Coping
with Addiction
A.
Thomas Horvath, Ph.D.
San
Diego, CA September, 1989
What Is An Addiction?
How Does An Addiction Develop?
Am I "Addicted"?
How Do I Cope With An Addiction?
Do I Need To Stop Completely,
Or Could I Just Cut Back?
Am I Someone Who Has No Choice? Do
I Have To Quit?
Do I Need To Attend Group Meetings?
What If I Don't Have Enough Willpower?
What Key Ideas Do I Need To Remember?
- I know I have
a problem with this sometimes, but do I have to stop entirely?
- What's the
big deal? Everybody has at least one vice.
- Why do they
give me such a hard time?
- I don't understand
why I still do it.
- Every so often
I get a big urge, and there go all my good intentions.
- Maybe I'm the
sort of person who just needs to be addicted to something. Anyway,
I've tried to stop before, and it's too hard, I can't do it.
- For several
months I was doing fine, but one night I slipped, and it's been
back downhill ever since.
- Quitting successfully
amounts to having enough willpower to do the job. I don't, so
why kid myself?
- Do I have to
go to those meetings for the rest of my life?
What Is An Addiction?
An addiction is an activity
or substance we repeatedly crave to experience, and for which we are
willing if necessary to pay a price (or negative consequence). In
recent years researchers have considered as examples of addiction
both substance addictions (alcohol, cigarettes, food, street drugs,
etc.) and activity addictions (gambling, impulsive sexual activity,
shoplifting, overspending, etc.). This article discusses techniques
and concepts which can be helpful in coping with both kinds of addictive
behavior.
Relatively
minor addictions, such as watching too much television, eating a certain
kind of candy, or lying in bed on weekend mornings, are often not
even considered addictions, because the price paid for indulging them
is not high. On the other hand, we tend to use the term "addict" to
describe the person who, at least in the eyes of others, continues
an addictive behavior long after it may have been clear that the substantial
price being paid was not worth the benefit. The individual who has
lost career, house, family and friends because of cocaine use, but
is unwilling to consider stopping, is an unfortunate example.
Negative addictions
range from those with very minor negative consequences, to those as
serious as the cocaine addict just mentioned, with much area in between.
Although it is sometimes true that a negative addiction grows stronger
(i.e., worse) over time, this is not necessarily or even typically
true. For instance, most overweight individuals do not keep gaining
and gaining weight, but rather settle into a weight range that, if
far from ideal, is also not morbidly obese. On the other hand, even
a constant level of addictive behavior (e.g., overspending $200 a
week) can lead to an increasing level of negative consequences.
You may be
surprised to learn that addictions can also be considered positive.
Positive addictions are those in which the benefits outweigh the price.
A common example would be exercise. The price of membership in a gym,
the time involved, and any clothing expense, is outweighed by the
benefits of better health, energy, self-confidence and appearance.
As with negative addictions, positive addictions may not get stronger
(i.e., better; greater benefits are obtained) over time, and there
is a broad range of how much benefit is actually obtained.
What is common
to both positive and negative addictions, and what helps us realize
that they are two sides of the same coin, is the urge or craving to
engage in the addictive behavior, and the satisfaction that is felt
when the urge is acted upon. The urge is a state of tension and anticipation
that is experienced as a desire for the substance or activity. The
urge is also experienced as uncomfortable, perhaps intensely so, especially
if it lasts long enough. Because we experience relief when the urge
is acted upon, there is an increased likelihood that we will act on
the urge again. One of the primary benefits of an addiction for many
individuals is the fact that the urge can be driven away by the addictive
behavior. Hunger, and eating to satisfy it, provide a good example
of a (positive or negative) addiction. We might even describe hunger
(along with thirst and sex) as one of the original addictions. Even
if there were no other benefits to eating (i.e., nutrition and survival),
it would be satisfying to eat simply because eating makes hunger go
away. Sometimes addictive behavior appears to be engaged in without
the presence of an urge, such as when a smoker is three puffs
into a cigarette before realizing that it is lit, or when an overeater
is three bites into a chocolate cake before realizing that this is
no longer the living room but the kitchen. However, if these individuals
were kept at a distance from their substance or activity, such that
deliberate effort (rather than behavior so habitual that it is unconscious)
were required to obtain it, urges would again be observed. In the
examples described the addictive behavior is used to prevent the occurrence
of an urge, which would nevertheless appear eventually if it were
not prevented.
An addiction
is an example of a habit. Like other habits, addictive behaviors are
learned behaviors that we acquire through trial and error (e.g., we
happen to gamble for the first time, having known little about it,
and experience it as exhilarating and captivating), or through observing
others (e.g., our parents had cocktails each evening before dinner
to relax). If we have ongoing experience with the substance or activity,
and if (and only if) we enjoy at least some aspect of that experience,
an urge or craving for it gradually emerges after repeated experience.
