DBT for Addiction in Tennessee

• Mindfulness + DEAR MAN: Before an event, name the goal (“leave sober, home by 9”), visualize likely pressure points, and prep a boundary script. Example: “I’m skipping drinks tonight—sticking to my plan, but I’m here to hang.”
• GIVE/FAST: Maintain warm relationships while protecting your self-respect. Validate others—“Totally celebrate; I’m just doing seltzer”—and avoid over-explaining.
• Distress tolerance on-site: Bring a self-soothing kit (mint gum, calming audio, fidget item). If intensity spikes, step outside for TIPP: cold water to the cheeks, a 2-minute brisk walk, and paced breathing (inhale for 4 seconds, exhale for 6 seconds).

• Emotion regulation—PLEASE: Protect your sleep window. Set a consistent lights-down routine: dim the lights at T-60, take a short journal entry at T-30, and practice breathing at T-10.
• Opposite action: When the thought is “I need a drink to relax,” do the effective opposite: a warm shower, stretching, or 10 minutes of guided breathing.
• Urge surfing: A craving is a wave. Time ten minutes; notice where it lives in the body; ride it as it peaks and falls. Pair it with a non-alcoholic substitute you actually like—cold and fizzy increases the success.

• Check the facts: Challenge “I can’t handle tonight without drinking.” List evidence for/against; choose the smallest effective action (eat dinner first, text a support, 5-minute walk).
• Pros/cons in the moment: Two columns—“If I drink” vs. “If I don’t”—with today and tomorrow morning effects. Read it aloud.
• Weekend plan: Pre-commit to low-risk activities and time-boxed socializing. Put your exit line in your notes: “Early morning tomorrow—heading out.”

• “I’m not drinking tonight—I feel better without it.”
• “I’ll toast with sparkling water.”
• “I’m heading out at nine, but I’m glad I came.”

Alcohol-specific progress markers: fewer last-minute plan changes, a consistent sleep window, and successful exits from events without rumination. DBT keeps you moving—one clear skill for each sticky moment—so “no” becomes easy and routine, not a battle.

• TIPP first: When adrenaline is high, logic won’t land. Use temperature (ice/cold water), brief intense movement, and paced breathing to downshift. Only then decide.
• Behavior Chain Analysis (BCA): Map the last lapse or “near miss.” Identify the earliest body cue (jaw clench, heat in chest), the thought (“just once”), and the scene (parking lot, bathroom, DMs). Insert a skill before the cue next time—such as text support, changing route, or public space only.
• Opposite action: If avoidance drives use (putting off a hard call), do the effective opposite in a tiny step: send a two-sentence email or start a five-minute timer and begin.

• Emotion regulation—build replacement highs: Schedule short, legal dopamine hits: intervals workout, ice-cold face splash, creative sprints, calling a friend who makes you laugh.
• Mindfulness of current emotion: Name it—“I’m restless”—and ride it like a wave. Pair with a values micro-goal (such as finishing one small task) to convert energy into progress.
• Pros/cons with a twist: Add a “three-day view.” How will this choice feel on day three? This widens the frame beyond the next 20 minutes.

• DEAR MAN, for boundaries: “I’m changing my routine and won’t be hanging out late. If you want to grab coffee during the day, I’m in.”
• GIVE/FAST: Stay kind and firm. You’re allowed to protect your recovery and your dignity simultaneously.
• Environmental redesign: Replace routes, adjust contact settings, mute or delete threads, and add friction (content filters, transportation plan, curfewed parking).
• Distress-tolerance stacks here: if you pass a trigger spot, do one TIPP cycle and keep moving.

• Payday protocol: Deposit → pay bills → pre-planned meeting with a sober support → home by a set time. Remove access points from 5:00 to 10:00 p.m.
• Unexpected invite: Text a prewritten decline: “Appreciate you—focusing on health right now. Coffee this weekend?”
• Solo evenings: Structured blocks (meal, 20-minute movement, shower, call, show, wind-down). Put “no idle scroll after 9” in writing.

ick boundary lines:

• “I’m not in that scene anymore.”
• “Coffee works; late nights don’t.”
• “If plans include substances, I’m out.”

Progress markers to watch: more time between triggers and actions, fewer unplanned route choices, shorter craving arcs, and a shrinking contact list of high-risk peers without isolation (you’re replacing, not just removing).

Anxiety narrows your world and fuels avoidance; panic floods the body and makes fast relief (including substances) look appealing. DBT teaches grounding and arousal-downshifting so the nervous system settles enough for wise choices:

• In-the-moment resets: TIPP (temperature, brief intensity, paced breathing, paired muscle relaxation), 5-4-3-2-1 sensory grounding, and “name it to tame it” labeling to lower physiological arousal.
• Check the facts: Challenge catastrophic predictions with evidence and probabilities; choose the smallest effective step rather than “all or nothing.”
• Exposure-supportive skills: When clinicians recommend graded exposure (e.g., driving, crowds, phone calls), we pair each step with a specific skill (such as breathing, coping statements, or urge surfing) so you can lean in without feeling anxious or overwhelmed.
• Relapse protection: Build a pre-event plan (script, support, and exit) and a post-event decompression routine so wins consolidate and setbacks don’t snowball.

