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

624 V. TREATMENTS FOR ADDICTIONSstandard DBT. In addition, because these clients tend to come into and go outof therapy, therapists may become easily demoralized. Thus, a strong emphasisis made on remoralizing and motivating therapists during consultation teammeetings. Other attachment strategies include orienting the client to this problem,increasing contact with clients toward the beginning of treatment, frequentcontacts with clients via voice mail, in vivo therapy sessions, decreasingor increasing session length as needed, family and friends network meetings,and calling clients when they are avoiding them when they repeatedly do notshow up for appointments or respond to telephone calls.Modes and Functions of TreatmentDBT-SUD includes methods for learning adaptive coping skills, generalizingsuch skills into relevant contexts, enhancing commitment to treatment, andpreventing demoralization of both the therapist and client. There are four primarymodes of treatment: group skill training, individual therapy, phone consultation,and consultation team. Because of the need for replacement medicationand the frequent comorbidity of Axis I disorders, DBT-SUD also canincorporate a pharmacotherapy mode. Next, the function, process, and structureof treatment modes are briefly reviewed.Skills TrainingWeekly 2-hour skills training classes occurs in a group format. The primaryfunction of skills training classes is the acquisition of new behavioral and cognitiveskills. Skills training classes are co-led by two skills trainers, and includeboth homework review of previously learned skills and didactic presentation ofnew skills from the skills training manual (Linehan, 1993b). Specifically, thereare separate skill modules for mindfulness, distress tolerance, emotion regulation,and interpersonal effectiveness.MindfulnessDerived from Eastern meditative and Christian contemplative traditions, mindfulnessis the practice of paying attention in a particular way: on purpose, in thepresent moment, and without judgment. In this module, clients learn that theirbehavior is a function of current emotions (emotion mind) or logical analysis(reasonable mind). “Wise mind” knowing and behavior is emphasized as a synthesisof emotion and reasonable minds, such that decisions and actions areboth effective and remain within personal values. For example, in order tochange a client’s identity as an addict, wise mind is emphasized as behaviorsthat are inconsistent with identity as an addict.Mindfulness skills specifically include the ability to observe, describe, and