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Dialectical Behavior Therapy for Substance Use Disorders

Dialectical Behavior Therapy for Substance Use Disorders

Following the initial evidence supporting DBT for suicide and non-suicidal self-injury (NSSI) in the early 1990s, Marsha Linehan and colleagues introduced modifications to target substance use disorders (SUD) as one of the greatest risk factors for fatal outcomes. DBT-SUD developed by adding new principles, strategies, protocols, and modalities to address common problems and complications of addiction, while maintaining all of those from the original model for NSSI. For example, individuals with BPD and SUDs tend to demonstrate “butterfly attachment,” characterized by limited treatment inclination, fleeting commitment, and minimal attachment to providers; whereas those with BPD without SUDS more often show an opposite attachment-seeking pattern. Therefore, a number of Attachment Strategies were added, such as assigning regular phone check-ins to build connection, orienting social networks to help reconnect with “lost” clients, and reinforcement of treatment participation. Some added DBT-SUD modalities include social networking meetings supporting attachment, urine toxicology screening, and pharmacotherapy to provide replacement medication for opioid addiction given its empirical support.

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How DBT Can Help Treat Eating Disorders

How DBT Can Help Treat Eating Disorders

Therapy Models for Treating Eating Disorders

The rationale for applying DBT to the treatment of eating disorders (EDs) has been described comprehensively in the literature. The rationale proposed suggests that alternative approaches are necessary for eating disorders because current empirically founded treatments (e.g. cognitive behavioral therapy and interpersonal psychotheray) may only be partially effective or ineffective for a select number of patients. DBT can be considered a logical alternative because, unlike other approaches, it is based on an affect-regulation model of treating ED symptoms. Eating pathology (e.g. binge-eating, self-induced vomiting, restriction, etc.) may now be understood as mechanisms to cope with emotional vulnerability (Telch et al., 2000), as opposed to errors in cognition or faulty interpersonal relationships alone ( Fairburn et al., 1993).

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Dialectical Behavior Therapy and Mental Healthcare Costs

Dialectical Behavior Therapy and Mental Healthcare Costs

The need for implementation of effective treatments for individuals at high-risk for suicide — and those diagnosed with borderline personality disorder (BPD) — is greater than ever. The most recent and highest quality epidemiological evidence indicates that the lifetime prevalence of BPD is between three and six percent in the U.S. population (Grant et al., 2008; Trull et al., 2010). Worldwide, nearly 1 million people die annually as a result of suicide (World Health Organization, 2016). Recently released data from the Centers for Disease Control and Prevention (CDC) indicates that rate of death by suicide has reached its highest level since 1991 (13.0 deaths per 100,000), making it the 10th leading cause of death for all ages (CDC, 2016). The rate of death by suicide has increased nearly uninterrupted since 1999, a 24 percent increase. And of great concern, over 40 percent of individuals who attempt suicide do not receive mental health care; half of those who do receive treatment report perceived unmet treatment need (Han, et al 2014). Subsequently, suicide results in an estimated $51 billion in combined medical and work loss costs in the U.S. (CDC, 2013).

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DBT with American Indian Youth

DBT with American Indian Youth

NOTE: The opinions expressed by this trainer do not necessarily reflect the opinions of the US Department of Health and Human Services, The Public Health Service, the Indian Health Service, or the trainer’s affiliated institutions.

Providing DBT within the Indian Health Service

The Indian Health Service (IHS), a component of the U.S. Department of Health and Human Services, operates two Youth Residential Treatment Centers (YRTC) in the Phoenix Area of the IHS. Desert Visions, located in Arizona on the Gila River Reservation, was established in 1994, and Nevada Skies, located on the Pyramid Lake Paiute Reservation in Nevada, was established in 2009.

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