Depression drains momentum; life shrinks, isolation grows, and relief-seeking can revert to use. DBT targets energy, routine, and meaning:

• Behavioral activation: Daily micro-actions that create movement—get light exposure within an hour of waking, five-minute tidy, ten-minute walk, one connection text. We track what reliably raises your energy levels.
• Opposite action: When urges say “cancel and isolate,” we do the effective opposite in tiny, repeatable steps—show up for 30 minutes, take one call, and attend a group, even if your mood is flat.
• PLEASE routine: sleep window, regular meals, medication adherence (as prescribed), and brief movement—depression eases when the basics are protected.
• Thought work that sticks: “Check the facts” reframes all-or-nothing beliefs (“This won’t help”) into testable experiments (“I’ll try ten minutes and re-evaluate”).
• Relapse protection: Evening wind-down + tomorrow’s first small step prevents late-night dips from turning into next-day avoidance.

Trauma symptoms—intrusions, hyperarousal, numbing—can drive substance use as an attempted solution. In dual diagnosis care, we stabilize first and introduce trauma processing when it’s safe:

• Phase 1: Safety and stabilization. Distress-tolerance (TIPP, self-soothe kits), grounding, environmental safety tweaks, and crisis planning. We reduce self-harm and use risk while building regulation capacity.
• Phase 2: Skills generalization. Mindfulness for triggers, emotion regulation to prevent overwhelm, and interpersonal effectiveness to set boundaries with unsafe people or situations.
• Phase 3: Trauma processing (when indicated). Once stability holds, we coordinate step-by-step with your trauma provider (e.g., EMDR or trauma-focused therapy). DBT supports pace, preparation, and post-session recovery to prevent destabilization of the recovery process.
• Relapse protection: Trigger maps (places, dates, sensory cues), anniversary reaction plans, and post-flashback scripts (“Call X, 5-minute breathe, hydrate, light snack, short walk”) keep safety at the forefront.

For bipolar spectrum conditions, rhythm and sleep are clinical priorities. We integrate DBT with medical care to reduce mood episodes and protect sobriety:

• Rhythm first: Fixed wake time, light exposure, consistent meals, and movement anchors. We track how small schedule shifts alter mood reactivity and urge intensity.
• Sleep protection: Wind-down routines, stimulus control, and caffeine timing to minimize sleep debt—because sleep loss can precipitate hypomania and relapse risk.
• Early-warning systems: Personal markers (spending, speech rate, goal stacking, irritability) become part of a written action plan, outlining who to inform, which skills to deploy, and how to simplify commitments.
• Medication coordination: With consent, we communicate with prescribers about the effects, side effects, and adherence strategies (such as alarms, pillboxes, and pharmacy synchronization). DBT skills + medication often outperform either alone.
• Relapse protection: If activation levels rise, we temporarily tighten the structure (by increasing coaching and reducing high-stimulation settings) and return to high-yield skills (TIPP, opposite action toward sleep and routine) until stability is restored.

When emotional intensity and relationship ruptures dominate, DBT is the gold standard. We use validation and dialectics to reduce shame and increase workable change:

• Validation that disarms: We acknowledge the logic of your feelings, given your history and the current moment, then pair it with change steps that actually help.
• Dialectics in practice: Two truths at once—“I’m doing the best I can and I can do things that move me toward my goals.” This stance reduces all-or-nothing swings and fosters a collaborative approach to treatment.
• Crisis planning: Clear step-by-step cards for urges and intense emotions; phone/skills coaching (as offered) to navigate the first 20 minutes of a spike; behavior chain analysis after a setback to find the insertion points for next time.
• Interpersonal effectiveness: DEAR MAN, GIVE, and FAST to reduce reactive texting, boundary flips, and “test-then-punish” patterns. We script and rehearse high-risk conversations until they become manageable and effective.
• Relapse protection: Since relationships can be the biggest trigger, we establish contact rules, cool-off windows, and repair scripts to prevent conflicts from escalating into use.

• One plan, shared team: Your goals, DBT skills, medical needs, and safety steps are all in a single, readable plan that is updated weekly. No more juggling separate advice streams.
• Measure what matters: We track skill usage, sleep window, craving arc length, and communication wins—so you can see progress and adjust quickly.
• Step-down continuity: Skills acquired during detoxification travel with you from residential care to PHP/IOP and beyond, into aftercare. Each level emphasizes what you need most (stabilization early; real-life practice later).
• Family/ally involvement (with consent): Education on warning signs, boundary scripts, and “helping without rescuing,” so your home environment supports your plan.

It’s simple: Call us, complete a brief, confidential screening, and we’ll run an insurance benefits check for you. From there, we’ll recommend the level of care (detox, residential, PHP, IOP, or outpatient), schedule your intake, and provide details on what to bring and what the first 72 hours will look like. If you’re local, we can help you choose between Murfreesboro, Nashville, or Clarksville and send a Google Maps directions link.

DBT is practical, teachable, and built for real-life recovery. Whether you’re starting in detox or transitioning to outpatient care, our DBT Tennessee program helps turn tough moments into manageable plans so you can move forward with clarity and support.