Application of Dialectical Behavior Therapy in patients with opioid dependence- a pilot study

Abstract

Background: Opioid dependency is a serious public health concern. India is one of the largest legal producers of opium and has an established pattern of use of opioid group of drugs. Opioid substitution therapy (OST) has displayed better outcomes compared with other existing treatment strategies. Dialectical Behavior Therapy (DBT) is a fast growing treatment modality used more and more to help individuals overcome addiction and maintain recovery. DBT incorporates concepts and modalities designed to promote abstinence and to reduce the length and adverse impact of relapses. DBT serves to improve patient motivation to change, enhance patient capabilities, generalize new behaviors, and restructure the individual’s environment. Aim: Present study was aimed to explore the effect of Dialectical Behavior Therapy (DBT) on level of severity of opioid dependence, distress tolerance, emotion regulation and interpersonal competence skills in patients with opioid dependence. Methods: This study consisted of 40 patients diagnosed with opioid dependence syndrome .The selected patients completed their individual baseline assessment. Afterward the patients were randomly assigned to the Experimental and control groups equally. The patients in experimental group attended 13 twice a week –
90 minutes’ individual DBT sessions focusing on Distress tolerance, Emotion regulation and inter-personal competence along with their TAU. The patients in control group were only on their TAU. Base line assessment scores were obtained using Severity of dependence scale (SDS), Brief-Cope Questionnaire, Emotional Regulation Questionnaire (ERQ) and Interpersonal Competence Questionaaire-15 (ICQ-15). Analysis was done using SPSS v 25.0 software and Wilcoxon Singed Rank Test was applied. A p value of <0.05 was considered to be statistically significant. Results: The experimental group (DBT+TAU) has proved effective in reducing levels of severity of opioid dependence, enhanced distress tolerance in domains (Self-distraction ,Active Coping ,Emotional support,
Acceptance, Positive Reframing and Religion), better emotional regulation( cognitive reappraisal , decreased emotion suppression) and Effective interpersonal competence (Initiation, Negative Assertion and Conflict Management ) than the control group (TAU).
Conclusion: Skills taught in DBT do seem to support the needed foundation of substance Dependence
treatment; motivation for change, motivation to continue in treatment, and staying mindful of high-risk
situations.