DBT for Substance Use: Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness

United States Department of Homeland Security

Distress tolerance skills help clients with substance disorders to manage their triggers, ride out their urges, and replace addictive behaviors with healthier forms of coping. Distress tolerance skills are inherently short-term rather than long-term strategies. They aren’t necessarily feel-good skills, but they are also not feel-bad skills.
Distress tolerance skills help clients survive the risk zone, in which problems only get worse.
Substances are often consumed to self-medicate psychopathology and to avoid or escape uncomfortable mood states, which only leads to even more emotional pain and chaos. Emotion regulation training for this population focuses on psychoeducation of emotions themselves, learning about the purpose and nature of emotions, as well as the personification of emotions, learning to relate to emotions the same way you would relate to a person.
Since substances take such a high physical toll on the user, emotion regulation also involves learning to improve self-care of the actual body.
Substances also take a major toll on relationships. This is especially problematic since the strength of a client’s support network is the main determinant of their long-term recovery. The purpose of interpersonal effectiveness skills is to help clients improve their relationships with both self and others through conflict management, boundary setting, assertiveness training, accountability, and validation, including self-validation.