The urge is a way of saying to ourselves: "I know this is going to
be good; I will enjoy this." Someone who has never experienced a substance
or activity cannot be addicted to it, nor will an addiction develop
if the experience is not pleasurable. Because of the uniqueness of
each individual, what is pleasurable for one person may not be for
another. For instance, many individuals report not enjoying alcohol,
even in small amounts. Such an individual would not ordinarily become
addicted to alcohol. Paradoxically, in a very strong addiction much
of the original pleasure may no longer be experienced. In this case
the primary satisfaction comes from driving the (uncomfortable) urge
away.
The pleasures
of an addiction can be diverse. In addition to promoting an increase
in positive mood (feeling more relaxed, feeling more "up"), the addiction
may also be a means to decrease negative mood (if I do this I won't
feel stressed, anxious, angry, depressed, bored, lonely, afraid, frustrated,
etc., anymore). There are many variations on this theme. If I am feeling
bad because it seems I am not "fitting in", I can reduce that negative
feeling by doing what others are doing (drinking, using drugs). If
because of a conflict with someone I am so upset "I can't stand it",
I can change this feeling through addictive behavior. Because the
pleasure of the addiction can be used to block out or replace an unwanted
emotion, an addiction can be a "way to cope". If the addiction is
used in this way, urges tend to occur in response to those negative
moods for which the individual has few other effective coping methods.
[TOP]
How Does An Addiction Develop?
It is possible to describe phases
in a negative addiction:
- Experimentation:
Urges arise out of curiosity
- Expected
enjoyment: Urges arise out of fond memories of past enjoyment
- Doing
it to cope: Urges arise primarily in response to stress
- Doing
it to survive: Urges are frequent (hourly, doing it as
a way of life daily); or urges may be prevented more than they
are experienced. Specific stressors are no longer needed as triggers
for urges, because the addiction is woven into many or most aspects
of life. The addiction helps the addict maintain a sense of stability
and normality.
An addiction could be described
as stronger or weaker according to which of these phases it occupied.
A similar set of phases applies to a positive addiction. An individual
may stop at any phase, or retreat to it after being in another one.
Predisposing
factors are also essential to the development of an addiction, because
it takes more than just curiosity to establish an addiction. Predisposing
factors are what enable an individual to experience a certain behavior
as pleasurable, and include biological predisposition (enjoying some
physical effects of the behavior, being insensitive to others), encouragement
from others, acceptance of the behavior by the individual and others,
low self esteem, craving for excitement/boredom, high life stress
(typically expressed as a specific emotional issue, such as depression,
anxiety, loneliness, etc.), and the availability of the substance
or activity. For instance, someone addicted to ocean swimming may
enjoy the feeling of being "massaged" by water as he swims in it,
not mind the coldness of the water very much, have gotten encouragement
from his wife (she thinks it's "manly"), accept the activity as part
of a healthy lifestyle (as his friends and family do), have a need
to prove himself to others (or to feel better about himself by swimming),
like the excitement/tension of knowing he could drown, enjoy the respite
from the very high anxiety of his sales job, and live near the beach.
The presence of all of these predisposing factors is not necessary
for addictive behavior to develop.
Once having
become a part of our behavior, pleasures (and the habits based on
them) continue or die away depending on whether we continue to experience
them as pleasurable. Life is a continuing process of developing, revising
and outgrowing pleasures. Although we may never entirely abandon a
well-established pleasure, the frequency with which we engage in it
can diminish dramatically. Each of us can probably remember pleasures
from childhood which were very strong at the time, but are now no
longer very pleasurable. For instance, how may adults still routinely
look for opportunities to play in the mud, or suck their thumbs, or
be praised for using the bathroom instead of a diaper? Consequently,
addictions both develop and possibly get outgrown according to the
pleasure we believe them to provide us.
To summarize
what has been said thus far about the definition and development of
an addiction, an addiction is the habit of making an urge (or craving)
go away (or preventing it from occurring) by engaging in the desired
activity or using the desired substance. The urge develops because
past pleasurable experience and related benefits from the substance
or activity are expected to reoccur on the next occasion. Urges are
uncomfortable, and engaging in the addictive behavior is also experienced
as pleasurable simply because (or perhaps only because) the urge is
driven away.
There is a
broad range of prices and benefits for addictions. The addiction is
negative if, for that individual, the price outweighs the pleasure
and benefits. Various predisposing factors contribute to the development
of an addiction. An addiction does not necessarily get stronger over
time. If the pleasure expected from the addiction is the reduction
of a negative mood, the addiction may, for that individual, be a primary
means for coping with stress. In a strong addiction the addictive
behavior has become integrated into many aspects of the individual's
life. As we mature, the pleasures we crave also mature, and consequently
our addictions can change.
[TOP]
Am I "Addicted"?
