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      Dialectical Behavior Therapy for Substance Abusers

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      Author(s): , Ph.D. 1 , , Ph.D. 2
      Publication date (Print):
      Journal: Addiction Science & Clinical Practice
      Publisher: National Institute on Drug Abuse

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          Abstract

          Dialectical behavior therapy (DBT) is a well-established treatment for individuals with multiple and severe psychosocial disorders, including those who are chronically suicidal. Because many such patients have substance use disorders (SUDs), the authors developed DBT for Substance Abusers, which incorporates concepts and modalities designed to promote abstinence and to reduce the length and adverse impact of relapses. Among these are dialectical abstinence, “clear mind,” and attachment strategies that include off-site counseling as well as active attempts to find patients who miss sessions. Several randomized clinical trials have found that DBT for Substance Abusers decreased substance abuse in patients with borderline personality disorder. The treatment also may be helpful for patients who have other severe disorders co-occurring with SUDs or who have not responded to other evidence-based SUD therapies.

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          Dialectical behavior therapy for binge eating disorder.

          Christy F. Telch, W Stewart Agras, Marsha Linehan (2001)
          This study evaluated the use of dialectical behavior therapy (DBT) adapted for binge eating disorder (BED). Women with BED (N = 44) were randomly assigned to group DBT or to a wait-list control condition and were administered the Eating Disorder Examination in addition to measures of weight, mood, and affect regulation at baseline and posttreatment. Treated women evidenced significant improvement on measures of binge eating and eating pathology compared with controls, and 89% of the women receiving DBT had stopped binge eating by the end of treatment. Abstinence rates were reduced to 56% at the 6-month follow-up. Overall, the findings on the measures of weight, mood, and affect regulation were not significant. These results support further research into DBT as a treatment for BED.
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            Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder.

            Marsha Linehan, Linda A. Dimeff, Sarah K Reynolds … (2002)
            We conducted a randomized controlled trial to evaluate whether dialectical behavior therapy (DBT), a treatment that synthesizes behavioral change with radical acceptance strategies, would be more effective for heroin-dependent women with borderline personality disorder (N = 23) than Comprehensive Validation Therapy with 12-Step (CVT + 12S), a manualized approach that provided the major acceptance-based strategies used in DBT in combination with participation in 12-Step programs. In addition to psychosocial treatment, subjects also received concurrent opiate agonist therapy with adequate doses of LAAM (thrice weekly; modal dose 90/90/130 mg). Treatment lasted for 12 months. Drug use outcomes were measured via thrice-weekly urinalyses and self-report. Three major findings emerged. First, results of urinalyses indicated that both treatment conditions were effective in reducing opiate use relative to baseline. At 16 months post-randomization (4 months post-treatment), all participants had a low proportion of opiate-positive urinalyses (27% in DBT; 33% in CVT + 12S). With regard to between-condition differences, participants assigned to DBT maintained reductions in mean opiate use through 12 months of active treatment while those assigned to CVT + 12S significantly increased opiate use during the last 4 months of treatment. Second, CVT + 12S retained all 12 participants for the entire year of treatment, compared to a 64% retention rate in DBT. Third, at both post-treatment and at the 16-month follow-up assessment, subjects in both treatment conditions showed significant overall reductions in level of psychopathology relative to baseline. A noteworthy secondary finding was that DBT participants were significantly more accurate in their self-report of opiate use than were those assigned to CVT + 12S. Copyright 2002 Elsevier Science Irealnd Ltd.
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              Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients.

              Matthew Armstrong, D. Heard, Jacqueline Linehan (1993)
              A randomized clinical trial was conducted to evaluate whether the superior performance of dialectical behavior therapy (DBT), a psychosocial treatment for borderline personality disorder, compared with treatment-as-usual in the community, is maintained during a 1-year posttreatment follow-up. We analyzed 39 women who met criteria for borderline personality disorder, defined by Gunderson's Diagnostic Interview for Borderline Personality Disorder and DSM-III-R criteria, and who had a history of parasuicidal behavior. Subjects were randomly assigned either to 1 year of DBT, a cognitive behavioral therapy that combines individual psychotherapy with group behavioral skills training, or to treatment-as-usual, which may or may not have included individual psychotherapy. Efficacy was measured on parasuicidal behavior (Parasuicide History Interview), psychiatric inpatient days (Treatment History Interview), anger (State-Trait Anger Scale), global functioning (Global Assessment Scale), and social adjustment (Social Adjustment Scale--Interview and Social Adjustment Scale--Self-Report). Subjects were assessed at 6 and 12 months into the follow-up year. Comparison of the two conditions revealed that throughout the follow-up year, DBT subjects had significantly higher Global Assessment Scale scores. During the initial 6 months of the follow-up, DBT subjects had significantly less parasuicidal behavior, less anger, and better self-reported social adjustment. During the final 6 months, DBT subjects had significantly fewer psychiatric inpatient days and better interviewer-rated social adjustment. In general, the superiority of DBT over treatment-as-usual, found in previous studies at the completion of 1 year of treatment, was retained during a 1-year follow-up.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Addict Sci Clin Pract
                Journal ID (publisher-id): 101316917
                Title: Addiction Science & Clinical Practice
                Publisher: National Institute on Drug Abuse
                ISSN (Print): 1940-0632
                ISSN (Electronic): 1940-0640
                Publication date (Print): June 2008
                Volume: 4
                Issue: 2
                Pages: 39-47
                Affiliations
                [1 ] Behavioral Tech Research, Inc., Seattle, Washington
                [2 ] Department of Psychology, University of Washington, Seattle, Washington
                Author notes
                CORRESPONDENCE: Linda A. Dimeff, Ph.D., Behavioral Tech Research, Inc., Seattle, WA 98105; e-mail: ldimeff@ 123456btechresearch.com .
                Article
                Publisher ID: ascp-04-2-39
                DOI: 10.1151/ascp084239
                PMC ID: 2797106
                PubMed ID: 18497717
                SO-VID: bfea78c4-4bec-46c4-a67c-b7d6aaa4420e
                Copyright ©
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                Categories
                Subject: Science and Practice in Action

                ScienceOpen disciplines: Health & Social care
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                ScienceOpen disciplines: Health & Social care

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