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

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. 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. 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 p s > 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). 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. This study provides preliminary evidence to suggest the importance of assessing substance use and emotion regulation to inform treatment targets.