DBT builds the emotional regulation and distress tolerance skills that reduce the relapse risk in people whose drinking is driven by difficult emotions. At iRely, DBT is delivered by licensed clinicians as part of an integrated treatment plan for alcohol use disorder.
How Dialectical Behavior Therapy Supports Alcohol Recovery
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4core DBT modules taught at iRely: mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness
Evidence-basedDBT developed by Dr. Marsha Linehan; adapted for AUD treatment
Co-occurringDBT especially effective for AUD combined with emotional dysregulation, BPD, or trauma
IntegrativeDBT delivered alongside CBT, EMDR, MAT, and group therapy at iRely
Clinically reviewed by Vinsent Franke, MBA, AMFT, CADC-II, RALast updated June 2026Sources: Linehan (1993) · Dimeff & Linehan (2008) · NIAAA
What Is DBT and Why Does It Apply to Alcohol Use Disorder?
Dialectical behavior therapy (DBT) was developed by Dr. Marsha Linehan to treat borderline personality disorder, a condition characterized by intense emotional dysregulation and self-destructive behaviors. The core insight of DBT is that people with severe emotional dysregulation need two things simultaneously: acceptance of who they are right now and the skills to change behaviors that cause harm. The dialectic is between acceptance and change.
A 2008 review by Dimeff and Linehan found that DBT produced significant reductions in substance use in populations with co-occurring emotional dysregulation. For people whose alcohol use is driven by attempts to manage overwhelming emotions, DBT targets the root mechanism directly.
In the context of alcohol use disorder, DBT is particularly relevant for clients whose drinking functions as emotional regulation. Rather than developing sober emotional coping skills, they learned to use alcohol to numb, escape, or manage emotional states that felt unmanageable. DBT builds those skills from the ground up.
The Four DBT Modules in Alcohol Treatment at iRely
DBT is organized around four skill modules that together address the emotional, behavioral, and relational dimensions of alcohol use disorder. At iRely, each module is taught and practiced in both individual and group formats.
1
Mindfulness
The foundation of all DBT work. Mindfulness teaches clients to observe thoughts, feelings, and urges without automatically acting on them. For alcohol use disorder, this means noticing a craving as a mental event rather than a command. Mindfulness creates the pause between impulse and action.
2
Distress Tolerance
Distress tolerance skills are designed for moments of crisis when the urge to drink is strongest. Techniques include radical acceptance (accepting reality without approval), self-soothing, TIPP skills (temperature, intense exercise, paced breathing), and distraction with purpose.
3
Emotional Regulation
This module teaches clients to identify, understand, and change their emotional responses rather than suppressing or amplifying them. Skills include reducing vulnerability to emotional reactivity, building positive experiences, and acting opposite to destructive emotional urges.
4
Interpersonal Effectiveness
Drinking is often deeply social. Interpersonal effectiveness skills address how to maintain relationships, set limits, and communicate needs without resorting to alcohol as a social lubricant or conflict avoidance mechanism.
Questions about whether DBT is right for you? A clinician can answer that directly.
DBT vs CBT for Alcohol Use Disorder
DBT grew out of CBT, and the two share some theoretical ground. But they differ in focus, philosophy, and who they tend to serve best. The question is rarely which one to use; at iRely, most clients benefit from both.
| Dimension | CBT | DBT |
|---|---|---|
| Primary focus | Identifying and changing thoughts and behaviors | Emotional regulation, distress tolerance, and behavioral change |
| Originated from | Aaron Beck's cognitive therapy (1960s) | Marsha Linehan's work with BPD (1990s) |
| Core balance | Change-focused | Acceptance and change (dialectical) |
| Best suited for AUD driven by | Specific triggers, automatic thoughts, cognitive distortions | Emotional dysregulation, impulse control, relationship problems |
| Group skills component | Optional | Core component; skills training is group-based |
| Used together at iRely? | Yes. Most clients receive both as part of an integrated plan. | |
For a deeper look at the cognitive-behavioral approach, see CBT for Alcohol Addiction.
Who Benefits Most from DBT for Alcohol Addiction?
DBT is not a universal first-line approach for all AUD. It is specifically powerful for people whose alcohol use is entangled with emotional dysregulation. iRely clinicians assess which modalities fit each person’s profile in the intake process.
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People whose drinking is primarily driven by attempts to manage painful emotions.
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Clients with borderline personality disorder or traits alongside AUD.
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Those with significant impulsivity and difficulty tolerating distress without substances.
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People who have experienced trauma and use alcohol to avoid emotional processing.
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Clients with a history of self-harming behaviors and AUD co-occurring.
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Individuals who struggle with interpersonal conflict and use drinking to cope with relationship stress.
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Anyone who has found insight-based therapy helpful but has not been able to translate insight into behavioral change.
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Those who benefit from structured skill sets with concrete techniques to practice between sessions.
Frequently Asked Questions
How is DBT delivered at iRely?
At iRely, DBT skills are taught through a combination of individual therapy and group skills training. In individual sessions, the therapist works with the client to apply DBT concepts to their specific challenges and recent situations. In group, clients learn and practice the four skill modules alongside peers. The combination of individual and group components is essential to effective DBT delivery.
Is DBT used for alcohol or just for mental health conditions?
DBT was originally developed for borderline personality disorder, but a growing body of research supports its use specifically for substance use disorders, including alcohol use disorder. The emotional dysregulation and impulsivity that make DBT relevant for BPD are also present in many people with AUD. DBT has been adapted for substance use by Linehan herself (DBT-S), and iRely’s clinicians integrate this adaptation into the alcohol treatment program.
How long does DBT take?
Standard DBT programs are designed as 6-12 month outpatient programs with weekly individual and group sessions. In a residential setting like iRely, the intensive daily schedule allows clients to cover significant DBT skill content in a shorter calendar period. The skills learned in residential are then continued and deepened in step-down and outpatient care.
Can DBT be used alongside medication-assisted treatment?
Yes. DBT and MAT address different dimensions of alcohol use disorder and work well together. Medications like naltrexone reduce the neurobiological craving and reward response; DBT builds the emotional coping skills that address the behavioral and psychological drivers. Many iRely clients use both as part of a comprehensive treatment plan.
What is the difference between DBT for BPD and DBT for AUD?
The core DBT framework and skills are the same. DBT-S (for substance use) adds specific modules and strategies for substance-related situations: attachment to substances, urge surfing for cravings, dialectical abstinence (combining acceptance of past use with commitment to abstinence going forward), and burning bridges to old using patterns. iRely clinicians trained in DBT-S integrate these adaptations when treating AUD.
Drinking to Manage Emotions Is Treatable.
DBT was built precisely for people who use destructive behaviors to regulate states that feel overwhelming. If drinking is how you cope with emotions that feel impossible to tolerate, a confidential call with iRely is where to start.
Available 24/7 · Private and confidential · Los Angeles, CA
Sources & References
Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
Dimeff, L.A., & Linehan, M.M. (2008). Dialectical behavior therapy for substance abusers. Addiction Science & Clinical Practice, 4(2), 39-47.
McMain, S., et al. (2007). Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: A randomized controlled trial. American Journal of Psychiatry.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Treatment Approaches for Drug Addiction.
Substance Abuse and Mental Health Services Administration (SAMHSA). TIP 57: Trauma-Informed Care in Behavioral Health Services.
