DBT Skills and Recovery: Finding Serenity Through Acceptance and Change

When we look at the landscape of addiction recovery, one truth becomes increasingly clear: the paths that lead to substance use are rarely straightforward. In my years working with clients at CravingRecovery, I’ve observed a profound pattern that research consistently confirms — the high prevalence of trauma histories among those struggling with addiction.

Studies show that up to two-thirds of people with substance use disorders report experiencing trauma during their lifetime. This isn’t coincidental. Trauma and addiction are often intertwined in a complex relationship where substances become a maladaptive coping mechanism for unbearable emotional pain.

The Trauma-Addiction Connection

For many of my clients, substances initially served as a solution, not a problem. Alcohol numbed the flashbacks. Opioids dulled the hypervigilance. Stimulants provided an escape from the emotional numbness. What began as self-medication evolved into dependency, adding another layer of suffering to already wounded lives.

Recovery, then, cannot focus solely on abstinence. True healing requires addressing the underlying trauma that drives the desire to escape through substances. This is where Dialectical Behavior Therapy (DBT) has proven to be remarkably effective, particularly because its fundamental philosophy aligns beautifully with the wisdom of the Serenity Prayer that many of us know from 12-step programs:

“God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”

The Dialectic of Acceptance and Change

The very name “Dialectical Behavior Therapy” points to its core principle: holding two seemingly opposite truths simultaneously. In recovery, we must accept ourselves exactly as we are while working toward change. This dialectic mirrors the essence of the Serenity Prayer — discerning between what must be accepted and what can be changed.

For trauma survivors in recovery, this dialectic is life-changing. The past cannot be changed. The trauma happened. No amount of substances will erase that reality. Yet how we relate to our past, cope with triggers, and build our future — these things are within our power to change.

Let’s explore how the four core skills of DBT align with recovery principles and support healing from both trauma and addiction:

Mindfulness: Present-Moment Awareness

DBT defines mindfulness as non-judgmental awareness of the present moment, including thoughts and emotions. For trauma survivors, being present can be terrifying. The mind has learned to time-travel — either ruminating on past traumas or anxiously anticipating future threats.

Substances offer a counterfeit present, a chemical shortcut that bypasses the difficult work of genuine presence. Recovery asks us to stay, be here now, and feel what arises without judgment.

When my clients practice mindfulness, they begin to recognize that cravings, like trauma triggers, are temporary states. By observing urges without automatically acting on them, they develop “response flexibility” — the space between stimulus and response where freedom lives.

The mindfulness component of DBT teaches us to accept the present moment exactly as it is, echoing the first part of the Serenity Prayer. We cannot change what we feel in this instant, but we can change how we respond.

Distress Tolerance: Weathering Emotional Storms

For those with trauma histories, emotional distress can feel catastrophic. The intensity of emotions connected to traumatic memories often exceeds normal coping capacities. Substances become a way to avoid this unbearable distress.

DBT’s distress tolerance skills offer healthier alternatives for crisis survival. Techniques like TIPP (Temperature change, Intense exercise, Paced breathing, Progressive muscle relaxation) help regulate the nervous system when triggered. Radical acceptance — fully accepting reality without fighting against it — helps clients stop suffering by rejecting what cannot be changed.

One client described her realization: “I spent years trying to drink away my past. DBT taught me that I can tolerate the pain of my memories without destroying myself in the process.”

Distress tolerance embodies the “serenity to accept the things I cannot change” portion of the prayer. We cannot change that distress will occur in life, especially during recovery, but we can learn to ride the waves without drowning.

Emotion Regulation: Changing Unwanted Emotions

While some emotions must simply be tolerated, others can be modified. DBT’s emotion regulation skills teach clients to identify, understand, and influence their emotional responses.

For trauma survivors, emotions often feel uncontrollable and overwhelming. Many turn to substances precisely because they lack the tools for emotional management. Learning to name emotions, identify their triggers, and implement strategies to reduce vulnerability creates a sense of agency that substances falsely promise.