Although the term "addict" is
often used to describe someone for whom the price of the addiction
outweighs the benefit, it is impossible to use this term precisely,
because prices and benefits are different for each individual. Furthermore,
how much bigger than the benefit would the price have to be for me
to be an addict? There is no clear answer to this question. It may
best to reserve "addict" for describing oneself (as opposed to others),
or not to use it at all. In this article, this term will be used as
a convenience, to describe anyone with an addiction in which the price
outweighs the benefit, no matter how slightly, from anyone else's
point of view. By using this definition, probably all of us are (negative)
addicts, according to someone.
Better questions
may be: Is my enjoyment of this substance or activity causing me enough
problems that I want to consider cutting back or stopping? Is this
behavior preventing me from enjoying even better and higher pleasures?
A careful approach
to answering these questions would include discussing them with family,
friends, co-workers, and health providers, among others. This outside
input is essential because experience has shown that most of us have
difficulty arriving at an accurate cost/benefit analysis of behavior
that is (or has been) intensely pleasurable, or that in our own mind
is indispensable for coping with a prominent problem. A careful approach
to answering these questions would also include reading about the
common signs and symptoms of the addiction you fear you may have.
For instance, in evaluating your alcohol use it would be useful to
consider how many blackouts you have had, or to consider your predicted
ideal body weight as compared to your actual weight if overeating
is a problem. Almost everyone knows one or more negatively addicted
individuals who deny or minimize the negative consequences of the
addiction. Do you fall into this category for those who know you?
For most strong negative addictions, regardless of the type, common
symptoms include preoccupation with the substance or activity, loss
of self-respect, extended periods of attempting to ignore or minimize
the problem, and blowing out of proportion the actual benefits.
Very often,
someone may hesitate to conclude that there would be benefits to stopping
or cutting back, because achieving that goal may seem like an impossible
task. Many individuals prefer not to identify a problem they do not
already have a solution for. The concepts and techniques described
in this article, in conjunction with psychotherapy as needed, can
be helpful in persuading you that solutions are possible.
Sometimes those
around the addict may need to consider their own roles in enabling
the addiction to continue unexamined. Relationships may need to be
altered dramatically, or ended altogether, before some addicts begin
to perceive the actual price of their addiction. The term "denial"
is often used to describe the apparent inability of the addict to
perceive what is so clear to others. Because significant others may
not have the communication skills to impart their perceptions without
also coming across as hostile or unfairly critical, the involvement
of a psychotherapist may be invaluable. Nevertheless, a small percentage
of addicts do not alter their behavior in any significant way, regardless
of how they are approached, and the addiction may not end until (premature)
death.
Regardless
of whether you are ready to cope with your addiction, or unsure about
whether you want to, the place to begin is with a careful evaluation
of what you enjoy and appreciate about this substance or activity.
That's right: begin with the benefits and pleasures of the addiction,
not the price. Because there is much to consider, it would probably
be helpful to write down your answers to the following questions,
so you can review and revise them later. You will end up with two
lists, the Benefits of Addiction, and the Benefits of Stopping/Cutting
Back. If you wish to evaluate more than one addiction, you will need
a separate pair of lists for each one.
For the first
list, start in a general way: What is it that I like about this substance
or activity? What does it do for me? What am I afraid my life would
be like if I did not engage in this behavior?
Now get more
specific (to make sure you have not missed any benefits and pleasures):
- What bad feelings
or moods does this behavior help me cope with (e.g., frustration,
resentment, anger, irritability, fear, boredom, depression, anxiety,
tension, loneliness, stress, anxiety, sadness, etc.)? How does
it help me cope with them?
- What positive
feelings or moods does this behavior make even better? What situations
does this behavior enhance?
- How painful
would withdrawal (from this substance) be?
- To what extent
does this behavior ease or reduce physical pain?
- How concerned
am I about experiencing urges or cravings? How much do they scare
me?
- How often and
how much do I like to test my control of this behavior (see how
close I can come to the "edge" without slipping over)?
- How often and
how much do I like to test my capacity for this behavior (e.g.,
see how much I can drink)?
- How much do
I enjoy the high? What exactly about the high is satisfying?
- How much does
this behavior help me socialize and fit in with others?
- How much do
I seem to need this behavior in order to feel normal? What does
feeling normal mean to me?
- How often do
I use this behavior to help me cope with conflicts with others?
It is important to begin your
evaluation of your addiction with the pleasures and benefits of it,
because these pleasures and benefits are valuable to you. Cutting
back or giving up the addictive behavior does not necessarily mean
giving up the experience of these pleasures and benefits, but perhaps
only finding other means for obtaining them, or reducing how often
or to what extent you obtain them. Coping with addiction is much easier
when the goal includes maintaining as much of the addiction benefit
as possible.
Before you
push ahead, review this list. Are the benefits I have listed ones
I actually get now, or ones I merely used to get at one time? Do I
actually get these benefits, or are they the benefits others get?
How important are these benefits (to me, not to someone else)?
Next, evaluate
the price of the addiction, or, as we are now calling it, the Benefits
of Stopping/Cutting Back. Start again in a general way: What is it
that I dislike about this substance or activity? How does it harm
me? What am I afraid my life would be like if I continue to engage
in this behavior?
