Cognitive therapy is a well develop system for teaching people how to effectively manage their thoughts, feelings, and behaviors. When cognitive therapy is applied to addiction treatment, it needs to be addiction-focused. It needs to teach abstinence skills, and address the thinking, feeling, and behavioral problems that can lead to relapse. The language of cognitive therapy also needs to be adapted to fit in with the culture of addiction recovery. That culture is strongly based on Twelve Step principles so the similarities between cognitive therapy and twelve steps programs must be explained in clear and easy to understand language.
Cognitive therapy for addiction focuses on five primary skill areas that are critical to addiction recovery: (1) Addiction-Focused Problem Solving; (2) Managing Addictive Thoughts; (3) Managing Addictive Feelings; (4) Managing Addictive Behaviors; and, (5) Making Cognitive Restructuring Skills A Habit.
When addicted people first enter treatment they are usually experiencing serious problems or life crisis. Although most of these problems are caused or complicated by their addiction, the problems must be stabilized before the client can focus on learning how to stop drinking and drugging, and how to stay sober. Once they get sober, a variety of situations and life problems can come up that can cause them to relapse.
To deal with these addiction-related problems, recovering people need to learn to manage these problems in a sober and responsible way by identifying and clarifying problems, setting appropriate goals for staying sober while solving their problems, developing concrete problem solving plans, and continuously reviewing problems and progress in problem solving with a therapist, spiritual advisor, and/or Twelve Step Sponsor. Throughout the problem solving process, recovering people must maintain a keen awareness of the relationship between their life problems and addiction.
Most addicted people have never established the relationship between alcohol and drug use and the problems they are experiencing. To establish this relationship, four clarifying questions are used: (1) How is this problem related to your alcohol or drug use? (2) What will happen to your ability to solve this problem if you KEEP USING alcohol or other drugs? (3) What will happen to your ability to solve this problem if you STOP USING alcohol or other drugs? (4) What can drinking and drugging do for you that you can’t do for yourself without drinking and drugging?
Addictive thinking is any way of thinking that justifies the use of alcohol or drugs in spite of the problems and pain they are causing. When the pain gets bad enough and the problems get severe enough the addict feels trapped with no way out. Feeling trapped activates an addictive thinking process that makes the recovering addict feel like alcohol and drugs can make the pain and problems go away. The addictive thoughts keep getting stronger until the recovering addict is convinced that the only way to manage the pain or solve the problems is to use alcohol or other drugs.
The thought management component of cognitive restructuring for addiction shows recovering people how to identify and manage the addictive thoughts that can cause unnecessary pain and problems and convince them that it’s OK to use alcohol or other drugs to manage their pain and solve their problems.
Addicted people tend to mismanage their feelings and emotions. They block, exaggerate, or distort their feelings. When people block their feelings, they push them down and refuse to acknowledge what they are feeling. When people exaggerate their feelings, they think thoughts that make the feelings more intense. As a result, recovering people can get into an emotional spiral. They have a feeling and think about it in a way that makes the feeling more intense. Then the feeling gets worse and they repeat the process until they are in an emotional crisis.
Unless they learn effective emotional management, they can start to feel so bad that drinking and drugging seem like a good choice. Cognitive Restructuring for Addiction teaches recovering people an effective system for managing feelings and emotions in recovery.
When people become addicted, they develop a wide range of habitual behaviors, called drug seeking behaviors, that have only one purpose – to put them around people, places, and things that support their drinking and drug use. In order to recover from addiction, people must learn to identify and change these drug seeking behaviors and replace them with sobriety seeking behaviors.
This involves three things: First, avoiding people, places, and things that can make them want to start drinking and using drugs. This leaves most recovering people with a lot of free time on their hands. Second, developing a schedule of recovery activities that put them around recovering people and forces them to think about and talk about their progress and problems in recovery on a daily basis. Third, develop the social skills needed to be able to fit in and enjoy their recovery activities.
These new cognitive restructuring skills must become habitual. To develop these habits they need to use addiction-focused problem solving whenever they face any problem in their life. It also means learning the habit of consciously monitoring and managing their thoughts, feelings, urges, actions, and social reactions.
