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From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission 
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).distress tolerance Handout 17   (Distress Tolerance Worksheet 14)
Dialectical a bstinence
SYNTHESIS  = Dialec Tical aBST inence
The goal is not to engage in addictive behavior again—  
in other words, to achieve complete abstinence.
However, if there is a slip, the goal is to minimize harm  
and get back to abstinence as soon as possible.
pros:  It works!
cons:  It’s work. You don’t get a vacation.
(You’re always either abstinent or working to get back to abstinence.)
An example of expecting the best and planning for the trouble spots:  
Olympic athletes must believe and behave as though they can win  
every race, even though they have lost before and will lose again. 
  
 
  
 
  HARM REDUCTION
(Acknowledging there will be
slips; minimizing the damage,
but not demanding perfection)ABSTINENCE
(Swearing off 
addictive behavior)vs.
Pro: People who commit to 
abstinence stay off longer.
Con: It takes longer for people 
to get back “on the wagon” once they fall off.Pro: When a slip does happen, 
people can get back “on the 
wagon” faster.
Con: People who commit to 
harm reduction relapse quicker.