Here are some
specific questions to ask. If I stopped or cut back:
- How much more
productive would I be if not preoccupied and obsessed with this
behavior? How much more time would I have?
- How much more
energy and stamina would I have?
- How would my
health improve?
- How much more
money would I have?
- How much would
my self-respect, self-esteem, pride and sense of self-control
increase?
- How much more
control of my emotions would I have?
- How much more
honest with myself could I be?
- How much more
clearly would I think? How much would my memory improve?
- What legal
problems could I avoid?
- How would my
sex life improve?
- How much guilt
would I be able to let go of?
- How would my
sleep improve? How would I feel in the morning?
- How would my
appearance improve?
- How would my
driving improve? How much would my overall alertness and concentration
improve?
- How much better
a spouse, parent, friend, lover, employee, etc., would I be?
- What pleasures
could I experience that it is difficult or impossible to experience
now?
There are many other specific
questions that could be asked, depending on the addiction involved.
Once you have listed all the benefits of stopping or cutting back,
review the list with several more questions in mind: If I stop or
cut back, can I actually get these benefits (or do others merely say
I will)? Could I get them even if I continued to use or act as I am
currently? How important are these benefits to me?
Now compare
the two lists. As you compare them, what conclusions do you draw?
For many individuals,
the answers to the above questions are clear, and they are ready to
push ahead to learning about how to cope with the addiction, or they
are confident (and have good reasons to be) that the benefits of their
addiction outweigh the costs. For others, these questions may create
more confusion than clarity. The resolution of that confusion may
require more thought, and discussion with trusted others, including
your psychotherapist.
[TOP]
How Do I Cope With An Addiction?
Let us assume that you have
decided, at least for the time being, to stop or cut back your addictive
behavior. In either case, you are now faced with several problems:
- How to maintain
your motivation through what could be a gradual and at times difficult
process of self-improvement.
- How to cope
with urges.
- How to cope
with problems using methods other than the addiction.
- How to get
the benefits of addiction, or as much of them as possible, without
giving up the benefits of stopping or cutting back.
- How to interrupt
unconscious habit patterns (like lighting a cigarette without
knowing it) if they exist.
- How to resolve
problems brought on by previous addictive behavior (e.g., relationship
problems, legal problems, drug debts, etc.).
- How to develop
a new life style that is not centered on the addiction.
Here are some guidelines for
each of these problems:
1) Motivation
is fundamental, because if you maintain motivation you can persist
past any temporary obstacles. In most cases, the simplest way to establish
and maintain motivation is to have an accurate and complete Benefits
of Stopping/Cutting Back list, and to revise this list to reflect
the changes that are occurring as progress and setbacks occur. From
this list make a shorter Major Benefits list, the benefits which are
the primary reasons you are stopping or cutting back. A Major Benefits
list may be easier to remember than the entire original list. If these
benefits are important enough to you, remembering them (and perhaps
picturing them) regularly will be your motivation. As in learning
any new skill, setbacks and rough spots should be expected, and made
the most of as opportunities for learning. Do not allow setbacks to
become distorted evidence for incorrect beliefs. Any skill can be
improved upon with time, consistent practice, and good coaching.
2) For many
individuals, the crucial problem is coping with urges. In order to
cope well with them, it is usually necessary to understand them accurately,
rather than in the distorted manner of many addicts. Some common distortions
about urges are that urges are excruciating or unbearable, that they
compel you to use or act, that they will drive you crazy if you do
not use or act, and that they will not go away until you use or act.
Some individuals are confused enough about their own thinking that
they have a difficult time identifying distinct urges, and simply
think of themselves as behaving a certain way "because I like to."
In actuality, urges can be uncomfortable but they are not unbearable
unless you blow them out of proportion; they do not force you to do
anything (there have probably been many instances where you had an
urge but did not act), they have not driven you crazy yet (and will
not), each urge will go away if you simply wait long enough, and there
are periods between urges which become increasingly longer if you
stop. Although during the initial days or weeks of abstinence or moderation,
especially after a long period of daily addictive behavior, you may
experience many urges of strong and even increasing intensity. Recovering
addicts of all types report that urges eventually peak in frequency,
intensity, and duration, and then gradually, with occasional flare-ups,
fade away. How long it will take for urges to peak, and how rapidly
they will subside, depends on many factors, including the specific
addiction, the length of the addiction, how successful the program
of abstinence or moderation has been, and the strength of the developing
alternative lifestyle. However, as a very broad guideline, within
six months to one year most addicts will report only feeble urges
(for instance, one a week, lasting a few minutes, a 1 or 2 on a 10
point scale).
It is also
crucial not to take responsibility for the occurrence of the urge,
but only your response to it. It is normal for any addict to experience
urges, and just because on Sunday you decide to stop does not mean
that on Monday you will not have urges. The fact that urges occur
does not indicate that your motivation is weak, but that your addiction
is strong. Because all habits have unconscious components, of which
the urge is one, it will take time for these to die away. What is
within your control, however, is how you respond to the urge. An analogy
could be made to someone knocking at your front door. All sorts of
individuals might knock at your door, but it is up to you to decide
with whom you will talk. Their knocking is not your responsibility,
but to what extent you choose to speak with them is.
