How We Treat
Dialectical Behavior Therapy for Substance Use Disorders
Clinically reviewed by Paul Rahn, LCSW-C, licensed clinician, Counseling Center Group. Paul has been specially trained in DBT for Substance Use Disorders (DBT-SUD) and received his certification from Behavioral Tech Institute.
Dialectical Behavior Therapy for Substance Use Disorders (DBT-SUD) is an evidence-based therapy designed to help individuals manage addiction, emotional dysregulation, impulsive behaviors, and relapse patterns.
DBT-SUD combines addiction recovery strategies with practical skills focused on mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. This approach is commonly used for individuals experiencing co-occurring mental health and substance use concerns, including trauma, anxiety, depression, and self-destructive coping patterns. At Counseling Center Group, DBT-informed therapy is provided by clinicians experienced in addiction recovery, trauma-informed care, and evidence-based behavioral treatment approaches.
Substance use is rarely separate from emotion. We treat both, at the same time.
Substance use is usually what someone reaches for when a feeling gets too big to sit with any other way. We believe recovery only holds when the emotional pattern underneath the use is treated alongside it, not after it. Dialectical Behavior Therapy for Substance Use Disorders is the most structured, evidence-based way we know to do both at once.
DBT-SUD combines the four DBT skill sets (mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness) with addiction-focused strategies that target relapse patterns directly. At Counseling Center Group, DBT-SUD is delivered by clinicians trained in both DBT and addiction recovery, in person and by secure telehealth across Maryland, Washington DC, Virginia, New York, New Jersey, and Florida.
Is DBT-SUD Right for You?
DBT-SUD is outpatient therapy for people whose substance use is tied to difficulty managing intense emotion, impulsivity, or trauma. It is built for the recovery work that follows medical stabilization. It is not detox, inpatient care, or crisis intervention, and it is not a placement or case management service.
Best For
- Emotion-driven relapse: cravings or use that spike with stress, shame, conflict, or emotional overwhelm rather than physical dependence alone.
- Co-occurring conditions: anxiety, depression, PTSD, or self-harm alongside substance use.
- Step-down care: people recently out of residential treatment, inpatient rehab, or an intensive outpatient program (IOP) who need structured outpatient continuity.
- Medication-Assisted Treatment (MAT) support: people on Methadone, buprenorphine (Suboxone), or naltrexone (Vivitrol) who want the behavioral health layer medication alone doesn’t provide.
- Chronic shame or self-criticism that fuels the cycle of use and relapse.
Consider First
- Active withdrawal or detox needs: DBT-SUD is outpatient therapy, not a medical detox program; medical stabilization comes first.
- Immediate safety risk: Someone in crisis should contact 911, the 988 Suicide & Crisis Lifeline, or the SAMHSA National Helpline (1-800-662-4357) before starting outpatient therapy.
- People seeking case management or placement only: DBT-SUD is clinical treatment, not a sober-living or placement service.
What Is Dialectical Behavior Therapy for Substance Use Disorders (DBT-SUD)?
Dialectical Behavior Therapy for Substance Use Disorders (DBT-SUD) is a specialized adaptation of DBT, originally developed by psychologist Marsha Linehan, created to support individuals whose substance use is tied to emotional dysregulation, impulsivity, self-destructive behavior, trauma, or a co-occurring mental health condition. It pairs standard DBT skills training with addiction-focused interventions that target relapse directly.
Treatment helps you see the relationship between emotions, triggers, and use, and then build something specific to reach for instead. Sessions are collaborative and structured around applying skills in real situations, not only discussing them. Treatment may include individual therapy, DBT skills training, relapse prevention planning, behavioral chain analysis, and coordination with your other recovery supports.
Why CCG Uses DBT-SUD
CCG uses DBT-SUD because we believe treating substance use without treating what it’s doing for someone emotionally sets recovery up to fail. Willpower and insight into “why” someone uses rarely survives the next moment of unbearable emotion. A specific, practiced skill can.
DBT-SUD closes that gap by giving clients a direct substitute for what the substance was providing: distress tolerance for cravings, opposite action for urges, radical acceptance for shame. Our clinicians are trained in both DBT and addiction recovery, so you are not asked to work with someone who knows one half of the problem.
