Dialectical Behavior Therapy was developed by Marsha Linehan for clients whose emotions arrived with an intensity that cognitive skills alone could not manage. Originally built for chronic suicidality and borderline personality disorder, the skills work now sits inside addiction treatment programs nationwide for clients whose substance use is tied to emotional dysregulation.
At Roanoke Refuge, DBT skills run through PHP, IOP, and Telehealth IOP. The treatment approach describes how DBT integrates with the rest of the clinical framework.
What Dialectical Behavior Therapy Is
DBT grew out of CBT. The defining addition is the dialectic itself: holding acceptance and change at the same time. You are doing the best you can with what you have, and you also need new responses to the situations that have ended in substance use.
The other addition is the explicit focus on emotion regulation and distress tolerance. Linehan’s clients could see that a thought was distorted and still feel the feeling at full strength. DBT teaches the skills that let a person stay present with that intensity without acting on it through substance use or self-harm.
What the Research Shows
The strongest evidence base sits in chronic suicidality and borderline personality disorder, where Linehan’s trials showed reductions in suicide attempts, self-harm, and psychiatric hospitalization. The substance-use adaptation (DBT-S) shows promising results for clients with co-occurring SUD and emotion dysregulation, including BPD and PTSD.
The clinical consensus: DBT skills work fits inside an integrated plan rather than standing alone as a substance-use intervention. The skills are taught the way any skill is taught,instruction, practice, repetition, feedback.
The Four Skills Modules
The curriculum is organized around four modules, each addressing a different layer.
Mindfulness
The foundation: noticing what is happening in the present without reacting to it. For a person in active SUD, mindfulness is the difference between a craving that ends in a drink and a craving that gets noticed, named, and ridden out.
Distress Tolerance
Skills for getting through an unbearable emotional moment without making it worse,tolerating intense emotions without acting, accepting reality, surviving crisis moments through techniques rehearsed in advance. For clients whose substance use has been a distress tolerance strategy, this module often delivers the most immediate practical benefit.
Emotion Regulation
The longer-term work of reducing vulnerability to overwhelming emotional moments: identifying and labeling emotions, attention to sleep, eating, and exercise, increasing positive experiences, and opposite action when the emotion does not fit the facts.
Interpersonal Effectiveness
Skills for asking for what you need, saying no to what you do not, and keeping relationships and self-respect intact in the process. Addresses the relational triggers,family dynamics, workplace stress,that often surround relapse.
How DBT Is Applied at Roanoke Refuge
DBT runs through several channels. Group skills work runs weekly in IOPPHP, with the four modules cycling across treatment. Individual therapy folds in the skills as they arise. Specific applications include:
- Crisis survival skills — Techniques for tolerating an acute craving without acting on it,distraction, self-soothing, riding the wave until it passes.
- Mindfulness practice — Exercises that build the capacity to notice early warning signs of a craving or emotional spike.
- Emotion regulation skills — Reducing the frequency and intensity of overwhelming moments through attention to sleep, nutrition, exercise, and substance use.
- Interpersonal skills — Practice in asking for what you need, setting boundaries with family or coworkers, and navigating conflicts that often precede relapse.
- Integration with CBT: DBT skills sit alongside the CBT thought-feeling-behavior framework, adding tools for the emotion side of the loop.
What a DBT Skills Group Looks Like
The group is structured around the four modules. Each session focuses on a specific skill, with clinical instruction, group discussion, and practical exercises. A clinician trained in DBT for SUD leads, combining didactic instruction with applied practice.
Between-session practice is part of the work. Clients try the skills in the moments where they have historically used, and bring observations back to the group. Over time, the skills become more automatic and the cycle of use begins to loosen.
Why DBT Matters for Substance Use Disorder
Many people in addiction treatment use substances to manage overwhelming emotions. The drinking quiets the anxiety, the opioid use silences the trauma, the stimulant use covers the depression. Telling these clients to stop without giving them other tools is incomplete clinical work. The substance was meeting a need, and the need does not disappear when the substance does.
DBT gives clients tools for the underlying need. Distress tolerance is taught the way a swim instructor teaches strokes — practiced in lower-stakes moments first, then in progressively harder ones, eventually in the high-risk situations that have ended in use.
Integration With Other Treatment Elements
DBT does not stand alone. Clients with significant trauma histories work with trauma-informed care alongside DBT. Clients with ambivalence about treatment goals start with Motivational Interviewing. Co-occurring conditions are handled through the dual diagnosis program. Families participate through the Family Program and, where indicated, formal family therapy.
Roanoke Refuge prescribes FDA-approved MAT medications on-site — buprenorphine, Suboxone, and acamprosate. Psychiatric medications are coordinated with community prescribers in the Roanoke region so DBT and pharmacotherapy work as one plan.
Levels of Care and Getting Started
DBT skills run across our outpatient levels of care. PHP (full-day outpatient) offers 25+ clinical hours weekly. IOP (part-day outpatient) provides 9+ hours weekly. Telehealth IOP delivers the same curriculum virtually for clients across Botetourt, Bedford, Salem, and the rest of Southwest Virginia where the commute is a barrier.
The path in begins with a confidential conversation with admissions. The first call covers substance use history, the emotional landscape around it, co-occurring mental health, and the level-of-care recommendation. What to expect walks through the steps. Insurance verification runs alongside at no cost.
Local, regional, and accessible.
This therapy is delivered as part of Roanoke Refuge’s outpatient PHP, IOP, and Telehealth IOP programs at the Salem facility on Braeburn Drive — easy access for clients across Roanoke City, Salem, Vinton, and the surrounding Roanoke, Botetourt, and Bedford counties. Telehealth IOP extends the same evidence-based curriculum to anywhere in the Commonwealth of Virginia.
If this is the modality you have been searching for or wondering whether it fits your situation, the admissions team can walk through how it lands inside our clinical model in a single call. Free, confidential, no pressure — and insurance coverage gets verified during the same conversation. Call (540) 900-0353 when you are ready.