Substance use disorders are highly prevalent across the world, making them a foremost public health concern. In the USA alone, 16.7% of Americans or approximately 48.5 million Americans above 12 years of age were found to suffer from some kind of substance use disorder as per 2023 data. The journey to quit substance use is fraught with a series of challenges for those affected including withdrawal risks and emotional distress as well as an ever-present risk of relapse. The treatment of SUD’ s involves a variety of therapeutic approaches out of which DBT has proven to be a highly effective intervention.
DBT was first developed by DR Marsha Linehan to specifically treat borderline personality disorder but has steadily evolved over time to become a sought-after therapy for treating wide-ranging mental health conditions, including substance use disorders.
There are multiple dynamics or external factors that impel an individual towards substance use disorders and hence negatively impact on his behaviors and mental health. Three key dynamics include:
In some cases, genetics plays a role in engendering a natural disposition towards SUD’s in individuals with a family history of addiction. Such individuals are genetically wired in a way that creates a disbalance in the normal neurochemical reactions , hence making them more prone to developing SUD’s. The dopamine system that is known for producing dopamine or feel good hormones is overactive that leads to heightened cravings for substances.
Various factors in the environment exert a major influence on an individual in turning to substance. These include peer pressure, a pre-existing trauma or feelings of inferiority due to the socio-economic status of individuals. This specially applies to individuals who have been subjected to adverse childhood experiences (ACE’s ) or chronic stress since childhood and hence resort to substance use as a coping mechanism.
Substance use disorders can also be a result of persistent habits or a form of learned behavior. Someone who is repeatedly exposed to substances finds it difficult to quit because his neural pathways have been conditioned to the effects of substances. Further, they are in a state of denial that distorts their ability to think rationally and thus impede recovery efforts.
Theoretically, DBT is grounded in the principles of Cognitive Behavioral therapy or CBT but goes a step further by combining the philosophy of acceptance with behavioral change techniques. The therapy is centered on four fundamental principles.
In simple words, mindfulness is all about being alive in the present instead of shying away from what you truly feel or think. A pillar of DBT, mindfulness emphasizes the need for individuals to embrace their consciousness so as to become more aware of their present thoughts, emotions and behaviors. This skill allows you to instantly identify whenever you are stuck in negative thoughts or memories and instead make you focused on the present. It's common for people to get caught up in relentless thoughts linked to either past and present which in turn contribute to self-destructive behaviors like substance abuse.
Distress Tolerance aims to strengthen inner resilience by altering how an individual comes to perceive and respond to challenging situations. DBT is especially focused on people who come from an invalidating environment that paves way for unhealthy thoughts and behaviors. Instead , distress tolerance aims to validate a person;s thought, emotions and experiences and thus mold how they choose to respond to a crisis or stressful situation.
This core principle aims to enable the client’s ability to regulate their own emotions in response to difficult situations and rein in their impulsive tendencies. Emotional regulation in DBT is concerned with recognizing emotional triggers to help individuals navigate their emotions and lower the possibility of indulging in impulsive or destructive behaviors. By encouraging individuals to engage in positive activities or activities that give them joy, emotional regulation emphasizes the need to cultivate positive experiences as a buffer against negative emotions.
This principle taps into the potential of communication to foster healthier relationships and encourage self-expression. DBT provides various strategies and tools to develop interpersonal skills such as active listening, empathy and assertiveness to enable individuals to navigate social situations with confidence. It seeks to foster healthy connections who would then serve as support networks that offer a space where clients feel accepted and heard. The presence of these connections acts as a crucial source of encouragement and emotional support to deal with challenging times and thus sustain their mental health and well-being.
At the heart of DBT lies the principle of dialectical thinking that is essentially rooted in the idea of embracing change by giving up rigid or obsolete thinking patterns that view things in terms of polarities and hence give rise to dysfunctional emotions and behaviors. It seeks to bring about a shift in perspective to achieve a healthy balance between contradictory ways of thinking so that they can coexist. This enables individuals to become more flexible and open in interpreting emotionally challenging experiences and feelings rather than avoiding them or dismissing them as negative. In the context of therapy, it aims to validate the emotional state of clients while encouraging them to explore alternative ways of thinking and behaving and hence create an incentive to make meaningful changes.
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DBT has established itself as a structured approach to equip individuals with practical skills needed to break free from a cycle of dependency caused by substance use. It thus plays a vital role in helping affected individuals manage anxiety and emotional suffering by working towards shaping positive behaviors and skills to build inner resilience. Therapists can bring about significant difference in the lives of their clients by integrating DBT into therapy sessions and hence promote overall well-being.
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