When Emotions Fuel Addiction: How DBT Supports Mental Health & Substance Abuse Recovery

What Is Dialectical Behavior Therapy (DBT)?

DBT is an evidence-based type of psychotherapy that combines aspects of cognitive behavioral therapy (CBT), mindfulness, and acceptance into one comprehensive treatment protocol.[1] While originally developed by psychologist Marsha Linehan to help people who struggled with borderline personality disorder (BPD) and self-harm, over time and through research, it has become a widely accepted form of treatment for numerous mental health and substance use disorders.

DBT skills include four areas:

• Mindfulness: Learning to notice what you are thinking, feeling, and experiencing in your body without immediately reacting.
• Distress Tolerance: Coping with the pain of a moment without making things worse.
• Emotion Regulation: Understanding where your intense emotions come from and learning how to manage them.
• Interpersonal Effectiveness: Learning how to express your needs to others, set boundaries, and form healthy relationships.

At The Lakes, DBT is adapted for people living with substance abuse, co-occurring mental health disorders, and complex life situations. It is a structured, skills-based type of therapy that can be used in individual therapy, group therapy, and alongside other methods of treatment.

How DBT Works for Mental Health & Substance Use Recovery

DBT helps you hold two truths at once: 

1. You are doing the best you can with the skills you have
2. You can also learn new skills that change your life. 

This “both/and” perspective makes DBT different from other types of treatment for substance use disorder (SUD) and mental health disorders. In DBT therapy sessions, you might:

• Learn mindfulness practices that help you slow down and notice what you are feeling before acting on urges
• Practice distress tolerance skills for riding out cravings, conflict, or emotional pain without turning to substances or self-harm
• Examine emotion regulation strategies to understand where intense feelings originate and how to manage them more effectively
• Build interpersonal effectiveness skills so you can say no, ask for help, and communicate clearly with loved ones, employers, and treatment providers

DBT interventions require action and application. You don’t just talk about your week. Instead, you will identify specific events that left you feeling overwhelmed, pushed you toward drugs or alcohol, or created feelings of disconnection. Then you and your therapist will identify which DBT skills could help you respond more effectively in those situations.

Some people also use self-guided DBT tools between sessions, such as worksheets, DBT diary cards, or mindfulness exercises. At The Lakes, your clinician can help you choose DBT therapy exercises and coping skills that fit your life.

Who Is DBT For?

DBT can be helpful for many people who are dealing with intense emotions and difficult behaviors. It may be especially useful if you:

• Struggle with strong mood swings, anger, or emotional dysregulation
• Have a history of self-harm, suicidal thoughts, or impulsive behaviors
• Live with borderline personality disorder, bipolar disorder, post-traumatic stress disorder, or other complex mental health conditions
• Feel that relationships are chaotic, unstable, or full of conflict
• Use alcohol, opioids, or other substances to manage emotional pain or numb out
• Find yourself moving between “all in” and “all out” in recovery, relationships, or work

DBT can also help people with depression, anxiety, eating disorders, and other mental health conditions by allowing them to notice negative thinking patterns, stay present in the moment, and make choices more aligned with their values than their fears.

Although DBT was first developed for adults, its core skills can be adapted for different ages and backgrounds. At The Lakes, our DBT-informed approach is tailored to adults and young adults in our care.

Efficacy of Dialectical Behavior Therapy for Substance Use Disorder and Mental Health

Dialectical behavior therapy is considered an evidence-based treatment for several mental health disorders and is increasingly used in addiction treatment. Clinical research and mental health guidelines have found that:

• DBT can reduce the incidence of self-harm, suicidal thoughts, and hospitalization among individuals living with BPD and other mental health disorders characterized by intense emotions. [2]
• DBT interventions can help decrease substance use when adapted for people with substance use disorders, especially when combined with other addiction treatment approaches.[3]
• DBT can improve emotional regulation, reduce symptoms, and support a better quality of life for those with anxiety and depression.[4]
• DBT skills training improves coping skills, stress management, and relationship functioning, which are key elements in lasting recovery.[5]

For individuals in treatment for substance use disorders, the combination of DBT and traditional treatment methods typically produces the best outcomes. DBT does not replace traditional methods of treatment like detoxification, medication management, or cognitive therapy. Rather, it provides additional support for handling emotional urges, cravings, and interpersonal conflicts that can affect sobriety.

DBT Treatment at The Lakes 

DBT at The Lakes is skills-focused, trauma-informed, and integrated with other therapies and services. Our clinicians use core DBT concepts while adapting them to the individual needs of each person in our care.

In practice, DBT at The Lakes may include:

• Individual therapy sessions that use DBT-informed strategies to explore real situations from your life, identify patterns, and practice new responses
• Group skills training where you learn and practice mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness alongside others who are also working on these areas
• Integration with other modalities, such as CBT, EMDR for trauma, motivational interviewing, and medication management, creating a comprehensive treatment plan
• Attention to co-occurring mental health conditions, such as depression, anxiety disorders, bipolar disorder, and PTSD, that can make substance use feel more appealing in the short term

DBT therapists at The Lakes focus on validation and change. They recognize how hard your experiences have been and also help you move toward new behaviors that support your safety, well-being, and recovery. Sessions are collaborative and respectful. You are not blamed for what you have been through, and you are not left alone to figure out how to change.