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Alcohol and Mental Health

How Can Dialectical Behavior Therapy (DBT) Help With Alcohol Misuse?

September 3, 2023
23 min read
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Reframe Content Team
A team of researchers and psychologists who specialize in behavioral health and neuroscience. This group collaborates to produce insightful and evidence-based content.
September 3, 2023
23 min read
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Certified recovery coach specialized in helping everyone redefine their relationship with alcohol. His approach in coaching focuses on habit formation and addressing the stress in our lives.
September 3, 2023
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Recognized by Fortune and Fast Company as a top innovator shaping the future of health and known for his pivotal role in helping individuals change their relationship with alcohol.
September 3, 2023
23 min read
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Reframe Content Team
September 3, 2023
23 min read

In the words of Wayne Dyer, overcoming destructive patterns is all about finding balance: “The single most important tool to being in balance is knowing that you and you alone are responsible for the imbalance between what you dream your life is meant to be, and the daily habits that drain life from that dream.”

For many, habits around alcohol can become the biggest source of imbalance. However, our minds are incredibly flexible, and it’s always possible to find our way back!

Dialectical Behavior Therapy (or DBT for short) can be a real game-changer when it comes to understanding and addressing alcohol misuse and reestablishing balance in our lives. And while the term might sound like something out of a fancy science journal, it's a user-friendly, practical approach that anyone can learn.

Diving into DBT: What's It All About?

DBT is a form of cognitive behavioral therapy that emerged in the late 1980s. Designed initially to help people with borderline personality disorder, research soon revealed its efficacy in treating a broad range of mental health disorders, including those linked with substance misuse.

Founded by psychiatrist Marsha Linehan, DBT is a cognitive-behavioral approach that equips individuals with skills to manage emotions, navigate social interactions, and be present in their daily lives.

Fantastic Four

First, let's get to know the four modules that make up this toolkit:

  • Mindfulness. At the heart of DBT lies mindfulness, the practice of being fully immersed in the present moment. Think of it as tuning in to a live broadcast of your life that allows you to observe your thoughts, feelings, and sensations without judgment.
  • Emotion regulation. Emotion regulation is about understanding the range and intensity of our feelings, harnessing their power, and ensuring they contribute positively to our lives. It’s less about control and more about understanding and guidance.
  • Distress tolerance. Life isn't without its hiccups, and distress tolerance is all about weathering the storms without getting drenched. It equips us with skills to handle challenging or upsetting situations without resorting to impulsive actions.
  • Interpersonal effectiveness. Imagine having a cheat sheet for social interactions that can help you express needs, set boundaries, and maintain relationships. That’s what this module is all about! It provides strategies to communicate assertively, negotiate differences, and understand others better.

Together, these modules offer a holistic approach, ensuring that we are well-equipped to handle life's obstacles with grace, understanding, and resilience. Whether it's a sudden surge of emotions, a challenging situation, or a tricky conversation, DBT has our back!

Why DBT and Alcohol Misuse Are a Match Made in Science

The main objective of DBT is to help us balance acceptance and change by learning to accept things as they are right now while also recognizing and working toward necessary shifts. For someone trying to reduce or quit alcohol, this dual approach is invaluable.

When we peel back the layers and peek into the realm of neuroscience, the synergy between DBT and tackling alcohol misuse becomes even clearer. The brain is an ever-evolving, intricate machine, and both alcohol and DBT have significant interactions with its wiring.

  • The brain’s reward system and alcohol. The brain's reward system, primarily centered around the neurotransmitter dopamine, plays a significant role in the pleasure we derive from various activities, including consuming alcohol, which boosts dopamine levels and leads to temporary feelings of pleasure or euphoria. However, over time and with excessive drinking, the brain starts depending on alcohol to release dopamine, and its natural ability to do so diminishes. This creates a vicious cycle: we start consuming more alcohol to achieve the same "feel good" effect.
  • Several tools provided by DBT can help us regulate dopamine levels naturally. For example, mindfulness has been scientifically proven to balance neurotransmitter levels. Likewise, effective interpersonal interactions are another great way to give dopamine levels a natural boost.
  • Emotion regulation and the amygdala. The amygdala plays a pivotal role in emotion processing and response. Chronic alcohol consumption can hyperactivate the amygdala, leading to heightened emotional responses and reduced ability to regulate them. DBT, with its emphasis on emotion regulation, provides tools to counteract this emotional hailstorm and recalibrate the amygdala by teaching us to understand and guide our emotions rather than impulsively reacting to them.
  • Prefrontal cortex engagement. The prefrontal cortex, which is responsible for decision-making, impulse control, and rational thinking, can be compromised with excessive alcohol consumption, resulting in poor decisions related to further alcohol consumption and other problems in life. Research shows that DBT skills, especially mindfulness and distress tolerance, work towards strengthening our ability to stay in the present and deal with adversity. Practicing these skills can help restore some of the decision-making prowess and impulse control that might have been dulled by alcohol.
  • Neuroplasticity and DBT. One of the brain's incredible features is neuroplasticity — the ability to rewire and adapt based on experiences. Engaging in DBT practices can encourage positive neural pathways to form, effectively rewiring some of the changes that chronic alcohol consumption might have induced. This means that consistent DBT practice can, over time, contribute to healing and strengthening the brain.

