Substance abuse and addictions

The Dialectical Abstinence Model

DBT addiction treatment uses a unique approach called "dialectical abstinence," which synthesizes the demand for total abstinence with the reality of relapse.

An unwavering commitment to absolute abstinence is established (the change pole), but a compassionate contingency plan is built in if a slip occurs (the acceptance pole).

This avoids the "abstinence-violation effect," where a small slip becomes a full-blown relapse due to shame and resignation ("I've blown it, I might as well keep using").

The individual is required to be 100% committed to not using in every present moment, but if he/she fails, he/she must immediately apply harm reduction skills and "get back on the wagon" without falling into paralyzing self-loathing, restarting the abstinence commitment instantly.

Environmental management and triggers.

Recovery requires a radical restructuring of the living environment, known as avoiding "people, places and things" associated with consumption.

The addicted brain creates strong conditioned associations; the mere sight of a place where one used or contact with former drinking buddies can trigger an overwhelming physiological craving before the conscious mind can intervene.

The strategy involves "burning the bridges" that connect to the life of addiction: deleting phone numbers, changing transportation routes, and removing any objects related to the habit.

Work is done on building new environments that offer safety and do not activate the substance-linked reward system, thus protecting the individual from the constant struggle against potent environmental stimuli.

Behavioral Function Substitution

Since substance abuse often arises as self-medication for pain or emptiness, simply eliminating the substance without offering an alternative leaves the individual helpless in the face of his or her discomfort.

It is necessary to identify the function that the drug served (e.g. relaxation, socialization, energy) and replace it with adaptive mechanisms that offer similar rewards, even if they are less intense at first.

If the consumption was used for arousal, it can be replaced by high intensity sports; if it was for calming, by practices of deep sensory regulation.

The idea is to fill the void left by addiction with activities that build a valuable life and event