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. Author manuscript; available in PMC: 2026 Mar 12.
Published before final editing as: Prof Psychol Res Pr. 2026 Mar 9:10.1037/pro0000672. doi: 10.1037/pro0000672

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

Jeremy W Luk 1
PMCID: PMC12978172  NIHMSID: NIHMS2143434  PMID: 41821603

Abstract

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.

Keywords: Addiction, Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Inpatient Rehabilitation, Inpatient Treatment

Alcohol misuse and addiction to drugs are prevalent in the United States. It is estimated that 29.1% and 9.9% of adults in the United States met criteria for a lifetime diagnosis of alcohol use disorder (AUD) and substance use disorder (SUD), respectively, but most of them never sought treatment for their addiction (Grant et al., 2015; Grant et al., 2016). Among adults with AUD in the past 12 months, 69.9% were screened about alcohol use in a health care setting, but only 11.6% received a brief intervention and only 5.8% obtained referred treatment for AUD (Mintz et al., 2021). The treatment gap for SUD has also remained substantial, where only 13.0% of adults with SUD in the past 12 months received any SUD treatment (Sahker et al., 2024). Barriers to care that contribute to low addiction treatment utilization rates include low perceived need for care, high treatment cost, and stigma related to alcohol and drug addiction (Han et al., 2017; Venegas et al., 2021). Improving access to evidence-based addiction treatment such as various forms of cognitive behavioral therapy (CBT) is a critical way to mitigate the burden associated with AUD and SUD (Boness et al., 2023; McHugh et al., 2010; Ray et al., 2019).

Dialectical behavior therapy, or DBT, is a form of third-wave CBT that was originally developed to treat suicidal behaviors and later adapted to treat borderline personality disorder (BPD) (Linehan et al., 1991). In its standard comprehensive form, DBT is comprised of four key components, including individual therapy to assess and address problem behaviors in accordance with the hierarchy of treatment targets, skills training group to enhance various types of acceptance- and change-based coping capabilities, phone coaching to aid skills generalization, and a consultation team for DBT clinicians to support each other and discuss clinical challenges (Rizvi et al., 2024). In their seminal randomized clinical trial and component analysis, Linehan et al. (2015) found interventions that included skills training, including standard DBT and skills-only DBT, resulted in greater improvement in nonsuicidal self-injury and depression outcomes than individual DBT. The adaptation of DBT skills training as a stand-alone treatment has since gained popularity in multiple areas of study, such as eating pathology, depressive symptoms, and SUD (Valentine et al., 2015; Valentine et al., 2020; Warner & Murphy, 2022).

While the utilization of standard multi-component DBT to treat substance use in the context of BPD has been around since the 1990s (Dimeff et al., 2000; Linehan et al., 1999), efforts to test DBT skills training as a standalone treatment for addiction is relatively new. Emerging research has shown that a 3-month DBT skills training program (yielding a total of 108 clinical hours) was promising in treating addictive behaviors as it targeted key underlying factors of substance use including impulsivity and emotional regulation (Cavicchioli et al., 2023; Cavicchioli et al., 2019; Maffei et al., 2018). Recognizing that many clinicians may not have the resources to run a similar training program, Luk and Thompson (2024) proposed the possibility of streamlining treatment by mapping a dozen of DBT skills to addiction clinical domains, including executive function (e.g., Pros and Cons and Clear Mind), incentive salience (e.g., STOP and TIP skills), and negative emotionality (e.g., Check the Facts and Opposite Action). Though an important step toward facilitating the dissemination of DBT skills to those in need, there remains a lack of literature on how to adapt DBT skills training to enhance clinical care in inpatient addiction treatment settings. This is a significant clinical gap because individuals who seek inpatient addiction treatment are often presented with severe and persistent symptoms than outpatients, but beyond basic CBT skills, addiction-specific DBT skills training is rarely offered as part of inpatient addiction treatment or rehabilitation programs.

To address this practice gap, the goal of this article is to illustrate how DBT concepts and skills training can be adapted to advance clinical care in inpatient addiction treatment settings. First, key differences between the delivery of DBT skills training in outpatient and inpatient addiction treatment settings are outlined, and the psychologist’s role as a consultant to the multidisciplinary team is highlighted. Second, three concepts/skills that are unique to DBT, namely (1) Wise Mind, (2) Dialectical Abstinence, and (3) ABC PLEASE, are described with illustrative examples of how they can help foster patient behavioral change and multidisciplinary team collaboration. Third, ethical and training related considerations are discussed in relation to the dialectical challenge of balancing the need to preserve fidelity to the DBT model versus the need to increase access to useful DBT skills.