Which DBT Skills Are Used in Substance Use Recovery?
DBT-SUD uses the four standard DBT skill modules, applied directly to urges, cravings, and relapse. You learn distress tolerance to get through a craving, emotion regulation to reduce how often the driving emotions show up, mindfulness to catch an urge before it becomes a decision, and interpersonal effectiveness to build a recovery environment that holds.
- Distress tolerance, including TIPP and radical acceptance. Get through a craving or urge without acting on it and without making the moment worse.
- Emotion regulation, including opposite action, PLEASE, and cope ahead. Reduce how often and how intensely the emotions that drive use show up in the first place.
- Mindfulness, including wise mind. Build the present-moment awareness that interrupts automatic, urge-driven behavior before it becomes a decision.
- Interpersonal effectiveness, including DEAR MAN, GIVE, and FAST. Repair and maintain the relationships that support a stable, recovery-oriented environment.
What Does DBT-SUD Treat?
DBT-SUD treats substance use alongside the emotional and behavioral patterns that drive it. It is used for alcohol and drug misuse, relapse prevention, emotional dysregulation, impulsivity, and co-occurring anxiety, depression, trauma, and self-harm.
- Alcohol Misuse: Structured skills target the emotional triggers, social cues, and distress states that sustain problematic alcohol use and complicate recovery.
- Drug Misuse: Builds the behavioral awareness and coping capacity needed to interrupt patterns of drug use driven by emotional dysregulation, avoidance, or urge-based responding.
- Relapse Prevention: Addresses the cognitive, emotional, and situational patterns that precede relapse, equipping individuals with concrete skills to recognize warning signs and respond effectively before a lapse occurs.
- Emotional Dysregulation: DBT’s core emotional regulation skills help individuals identify, understand, and modulate intense emotional states that frequently drive substance use as a coping mechanism.
- Impulsivity & High-Risk Behaviors: Targets the impulsive patterns and risk-taking tendencies that often co-occur with substance use, building self-awareness and behavioral control over time.
- Co-Occurring Anxiety: Addresses anxiety and substance use as interconnected concerns, reducing both the emotional overwhelm that drives use and the anxiety recovery itself can produce.
- Depression & Mood Concerns: Because depression and substance use frequently reinforce one another, DBT-SUD targets mood dysregulation and substance-related behavior within one structured framework.
- Trauma & PTSD: When substance use is rooted in or complicated by trauma, DBT-SUD’s trauma-informed structure addresses both without destabilizing the recovery process.
- Self-Harm Behaviors: DBT was originally developed to address self-harm; its application in SUD treatment provides skills for replacing self-destructive patterns with safer, adaptive alternatives.
- Chronic Shame & Self-Criticism: Shame is one of the most powerful drivers of continued use and relapse; DBT-SUD targets shame-based emotional cycles and builds the self-compassion needed to sustain recovery.
- Stress, Avoidance & Distress Intolerance: For clients who have relied on substances to manage stress or avoid painful emotions, DBT-SUD builds concrete distress-tolerance skills that make it possible to move through difficult states without chemical coping.
- Interpersonal & Relationship Challenges: The interpersonal effectiveness module builds the communication, boundary-setting, and relationship skills that support a stable, recovery-oriented social environment.
- Co-Occurring Concerns During MAT: For clients engaged in Medication-Assisted Treatment, DBT-SUD addresses the emotional dysregulation, relapse triggers, interpersonal stressors, and co-occurring mental health concerns that medication alone does not target.
What to Expect from DBT-SUD at CCG
You start with an intake call, then get matched with a clinician trained in both DBT and addiction recovery. Sessions run 45 to 60 minutes, weekly, in person or by secure telehealth. Most clients combine individual therapy with a DBT skills group. If the match is not right, we will rematch you at no cost.
Our intake team matches you based on what you are actually dealing with: the substance, the emotional pattern underneath it, any co-occurring conditions, where you are in recovery, and whether you are stepping down from a higher level of care or working alongside MAT. You are not put on a general waitlist and assigned to whoever is free.
