A diverse array of therapeutic options exist for the treatment of alcohol and substance use disorders.

One option is dialectical behavior therapy (DBT), a type of therapy developed by psychologist Marsha Linehan in the 1980s. Linehan initially devised DBT to help treat people with borderline personality disorder (BPD), but over the past three decades, therapists have adapted and used DBT to effectively treat a number of behavioral and emotional disorders, including alcohol use disorder (alcoholism) and substance use disorder (drug addiction).

This article offers a basic definition of DBT and explains how it benefits people in treatment, detox and recovery.

Understanding Dialectical Behavior Therapy

Behavioral therapies involve one-on-one and/or group counseling that focuses on teaching people how to identify and correct problems in their thoughts and actions. DBT is a specific subtype of cognitive behavioral therapy (CBT).

To learn about CBT and addiction treatment, click here.

During CBT, a trained therapist helps a person in recovery learn how their specific thoughts influence their emotions and behavior. By identifying and changing negative thought patterns, a person in recovery can change their non-productive, life-interrupting feelings and actions.

DBT takes this principle – changes in thought lead to changes in behavior – and adds specialized components that focus on emotional regulation, stress tolerance, and mindfulness. The core idea behind DBT lies in the word dialectical, which has two meanings that are relevant to understanding how DBT works.

Dialectical means:

1. Of or relating to the logical discussion of ideas and opinions
2. Concerned with or acting through opposing forces.

During DBT, therapists engage in an open and honest dialogue with individuals in treatment – that’s how DBT relates to the first part of this definition. The primary distinguishing feature of DBT, however, lies in the second definition. DBT therapists help people in recovery understand that two opposing ideas or concepts can coexist and that this interplay of fundamental opposites is a defining aspect of reality. Dynamic opposites are a feature of reality – not a bug.

The dialectic at the core of the disordered use of substances is the oppositional relationship of acceptance and change. A person in recovery must accept the reality that they have a behavioral disorder while simultaneously realizing they have the power to change that reality by taking steps to manage their behavioral disorder.

What Are the Benefits Of DBT?

The benefits of DBT are best explained by understanding the core skills DBT therapists teach patients in recovery. These include:

1. 
   

   Emotional Regulation

   
   

People with alcohol and substance use disorder often experience erratic behavior and extreme mood swings. DBT therapists use mindfulness to help people in recovery identify their emotional states without judging them. Once they accept their internal reality as-is, they can then step back and learn to process their disruptive emotions or patterns of thought in ways that help them, rather than hurt them.

2. 
   

   Distress Tolerance

   
   

Painful emotions related to past trauma or present challenges often play a large role in addiction. People turn to alcohol and drugs to soothe their emotions and live with difficult circumstances. A DBT therapist teaches people in recovery the skills needed to accept their emotional states and life circumstances without judgment – as mentioned above – then teaches them specific practical skills to handle stressful situations without resorting to non-productive behaviors, such as drinking or using drugs.

3. 
   

   Improved Self-Esteem

   
   

DBT teaches real skills that people in recovery can apply immediately – even before they leave treatment. With practice, over time, the emotional regulation and distress tolerance skills learned during DBT becomes new default coping skills. People in treatment learn they have the power to navigate life without using alcohol and drugs. This improves their feelings of self-worth and ultimately improves their confidence, self-image, and self-esteem.

4. 
   

   Setting and Achieving Goals.

   
   

Active addiction can cause an individual to give up on both short-term and long-term goals. Improved emotional regulation combined with enhanced distress tolerance and elevated self-esteem can lead a person in recovery back to goals they may have forgotten, or lead them to a place where they can create new goals – and use their DBT skills every day to achieve those goals.

5. 
   

   Improved Relationships.

   
   

Addiction often impairs the ability to maintain healthy and positive personal relationships. It can damage friendships, romances, workplace dynamics, and family interactions. This is not always because the person in active addiction engages in problematic behavior while they’re under the influence of intoxicants. It’s often because they lose the ability to create and maintain healthy boundaries. They forget how advocate for their basic emotional and psychological needs. They lose the ability to communicate effectively in difficult situations.