We’ll explore how each module is relevant to healing from alcohol misuse in more detail below.

Emotion Regulation: Navigating the Stormy Seas of Feelings Without Drinking

Emotion regulation, an integral part of DBT, isn't about suppressing or ignoring feelings—quite the opposite! It’s all about recognizing, understanding, and managing intense emotions in order to harness their power without resorting to unhealthy behaviors and ensure they enhance rather than overshadow our lives. For those looking to cut back or quit alcohol, gaining mastery over emotions can be transformative.

Alcohol is often a go-to for many when emotions run high. Whether it's a drink to "calm the nerves" or "drown the sorrows," it can quickly become a crutch. However, relying on alcohol to cope often masks the real issues and can lead to increased dependence over time.

Learning emotion regulation provides an alternative path. It gives people tools to recognize emotional triggers, techniques to respond rather than react, and strategies to find relief without external aids like alcohol. By integrating emotion regulation skills into our lives, we’re not just decreasing reliance on alcohol. We’re crafting a richer, fuller emotional landscape. And the beauty of it? With practice, we become better equipped to handle life's ups and downs without the temporary solutions that alcohol might have once offered.

Here are a few DBT emotion regulation staples:

  • Identify and label emotions. It all starts with awareness: by naming an emotion, we’re already on our way to managing it. Is it sadness, anger, frustration, or anxiety?
  • Check the facts. This technique allows us to challenge the emotion by asking ourselves if it’s justified or if there might be another way to interpret the situation.
  • Opposite action. This method involves intentionally doing the opposite of what our emotion is telling us to do. For instance, if sadness is making us want to isolate, we can consider doing something social instead. It can feel awkward at first, but it works!
  • Self-soothe. Using our five senses to calm down is simple yet effective. For example, we can listen to music, light a scented candle, or take a warm bath.
  • Build positive experiences. Engaging in activities that bring joy and happiness builds a reservoir of positive emotions that make alcohol more and more irrelevant in our lives.

Distress Tolerance: The Art of Weathering Life's Storms Without Alcohol

It’s no secret that life throws curveballs. DBT provides skills to cope with these unexpected challenges without reaching for a bottle.

Distress tolerance is all about managing painful situations without making them worse. It's not about dismissing uncomfortable feelings or waiting for them to pass. Instead, it's about actively navigating difficult moments without resorting to behaviors that might provide short-term relief but long-term complications.

For many, alcohol can feel like a quick escape hatch from distressing emotions or situations. But this "solution" often exacerbates the  problem, leading to intensified emotions, regrets, and health risks. Distress tolerance techniques equip us with alternative coping mechanisms, allowing us to face challenges head-on and reducing the allure of alcohol as a temporary solution.

By mastering distress tolerance, we’re building resilience. Life's inevitable challenges become more manageable, and the siren song of alcohol as a quick-fix loses its appeal. With time, we find ourselves better equipped to face distress head-on, confident in our arsenal of tools and techniques. Here are a few golden nuggets:

  • Distract with Wise Mind ACCEPTS. This acronym guides us to distract in a healthy way through Activities, Contributing, Comparisons, Emotions (opposite), Pushing away, Thoughts, and Sensations. For instance, we can dive into a hobby or listen to music that evokes a different emotion.
  • Self-soothe with the five senses. This technique invites us to engage our senses to find calmness. For example, we can feel the texture of a soft blanket, taste a favorite (non-alcoholic) drink, or listen to the sounds of nature.
  • Improve the moment with IMPROVE. Another acronym, this one focuses on Imagery, Meaning, Prayer, Relaxation, doing One thing at a time, taking a brief mental Vacation, and Encouragement.
  • TIPP skills for a quick reset. When we need an immediate shift, Turning the temperature (for example, by splashing cold water on our face), Intense exercise, Paced breathing, and Paired muscle relaxation can do the trick.

Mindfulness: Being Present in Every (Booze-Free) Moment

Grounded in ancient Zen practices, DBT’s take on mindfulness is all about being in the moment. It teaches us to be fully present, making it easier to say no to that drink.