In recovery, emotion regulation skills help manage the feelings that arise when substances are removed. They also address the emotional dysregulation that often accompanies trauma, reducing reliance on unhealthy coping mechanisms.

This component represents the “courage to change the things I can” aspect of the Serenity Prayer. We can change how we relate to emotions, express them, and often, how intensely we experience them.

Interpersonal Effectiveness: Healing Relationships

Trauma and addiction both take a severe toll on relationships. Many clients struggle with trust, boundaries, and communication, essential for healthy connections with others.

DBT’s interpersonal effectiveness skills provide concrete strategies for expressing needs, setting boundaries, and maintaining self-respect during conflicts. These skills are crucial in recovery, where rebuilding relationships and creating healthy support systems can make the difference between sustained sobriety and relapse.

For trauma survivors, interpersonal effectiveness also means learning to trust others and themselves again. It means recognizing when relationships are safe and when they’re dangerous. It means courageously being vulnerable in appropriate contexts while maintaining firm boundaries with others.

This skill set embodies acceptance (we cannot control others’ responses) and change (we can modify how we communicate and what relationships we nurture).

The Wisdom to Know the Difference

Perhaps the most profound part of the Serenity Prayer, and the most challenging aspect of recovery, is developing “the wisdom to know the difference” between what we must accept and what we can change.

For my clients with co-occurring trauma and substance use disorders, this discernment doesn’t come easily. Trauma distorts perception, making everything feel either completely within or entirely beyond one’s control. Substances further cloud this judgment.

DBT provides a framework for developing this wisdom. Through mindfulness, clients learn to see reality more clearly. Through distress tolerance, they discover what must be accepted. Through emotion regulation and interpersonal effectiveness, they learn what can be changed.

Over time, this dialectical approach — accepting reality while working toward change — becomes internalized. The wisdom becomes intuitive rather than intellectual.

The Recovery Journey: Acceptance and Change

Recovery isn’t linear. For those healing from both trauma and addiction, there will be setbacks, triggers, and moments when old coping mechanisms feel irresistible. This must be accepted without judgment while maintaining a commitment to change.

What makes DBT so valuable in this journey is its balanced approach. It doesn’t demand immediate transformation. It acknowledges suffering while offering practical tools for growth. It meets clients where they are while guiding them toward where they want to be.

In my practice, I’ve witnessed remarkable transformations when clients embrace this dialectic. A young woman who used alcohol to numb childhood trauma developed the capacity to sit with painful memories without drinking. A middle-aged man who used opioids to cope with combat-related PTSD learned to recognize triggers and implement alternatives to using.

These journeys weren’t easy or perfect. There were relapses and difficult days. However, through consistent practice of DBT skills, these individuals developed what the Serenity Prayer seeks: serenity amid difficulty, courage amid fear, and wisdom amid confusion.

Bringing It All Together

If you’re struggling with both trauma and substance use, know that you’re not alone. The connection between these challenges is well-established, and there are evidence-based approaches that address both simultaneously.

DBT offers a comprehensive framework that aligns beautifully with recovery principles. By developing skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, you can heal from trauma while maintaining sobriety.

At the heart of this approach is the wisdom of the Serenity Prayer—learning to discern between what must be accepted and what can be changed. This discernment isn’t achieved overnight. It’s developed through practice, community support, and compassionate self-reflection.

At Craving Recovery & in my private practice at Ascend Counseling and Wellness, we incorporate DBT skills into our comprehensive treatment approach precisely because we recognize the prevalence of trauma among those seeking recovery from substance use. We understand that addressing both is essential for lasting healing.

Whether you’re early in your recovery journey or well along the path, consider how the dialectic of acceptance and change might support your healing. Like the Serenity Prayer, DBT reminds us that true peace comes not from controlling everything or from surrendering to everything but from the wisdom to know the difference.

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If you or someone you love is struggling with co-occurring trauma and substance use disorders, reach out to us at Ascend Counseling and Wellness. Our trauma-informed approach integrates DBT skills with evidence-based addiction treatment to support comprehensive healing.

Kevin Brough / Ascend Counseling and Wellness / 435-688-1111