Key Differences Between Outpatient and Inpatient Delivery of DBT Skills Training

DBT was originally developed as a manualized outpatient treatment that addresses suicidal behavior and BPD through multiple treatment components (Linehan et al., 1991). In addition to weekly individual and group therapy, the DBT consultation team and in-between session phone coaching calls are essential components of standard DBT (Linehan & Wilks, 2015). In an inpatient treatment setting, however, a DBT consultation team may not be available and in-between session phone coaching calls may be less relevant given that the patients are at the treatment facility full-time. Prior attempts to use DBT for inpatient treatment of BPD generally showed improvements in mood and suicide-related symptoms, but there was wide variability in how adaptations were made, such as focusing more on the skills training group, removing the phone coaching calls, as well as varying the length of time in treatment (Bloom et al., 2012). To date, a formalized inpatient DBT protocol for the treatment of BPD has remained absent from the literature (Rizvi et al., 2024), and clinical guidance on how to best adapt DBT skills training to treat AUD and SUD in inpatient settings is lacking. To inform clinical practice, it would be helpful to understand key differences between outpatient and inpatient delivery of DBT skills training for AUD and SUD (see Table 1 for a summary).

Table 1.

Key Differences Between Outpatient and Inpatient Delivery of DBT Skills Training for AUD and SUD

Outpatient Setting Inpatient Setting Clinical Considerations and Recommendations
1. Team of Health Care Providers Outpatient psychology practice is typically staffed with a team that is primarily made up of psychologists, with the possibility of having a full DBT consultation team. Inpatient addiction treatment is typically staffed with a multidisciplinary team of health care providers, including psychiatrists, nurses, addiction counselors, and social workers. (a) A co-leader for DBT skills group may not be readily available.
(b) Opportunity to consult with other psychologists about the application of DBT skills may be more limited in an inpatient setting than in an outpatient setting.
(c) The psychologist may act as a consultant to the multidisciplinary team by illustrating how DBT concepts/skills can be utilized to help patients.
2. Generalization of DBT Skills Patients spend most of their time in everyday life situations and encounter common stressors and addiction-specific triggers that require use of DBT skills. Patients spend all their time in a protected environment with relatively few stressors or triggers that prompt distress or cravings. (a) When patients report minimal mental health symptoms or substance use cravings in an inpatient setting, DBT skills can be taught and acquired but harder to practice.
(b) Clinicians may need to be intentional about identifying ongoing challenges (e.g., shame and guilt with family, or interpersonal conflict with other inpatients) as practice grounds.
(c) Clinicians can also focus on coping ahead with anticipated challenges that patients may encounter as part of their recovery outside of the inpatient treatment program.
3. Length of Treatment The length of outpatient treatment tends to be longer. The length of inpatient treatment is variable but tends to be shorter. (a) Given time constraints, modifications to the structure of DBT skills group are likely needed.
(b) Clinicians can focus on DBT skills that have less overlap with other treatment groups.
(c) Clinicians can prioritize the teaching of DBT skills that are most helpful for the current group of inpatients.
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First, outpatient delivery of DBT within mental health facilities is typically staffed with a team that is primarily made up of psychologists, with the possibility of having a full DBT consultation team in well-resourced clinics, especially when standard DBT is offered. In the outpatient setting, the implementation of DBT skills training group for AUD and SUD may be relatively straightforward as much of the DBT treatment model can be directly applied (Dimeff & Linehan, 2008). In contrast, inpatient addiction treatment is typically staffed with a multidisciplinary team of health care providers, including psychiatrists, nurses, addiction counselors, and social workers who may or may not be familiar with DBT. A practicing psychologist who would like to introduce DBT skills training in this type of inpatient setting may face unique implementation challenges such as having to run a DBT skills group without a co-leader or having to alter the DBT session format with limited or no input from other DBT clinicians. In many situations, knowledge and expertise in different treatment modalities from the multidisciplinary team can be leveraged to improve overall clinical care, but DBT specific consultation may be harder to access. The psychologist with training in DBT may act as a consultant to the multidisciplinary team by illustrating how DBT concepts/skills can be utilized to help patients in an inpatient addiction treatment setting.

