Dialectical Behaviour Therapy in Community Mental Health: Associations Between Substance Use, Emotion Regulation and DBT Programme Outcomes

Background: Substance use and emotion regulation are common treatment targets in dialectical behaviour therapy (DBT) and they may be categorised as a life-threatening behaviour, a treatment interfering behaviour, or a quality of life interfering behaviour. Research examining these constructs in DBT-informed community mental health samples is limited. Aims: This study examined substance use, difficulties in emotion regulation (DERS) and programme outcomes (attendance and graduation) among 55 adults from a DBT intensive outpatient programme within a community mental health centre in the United States. Results: Our results revealed a statistically significant inverse relationship between substance use at programme entry and the DERS total scale (Hyp-1: r = −0.29, p < 0.05). No statistically significant relationships were established between the remaining DERS subscales (all other ps > 0.05). In addition, there were no statistically significant relationships between substance use with attendance (Hyp-2: β = −2.17, p = −0.78) and graduation (Hyp-3: β = −0.55, p = 0.40). Discussion: Substance use may regulate emotions as a maladaptive short-term benefit with long-term cost. When not influencing life-threatening behaviours, substance use may be identified as a quality of life interfering behaviour as opposed to a therapy-interfering behaviour. Conclusion: This study provides preliminary evidence to suggest the importance of assessing substance use and emotion regulation to inform treatment targets.