DBT skills give people in treatment the tools they need to do all of the above: create positive boundaries, seek and find emotional and psychological safety, and discuss their emotions without precipitating a crisis. The net effect of these skills on relationships is that they become enriching and fulfilling – or they have the potential to, when DBT skills are applied appropriately

The full suite of DBT skills enables an individual in recovery from alcohol or substance use disorder to create sustainable behavioral change. Once they begin to create the change they want to see in their lives, DBT skills give them the ability to review and revise their behavior as needed. This dynamic element is critical. As people grow in recovery, they change. As they change, they need the skills to create new coping skills that match their development. DBT creates that template, which evidence shows is durable, adaptable, and capable of supporting both small and large behavioral changes over time.

Treatment Helps You Take Control of Your Life

If you’re seeking treatment for an alcohol or substance use disorder, look for one that offers elements of DBT, like mindfulness. That’s not the only thing to look for, though. The most effective treatment centers use an integrated, holistic approach to treatment. DBT is one piece of the puzzle. It’s important, but it’s not the be-all, end-all therapy that solves everything. That doesn’t exist.

At treatment centers that use up-to-date, evidence-based therapeutic practices, individual counseling approaches like DBT are included alongside other treatment approaches, such as:

• Group therapy
• Family therapy
• Experiential therapy
• Dual diagnosis treatment
• Cognitive behavioral therapy

Recovery is a lifelong journey that you do not have to take on your own. Compassionate, evidence-based treatment provided by caring, experienced practitioners can help you change your life for the better. Inpatient and other treatment programs can give you the practical tools you need to learn, grow, and thrive. The life you create in recovery is a life you live on your own terms, free from the painful cycles of alcohol and drug addiction.

The Relationship Between Isolation and Addiction Relapse

For decades, medical experts have called addiction a “disease of isolation.” Although we’ve changed the way we think about addiction in recent years – we now call alcoholism or alcohol addiction alcohol use disorder (AUD) and call substance abuse or drug addiction substance use disorder (SUD) – that hasn’t changed the fact that isolation and addiction are intimately related.

In fact, isolation is both a known risk factor for addiction and a symptom of addiction.

That means the last two years in the U.S. were a one-two punch for people in recovery from alcohol use disorder or substance use disorder.

The first punch: many people who develop an addiction identify isolation and loneliness as contributing factors. Other factors include genetics, family history, the presence of past trauma, or the presence of a co-occurring mental health disorder.

The second punch: stay-at-home mandates, social distancing guidelines, and prohibitions against group gatherings – which includes in-person social supports like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) – resulted in the very isolation that many cite as a contributing factor to their addiction.

National experts on addiction recognized the dual threat COVID-related isolation poses to people in recovery. In an interview in April 2021, Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), said:

“Whenever there’s been a catastrophe like this, there is an increase in drug consumption across the board. Our alcohol drinking goes up, smoking goes up, and people relapse. We do know that drug-taking is one of the ways that people try to cope, and unfortunately, this can have very adverse effects. Meanwhile, social isolation is one of the most important factors contributing to drug-taking behavior.”

Let’s explore why social isolation is recognized by addiction professionals like Dr. Volkow as a contributing factor to substance use and addiction.

The Relationship Between Isolation and Mental Health

We’ll connect the dots between isolation and the risk of relapse so there’s no doubt in your mind about the challenges people in recovery face. If you’re in recovery, we’ll connect the dots so you understand them, as well. It’s important to know the challenges you face during the coronavirus pandemic are not in your head. They’re very real, backed by evidence, supported by data, and agreed upon by almost any mental health professional you ask.

The first two dots to connect are between isolation and mental health. Dr. Volkow made the connection between isolation and addiction in the quote offered above, but now we’ll explain why isolation increases the risk of both addiction and relapse – because she did skip that step.

According to the American Psychological Association, loneliness and isolation have a wide range of negative consequences on emotional, physical, and cognitive health. Here are the adverse consequences of isolation and loneliness they identify:

• Emotional health:
  • Depression
  • Anxiety
  • Stress
  • Insomnia
• Physical Health:
  • Poor cardiovascular function
  • Increased risk of coronary heart disease
  • Increased risk of stroke
  • Impaired immunity
• Cognitive Health:
  • Impaired executive function
  • Increased risk of dementia
  • Accelerated cognitive decline

That evidence is clear. In addition to increasing stress, loneliness and isolation can increase the risk of mental health disorders like anxiety, depression, and insomnia. Now it’s time to connect the next two dots: mental health and addiction.