Second, opportunities to practice and generalize DBT skills may be more limited in an inpatient setting given the relatively protected inpatient environment where addiction-specific triggers are generally not present. Being shielded from everyday life stressors, patients may share that they are doing well during the inpatient stay and note that the real challenges are outside of the inpatient environment. On occasion, the idea of practicing DBT skills in the inpatient setting may therefore be challenged by some patients. To address this issue, clinicians may need to be intentional about eliciting examples that reflect ongoing challenges in recovery (e.g., shame and guilt with family) or finding examples that occur in the inpatient setting (e.g., interpersonal conflict with other inpatients) while working collaboratively with patients to determine skill prioritization in recovery. Practically, instructions for homework practice of DBT skills may benefit from minor revisions to accommodate restrictions within the inpatient setting (e.g., create separate lists of pleasant events for practice in the inpatient setting versus for future use after discharge and return to the community). Clinicians can also focus on coping ahead with anticipated challenges that patients may encounter in their recovery from addiction (e.g., challenges with employment and barriers to accessing outpatient care), which promotes generalization of DBT skills in contexts other than the inpatient setting.

Third, standard DBT skills group typically lasts for 1 year in length, with weekly groups lasting 2.5 hours to cover all DBT skills modules in a comprehensive way (Linehan et al., 2015). The standard format of each DBT skills group session includes a beginning ritual (mindfulness exercise), review of homework practice, a break, presentation of new materials/skills, and closing wind-down (Linehan, 2015). Given time constraints, modifications to the structure and format of DBT skills group are likely needed in inpatient settings. For example, the time given to run an inpatient therapy group may be set at 1 to 1.5 hours rather than 2.5 hours. If the allocation of more time is not feasible, the psychologist with training in DBT will have to substantially condense the DBT skills group materials. The question of how to do so effectively may be especially challenging given the lack of input or support from other psychologists or the DBT consultation team. To guide the selection of DBT skills covered, clinicians can evaluate what DBT skills are unique and not yet covered in other inpatient treatment groups. Clinicians can also prioritize the teaching of DBT skills that are most helpful for the current group of inpatients.

Three DBT Concepts/Skills to Advance Inpatient Addiction Treatment

Building on the ideas described above, in this second section, three examples of how unique DBT concepts/skills can be utilized to advance inpatient addiction treatment are given.

Wise Mind

Mindfulness-based interventions have been widely used in the treatment of addictive behaviors (Sancho et al., 2018), as they may alter biological and behavioral mechanisms linked to craving, distress, and substance use (Garland & Howard, 2018). Mindfulness practice in addiction treatment typically involves bringing one’s attention to the present moment in a non-judgmental way, so that an individual can more effectively manage experiences of cravings, sadness, and pain by simply observing them without needing to avoid or react to them (Korecki et al., 2020). Mindfulness skills are at the core of DBT. In standard DBT skills training, the Mindfulness module is being taught repeatedly before the start of each of the other three modules (i.e., Interpersonal Effectiveness, Emotion Regulation, Distress Tolerance), and each DBT skills training session begins with a mindfulness exercise (Linehan, 2015). Practicing mindfulness skills as taught in DBT may lead to multiple benefits such as having improved attention, increased non-judgmental awareness, and reduced impulsivity (Eeles & Walker, 2022).

In DBT, a unique skill called the “Wise Mind” is introduced before teaching other components of mindfulness. “Wise Mind” is the mindfulness practice of accessing each person’s inner wisdom through integrating opposites, including reasonable and emotional states of mind, while being open to reality as it is (Linehan, 2015). The “Wise Mind” concept can be introduced to patients in inpatient addiction treatment to help them reflect upon their most recent relapse in the form of a functional behavior chain analysis to inform the development of an individualized relapse prevention plan. When reviewing the functional behavior chain analysis, past failures or decisions that one regrets can be reframed as actions stemming from the Emotion Mind, and more skillful behaviors can be discussed as alternative strategies for practice from within the Wise Mind to prevent a future relapse. The positive assumption that patients can access their personal inner wisdom through mindfulness practice can be empowering to those who feel ashamed of seeking inpatient addiction treatment, which is often seen as a personal failure.