From there, the work is practical. You and your clinician build the specific skills that replace substance use as a coping strategy: mindfulness, emotion regulation, distress tolerance, relapse prevention, interpersonal effectiveness, and behavioral chain analysis to map what happens between a trigger and a use. Skills are practiced between sessions, not just discussed in them.
Is DBT-SUD an Outpatient Program? How It Compares to Rehab, PHP, and IOP
DBT-SUD at CCG is outpatient therapy, not an intensive outpatient program. It is weekly individual therapy plus an optional skills group, for people who are medically stable. If you need daily structure or medical supervision, a PHP, IOP, or residential program is the right level of care first, and DBT-SUD is what comes after.
| Level of care | What it involves | Best for |
|---|---|---|
| Medical detox | 24/7 medical supervision through withdrawal, typically several days. | Anyone in active withdrawal or physically dependent on alcohol, opioids, or benzodiazepines. |
| Residential or inpatient rehab | Living on site with structured programming, typically 30 to 90 days. | People who need to be removed from their environment to stabilize. |
| Partial hospitalization (PHP) | Roughly 20 or more structured hours per week while living at home. | Medically stable people who still need near-daily clinical structure. |
| Intensive outpatient (IOP) | Roughly 9 to 15 structured hours per week, several days a week, while living at home. | People who need high structure but can manage work, school, or family alongside it. |
| DBT-SUD at CCG (outpatient therapy) | A 45 to 60 minute individual session each week, plus an optional DBT skills group. In person or secure telehealth. | Medically stable people ready for skills-based work: stepping down from a higher level of care, working alongside MAT, or addressing use before it escalates. |
If you are not sure which level of care you need, contact us. If DBT-SUD is not the right fit right now, we will help point you toward what is.
DBT-SUD as a Step-Down After Rehab, Residential, or Intensive Treatment
The weeks after residential or intensive treatment are the highest-risk period in recovery. DBT-SUD gives you structured outpatient continuity in that window: a clinician who understands where you have been, the same skills reinforced against real-world stressors, and coordination with your existing treatment team rather than a restart from zero.
- Provides structured, clinician-matched outpatient support that reinforces the progress made in residential rehabilitation or intensive outpatient programs (IOP).
- Builds and sustains core recovery skills like distress tolerance, emotional regulation, relapse prevention, and urge management within the context of real-world stressors.
- Bridges the gap between intensive programming and independent daily life through a structured, evidence-based framework that doesn’t leave you to figure it out alone.
- Our clinicians work collaboratively alongside your existing recovery team to ensure continuity of care, not a restart from zero.
If you’ve recently completed a higher level of care and are ready for the next step, we’ll match you with a specialist who understands where you’ve been and what it takes to keep moving forward.
Supporting Recovery Alongside Medication-Assisted Treatment (MAT)
Medication-Assisted Treatment works best when it’s paired with behavioral health support, and that’s precisely where DBT-SUD at the Counseling Center Group comes in.
- MAT medications including Methadone, buprenorphine (Suboxone), and naltrexone (Vivitrol) are among the most well-researched tools available for opioid use disorder and alcohol use disorder; NIDA research shows they are most effective when combined with behavioral therapy.
- Our DBT-SUD clinicians work directly with clients currently engaged in MAT, targeting what medication alone cannot reach: emotional dysregulation, relapse triggers, interpersonal stressors, and co-occurring mental health concerns.
- Treatment is individualized and may include individual therapy, skills-based interventions, relapse prevention planning, and group therapy. All treatment is available in person or via secure telehealth in 45–60 minute sessions.
- When clinically appropriate, our clinicians coordinate directly with prescribing providers to ensure a cohesive, whole-person approach to recovery
If you are currently engaged in MAT and are ready to add the behavioral health layer that makes recovery sustainable, we’ll match you with a DBT-SUD specialist who will meet you with evidence-based, nonjudgmental care from the first session.
Where to Access DBT-SUD
Counseling Center Group currently provides DBT-SUD in person and via secure telehealth in Maryland and Washington DC. Because DBT-SUD requires specialized training beyond core DBT, availability varies by location and clinician. Contact us, and we will confirm a DBT-SUD-trained clinician licensed in your state.
