Dialectical Abstinence & Harm Reduction

Navigating Crisis Survival in Dialectical Behavior Therapy


Dialectical Behavior Therapy (DBT), developed by Dr. Marsha Linehan in the late 1980s, is a cognitive-behavioral treatment that emphasizes the psychosocial aspects of treatment. DBT focuses on helping individuals build new skills to manage painful emotions and decrease conflict in relationships. A crucial component of DBT is distress tolerance, particularly in crisis situations. One of the key strategies under this component is “Dialectical Abstinence,” a synthesis of abstinence and harm reduction philosophies. This article aims to explore this concept and its relevance in DBT, providing insights for individuals and practitioners involved in health and wellness programs.

Understanding Dialectical Abstinence

Dialectical Abstinence is rooted in the dialectical philosophy of DBT, which involves integrating opposites. It is a synthesis of two seemingly conflicting approaches: abstinence and harm reduction.

  • Abstinence: Traditionally, abstinence refers to the complete avoidance of a behavior or substance that is causing harm. In mental health and substance abuse treatment, it is often seen as the primary goal or ideal outcome.
  • Harm Reduction: This approach acknowledges that while abstinence might be the ideal, it may not always be realistic or achievable for everyone. Harm reduction focuses on minimizing the negative consequences associated with a behavior or substance use, without necessarily eliminating the behavior entirely.

Dialectical Abstinence, therefore, involves a nuanced balance between these two philosophies. It promotes the idea of striving for abstinence while also recognizing and planning for potential relapses, thereby reducing harm.

Distress Tolerance and Crisis Survival

Distress tolerance skills in DBT are designed to help individuals cope with intense emotional pain in difficult situations without resorting to self-destructive behaviors. Crisis survival strategies are part of these skills and are intended to help individuals survive a crisis without making it worse. Dialectical Abstinence plays a vital role in this aspect of DBT.

Key Components of Dialectical Abstinence

  1. Radical Acceptance: This involves accepting reality as it is, not as what we want it to be. It’s acknowledging the presence of urges or desires without acting on them.
  2. Mindfulness: Being fully present in the moment helps individuals recognize their thoughts and feelings without judgment, allowing for greater control over their responses.
  3. Balanced Thinking: Instead of seeing situations in black-and-white terms (abstaining vs. indulging), DBT encourages a more balanced view, recognizing the complexity of human behavior and experiences.

Implementing Dialectical Abstinence in Therapy

For therapists and counselors, incorporating Dialectical Abstinence into treatment involves:

  1. Assessment and Goal Setting: Understanding the client’s relationship with the behavior or substance in question and setting realistic goals.
  2. Skill Development: Teaching clients skills to manage urges, such as distress tolerance and emotion regulation strategies.
  3. Contingency Planning: Helping clients develop plans for potential relapses, focusing on minimizing harm and getting back on track.
  4. Non-judgmental Stance: Maintaining an attitude of acceptance and understanding, avoiding moral judgments about relapses or struggles.

Challenges and Considerations

  • Individual Differences: Every individual’s journey is unique, and what works for one may not work for another. Personalization of treatment is key.
  • Stigma: There is often stigma associated with relapse in traditional abstinence models. Dialectical Abstinence aims to reduce this stigma by acknowledging relapses as part of the journey.
  • Therapist Training: Adequate training in DBT and an understanding of the dialectical approach are crucial for therapists implementing these strategies.


Dialectical Abstinence is a compassionate, realistic approach within DBT that acknowledges the complexities of human behavior. By balancing the ideals of abstinence with the practicality of harm reduction, it offers a flexible, non-judgmental path to managing distress and crisis situations. For individuals in health and wellness programs, understanding and utilizing this approach can be a significant step towards effective coping and recovery.


  1. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
  2. Tatarsky, A. (2007). Harm reduction psychotherapy: A new treatment for drug and alcohol problems. Jason Aronson.
  3. Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.
  4. Dimeff, L. A., & Koerner, K. (2007). Dialectical behavior therapy in clinical practice: Applications across disorders and settings. Guilford Press.

Note: The above references are suggested for further reading and do not necessarily reflect the latest developments in DBT and related fields.