Beyond the functional behavior chain analysis, the Wise Mind concept is permeated through various DBT skills (Linehan, 2015) that can be applied to address motivational and behavioral issues commonly seen on inpatient addiction treatment settings. For example, in situations where patients find components of the inpatient treatment program boring or irrelevant (a motivational issue that the multidisciplinary team needs to address), the Opposite Action skill can be used to increase treatment participation via asking Wise Mind: “Is expression or acting on this emotion [boredom] effective in this situation?” By reframing this motivational issue as an opportunity to practice DBT skills, patients are encouraged to find new ways to help make treatment activities and groups more meaningful for themselves and other patients. Alternatively, in situations where patients use inappropriate language that cause disruption to the inpatient treatment milieu (a behavioral issue that the multidisciplinary team needs to address), the STOP Skill can be used to encourage patients to pause, take a break, and act with mindful awareness in Wise Mind by asking the question: “Which actions [using inappropriate or appropriate language] will make it better or worse?” By reframing this behavioral issue as an opportunity to practice DBT skills, patients are encouraged to evaluate how the use of appropriate language may better facilitate communication of their wants to nursing staff and is therefore more in line with their goals. These examples illustrate how a DBT clinician can work directly with individual patients to help them make decisions from Wise Mind to increase their effectiveness within an inpatient addiction treatment setting.

Extending the Wise Mind concept, dialectical thinking is taught in a more in-depth way as part of DBT’s Interpersonal Effectiveness skills. In DBT, dialectics assume that the universe is filled with opposite sides/opposite forces, and that everything and every person is connected in some way (Linehan, 2015). Teaching patients with addictive behaviors about dialectics can help them stay away from extreme thinking and enable them to walk the middle path. Encouraging dialectical thinking may help patients better cope with challenges encountered in inpatient addiction treatment settings. For example, when patients are attending group therapy sessions, they may need to decide on how much they wish to share with others. The saying “You can share some things with others AND also keep some things private” may be a useful and practical suggestion for patients to strike a balance between disclosure and nondisclosure in a group therapy setting. Alternatively, some patients may find rules on an inpatient unit to be unnecessary or overly restrictive (e.g., personal items deemed potentially dangerous may be removed after a room check). The saying “You can disagree with the rules AND also follow the rules” may be helpful to these patients so that they can remain in and get the most out of the inpatient addiction treatment program. A DBT clinician can also remind patients that “focus on what works” and “play by the rules” are integral parts of the Mindfulness “How” skill and encourage them to think about the validity of other people’s perspectives.

Dialectical Abstinence

A multidisciplinary team of health care providers, including psychiatrists, nurses, clinical psychologists, social workers, and addiction specialists, are often needed to run a comprehensive inpatient addiction treatment program. As the type of clinical training received likely varied by discipline, it would be realistic to expect differences in the providers’ preferred treatment approach. For some providers, they may prefer the traditional 12-step approach and place much emphasis on the importance of total abstinence. For other providers, they may prefer meeting patients where they are and be more open to alternative approaches such as the incorporation of harm reduction strategies. In DBT, the Dialectical Abstinence skill seeks to integrate the full spectrum of treatment approaches from abstinence to harm reduction into a single framework (Linehan, 2015). This allows for a flexible approach to help patients make progress in their recovery toward abstinence and facilitate effective collaboration among treatment providers.

At the core of the dialectical approach to abstinence is the synthesis of both change and acceptance strategies that promote effective coping and sobriety (Dimeff & Linehan, 2008). In terms of change strategies, DBT promotes absolute and total abstinence through recommending radical changes to get rid of all things that make the addiction possible (e.g., getting a new phone number, announcing abstinence to family and friends, throwing away paraphernalia, and much more). As part of Burning Bridges, an addiction-specific DBT skill, patients are asked to accept at the most radical level that they are not going to engage in addictive behavior again, and the metaphor of walking into the garage of abstinence and slam the garage door shut is described (Linehan, 2015). On the other hand, DBT integrates acceptance strategies to help patients “fail well” during a slip and get back “on the wagon” faster to prevent a full-blown relapse (Dimeff & Linehan, 2008). The metaphor of Olympic athletes expecting the best in a race while planning for the trouble spots is described, where the mentality of winning a bronze medal “would be just fine” is refuted as an effective way of thinking as it would negatively impact training and performance (Linehan, 2015). At the same time, DBT addresses the abstinence violation effect (Marlatt & Donovan, 2005) using harm reduction strategies to help patients manage the intense negative cognitive (e.g., I have failed and might as well go all the way) and affective responses (e.g., guilt and shame) following an initial return to the addictive behavior, and support reestablishing abstinence as quickly as possible.