The Relationship Between Mental Health and Addiction

The National Institute on Drug Abuse (NIDA) website offers an abundance of information about the relationship between mental health – or mental illness – and substance use disorder. They lead their resource section on co-occurring disorders – the term clinicians use when one person has a mental health disorder and a substance use disorder – with the following simple statement:

“Multiple national surveys have that that about half of those who experience a mental illness during their lives will also experience a substance use disorder, and vice-versa.”

You can read two of those national surveys here and here.

NIDA goes on to list the mental health disorders that may co-occur with SUD:

• Anxiety disorders:
  • Generalized anxiety disorder
  • Panic disorder
  • Post-traumatic stress disorder
• Mood disorders:
  • Depression
  • Bipolar disorder
• Other disorders:
  • Attention-deficit hyperactivity disorder
  • Borderline personality disorder
  • Schizophrenia
  • Psychotic illness
  • Antisocial personality disorder

While all the disorders above may co-occur with substance use disorder (SUD), the most common mental health disorders that co-occur with SUD are anxiety and depression. Research shows that:

• People with depression are approximately twice as likely to have a SUD as people without depression
• About 20% of people with an anxiety disorder also have SUD

When we look back at the mental health disorders that are most often associated with isolation and loneliness, we find that depression and anxiety are at the top of the list. That means that the dots between isolation and addiction now connect in a clear and unmistakable way.

Isolation, Mental Health, COVID, and Relapse

Here’s the simplified version:

1. Isolation can lead to anxiety and depression.
2. Anxiety and depression commonly co-occur with – and are risk factors for – both addiction and relapse.
3. Therefore, isolation can increase the risk of substance use and relapse to substance use.

That’s the default situation many people in recovery faced during the height of the pandemic: they were isolated because of coronavirus, and this isolation increased and intensified many of the factors that may have led to their addiction in the first place. And we didn’t mention the additional factors at play that have caused significant stress, and increased risk of relapse:

• Fear of contracting COVID-19
• Fear of loved ones contracting COVID-19
• Uncertainty about everything related to COVID-19:
  • How it’s transmitted
  • Risk of serious illness or death
  • How long the pandemic will last
• Unemployment
• Income instability

When we said one-two punch at the beginning of this article, that may have seemed dramatic, or possibly hyperbolic. Now we can see that it’s the opposite: calling isolation during COVID a one-two punch understated the situation. In addition to the one-two of isolation, several additional factors increase the risk of relapse during COVID, such as general stress, worry about COVID, income instability, and unemployment.

What to do if You Still Feel the Effects of Isolation

If isolation and uncertainty threatened your sobriety over the past two years – and still are – there are two critically important things for you to do: stay on your program and stay connected to your support community.

Staying on your program means doing all the things you know support your sobriety. That includes eating healthy food, getting enough sleep, exercising regularly, and participating in activities or hobbies you know are safe, sober-friendly, and life-affirming. Staying connected to your support community means attending virtual AA or NA meetings (visit their websites here and here for virtual meeting information), talking on the phone to your recovery peers, and participating in teletherapy with your counselor or therapist.

If you need more intensive support than you can receive by doing all those things, then it’s important to know that most residential programs are open and ready to help.

Finally, if you’re worried a friend or loved one in recovery is in danger of relapse, you can take action. Reach out to them, remind them to stay on their program and stay connected to their recovery community – as described above – and remind them that if they need intensive support, they can seek professional detox treatment.

What is the link between trauma and addiction?

Trauma comes in many forms. It can affect an individual, a family, and an entire community. Many people who experience trauma don’t understand the significance or impact of trauma in their lives. They may not consider themselves trauma survivors. They may show all the clinical signs of having experienced damaging trauma, but do not believe they have post-traumatic stress disorder (PTSD), which often develops in response to trauma.