DBT-SUD FAQs
Dialectical Behavior Therapy Substance Use Disorders (DBT-SUD) is an evidence-based adaptation of DBT designed to help individuals struggling with addiction, emotional dysregulation, impulsivity, and relapse behaviors develop healthier coping skills and long-term recovery strategies.
DBT-SUD places a stronger emphasis on emotional regulation, mindfulness, distress tolerance, and behavioral coping skills. In addition to addressing substance use directly, DBT-SUD helps individuals understand and manage the emotional patterns that often contribute to addiction and relapse.
Yes. DBT-SUD is commonly used for individuals experiencing both substance use disorders and co-occurring mental health concerns such as anxiety, depression, trauma, self-harm behaviors, and emotional dysregulation.
Yes. DBT-informed treatment approaches for substance use disorders are supported by peer-reviewed research and are commonly used in behavioral health and addiction treatment settings, particularly for individuals with co-occurring emotional and behavioral difficulties.
Treatment length varies depending on recovery goals, relapse history, symptom severity, and co-occurring mental health needs. Some individuals benefit from shorter-term skills-focused treatment, while others participate in ongoing therapy for longer-term recovery support.
Yes. Depending on clinician licensure and client location, DBT-informed therapy for substance use concerns may be available through secure telehealth sessions in addition to in-person appointments.
Yes. DBT-SUD is well suited to the step-down period after residential treatment, inpatient rehab, or an IOP. That transition is the highest-risk window in recovery, and DBT-SUD provides ongoing structure, skills reinforcement, and relapse prevention support as you reintegrate into daily life. Our clinicians coordinate with your existing treatment team so nothing restarts from zero.
No. DBT-SUD may benefit individuals at various stages of recovery, including those struggling with emotional coping patterns, relapse concerns, problematic substance use, or co-occurring mental health difficulties.
Yes. DBT-SUD is well-suited for individuals transitioning out of residential treatment, inpatient rehabilitation, or intensive outpatient programs (IOP). The step-down period is clinically significant, and DBT-SUD provides ongoing structure, skills reinforcement, and relapse prevention support as individuals reintegrate into everyday life. Our clinicians can also coordinate with your existing treatment team to support continuity of care.
Yes. DBT-SUD is commonly used alongside Medication-Assisted Treatment (MAT). Research supports combining behavioral therapy with MAT as more effective than medication alone for long-term recovery from opioid and alcohol use disorders. Our clinicians are experienced working with clients engaged in MAT and can collaborate with prescribing providers when clinically appropriate.
Does Insurance Cover DBT-SUD?
Counseling Center Group is an out-of-network provider, so we do not bill insurance directly for DBT-SUD. Many insurance plans reimburse a portion of out-of-network mental health and substance use treatment costs; contact your insurance provider to confirm your specific out-of-network benefits, or reach out to our team with questions.
Building Recovery That Holds
At CCG, we believe recovery is not just about stopping substance use. It is about building the emotional skills that make stopping sustainable. Whether you’re newly out of residential treatment, navigating MAT, or working through the emotional patterns that keep pulling you back, our DBT-SUD-trained clinicians can help you build a recovery that holds. If any of this resonates, we are here.
About the Reviewer
Paul Rahn, LCSW-C
I am a licensed clinical social worker who believes in the human potential for transformation. Compassion, collaboration, and connection are important in my approach to therapy. Mental health challenges affect ...
Sources and Additional Resources
- Dialectical Behavior Therapy for Substance Abusers, National Institutes of Health / PMC
- Medications for Opioid Use Disorder, National Institute on Drug Abuse (NIDA)
- SAMHSA National Helpline (1-800-662-4357), Substance Abuse and Mental Health Services Administration
- 988 Suicide & Crisis Lifeline
- DBT Therapy, Counseling Center Group
- DBT-PE (Trauma-Focused DBT), Counseling Center Group
- Emotion Fitness Program (EFT), Counseling Center Group
- Addiction, Counseling Center Group Conditions
- Anxiety, Counseling Center Group Conditions
- Locations, Counseling Center Group
- Contact Us, Counseling Center Group