Specific techniques
for coping with urges include the following. When an urge occurs,
accept it, but keep it at a distance. Experience it as you would a
passing thought, one which "comes in one ear and out the other". Detach
yourself from it, and observe and study it as an outside object for
a moment. Then return your attention to what you were previously doing.
If the urge is intense, remember (and perhaps picture) your benefits
of stopping/cutting back (which can be carried in your wallet or purse).
Recall a "moment of clarity", a moment when changing your addictive
behavior seemed almost without question the right course of action.
Think your addictive behavior through to the end: When an urge is
present, you tend to think only of the Benefits of the Addiction,
but completing the image to include the negative consequences that
follow will give you a more accurate view of the whole scenario. If
the urge is very intense, engage yourself in a distracting activity,
one which you have enjoyed before and which will take your mind off
the urge, or use a specific distraction technique, such as counting
things (e.g., leaves on a plant, books on a shelf), doing arithmetic
(e.g., continually subtracting 7 from 1000, 993, 986, etc.), or focusing
on alphabetical/verbal games (e.g., saying the alphabet backwards,
reading signs backwards, searching book titles or license plates for
the alphabet, etc.). Any simple activity conducted at high speed can
fill up your attention, thereby allowing no attention for the urge.
Any thought or activity on which you completely focus your attention
is all that is needed, because if no attention is paid to the urge,
then it will no longer exist. Although another urge may come along
at any point, that urge also can be dealt with in a similar fashion.
Over time the urges come less frequently, as already stated.
To summarize
these urge coping techniques, all urges should be accepted. Low level
urges can be observed but kept at a distance. Attention can then be
re-directed to whatever one was paying attention to prior to the urge.
More intense urges can be "counterargued" by reviewing in some fashion
the benefits of not engaging in the addictive behavior, and the facts
about urges mentioned above (e.g., all urges go away eventually; they
are uncomfortable but not unbearable unless I blow them out of proportion;).
Very intense urges can be dealt with using some form of distraction,
repeated as necessary. All urges eventually go away.
To help discover
for yourself some of the basic facts about your own urges, it is helpful
to keep an "urge log", a record of all of your urges. Record the date
and time, the peak intensity (on a 1-10 scale), the duration, what
seemed to give rise to the urge (e.g., feeling down, fight with a
co-worker, just came out of the blue, etc.), and, if you engage in
the addictive behavior, to what extent you did so, and your reactions
to this (e.g., I hated myself, I felt good at first but bad later,
I was confused, etc.). Reviewing this log is often a significant part
of early psychotherapy sessions. The information on what gives rise
to the urge can be used to identify "high risk" situations (which
are discussed more below).
To keep yourself
in practice for coping with urges, it is useful to "bring out urges"
deliberately, rather than waiting for them to occur. By remembering
past good times with your addictive behavior, or by being around certain
individuals, places, or things, you can probably bring out an urge,
and then practice coping with it. Because you will have some control
over how strong an urge you bring out, you can, for instance, attempt
to have a 5 (on a 10 point scale), which you are confident of coping
well with, as preparation for dealing with 8's, 9's, and 10's, which
you may be less confident of coping well with. If you bring out urges
daily (even hourly) you may also tend to weaken any particular urge,
just as someone who is eating five or six times per day has less opportunity
to develop strong hunger than someone who eats only once or twice.
Ultimately you can gain confidence that you can cope with any urge,
but in the initial stages of developing this confidence it is easier
to cope with many smaller urges you bring on yourself, rather than
waiting for bigger urges which arrive on their own.
Although it
may be useful to avoid certain places, persons, or situations at first,
as you are gaining confidence in your ability to cope well with urges,
ultimately avoidance is not a useful strategy. You can avoid everything
that you think is risky, but nevertheless still experience urges which
seem to come "from out of the blue". To avoid much is also to restrict
your life in ways which are probably not helpful to your overall goals
in life. Avoidance is at best a temporary (though perhaps useful)
crutch.
Similarly,
some addicts attempt some sort of substitution, such as eating celery
(low calorie) every time you get an urge to overeat (high calorie).
Although the substitute may seem like a safer addiction than the original
one, nevertheless you are still reinforcing the original urge, and
essentially living in fear of it. Typically the substitute breaks
down eventually, with no gains in urge coping skills having been made.
If the substitute addiction is maintained, it may present substantial
costs itself (smoking marijuana instead of smoking coke). If the substitute
is strong enough to satisfy the urge (as perhaps in the marijuana
example), then there may be no substantial improvement in your overall
situation. If the substitute is not strong enough (as perhaps in the
celery example), you will end up needing to cope with urges anyway.
