Feasibility of dialectical behavior therapy skills training as an outpatient program in treating alcohol use disorder: The role of difficulties with emotion regulation and experiential avoidance.

Background: This study aimed to investigate the feasibility of a 3-month Dialectical Behavior Therapy Skills Training stand-alone outpatient program (DBT-ST-OP) for alcohol use disorder (AUD) by compar- ing primary and secondary outcomes with the same intervention provided in a mixed format (inpa- tient þ outpatient). The study also assessed experiential avoidance (EA) changes during treatment and its early predictive role in treatment retention. Ultimately, the mediating role of difficulties with emo- tion regulation (DER), EA changes, and the functional relationships between them were explored in relation to abstinence maintenance (AM). Methods: A voluntary sample of 171 treatment-seeking individuals with AUD was consecutively admit- ted. AM was indicated by random weekly urine toxicological screening. DER and EA were assessed at the beginning, after 1 month, and at the end of treatment. Two serial multiple mediational models were estimated. Results: DBT-ST-OP showed more beneficial primary (i.e., AM, attrition rate, treatment attendance) and secondary (i.e., DER levels) outcomes compared with the same treatment provided in a mixed format. EA significantly decreased during the treatment, independently of baseline levels. Further, it did not represent an early predictive factor for drop-out. DER changes were a full mediator of AM and explained EA changes during the treatment. Conclusion: DBT-ST is a feasible stand-alone outpatient program for AUD. DER represents a relevant therapeutic process in explaining AM and EA changes. Future controlled and follow-up studies should focus on the efficacy of DBT-ST in treating AUD and evaluate the role of DER and EA in long-term relapse prevention.