DBT in the Treatment of Addiction

dbtWhat is addiction? There are many definitions, but one of the most basic features of any addiction is that there is a compulsive repetition of behaviors that are known to be harmful—no matter how good they feel initially—but are chronically engaged in nonetheless. The tools for harming oneself might be alcohol, drugs, cutting, overeating and unsafe sexual practices (amongst others) but the result is the same.

One of the more promising therapies for addiction, Dialectical Behavioral Therapy, or DBT, was developed by its inventor, Dr. Marsha Linehan to help treat compulsive patterns of self-harm with simple, practical, and effective techniques. For Linehan, DBT is anything but an exercise in abstraction. As she only recently revealed, its methods come from insights gained, at a huge personal cost, from her own struggles with mental illness. Though Linehan was never a substance abuser per se, she was nonetheless, like many substance abusers, trapped in a downward spiral of shame, self-loathing, psychic pain, and self-harm from which there seemed to be no escape.

Linehan originally developed DBT as a treatment for highly suicidal patients often with a compulsion to injure themselves. Such patients are now often diagnosed with Borderline Personality Disorder, a psychiatric illness characterized by sometimes lifelong patterns of violent mood swings, unstable relationships, poor self-image, and a tendency to act impulsively. Often, there are also persistent feelings of abandonment and the majority of those with a BPD diagnosis harm themselves, as well as make repeated suicide attempts. Dr. Linehan believed that if these individuals could be taught skills to better deal with emotional and life issues and thus lessen psychic pain, then the desire to be dead or harm themselves would be greatly diminished. The goal of DBT is to acquire skills to deal with the mental anguish the sufferer experiences and create a life worth living. The tools offered in DBT are meant to aid in the achievement of these goals.

Dr. Linehan was, at first, diagnosed with schizophrenia at the age of 17. As a teenager she was, according to an in-depth look at her struggles with mental illness published in the New York Times in 2011, “precocious” but also dangerously violent towards herself. “The girl,” wrote Times correspondent Benedict Carey, “attacked herself habitually, burning her wrists with cigarettes, slashing her arms, her legs, her midsection, using any sharp object she could get her hands on.” In the same story Linehan said, “I felt totally empty, like the Tin Man; I had no way to communicate what was going on, no way to understand it.” She was “dosed with Thorazine, Librium, and other powerful drugs, as well as hours of Freudian analysis; and strapped down for electroshock treatments … nothing changed, and soon enough the patient was back in seclusion on the locked ward.”

In 1967, Linehan had what can only be described as an epiphany: she had been regularly praying at the Cenacle Retreat Center in Chicago, and had suddenly felt transformed. “It was,” she told the Times, “this shimmering experience, and I just ran back to my room and said, ‘I love myself.’ It was the first time I remember talking to myself in the first person.'”

“The high,” Carey writes, “lasted about a year, before the feelings of devastation returned in the wake of a romance that ended. But something was different. She could now weather her emotional storms without cutting or harming herself.”

Quite simply, she accepted herself as she was. She referred to this as “Radical Acceptance”—acceptance of life as it is, not as it is supposed to be; and the need to change, despite that reality and because of it. These seem to be opposites: on the one hand, you have to take life as it is; on the other hand, that change is essential for survival. But for real change to happen, both self-acceptance, and acceptance of the need for change have to come together. This blending of two seemingly opposite views is called a dialectic—and it’s the vision behind the name of Dialectical Behavioral Therapy.