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

628 V. TREATMENTS FOR ADDICTIONSaddition, skills are practiced during session and are woven into plans in anticipationof upcoming events.Diary CardsIn order to monitor a variety of targets, a daily diary card is used. For example,clients may rate their mood, monitor the frequency of self-injurious behaviorand drug use urges, and track other relevant targets. The diary card is reviewedat the beginning of each session, and the therapy session is organized aroundtargets evident on the diary card. Given the plethora of treatment targets andthe possibility that clients will not remember salient events from the previousweek, the diary card is instrumental in directing therapy sessions toward highlyrelevant targets.Behavioral AnalysisTo change dysfunctional behaviors, DBT-SUD uses a number of problemsolvingstrategies. Behavioral analysis is used to identify problem behaviors andto understand the relevant contexts in which these behaviors generally occur.Behavioral analysis involves an active, directive effort by the therapist to identifyspecific antecedents and consequences associated with the problem behavior.A thorough elaboration of events before, during, and after problem behaviorsfacilitates the selection of appropriate treatment interventions. Based on afunctional-analytic approach to behavioral assessment, the goal of behavioralanalysis is prediction and control of functional classes of problem behaviorrather than traditional diagnostic assessment of disease entities (Hayes &Follette, 1992; Kanfer & Saslow, 1969). In other words, in DBT-SUD, borderlinesymptoms and substance use are conceptualized as problem behaviors. Thesemay be external, publicly observable behaviors, such as self-mutilation orimpulsive aggression, or internal, publicly unobservable experiences, such asself-judgmental thoughts or urges to use substances.Because behavioral analysis in DBT-SUD involves explicating the links ina specific chain of events, it is often referred to as a “chain analysis.” During achain analysis, the topography, intensity, and duration of the target problem isdiscussed. As links in the chain of events (including internal experiences andexternal events) before and after the target behavior are explored, the therapistconsiders the role of classical and instrumental conditioning. Classically conditioned(respondent) behaviors are under the control of an antecedent stimulus,and instrumentally conditioned (operant) behaviors are under the control ofconsequent events. For example, strong urges to use substances may be classicallyconditioned to occur after interpersonal conflicts. On the other hand, substanceuse may be instrumentally conditioned by the consequences that follow,such as less hostility or increased attention from others. A chain analysis is a