Culturally Informed DBT for Stimulant Use Disorder in Low-Literacy Context: A Case From Pakistan

Abstract

Stimulant use disorder in low-resource settings face significant challenges due to limited treatment resources, prevalent stigma, and widespread literacy barriers. Standard evidence-based psychotherapies often rely on literacy and resources-dependent tools, which may reduce engagement and accessibility. To address these challenges, the current study presents the case of a young adult male with stimulant use disorder characterized by anger dysregulation, interpersonal conflict, and repeated relapse, treated using a literacy-sensitive, DBT-informed approach. DBT was chosen over other psychotherapies because of its structured, skills-based format and established efficacy in targeting emotional dysregulation, impulsivity, and relapse vulnerability, all which are core difficulties in stimulant use. Over 13 sessions, the intervention was based on simplified psychoeducation, culturally adapted skills training, motivational interviewing, and relapse prevention strategies. Progress was evaluated through the Drug Abuse Screening Test (DAST-20), the University of Rhode Island Change Assessment (URICA), and the Anger Expression Scale. Post-intervention results showed reductions in substance-related problems and anger dysregulation, alongside increased motivation for change, improved self-reflection, and early adoption of emotion regulation skills. While ongoing vulnerability to relapse was evident, the client demonstrated stronger insight into triggers, greater emotional regulation, and a commitment to sustained recovery. This case highlights the potential of literacy-sensitive, DBT-informed tailor-made approach to enhance engagement, skill generalization, and relapse prevention in stimulant use disorder within low-literacy, low-resource contexts.