3) Another
key issue for most recovering addicts is coping with problems previously
coped with by the addiction. These can include problems worthy of
psychotherapy in their own right. The list includes all the problems
mentioned or hinted at above (in the Benefits of Addiction list).
Often the majority of addiction treatment, once the cost/benefit analysis
is conducted and urge coping is taught, is focused on learning how
to cope with these problems. In many cases one or more problems pre-exist
the addiction, and are a predisposing factor for it. Thus they may
be "bigger" problems than the addiction itself. On the other hand,
having made a decision to stop, and gaining confidence in coping with
urges, often gives an addict such a boost in confidence that other
problems are attacked with new vigor and enthusiasm.
A useful way
to identify what these problems may be is to identify your high risk
situations. These are the situations, places, persons, moods, activities,
or conflicts that you suspect will give you difficulty in your plan
to abstain or cut back. Most addicts are very able to specify what
these are. Rather than using this information in a pessimistic fashion
("I know I won't be able to pass up a drink if I'm out with Joe"),
use this information as an opportunity to develop the additional coping
skills you need to get through the difficulty. Other individuals you
know are able to cope with these experiences, and you can learn from
their example, or with the coaching of your psychotherapist. It is
also important to remember as you work on developing these coping
skills that even though they are not yet fully developed, you can
use your urge coping techniques nevertheless. For instance, suppose
that arguments with your spouse are a high risk situation for you,
and the two of you are still working on preventing and moderating
them. Even though you have a terrible fight, and are very upset about
the fact that these fights are still occurring, you can nevertheless
cope effectively with the urge that the fight gives rise to.
4) For many
individuals, getting the benefits of an addiction even though stopping
it, is synonymous with learning the coping skills described in #3
above. However, there may be benefits of the addiction that are not
based on its ability to help you cope. These benefits might include
enjoying certain rituals surrounding the behavior, companionship with
other addicts, the "high", or the sense of power or self-confidence,
if these benefits are enjoyed for their own sake, and not as a direct
means to cope with some problem.
Experience
has shown that cognitive distortions may be a significant factor in
these perceived benefits of addiction, which, once no longer experienced,
are often perceived to have had only the appearance of what was desired,
without much of the actuality. For instance, the companionship of
other users at a crack house is often considered highly valuable to
the crack user, but rarely to the recovered crack user, who recognizes
in retrospect that he or she had confused others' interest in getting
high with an interest in him or her. The recovered user also recognizes
what the addict may not, that rituals, companionship, a rush of good
feeling, selfconfidence, and other addiction benefits that are enjoyed
for their own sake can also be experienced from a number of other
sources and activities. Even if the intensity of these benefits is
at first less than what was experienced with the help of the addiction,
with practice these benefits exceed the intensity of the addiction
benefit, because they are the "real thing", not a deceptive substitute
with major side effects.
5) Interrupting
unconscious habit patterns is typically not difficult, and can usually
be accomplished by putting a barrier between oneself and whatever
one uses for the addiction (food, credit cards, gaming devices, etc).
In the process of overcoming a big enough barrier, there is enough
time to experience an urge, which can then be coped with using one
of the methods already described.
6) The problems
that have arisen from the addiction may not go away just because the
addiction is stopped or under control. These problems are also a legitimate
focus of attention in psychotherapy.
7) Ultimately,
the development of a lifestyle filled with positive addictions is
the best safeguard against a return to strong negative addictions.
The Benefits of Stopping/Cutting Back list can provide initial guidance
for which positive addictions to work on. For instance, if one of
your Benefits is "physical health", you could now consider other habits
which could contribute to obtaining this goal. You may wish to exercise
more, sleep more, or eat better. As new health habits become more
deeply woven into your life, you may also find yourself getting from
them the benefits you previously sought from your addiction (e.g.,
feeling good about myself; having more energy).
In addition
to helping yourself get the Benefits of Stopping/Cutting Back by developing
new habits, this is also a time to consider what is most important
for you to experience in the finite but uncertain period that is your
lifetime. There is no better time than now to begin moving toward
what is most important. As you take small steps toward your ultimate
goals--and there is rarely any other way than by small steps--you
will also be building positive addictions, and safeguarding against
the return of negative addictions. How could a negative addiction
again take hold if I am actually pursuing what is most important to
me?
Just in case
this last question confuses you, consider the difference between means
and ends. If someone states that "what is most important to me is
using heroin", follow-up questions will reveal that using heroin is
actually a means to an end, such as "feeling calm and at peace". It
is the feeling calm and at peace that is most important, not the heroin
use, and the heroin user can discover ways to accomplish that end
by other less costly means. It is not the end that is the problem,
but the means. In fact, all of us (including every addict) should
give himself or herself credit for pursuing noble ends, and get to
work on finding better means.
Thus, this
question could be rephrased, how could it happen that a more costly
way of getting what I truly want could actually replace a less costly
way? Perhaps the only way this could occur is if you believed that
your addiction were the only way, or the fastest way, or the only
way for you to achieve your goal. With luck you are recognizing that
such a belief is highly questionable.
