Mapping Dialectical Behavior Therapy Skills to Clinical Domains Implicated in Contemporary Addiction Research: A Conceptual Synthesis and Promise for Precision Medicine

Abstract

Recent addiction research has identified clinical domains that are central to the development and maintenance of alcohol use disorder (AUD). Yet existing psychotherapy approaches are not typically organized around these clinical domains and are often limited in scope. Dialectical behavior therapy (DBT) is an intensive, multicomponent cognitive behavioral treatment that includes individual psychotherapy, group-based skills training, phone coaching, and consultation team for DBT therapists. Despite its efficacy on various mental health conditions, access to full DBT is often a challenge. In this paper, we describe how the skills training component of DBT can be flexibly applied to target clinical domains that underlie the three stages of the addiction cycle or impair quality of life during recovery from AUD. Using three clinical case vignettes, we illustrate how DBT skills can be mapped onto addiction clinical domains (e.g., Dialectical Abstinence and Clear Mind on executive function, STOP and TIP skills on incentive salience, Check the Facts and Opposite Action on negative emotionality, and ABC PLEASE skill on quality of life). Based on this integrated framework, we offer practical recommendations for case conceptualization, stigma reduction, and implementation through multiple delivery options. Implications on precision medicine are also discussed. Together, this conceptual synthesis serves as a bridge for practitioners to learn about contemporary addiction theories and for addiction researchers to appreciate the value of DBT in substance use treatment. The promotion of DBT skills training as a stand-alone or adjunctive intervention may help address the significant treatment gap in alcohol and substance use behaviors.