The Dialectical Abstinence framework in DBT is valuable for patients to make sense of and integrate the various types of treatment approaches (e.g., 12-step facilitation, CBT, and relapse prevention) and groups (e.g., Alcoholic Anonymous and SMART Recovery) that they may engage in as part of an inpatient addiction treatment program. It also provides an inclusive framework to not leave any patient behind as the full spectrum of treatment options – from abstinence only to harm reduction – are discussed, effectively allowing a DBT clinician to meet patients where they are and engage them in conversations about how to utilize DBT skills to support abstinence using both change and acceptance strategies. Consistent with empirical studies that demonstrate more than one pathway of addiction recovery (Kelly et al., 2017; Tucker & Witkiewitz, 2022; Witkiewitz & Tucker, 2019), the Dialectical Abstinence skill offers many strategies for potential use to support an individualized plan to addiction recovery, and is compatible with other treatment approaches such as relapse prevention strategies taught in CBT and the “making amends” steps in the Twelve Steps (Dimeff & Linehan, 2008).

ABC PLEASE

The overarching goal of DBT is to help individuals build “a life worth living” (Linehan, 1993; Linehan, 2021). Within the Emotion Regulation module of DBT skills training, the ABC PLEASE skill is presented to help patients achieve this goal through reducing vulnerability to the Emotion Mind (Linehan, 2015). In their recent conceptual synthesis, Luk and Thompson (2024) proposed the use of the ABC PLEASE skill to address physical and psychological quality of life issues among patients with addictive behaviors. Consistent with this proposal, patients who receive inpatient addiction treatment may benefit from learning about the PLEASE skill, which is comprised of (1) treat physical illness, (2) balance eating, (3) avoid mood-altering substances, (4) balance sleep, and (5) get exercise. In inpatient settings that are resourceful, patients may have the opportunity to receive additional services such as physical therapy, nutrition education or counseling, and recreational therapy. A DBT clinician can teach patients about the PLEASE skill to foster patient participation in these aligned health care services to motivate behavioral change and support whole person recovery (Witkiewitz & Tucker, 2025).

Within a multidisciplinary team, a DBT clinician can play an active role in supporting patient participation and engagement with medical screening and intervention procedures. As part of Clear Mind, an addiction-specific DBT skill, “avoiding doctors” is mentioned as a behavioral characteristic of the state of mind when one is preoccupied and ruled by the addiction (Linehan, 2015). Patients may be reluctant to see doctors even though their physical health may be compromised due to a variety of reasons, including provider insensitivity and perceived stigma (Hoover et al., 2022; Van Boekel et al., 2013). A DBT clinician is uniquely positioned to help patients navigate this type of treatment barrier by drawing attention to the mind-body connection as taught in the PLEASE skill and by addressing negative emotions that may arise from past interactions with treatment providers. In scenarios where ongoing multidisciplinary management of a medical condition is essential (e.g., a patient with advanced alcohol-associated liver disease), the Cope ahead of time with emotional situations strategy from the ABC skill can be used to help patients practice effective coping prior to medical appointments to increase the likelihood of treatment adherence over time (Luk et al., 2024; Luk & Thompson, 2024).

A Dialectical Framework to Balance Fidelity and Accessibility to DBT Skills Training

In the above section, three unique DBT concepts/skills that are less likely to be covered in other treatment modalities are highlighted. It should be emphasized that other DBT skills not mentioned above may also have high relevance for individual patients with addiction going through inpatient treatment. However, given the many skills that are available in DBT, it would be beyond the scope of this article to comment on each. Indeed, the implementation of DBT skills training in inpatient addiction treatment settings is likely site specific and there is no one-size-fits all recommendations that will work universally. Ultimately, DBT trained clinicians will have to navigate the unique setting they are in and deliver DBT skills training that appears to be most suitable for the inpatients they serve. As a complementary tool to the specific adaptation examples given above, a dialectical framework was developed to help clinicians balance fidelity to the DBT treatment model while also maximizing access to DBT skills that are potentially helpful to patients with AUD and SUD. This dialectical framework is summarized in Figure 1, where relevant APA ethical principles, clinical challenges, and proposed solutions are discussed.

Figure 1.

Figure 1.

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A Dialectical Framework to Balance Fidelity and Accessibility to DBT Skills in Inpatient Addiction Treatment Settings

It is important for practicing psychologists to consider relevant APA ethical principles when adapting DBT skills training for inpatient addiction treatment (American Psychological Association, 2002, 2017). In terms of fidelity to the DBT treatment model, the principle of integrity would require the psychologist to be accurate, honest, and truthful in the practice of psychology. Depending on which specific DBT skills are taught and how they are adapted, the psychologist may have to wrestle with the question of how to call the service provided (e.g., a weekly DBT skills training group is more accurate than a weekly DBT group). Moreover, given the clinical challenge of having to deliver a subset of DBT skills only, the psychologist may need to be clear what type of clinical data are available versus what type of clinical data are yet to be collected (e.g., more clinical data on using DBT to treat substance use in the context of BPD, and emerging data on using DBT skills training as a standalone treatment approach for AUD and/or SUD). The proposed solutions here include being transparent about the provision of a condensed version of DBT skills training, as well as conducting program evaluation of brief addiction targeted DBT skills training so that clinical data will be available in the future.

