Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

27. Dialectical Behavior Therapy 617EMPIRICAL SUPPORTTwo randomized trials examining DBT-SUD have been conducted. Linehanand colleagues (1999) compared DBT-SUD to treatment as usual (TAU) inthe community in a sample of 28 women diagnosed with BPD and either SUDor polysubstance use disorder. Subjects received 1 year of treatment, and wereassessed at 4, 8, 12, and 16 months after treatment, and were matched at pretreatmenton age, severity of drug dependence, readiness to change, and globaladjustment. Subjects in the DBT-SUD condition attended significantly moreindividual psychotherapy sessions during treatment, dropped out of treatmentless, and, importantly, evidenced significantly less drug use, as determined byurinary analyses. At 16-month follow-up, subjects in the DBT-SUD conditionhad higher scores on measures of global adjustment and social adjustment comparedto subjects in the TAU condition.In a second study, 23 subjects with BPD and heroin dependence were randomlyassigned to receive 1 year of DBT-SUD or comprehensive validationtherapy, a treatment consisting of therapist validation coupled with 12-stepmethods (Linehan, Dimeff, et al., 2002). Subjects also received ORLAAM concurrentlyas an opiate replacement medication, and were matched at pretreatmenton age, cocaine dependence, antisocial personality disorder, and globalfunctioning. Although subjects in both conditions had a small proportion ofpositive urinary analyses at follow-up, in the last 4 months of treatment, thosein the DBT-SUD condition maintained treatment gains, whereas those in thecomprehensive validation condition had a significant increase in opiate useduring this period. In addition, subjects in both conditions reported greatersocial adjustment and general adjustment following treatment. Taken together,these studies suggest that DBT-SUD is an efficacious treatment for substanceusers with BPD.PHILOSOPHY AND THEORYPhilosophers such as Hegel and Kant discussed dialectics as a means of understandingor synthesizing apparent contradictions. Dialectics includes both aworldview and a process of change in DBT-SUD. From a dialectical worldview,behavior is conceptualized as interrelated, contextually determined, and systemic.The dialectical process of change is guided by the fundamental notionsthat (1) for every point an opposite position can be held, and (2) natural tensionscan be resolved and adaptive change can occur when workable synthesesemerge from the consideration of contradicting polarities or opposing ideas. Forexample, clients might insist that substance use helps them feel less bored,whereas the therapist might insist that substance use is the problem. Using a