It’s not unusual for people to downplay their trauma. They may categorize their experience as a bad memory or simply a tough time they went through. In many cases, people think that because something difficult or negative happened a long time ago, and they don’t think about it every day, it has nothing to do with their lives in the present moment. They cope as best they can and soldier on without complaint – even when their friends, family, and therapist – if they have one – can see plainly how their history of trauma affects their current behavior.

This misunderstanding of trauma and PTSD can have serious consequences. The long-term effects of untreated PTSD include, but are not limited to:

• Depression
• Anxiety
• Alcohol use disorder (alcoholism)
• Substance use disorder (drug addiction)
• Eating disorder
• Insomnia
• Chronic pain
• Autoimmune disease
• Disrupted relationships
• Family problems
• Cardiovascular disease
• Self-harming behavior
• Suicidal ideation

These effects can begin early and last a lifetime. However, not all people who experience them understand they’re connected to trauma.

Why Do People Minimize Trauma?

Trauma survivors include people who’ve been bullied, physically assaulted, or emotionally abused and/or neglected. As we mentioned, many people who experience these things don’t consider themselves trauma survivors. Instead, they think they’ve just been through some tough times, which are now in the past.

An interesting fact about trauma is that it isn’t necessarily defined by the event itself. It’s more about how the individual perceives the experience. Think of it this way: one individual may experience bullying at work but doesn’t perceive the behavior of their boss or colleagues to be that disturbing. Another person may experience the same thing with a completely different take on the incidents and have an entirely different outcome in response. They may develop anxiety, have trouble sleeping, or quit their job. Their self-esteem may suffer. They may avoid places or people that remind them of the traumatic experience.

With all that in mind, let’s dig deeper into trauma, beginning with a clear definition.

Trauma: A Clinical Definition

We hint at the definition above, but it’s important to understand exactly what we’re talking about. Here’s a helpful definition provided by trauma experts at the Substance Abuse and Health Services Administration (SAMHSA):

“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that can have lasting adverse effects on the individual’s functioning and physical, social, emotional well-being.”

They go on to define events mental health professionals consider traumatic:

• Natural disasters
• Sexual abuse
• Physical abuse
• Domestic violence
• Witnessing domestic violence
• War, terrorism, political violence
• Medical injury, illness, or procedures
• Community violence
• Neglect or deprivation as a child, adult, or senior
• Kidnapping
• Accidents
• School violence
• Loss of a family member, loved one, or peer

Trauma experts define three distinct types of trauma. All three of these may involve the events or experiences listed above, in varying degrees:

1. Acute trauma. Acute trauma is the result of a single incident.
2. Chronic trauma. Chronic trauma is caused by repeated and prolonged exposure to traumatic experiences, such as domestic violence or childhood abuse.
3. Complex trauma. Complex trauma is caused by repeated exposure to multiple traumatic events of different types.

It’s important to understand that not every person who experiences trauma will go on to develop post-traumatic stress disorder (PTSD). Many will develop low-level anxiety, low self-esteem, and mild depression. In many cases, people who experience these symptoms turn to drugs and alcohol to alleviate the uncomfortable emotions and patterns of thinking associated with them.

It’s also important to understand that effective, evidence-based treatment for PTSD exist and can help people manage the effects disruptive effects of trauma in their lives. We’ll talk about treatment in a moment.

Before we do, we’ll share statistics on the prevalence of trauma worldwide and in the United States.

Prevalence of Trauma

Research on the prevalence of trauma shows surprising results. Here’s are some key points from a survey published by the World Health Organization (WHO) in 2017:

• 70.4% of respondents reported at least one traumatic event in their lifetime
• 31.4% reported experiencing the death of a loved one
• 23.7% reported witnessing or discovering a death or serious injury in another person
• 22.9% reported experiencing physical violence
• 14.0% reported intimate partner violence
• 13.1% reported war-related trauma

Here are the results of a study on trauma prevalence conducted in the U.S. in 2013:

• 89.7% reported at least one traumatic event in their lifetime
• 53.1% reported experiencing interpersonal violence (assault, rape, assault with intent to kill, assault with a weapon)
• 43.7% reported experiencing physical assault
  • 44.9% of women
  • 42.4% of men
• 29.7% reported experiencing sexual assault
  • 42.4% of women
  • 15.8% of men

In addition to these statistics about adults, it’s important to understand the prevalence of trauma experienced by children. In the United States, approximately two-thirds of children experience at least one traumatic event before the age of sixteen, twenty percent of high school students experience bullying, seventeen percent experience cyberbullying, and close to twenty percent of children who experience trauma have post-traumatic stress disorder. Research shows a direct relationship between experiencing childhood trauma and developing an alcohol or substance use disorder later in life.