The Cognitive Restructuring for Addiction process can be summarized in the following steps:
Step 1: Addiction-focused Problem Solving: Learn to solve problems that cause pain in recovery and can lead to relapse.
Step 2: Thought Management: Learn to identify and manage irrational thoughts that can activate cravings to use alcohol or other drugs.
Step 3: Feeling Management: Learn to identify, label, talk about, and resolve feelings without using alcohol or other drugs.
Step 4: Behavior Management: Learn to identify alcohol and drug seeking behaviors that put you around people, places and things that support your addiction and replace them with sobriety-seeking behaviors that support recovery.
Step 5: Develop New Habits In Recovery: Consciously monitor the addictive thoughts, feelings, and behaviors that cause unnecessary pain, problems, and cravings for alcohol or other drugs. Learn to replace them with sober thoughts, feelings, and behaviors that help to manage stress, relieve pain, and solve problems without having to use alcohol and other drugs.
The successful use of cognitive restructuring can result in profound changes in the thoughts, feelings, and behaviors of the recovering addict. Cognitive restructuring is an efficient and effective technique that the client can readily employ when the need arises. Through the structured and systematic process of change, the client can reduce the risk of relapse and create a life of sober and responsible living.
Cognitive Restructuring for Addiction is available as a three day intensive seminar. The publication is available athttp://www.relapse.org.
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ReplyDeleteLike many people, at the start of the year, I made a resolution to decrease my alcohol intake.
ReplyDeleteDrink Less in Seven Days by Georgia Foster has really helped me stick to this resolution. Georgia is a clinical hypnotherapist and alongside the written version of the book, there are also 4 "Hypnosis Hub" recordings that readers are encouraged to access to help them with the program.
One of the great things about Drink Less in Seven Days is that Georgia (and I"m going to call her Georgia because she kind of feels like a friend) is totally non-judgemental about how much you drink, why you drink, why you feel you drink too much etc. I feel that this is an area where people carry a lot of shame and negative feelings and to have someone who approaches an emotional issue like this with absolute objectivity is helpful in driving the desired behaviours. She's on your side!
There are two main parts to Drink Less in Seven Days. The first is how your amygdala (the part of your brain that deals with emotions and fear/stress responses) can actually work against your efforts to quit or reduce your drinking. It shows you how to move your decision to drink away from this very instinctive part of your brain to your prefrontal cortex which is the part of your brain that is more concerned with considered decision-making.
I found this part of the book fascinating, particularly the parts where she spoke about silencing your inner critic.
However, it was the second part of the book, where Georgia broke down different personality types. what triggers them to drink and how to circumvent these triggers that I found most useful. (Also fascinating, if like me you love a good theory of behaviour and the ability to proclaim "Yes!!!! That's me!"). Because it makes total sense right? If you drink out of social anxiety (which is me a little bit) your methods to success will likely be different to someone who drinks because everyone around you is (also me a little bit).
The biggest take away for me was starting to understand what triggers my wanting to drink and learning alternative strategies should I decide not to. I think a really important thing about Drink Less in Seven Days is that it is NOT about quitting drinking altogether. It is about cutting down to a level that you are comfortable with, whatever that is for you. And this feels more manageable than quitting altogether.
The cru of this type of book though is does it work?
So here's the real deal. I started this program in January. It's now March and I can count the times I have drunk alcohol on one hand. During this time I have been to pubs, bars and restaurants, entertained at home and been entertained at other people's homes so it's not like I have been hiding myself away. I have been around alcohol and people drinking as much as I ever was.
Will I drink again? Almost definitely. For me, this experiment was never about giving up altogether. And I have far too much fun making cocktails for this to give it up completely! However, I feel that moving forward I will be able to drink in a more mindful considered way.
Thank you to Georgia Foster for a thoroughly fascinating book that does exactly what it says on the cover!
Here's a link to The 7 Days To Drink Less Online Alcohol Reduction Program.
John