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Questions/Psychotherapy/Q40 of 79
advancedDBTsubstance use disorderdialectical abstinenceharm reductionrelapse preventionborderline personality disorder
A 27-year-old woman with borderline personality disorder and alcohol use disorder is being treated in a DBT program adapted for substance use. She has maintained sobriety for four weeks but expresses anxiety about an upcoming family gathering where alcohol will be present. Her therapist discusses a framework in which the patient commits with absolute resolve to abstinence before the event, but if a lapse occurs, the patient is coached to immediately apply harm reduction strategies, nonjudgmental analysis, and rapid recommitment to abstinence rather than progressing to a full relapse. The therapist frames this as synthesizing two seemingly contradictory stances.
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