We should point out that though the relationship between trauma and addiction is unmistakable, not everyone who experiences trauma or develops PTSD will develop an alcohol or substance use disorder. The most effective way for people to process trauma and avoid its negative long-term effects is professional mental health treatment.

Treatment for Trauma and PTSD

The Anxiety and Depression Association of America (ADAA) indicates that psychotherapy – in some cases accompanied by medication – is the best way to treat trauma and PTSD. One-on-one sessions with experienced therapists help trauma survivors develop skills to manage their symptoms and cope with them when they arise. Therapy sessions often focus on recognizing and changing patterns of thinking and behavior related to the original trauma. Therapists and patients work together to identify these life-interrupting patterns and replace them with patterns of thought and behavior that are non-disruptive and life-affirming.

The most common types of therapy used to treat PTSD and process trauma include:

• Cognitive Behavioral Therapy (CBT)
  • This solution-focused therapy stressed behavioral change. The talk component typically includes specific strategies that a patient can apply right away.
• Exposure Therapy
  • Exposure therapy involves a therapist carefully re-introducing a patient to traumatic stimuli – or directing a patient to the memory of traumatic stimuli – in such a way as to minimize its power.
• Eye Movement Desensitization and Reprocessing (EMDR)
  • EMDR blends exposure therapy with directed eye movements. This process helps patients change their reactions to traumatic memories and reduce the frequency and intensity of symptoms related to those memories.

Because each person is different, each course of treatment for trauma is different. Techniques that work for one person will not necessarily work for another. Therapists collaborate with patients to find what works for them, then move forward together to develop effective strategies to manage symptoms and mitigate the effect of trauma in daily life.

This is crucial for people in treatment for alcohol or substance use disorders, since they often develop their disordered use of alcohol or substances to alleviate the uncomfortable symptoms of PTSD or early trauma. Evidence shows that when treatment addresses PTSD/trauma and alcohol/substance use simultaneously, outcomes improve – and patients learn to live a life that’s not dominated by their past trauma or present mental health or substance use issues.

The Ridge in Cincinnati offers an inpatient facility to help people suffering from addicts to undergo a complete detox program.

How prevalent is alcohol use disorder in women? What are the consequences?

Alcohol use in the U.S. is common. People serve alcohol at parties, commemorative events, and at home. They include it as an option at occasions as diverse as backyard barbecues and executive business lunches. Adolescents experiment with alcohol, college students often make consuming alcohol a way of life, and adults use alcohol to relax, facilitate social interaction, and reward themselves after a hard day of work or play.

Its prevalence – while innocuous in many instances – can also lead to misuse. The 2020 National Survey on Drug Use and Health (2017 NSDUH) shows the following population-level data on alcohol use disorder (AUD) in the U.S.:

• Adolescents (12-17): 712,000 (2.8%)
• Young Adults (18-25): 5.2 million (15.6%)
• Adults (26+): 22.3 million (10.3%)

Quick math tells us that almost 30 million people in the U.S. meet the clinical criteria for AUD, or what most people think of as alcoholism. Further examination of the numbers shows the rate of AUD gradually decreased for all age groups between 2002 and 2017, then increased between 2017 and 2020. However, additional research reveals an increase in the prevalence of AUD in one group over the same time: women.

A study published by the American Psychological Association (APA) in 2014 explores the differences in the development and consequences of alcohol use disorder in women, and how they differ for women and men. This article summarizes that study and discusses its implication for the treatment of alcohol use disorder in women.