At its core, mindfulness is about being fully present, staying aware of where we are and what we're doing, and not being overly reactive or overwhelmed by our surroundings. It’s akin to having a mental flashlight that illuminates our current experience, thoughts, and feelings without judgment.

When battling with alcohol misuse, the mind can be a swirl of regrets, anxieties, and cravings. Mindfulness offers a respite, redirecting attention to the present. This shift helps us recognize triggers or cravings as they emerge, respond to them without impulsivity, gain clarity, and make better decisions. It can also reduce anxiety and rumination which might lead to drinking.

Engaging in regular mindfulness practices can open up a new world of awareness and calm. For those on a journey away from alcohol, it’s like having a trusty compass, always pointing towards the present moment, the place where real change happens. With every mindful breath and moment, the weight of past regrets and future anxieties lightens, making the path forward clearer and more manageable.

DBT weaves mindfulness into its fabric, emphasizing its role in improving emotional well-being. Here are some DBT-inspired mindfulness practices:

  • Wise mind. This DBT concept refers to the balance between emotional and logical thinking. By tuning into our “Wise Mind,” we can make decisions that align with our goals and values and avoid being swayed by impulses or external pressures.
  • Observing, describing, and participating. These core mindfulness skills encourage us to observe our emotions, thoughts, and sensations without getting tangled in them; to describe our experiences in words, grounding them in reality; and to immerse ourselves fully in our current activity without self-consciousness.
  • Non-judgmental stance. This method encourages us to see things as they are, without labeling them as "good" or "bad". By letting go of judgments, it becomes easier to accept ourselves and our current situation, reducing the urge to escape through alcohol.
  • One-mindfulness. Doing one thing at a time can work wonders. If we’re washing dishes, we can just wash dishes. If we’re talking to a friend, we can be fully present in the conversation. This singular focus can diminish distractions and strengthen concentration.

Interpersonal Effectiveness: Building Bridges, Not Walls

We’ve all been there: that moment when we wish we had said "no" to another drink at a social gathering or when we struggled to communicate our boundaries with friends who encourage “just one more.” Sometimes, the social pressures to drink can be overwhelming.

Enter interpersonal effectiveness—a cornerstone of DBT—which arms individuals with the skills to navigate these social intricacies, especially vital for those aiming to cut back or quit alcohol. DBT helps us communicate and assert our boundaries, ensuring we remain true to our goals.

Interpersonal effectiveness is about ensuring our interactions with others are productive, respectful, and assertive. It's the art of achieving our objectives in interactions, maintaining relationships while keeping self-respect intact. Imagine it as having a toolkit filled with communication skills that protect your boundaries while fostering understanding and harmony.

Social situations can be a minefield for those trying to reduce or quit alcohol. Peer pressure, societal norms, or even miscommunication can make it challenging to stick to our goals. Effective interpersonal skills help articulate personal boundaries clearly, foster understanding with friends and family about our journey, manage potential conflicts related to drinking decisions, and build supportive networks that respect and understand our choices.

DBT offers a set of strategies to enhance one's interpersonal skills, making social situations easier to navigate:

1. DEAR MAN. To express desires clearly,

  • Describe the situation.
  • Express feelings using "I" statements.
  • Assert yourself by asking for what you need or saying no.
  • Reinforce your message by explaining the benefits.
  • Stay mindful by focusing on the conversation.
  • Appear confident, maintaining composure.
  • Negotiate with a give-and-take approach.

2. GIVE. For when maintaining the relationship is a priority,

  • Be gentle in approach.
  • Act interested in the other person's point of view.
  • Validate their feelings.
  • Use an easy manner with humor and smiles.

3. FAST. To maintain self-respect in interactions,

  • Be fair to yourself and others.
  • Don’t make apologies for any reason.
  • Stick to values.
  • Be truthful, avoiding exaggerations or lying.

By harnessing these DBT-inspired interpersonal tools, we can engage in social situations with confidence, clarity, and composure. Gone are the days of feeling cornered into making choices that don’t align with our personal goals!

DBT and Its Cousins: How They Compare

Dialectical Behavior Therapy (DBT) might be your current favorite, but it's not the only method out there. Several therapeutic approaches aim to help people navigate their emotions, behaviors, and relationships while healing from alcohol misuse. Let's pull back the curtains and see how DBT stands in comparison to some of its close relatives.

