Adaptation of Dialectical Behavioral Therapy Skills to Advance Clinical Care in Inpatient Addiction Treatment Settings.

Addiction to alcohol or drugs is prevalent in the United States, but most individuals with an alcohol or substance use disorder do not receive evidence-based addiction treatment. Dialectical behavior therapy (DBT) is a multi-component cognitive behavioral treatment that includes skills to manage addictive behavior, but its application to inpatient addiction treatment is less explored in the literature. This is a significant clinical gap because those who receive inpatient addiction treatment tend to exhibit more severe and persistent symptoms than outpatients, often requiring more intensive therapy and advanced coping skills training. In this article, adaptations of DBT skills to advance clinical care in inpatient addiction treatment settings are illustrated. First, key differences between teaching DBT skills in inpatient versus outpatient settings are described, and the psychologist's role as a consultant to the multidisciplinary treatment team is emphasized. Second, practical illustrations of how three specific DBT concepts/skills, namely Wise Mind, Dialectical Abstinence, and ABC PLEASE, can be integrated into inpatient addiction treatment are provided. Third, ethical and training related considerations are discussed in relation to the dialectical challenge of balancing the need to preserve fidelity to the DBT treatment model versus the need to increase access to useful DBT skills. Together, this paper provides the first comprehensive account of how psychologists can flexibly utilize DBT skills and dialectical thinking to promote patient behavioral change and foster multidisciplinary collaborative care in inpatient addiction treatment settings.