Prevalence of Alcohol Abuse in Women Compared to Men

In general, men experience higher rates of AUD than women. Here’s the data:

• AUD in men: 24.6%
• AUD in women: 11.5%

These numbers represent a distinct shift, not only over the past 15 years, as indicated above, but over the past 90 years. In the 1930s, data places the ratio of disordered alcohol use for men, compared to women, at seven to one (7:1). When we fast forward to 2017, we see that ratio close significantly: it now hovers around two to one (2:1). If you’re not used to reading or thinking in ratios, what this means is that about a hundred years ago, seven times more men than women experienced problem drinking. Now – or according to data from 2017 – only twice as many men than women experience problem drinking.

That’s a big change. The specific reasons behind the change are beyond the scope of this article, but it’s reasonable to suggest that the increased reporting of rates of AUD for women mirror their increased ability to participate in all aspects of society, from working, to owning property, to securing equal rights and access to a variety of social, political, and cultural activities that were previously denied them, as Supreme Court Justice Ruth Bader Ginsburg observed, “on the basis of sex.”

What is within the scope of this article, however, is identifying differences in the development and impact of AUD on women compared to men.

We’ll talk about those now.

Alcohol Use Disorder in Women: The Negative Effects

Disordered alcohol use causes severe, lasting, and negative impacts for anyone. Men, women, young people, old people – any person who develops disordered drinking patterns risk damage to their brain and body. The latest research tells us two important things: some of the negative impacts of AUD are more pronounced in women than in men, and AUD develops differently in women, as compared to men.

Research indicates the following short-term differences in the effect of alcohol consumption on women, compared to men. Women show:

• Higher blood alcohol levels when consuming the same amount of alcohol
• Increased cognitive impairment
• Increased sedation (sleepiness)
• Higher levels of impairment (drunkenness)
• Increased levels of acute, alcohol-related injury
• Increased risk of sexual assault (as a victim)

Long-term differences in the effect of alcohol use disorder on women, compared to men, include:

• Increased risk of brain damage and shrinkage
• Shorter time for brain damage and shrinkage to occur
• Increased memory impairment
• Increased cognitive impairment
• Elevated risk of alcohol-related liver disease
• Elevated risk of mouth, throat, esophageal, liver, breast, and colon cancer
• Greater risk of heart disease and cardiovascular complications
• Increased risk of depression and mood disorders

Pregnancy And Alcohol Use Disorder

Studies also show the negative impacts of alcohol consumption during pregnancy. Risks to newborns of mothers who consume alcohol excessively during pregnancy include:

• Birth defects
• Low birth weight
• Fetal Alcohol Syndrome (FAS), which can cause:
  • Physical deformations
  • Slow growth (before and after birth
  • Defects in major organs
  • Defects in the brain and nervous system
  • Cognitive impairment
  • Social impairment
  • Memory impairment
  • Disrupted emotional development
  • Impaired balance

These elevated risks mean, in a nutshell, that AUD – or simply excessive drinking – has the chance to cause more damage, more quickly, to women than men. The authors of the APA study cited above put it this way:

“AUD appears to be a more severe form of psychopathology in women.”

Alcohol Use Disorder Rehab For Women

There are two more pieces of information we left out – and both are relevant to our discussion. First, following initiation of alcohol use – i.e. their first drink – women develop patterns of disordered drinking more rapidly than men. Second, when women begin drinking during adolescence, the intensity and duration of alcohol use disorder are greater than that found in men who begin drinking around the same time.

Taken together, all this information is critical for primary care physicians, physicians who specialize in women’s health, therapists, psychiatrists, and social workers involved with women’s issues. In other words, anyone directly involved in the health and wellbeing of women should understand the increased physical, emotional, and psychological risks associated with AUD in women compared to men.

Putting this knowledge into action means that medical and mental health professionals can include questions regarding alcohol consumption in any screenings they conduct during regular office visits. These professional caregivers can then act quickly on the information they collect. If women show signs of AUD, doctors and therapists can recommend a drug and alcohol rehab for women and treatment plan sooner rather than later – which can help women with disordered drinking patterns live healthy lives and significantly mitigate the negative short- and long-term consequences of alcohol abuse.

Sources:

https://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NSDUHDetailedTabs2020/NSDUHDetailedTabs2020/NSDUHDetTabsSect5pe2020.htm