DBT for Substance Use: Mindfulness and Dialectical Abstinence

United States Department of Homeland Security

DBT is an evidence-based model, a synthesis between humanism and behaviorism, and an integrated approach that is uniquely equipped to address both mental health and substance abuse issues, which are highly and complexly correlated.
There are many ways to teach mindfulness skills, including psychoeducation, guided meditation, breathing exercises, body scans, diary cards, and chain analyses.
Mindfulness skills are foundational because we can’t change what we don’t understand. Mindfulness skills help substance disordered clients to decrease impulsivity, slow down the decision-making process, and become more aware of triggers and urges.
People in recovery tend to have an all-or-nothing thinking style that leads to the abstinence violation effect, which is completely giving up on recovery following a relapse.
Dialectical abstinence is the middle path between these binary extremes. It prioritizes complete abstinence as Plan A, but in the event of relapse, simultaneously prioritizes a skillful return to complete abstinence as Plan B. Dialectical abstinence reframes a slip as skills learning in progress, rather than as a treatment failure.