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Dialectical behavior therapy (DBT) for co-morbid substance use disorder and serious mental illness

Substance Use Disorders: Treatment for Adults
  Literature review updated May 2014.
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Dialectical behavior therapy (DBT) is a cognitive-behavioral treatment originally developed by Marsha Linehan at the University of Washington to treat those with severe mental disorders including chronically suicidal individuals often suffering from borderline personality disorder. DBT for substance abusers was developed by Dr. Linehan and colleagues to treat individuals with co-occurring substance use disorders and borderline personality disorder. DBT for substance abusers focuses on the following five main objectives: (1) motivating patients to change dysfunctional behaviors, (2) enhancing patient skills, (3) ensuring the new skills are used in daily life, (4) structuring the client’s environment, and (5) training and consultation to improve the counselor’s skills. For substance abusers, the primary target of the intervention is the substance abuse and specific goals include reducing abuse, alleviating withdrawal symptoms, reducing cravings, avoiding opportunities and triggers for substance abuse, and creating a healthy environment and community. Treatment generally includes 90 minute sessions twice per week for 12 months.
 
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Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured No. of effect sizes Treatment N Adjusted effect size(ES) and standard error(SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Alcohol use disorder
Clinical diagnosis of alcohol use disorder or symptoms measured on a validated scale.  
 0 1 27 0.149 0.264 34 0.149 0.573
Illicit drug use disorder
Clinical diagnosis of illicit drug use disorder or symptoms measured on a validated scale. When possible, we exclude cannabis/marijuana use disorder from this outcome.
 0 2 39 -0.024 0.348 34 -0.024 0.946
Cannabis use
Adult use of cannabis that does not rise to the level of “disordered.”
0 1 27 -0.090 0.263 34 -0.090 0.732
Psychiatric symptoms
Mental health symptoms (such as symptoms of psychosis) in individuals with serious mental illness, measured on a validated scale.
 0 1 27 -0.596 0.270 34 -0.596 0.027

Citations Used in the Meta-Analysis

Linehan, M.M., Schmidt, H., Dimeoff, L.A., Craft, J.C., Kanter, J. & Comtois, K.A. (1999). Dialectical Behavior Therapy for Patients With Borderline Personality Disorder and Drug-Dependence. American Journal on Addictions, 8(4), 279-292.

van den Bosch, L., Koeter, M., Stijnen, T., Verheul, R., & van den Brink, W. (2005). Sustained efficacy of dialectical behaviour therapy for borderline personality disorder. Behaviour Research and Therapy, 43(9), 1231-1241.

van den Bosch, L.M.C., Verheul, R., Schippers, G.M., & van den Brink, W. (2002). Dialectical Behavior Therapy of Borderline Patients With and Without Substance Use Problems: Implementation and Long-Term Effects. Addictive Behaviors, 27(6), 911-923.