health/topics/psychotherapies
Substance Abuse and Mental Health Services Administration (SAMHSA). Behavioral Therapies. https://www.samhsa.gov/
National Institute on Drug Abuse (NIDA). Behavioral Therapies. https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies
National Education Alliance for Borderline Personality Disorder (NEABPD). DBT. https://www.borderlinepersonalitydisorder.org/
National Health Service (NHS). Dialectical Behaviour Therapy. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/
National Institute on Drug Abuse (NIDA). Comorbidity: Substance Use and Other Mental Disorders. https://nida.nih.gov/research-topics/comorbidity
DBT for recovery — key entities and related terms
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