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Dbt substance abuse presentation

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  • Honoring the part that wants to not conform or go along with things. Giving that energy somewhere to go that is sa
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    • 1. DIALECTICAL BEHAVIOR THERAPYFOR SUBSTANCE ABUSESkills for Recovery and Relapse PreventionAlicia Lawson, Psy.D. Dr. Alicia Lawson – www.dbtmarin.com
    • 2. What we’ll cover• What is Dialectical Behavioral Therapy (DBT)?• What is the dialectical approach to treating substance abuse?• Why skills?• What makes a great skill?• How do you choose the right skills at the right time? Dr. Alicia Lawson – www.dbtmarin.com
    • 3. What is DBT? Cognitive Behavioral Therapy + Validation (acceptance) + Dialectics Dr. Alicia Lawson – www.dbtmarin.com
    • 4. What is DBT?Cognitive Behavioral TherapyFour main change strategies1. Skills Training2. Exposure Therapy3. Cognitive Therapy4. Contingency Management Dr. Alicia Lawson – www.dbtmarin.com
    • 5. What is DBT?Validation Dr. Alicia Lawson – www.dbtmarin.com
    • 6. What is DBT?Dialectics1. Everything is connected to everything else1. Change is constant and inevitable1. Opposites can be integrated to form a closer approximation to the truth (which is always evolving). Dr. Alicia Lawson – www.dbtmarin.com
    • 7. What is DBT?Dialectics Balancing Change/Problem Acceptance Solving Validation Dr. Alicia Lawson – www.dbtmarin.com
    • 8. What Is The Dialectical Approach?Polarities in Substance Abuse Treatment Abstinence Only Model vs. Harm Reduction Model Dr. Alicia Lawson – www.dbtmarin.com
    • 9. What Is The Dialectical Approach?The Abstinence ModelNever using againPro:People who commit to abstinence stay off longerCon:It takes longer for people to get back on the wagon once they fall off Dr. Alicia Lawson – www.dbtmarin.com
    • 10. What Is The Dialectical Approach?Harm Reduction ModelAcknowledging there will be slips; minimizing the damage but notdemanding perfectionPro:When a slip does happen, people can get back on wagon fasterCon:People who commit to harm reduction relapse quicker Dr. Alicia Lawson – www.dbtmarin.com
    • 11. What Is The Dialectical Approach? HARM ABSTINENCE vs. REDUCTION SYNTHESIS: DIALECTICAL ABSTINENCE Dr. Alicia Lawson – www.dbtmarin.com
    • 12. What Is The Dialectical Approach?Dialectical AbstinenceThe goals is not to use drugs again. Complete abstinence. However, ifthere is a slip, the goal is to minimize harm and get back to abstinenceas soon as possible.Pro:It works!Con:It is work!You don’t get a vacation (you’re either abstinent or working to get backto abstinence at all times) Dr. Alicia Lawson – www.dbtmarin.com
    • 13. Why Skills? • Pain and distress are a part of life (inability to accept pain can increase suffering) • Prevents impulsive actions (i.e. drug use) that can make things worse. • Replaces old behaviors that work in short term yet can cause problems in the long term. Dr. Alicia Lawson – www.dbtmarin.com
    • 14. What makes for a GREAT skill? • People have to actually use it • It has to be measurable • It has to work in stopping the problematic behavior without causing new problems • It allows the individual to build mastery (self – reinforcing) Dr. Alicia Lawson – www.dbtmarin.com
    • 15. What makes a Great skill?People have to actually use it1. UNDERSTAND THE PROBLEM Conducting a Behavioral Chain Analysis Trigger LinkVulnerabilities Link Link Self-Destructive Behavior Consequences Dr. Alicia Lawson – www.dbtmarin.com
    • 16. What makes a Great skill?People have to actually us it2. FIGURE OUT WHAT TO DO PROBLEM CUE CONSEQUENCES BEHAVIOR CUE SKILL REWARD Dr. Alicia Lawson – www.dbtmarin.com
    • 17. What makes a Great skill?People have to actually us it3. ADDRESS FACTORS THAT GET IN THE WAY “Yes, but” “Just one more time” “I can’t do this” “It’s not my fault” Dr. Alicia Lawson – www.dbtmarin.com
    • 18. What makes a Great skill?It has to be measurable Pre/Post measures of SUDs (subjective units of distress) Dr. Alicia Lawson – www.dbtmarin.com