[TOP]
Do I Need To Stop Completely,
Or Could I Just Cut Back?
Just as only you can decide
whether one of your addictions is positive or negative, and how much
so, only you can decide whether the best way to cope with the problems
of a negative addiction is abstinence or moderation. Because the methods
of accomplishing either goal are similar, they have not been differentiated
thus far in this article, but you may have had the question much on
your mind as you were reading.
A common sense
approach to the problem of "overdoing it" would be simply to moderate
the behavior and cope with the negative consequences (if eating dessert
every night makes me fat, I'll only eat it on the weekends, and I'll
exercise more). The rationale would be that, in this manner, you could
still enjoy the behavior, without suffering the more serious negative
consequences. Although, for many years, many have suggested that moderation
is not an appropriate goal for someone who is "addicted", there are
not widely accepted guidelines for how bad a problem must be for it
to be called an addiction. Furthermore, some individuals who by some
definitions are considered addicted are nevertheless able to moderate
their behavior, and some addictions are of necessity approachable
only with a moderation approach (e.g., eating, spending). Consequently,
common sense, experience, and necessity (a compelling combination)
suggest that moderation be considered.
The following
guidelines may help you in your decision. The most crucial factor
in adopting moderation as a goal is whether you can actually do it.
Relabeling your out of control behavior as "moderation", but not changing
it, does not improve your life. Cutting back for a period of time,
but gradually resuming former patterns, is only momentary improvement.
Are you moderating most of the time, but still having binges which
are very costly, but easy to ignore and rationalize because they are
not in a fixed pattern? Any attempt at moderation remains an experiment
for as long a period of time as is needed to conclude that danger
is past. Because you could never conclude this with certainty (although
if it is working, you would have increasingly higher levels of confidence),
moderation should always be open to review. No matter how successful
you were, there would always be some risk that you would engage in
some degree of denial, and slip back to non-moderate behavior. Because
such non-moderate behavior could lead to death or ruin, such a risk
should not be taken lightly.
If you seem
to be having success with moderation, at what price is it? Are you
frequently needing to cope with strong urges, such that you are wasting
significant time and energy on them? Is your substance or activity
preoccupying you, in ways other than urges, nevertheless? Are you
still experiencing substantial negative consequences, just at a slower
rate (e.g., the drinker who is killing off his liver at the rate of
3% a year instead of 5%)?
Because there
is no benefit of a negative addiction that cannot be obtained or approximated
by another method (which, with proper practice and coaching you could
learn), the safest decision remains abstinence, because over the long
run you would lose nothing or little by it, whereas with moderation
there remains the danger of runaway addictive behavior. However, abstinence
can require a greater expense of time and effort up front, if many
new skills need to be learned. This expense understandably deters
many individuals. However, over the long run abstinence may be "cheaper",
because the cost is at the beginning, and the maintenance expense
and risk are low thereafter.
If moderation
is your goal (actually a sub-goal or means to the larger goal of getting
the Benefits of Stopping/Cutting Back), then you may need specific
guidance on what moderation for your addiction would be. For instance,
up to one drink an hour, up to three drinks a day, up to four days
per week, is one definition of moderate drinking. Beyond this amount
you would to some extent be losing the Benefits you desire.
[TOP]
Am I Someone Who Has No Choice?
Do I Have To Quit?
There is no one who has to quit
an addictive behavior. There may be many benefits to your quitting,
it may be quite unintelligent of you not to quit, and your behavior
may kill you or ruin you or lead to your imprisonment if you do not,
but it remains quite possible for you to continue on (just as many
before you have done--even in prison!). Only you can make this decision,
and presumably you will do so by examining the benefits of the addictive
behavior and the benefits of stopping or cutting back.
If you accept
the notion that you are someone who cannot do this, who has to stop,
you are very likely setting yourself up to feel angry, resentful,
left out, frustrated, like you are missing out, depressed, irritated,
bored, and so forth. If you are already using your addictive behavior
to cope with various negative feelings, you may use it to cope with
these also. To prevent these feelings, it is better to tell yourself
what is really true, that you can do this activity or use this substance.
The crucial question is whether you truly want to.
Others may
tell you that you have to stop, or that you are the kind of person
who has to stop. Despite a poor choice of words, they are actually
attempting to express their concern for you, and their fear that you
are denying the extent of your problems. Unwittingly, they may be
creating more problems for you, because most of us react to being
forced (boxed in, railroaded, not given a choice) by attempting to
prove that we do have a choice. Unfortunately, this reaction leads
back to more addictive behavior, which may not be what you truly want.
One expression for this kind of behavior is "cutting off your nose
to spite your face".
If someone
insists that you have to stop, ask for the observations on which this
conclusion is based. You can disagree with the conclusion but still
learn a great deal from the observations.
You do not
need to accept any label that anyone, including this author, suggests
to you. If someone asks if you are an addict (or some other term),
you can simply say "No, I just thought y life would be better if I
stopped (cut back), so I did". If offered your substance or activity
by someone, you might in all sincerity reply: "No thanks, I enjoy
it too much!"
