by Thaddeus Camlin, Psy.D.
Much is being said about changing the nomenclature in the treatment of problematic substance use. The latest diagnostic manual (DSM-5) no longer uses the term ‘addiction.’ Anne Fletcher wrote about the value of cleaning up the language of addiction using powerful comparisons to other avenues of treatment. She astutely pointed out that no therapist would tell people trying to lose weight that no progress would be made until they labeled themselves in a pejorative way. Can you imagine a therapist telling someone who is overweight that before work can begin she or he must identify as a fat pig? To do so would be unconscionable. Yet, it is all but universal in the treatment of problematic substance use that an individual is told that no progress will be made until she or he embraces a label like addict, alcoholic, drunkard, junkie, etc.
Another such word that deserves rethinking is trigger. Pretty much every treatment facility I’ve ever encountered insists that clients identify triggers as a fundamental aspect of treatment. Once identified, much thought and effort is put into planning how triggers will be avoided. However, the reality is that it is impossible to avoid all triggers.
Luckily behaviors cannot be triggered, only thoughts and feelings. Certain thoughts and feelings then prime us to act in habituated ways. But in fact, our freedom lies in choosing how we respond to the thoughts and feelings that are triggered, which makes triggers excellent opportunities for growth and progress. Systematic exposure to triggers is one of the most effective forms of treatment. Yet, the word trigger inherently implies that an irreversible process has been set into motion. Once you pull the trigger, there is no getting the bullet back into the gun.
A more accurate term to describe events that lead to urges to use substances is ‘cue.’ If we fight with a loved one we may feel the urge to drink, but we don’t have to. Saying we drank because we were triggered implies that we couldn’t help the decision, and places the responsibility for our actions on external sources. If you doubt these points about triggers, try going to court and telling a judge that it’s not your fault you drove drunk because your boss triggered you.
In early recovery, avoiding obvious cues is highly valuable. It’s probably not the safest decision to go to your favorite bar in the first week of addressing a problem with drinking. But as you progress, systematically exposing yourself to cues, ideally with profession support (see Cue-Exposure Therapy), is an excellent way to build confidence and self-empowerment.