  • Cognitive Behavioral Therapy (CBT). CBT acts as a magnifying glass for our thoughts that helps us examine and reframe them. It emphasizes identifying and changing negative thought patterns and behaviors, is typically short-term, and focuses on specific goals.
  • While both DBT and CBT focus on cognitive processes and behaviors, DBT includes additional components such as mindfulness and distress tolerance, making it particularly effective for people with severe emotional dysregulation.
  • Acceptance and Commitment Therapy (ACT). ACT is all about accepting our feelings rather than resisting them and committing to actions that align with our values. It emphasizes psychological flexibility: the ability to be open, adaptable, and effective in the presence of difficult emotions.
  • Both DBT and ACT emphasize acceptance and mindfulness. However, while DBT provides more structured skills training, ACT focuses on flexibility and value-driven actions.
  • Mindfulness-Based Cognitive Therapy (MBCT). MBCT combines traditional cognitive behavioral approaches with mindfulness strategies. It's tailored to prevent the recurrence of depression and emphasizes meditation practices and awareness exercises.
  • Both DBT and MBCT integrate mindfulness, but DBT offers a broader range of strategies and is more focused on behavioral outcomes and emotional regulation.
  • Schema therapy. This therapy delves deep into understanding and changing long-standing patterns—“schemas”—formed in childhood. Key Concept: It deals with emotional needs that weren’t adequately addressed during youth and contributed to unhealthy life patterns in adulthood.
  • While both DBT and schema therapy address deep-rooted emotional issues, DBT offers more immediate tools and coping strategies, whereas Schema Therapy involves a more extended exploration of past experiences.
  • Interpersonal Therapy (IPT). IPT zeros in on interpersonal relationships and communication patterns. It’s typically short-term and very structured.
  • While both DBT and IPT address interpersonal issues, DBT offers a broader spectrum of tools that also tackle emotional regulation, distress tolerance, and mindfulness.

In a nutshell, while each therapeutic approach brings its unique flair to the stage, DBT offers a comprehensive, multifaceted approach. It's like a Swiss army knife, packed with tools and strategies for a wide range of situations. However, the best approach always depends on individual needs. It's essential to work with a professional to find the therapy tune that resonates best with your rhythm!

How To Start Using DBT in Your Journey Away From Alcohol

  • Daily mindfulness exercises. Set aside 5 minutes each day to practice mindfulness. This could be as simple as focusing on your breathing or noticing the sensations in your body. Remember, it's about being present!
  • Journal your emotions. Track your feelings daily. When do you feel the urge to drink the most? Recognizing these patterns can help you anticipate challenges.
  • Develop a distraction toolbox. Jot down a list of activities that can distract you when the craving hits. This might be reading, taking a short walk, or even calling a friend.
  • Role-play saying "No." Practice makes perfect. With a trusted friend or family member, rehearse situations where you might feel pressured to drink and practice declining.
  • Join a DBT group. Consider joining a DBT therapy group or seeking out a trained DBT therapist. The shared experience and expertise can provide the support you need.
  • Educate friends and family. Share your journey with loved ones. Let them know about the principles of DBT and how they’re helping you. This builds a support system and increases understanding.
  • Celebrate small wins. Every time you successfully employ a DBT technique to avoid or limit drinking, give yourself a pat on the back. Recognizing your progress is essential.

Summing Up

All in all, DBT can be a trusted ally in your journey away from alcohol misuse. While it might sound a bit technical at first, it's truly a hands-on approach filled with actionable steps and strategies. So, as you continue your journey, remember that you've got science on your side and practical tools to help you along the way.

Summary FAQs

1. What is Dialectical Behavior Therapy (DBT)?

DBT is a cognitive-behavioral approach founded by Dr. Marsha Linehan. It equips individuals with skills to manage emotions, handle challenging situations, navigate social interactions, and be present in their daily lives.

2. How does DBT use mindfulness in its approach?

Mindfulness, at the heart of DBT, emphasizes being fully present in the moment. DBT incorporates practices like observing emotions without judgment, describing experiences in words, and participating fully in current activities.

3. Can DBT help me manage my emotions better?

Absolutely! The Emotion Regulation module in DBT helps individuals understand their emotions, ensuring they contribute positively to their lives. It's about guiding emotions, not suppressing them.

4. What's the deal with Distress Tolerance in DBT?

Life comes with its challenges. Distress Tolerance provides tools to cope with these ups and downs without resorting to impulsive actions. It's about weathering the storm without getting drenched.

5. How can DBT help improve my relationships and social interactions?

DBT's Interpersonal Effectiveness module offers strategies to communicate assertively, set boundaries, maintain relationships, and understand others. It’s like having a cheat sheet for successful social interactions.

6. How does DBT compare to other therapies like CBT or ACT?

While DBT shares similarities with other therapies, it offers a comprehensive approach that combines cognitive processes, behavioral outcomes, emotional regulation, and mindfulness. It's like having a multi-tool for various life challenges.I want to integrate DBT into my journey.

7. How do I start?

Starting with a licensed therapist trained in DBT is the best step. They can provide guidance, introduce the various modules, and tailor the approach to suit your unique needs.

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