[TOP]
Do I Need To Attend Group Meetings?
Alcoholics Anonymous (AA) was
founded over 50 years ago as a fellowship of individuals with alcohol
problems. Through fellowship with one another, and spiritual re-awakening,
abstinence was believed to be possible. The AA approach has been beneficial,
in one way or another, to millions of individuals. The Twelve Steps
(or principles) of AA have been adapted to groups serving most of
the major addictions (Cocaine Anonymous, Overeaters Anonymous, Narcotics
Anonymous, Debtors Anonymous, etc.). All groups are free of charge,
and most are widely available.
Twelve Step
groups for substance addictions encourage abstinence from all mood
altering chemicals except caffeine and nicotine. Twelve Step groups
for activity addictions encourage abstinence from the activity. Overeaters
Anonymous differentiates normal eating from overeating, and encourages
abstinence from overeating. Twelve Step groups view addictions as
diseases. The central premise of the disease concept (or disease model)
of addiction is a paradox: the addict has no control over the addiction,
except through complete control by abstinence. From the disease model
point of view, moderation of addictive behavior is an unrealistic
goal for a true addict.
The available
scientific evidence on the question of "loss of control" provides
very little support for the disease model. There are many anecdotes
that appear to support the disease model, but anecdotes represent
a very low level of scientific evidence, and appearances are not always
realities. An excellent review of this question (for alcohol) is provided
in Heavy drinking: The myth of alcoholism as a disease, by Herbert
Fingarette, published in 1988 by the University of California Press.
This short but well referenced volume is intended for the general
reader.
An alternative
approach to addiction is outlined in this article. This alternative
model does not yet have a widely accepted name (cognitive model, social
learning model, relapse prevention model), but there is already a
significant body of research supporting its premises and effectiveness.
In this alternative model addiction is considered a bad habit, not
a disease. Moderation can be an acceptable goal.
Belief in a
"higher power" (another central concept of Twelve Step groups) is
neither encouraged nor discouraged: You don't need to go that high
to solve the problem! Self-reliance, not reliance on a higher power,
is emphasized. The concepts and techniques outlined above can help
you build upon the good habits you already have, until the negative
consequences of the addiction are resolved.
Perhaps most
importantly, an all-or-none approach is not employed in this alternative
model. If there are slips along the way, it does not mean that you
have lost everything and must start again at the beginning. The slip
that has occurred may only be a sign that you have pushed yourself
to face a new level of challenge, and somewhat misjudged the challenge
or your skill level. This is not written to encourage slips, but to
help you recognize that they can be a part of learning. If a slip
seems to indicate that your approach is not working, this too is learning,
and suggests finding a new approach, or getting more coaching. Over
the long term, success is obtained if you prevent slips from becoming
total relapse. If a relapse does occur, re-commit yourself to your
goal.
Some individuals
will not attend Twelve Step meetings because of fears regarding confidentiality,
dislike of groups, disagreement with the disease model, lack of belief
in a higher power, or other reasons. Nevertheless, these groups may
represent an important resource for you. One can accept the social
support without necessarily agreeing with all of the concepts presented.
It can also be very encouraging to observe others who have coped successfully
with a problem you may still be struggling with.
[TOP]
What If I Don't Have Enough Willpower?
There are two main components
to accomplishing any task: knowing what to do, and being motivated
to do it. Reviewing the Benefits of Stopping/Cutting Back will remind
you of your motivation.
However, being
motivated is not enough. No matter how motivated you are, you cannot
perform a skill you have not learned. Practicing the techniques suggested
here, and getting the coaching you need, will eventually get you skilled
enough to be able to cope with urges and with any other problems relevant
to your addiction. Although there may be slips along the way, each
slip is an opportunity to identify and learn better coping skills.
You probably
know someone who wants to have a skill you already have, but who does
not practice it sufficiently, or who stubbornly refuses to take guidance
from those who know more.
You may observe
this behavior and think: If he (she) would just work at it harder,
or be more open to suggestion, eventually success would occur; not
to do so is self-defeating. Are you any different?
[TOP]
What Key Ideas Do I Need To Remember?
If, after careful consideration,
you have decided that the benefits of stopping or cutting back on
a substance or activity outweigh the benefits of engaging in that
behavior, then you may have one or more problems to solve, such as
maintaining motivation, coping with urges, coping with underlying
and predisposing problems, replacing the pleasure of the former behavior,
changing unconscious habit patterns, coping with problems left over
from previous behavior, and developing a lifestyle of positive addiction.
With practice and good coaching, and a continued focus on the benefits,
you will obtain by changing your behavior, you can learn the skills
necessary to solve these problems, even if at times your progress
is not smooth or continuous. In this way, you can move forward to
new and greater pleasures and benefits in life, rather than being
stuck in repetitive and harmful behavior patterns.
[TOP] |
|