    • 19. What makes a Great skill? D B T D i a measurable has to be r y Ca r dItName:__________________________________ Date Started:_____________________ Urges 0 - 5 Em otions 0 - 5 Behaviors sucide alcohol drugs binge skip Pain Sad Shame Anger Fear/ Joy alcohol drugs binge meds study Sleep Exercise self Diary Date: therapy Anx. reienforce Card Mon. Tue. Wed. Thurs. Fri. Sat. Sun. Homework / Notes: * 0=Not thought about or used 2=Thought about, not used, wanted to 4=Tried, could do, but didnt help 6=Didnt try, used, didnt help 1=Thought about, not used, didnt want to 3=Tried, but couldnt use 5=Tried, could use, helped 7=Didnt try, helped Dr. Alicia Lawson – www.dbtmarin.com
    • 20. What makes a Great skill?It has to work without causing problematic side effects Behaviors to Increase Behaviors to Decrease Mindfulness Skills • Identity confusion • Emptiness • Cognitive dsyregulation Distress Tolerance Skills • Impulsive behaviors • Suicide threats • Intentional self harm Emotion Regulation Skills • Libile Affect • Excessive Anger Interpersonal Skills • Interpersonal Chaos • Fears of Abandonment Dr. Alicia Lawson – www.dbtmarin.com
    • 21. What makes a Great skill?It allows the individual to build mastery Dr. Alicia Lawson – www.dbtmarin.com
    • 22. The right skills at the right time?DBT skills for substance abuse disorders1. Avoiding Cues & Triggers2. TIP3. Urge Surfing4. Pros and Cons5. Alternative Rebellion Dr. Alicia Lawson – www.dbtmarin.com
    • 23. The right skills at the right time?DBT skills for substance abuse disordersAvoiding Cues & Triggers Dr. Alicia Lawson – www.dbtmarin.com
    • 24. The right skills at the right time?DBT skills for substance abuse disordersTIP T Temperature I Intense Exercise P Progressive Muscle Relaxation Dr. Alicia Lawson – www.dbtmarin.com
    • 25. The right skills at the right time?DBT skills for substance abuse disordersUrge Surfing Dr. Alicia Lawson – www.dbtmarin.com
    • 26. The right skills at the right time?DBT skills for substance abuse disordersPros and Cons Pros Cons Using Drugs Using Skills Dr. Alicia Lawson – www.dbtmarin.com
    • 27. The right skills at the right time?DBT skills for substance abuse disordersAlternative rebellion Dr. Alicia Lawson – www.dbtmarin.com
    • 28. The right skills at the right time?Case #1: Party CrisisOptions for skills1. Avoiding Cues & Triggers - Leaving the party immediately!2. TIP – Go dance intensely to the music3. Urge surfing – acknowledged the desire for a cigarette and remind yourself it’s a wave and will pass4. Think about the pros and cons of smoking5. Use alternative rebellion (double dip, leave the toilet seat up, …) Dr. Alicia Lawson – www.dbtmarin.com
    • 29. The right skills at the right time?• Cognitive – Review the data; what has been measured pre/post scores after skills use, diary cards, etc.• Behavioral - Know the situation; what are the cues, triggers, emotions, vulnerability factors, etc.• Validation – Build on any past successes• Dialectic – Accepting the moment and current situation completely while focusing on skills to create change and build a life worth living. Dr. Alicia Lawson – www.dbtmarin.com
    • 30. References• Dimeff, L., & Linehan, M.M., (2008). Dialectical Behavior Therapy for Substance Abusers. Addiction Science & Clinical Practice 4(2)39-47.• Dimeff, L., et. Al., (2000). Dialectical behavior therapy for substance abuse: A pilot application to methamphetamine-dependent women with borderline personality disorder. Cognitive and Behavioral Practice. 7(4) 457-468• Linehan, M.M., (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press. Linehan, M.M., in press. Skills Training Manual for Disordered Emotion Regulation. New York: Guilford Press.• Marlatt, G.A., and Donovan, D.M., (2005). Relapse Prevention: Maintenance Strategies in the Treatment of Relapse Prevention. New York: Guilford Press. Dr. Alicia Lawson – www.dbtmarin.com
    • 31. How you can learn more Books Koerner, K. (2011). Doing dialectical behavior therapy: A practical guide. New York: Guilford Press. Linehan, M.M., 1993. Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press. Marlatt, G.A. & Gordon, J.R. (1995). Relapse Prevention. New York: Guilford Press. Pryor, K. (1999). Don’t shoot the Dog: The New Art of Teaching and Training. New York: Bantam Doubleday Dell Pub. Websites http://www.dbtselfhelp.com/ http://behavioraltech.org/ http://www.addictionpro.com/article/dbt-meets-12-steps Dr. Alicia Lawson – www.dbtmarin.com
    • 32. Thank you! Dr. Alicia Lawson Clinical Psychologist Owner DBT Center of Marin www.dbtmarin.com Dr. Alicia Lawson – www.dbtmarin.com