In terms of accessibility to DBT skills, the principle of justice would require the psychologist to be fair and just in sharing DBT skills with all patients who can likely benefit from skills training to help with their recovery from AUD and/or SUD. However, given that a DBT consultation team is typically not available as part of the inpatient addiction treatment setting, the psychologist may need to figure out how to manage the demand for DBT skills training in a resource-limited environment, both in terms of limited treatment time with patients and lack of peer support for DBT treatment delivery. These clinical challenges highlight the need for inpatient programs to support treatment providers in the multidisciplinary team to get formal training in DBT so that greater capacity for delivery can be achieved. In situations where demand for DBT cannot be fulfilled within the inpatient addiction treatment setting, referrals should be made to have patients receive outpatient DBT or DBT skills training in the community.

The dialectical framework presented in this article serves as an important step toward helping psychologists and other DBT clinicians navigate the unique inpatient addiction treatment environment. As an extension of this framework, further consideration of ethical and training related issues is warranted. Specifically, while DBT training for treatment providers has the potential to increase capacity for treatment delivery, the level and intensity of DBT training needed for providers to be considered competent to co-lead or lead an addiction-specific DBT skills group are not yet established. To increase fidelity to the DBT model, more intensive DBT training would be required for treatment providers to not only learn how to teach specific skills but also gain a good handle of DBT’s biosocial theory and treatment principles. On the other hand, if the bar for training is set too high, it would restrict access to useful DBT skills that could benefit patients with AUD and/or SUD. Recognizing that each inpatient addiction treatment setting is different (e.g., resources for training and ongoing supervision may vary), a dialectical framework to guide these ethical and training decisions would likely be helpful for practitioners who can weigh the pros and cons based on their unique clinical setting.

Conclusions

Effective adaptation of DBT skills has the potential to benefit patients in addiction recovery who needed inpatient treatment. In this article, key differences between inpatient and outpatient delivery of DBT skills training were outlined, followed by examples of how unique DBT concepts/skills can be applied to address addiction related issues as well as challenges that are specific to the inpatient treatment environment. Furthermore, ethical and training related considerations were discussed within the dialectical framework of balancing fidelity to DBT model and accessibility to 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. In terms of future directions, empirical evaluation of condensed versions of DBT skills training adapted for AUD and/or SUD across both inpatient and outpatient settings should be conducted. Moreover, the extension of DBT skills training to treat alcohol and drug use among adolescents may also be explored from a developmentally informed perspective. Innovations in the adaptation of evidence-based approaches tailored for addiction treatment across the lifespan hold promise in enhancing patient care, reducing the burden posed by addictions, and helping individuals build a meaningful and fulfilling life.

Public Significance Statement.

Practicing psychologists can play a vital role in reducing the addiction treatment gap and in enhancing the quality of patient care through the promotion of evidence-based practice. This article outlines the promise and challenges of applying DBT skills training in inpatient addiction treatment settings. To bridge the gap between empirical research and clinical practice, illustrative examples of how DBT skills training can be adapted along with a discussion of ethical and training related issues are provided.

Financial Support:

This study was supported by the Intramural Research Program of the National Institutes of Health (NIH) and the National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research. The contributions of the NIH author were made as part of his official duty as a NIH federal employee, are in compliance with agency policy requirements, and are considered Works of the United States Government. However, the findings and conclusions presented in this paper are those of the author and do not necessarily reflect the views of the NIH or the U.S. Department of Health and Human Services.

Biography

Dr. Jeremy Luk is a licensed clinical psychologist, and he is board certified in addiction psychology. He obtained his Ph.D. in clinical psychology from the University of Washington and received postdoctoral training at the University of California, San Diego and at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. In his current role, Dr. Luk provides clinical services to patients with alcohol use disorder and supervises doctoral students in clinical psychology for their clinical externship. His recent research focuses on understanding multidimensional quality of life in the context of recovery and the application of third-wave behavioral therapies to treat addictive behaviors. He is passionate about clinical translation of scientific research and hopes his work can help bridge the gap between science and practice.

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