When reading this section, remember that if

addiction was a product of the rational, logical 

parts of your brain, there would be no such thing as addiction.

No one chooses slavery. You must negotiate with your inner caveman.

There is a space between suspecting you may have an addiction and deciding that you are going to do something about it.

People, on a regular basis, suspect they may be addicted to some behavior or substance.  At such times they may contemplate doing “something” in order to get a handle on things.  Typically, they will try to avoid the behavior.  I will be using the term “behavior” here to mean both substance addictions, such as addictions to cocaine or alcohol, and behavior addictions. such as addictions to porn or gambling, since the activities of cocaine and alcohol consumption, along with other substances, frequently involve addictive behaviors coupled with tolerance to, and withdrawal from, the substances.  As far as the brain is concerned, the addictions all work with the same areas of the brain and involve the same mechanisms and stopping the behavior is always uncomfortable.  If it were not uncomfortable, stopping would not be a problem.

The time between suspecting that you have a problem and actually stopping the behavior is the space I want to explore at this point.

Between now and could be

A decision impatiently waits

Sometimes, you have an itch and you scratch it and you feel better, and that’s the end of it. Sometimes, you have an itch and you scratch it, and you feel better for a short while, and then the itch comes back and you scratch it again, and it comes back and you scratch it and your skin becomes sensitive and raw and you scratch it and you start to bleed and your skin becomes a mess. So you realize that you have to stop scratching or your insides will be on the outside. So you stop scratching and you go through an unpleasant period of time of itching a lot and eventually your nerves stop sending itch messages to your brain because that’s the way nerves work. It’s like they become numb or non-functional or exhausted. So, if you have that kind of an itch just stop scratching as soon as possible. You’re going to have to do it sometime, so do it now, before your insides are on the outside.

People who are unfamiliar with addictions and neuroscience have a tendency to think “What’s the problem?  If you decide something is not good for you, just stop!”  In reality, that is not how our brains work.  Asking someone to “Just stop! is like telling someone to “Make your brain work differently!” Making good choices is a part of the solution but by the time someone is addicted, other parts of their brain are strongly involved in making decisions. Addictions reside, for the most part, in the areas of our brains where our basic drives come from.  Urges to engage in sexual activity or to act upon hunger by seeking food also reside in these areas of the brain.  Most people understand that we are not always wise when it comes to having sex or who we have it with. And when we eat we frequently eat unhealthy foods because they taste good, or when we drink we may possibly drink unsafe  water just because we are very thirsty. We all have experience giving in to these drives and engaging in potentially unsafe or problematic behaviors. When a person is addicted they have created an artificial drive which is just as powerful, if not more so, than the drive for sex, food, or thirst and which resides in the exact same areas of the brain and which uses all the same neural pathways as our hardwired drives.  To understand how our brains can have different, sometimes conflicting, goals and objectives please see my page The Divided Mind.

I strongly urge that anyone contemplating ending an addiction think long and hard about how they want their life to proceed.  Make this evaluation while you are still actively addicted, before you feel the discomfort which comes with cessation.  Understand that it is NOT easy.  Do a Cost Benefit Analysis and get a feel for how the addiction is impacting your life.  Take as much time as you need for this and when you have made your decision, PROCEED.

 

“If you took a moment to reflect upon how many human beings across all of history have had to live all of their years — their brief stint on this imperfect planet — beneath the weight of disappointment, emptiness and regret, you would look at the opportunities in front of you and you would see them in a new light.
You would take yourself more seriously.
You would realize that perhaps you are not someone held back by true impossibility, but by an unwillingness to be uncomfortable. Held back by the compulsion to seem cool and fit in and to do what has always been done in the way that you have always done it, to slide by on the surface and never touch anything calling to you from just beneath.
You would realize that the stories you tell yourself about why you are stuck and cannot move forward are just that — stories. That anybody who has changed their life in any significant, beautiful way was also confronted with a terrifying, endless unknown through which they had to hold up a torch lit by their own desire and make their way to the other side.
You would realize that you now have to choose what you will hurt for — the pain of the life you might have had, or the pain it takes to start having it. One is an endless suffering masked by a constant pleasure. The other is a more acute discomfort that opens the path to genuine happiness and inner peace.
Then you would realize that there is only one choice.
And you would start running toward the horizon.”

Brianna Weist

 

If, after evaluating the affects the addiction is having on your life, you decide to stop right then, do so. If that seems to be too radical of a move, then set a date to stop and prime yourself so that you are ready when the date arrives. (See What Worked for Me and What Might Work for You at the bottom third of this page). If you decide to stop, don’t look back.  Implement your decision.  Every person who has actually given up an addiction will be familiar with the thoughts and actions which follow, and will have experienced the fear and reluctance which accompanies a quit attempt.  When you think any of these thoughts, understand that you are thinking them because that primitive part of your brain is hungry and is trying to influence your behavior, but also understand that if you allow this part of your brain to call the shots, you will never end your addiction and all the negative things you wrote down in your Cost Benefit Analysis will continue to be a part of your life, and they will, almost certainly, be worse and will be joined by new horrors which you have yet to imagine:

1.  You decide to stop but think some indefinite time in the future is a much better time to stop instead of today.

Caught between quitting

And using, I’m motionless

A fly poops on me

“A year from now you will wish you had started today.” -Karen Lamb 

• You are motivated NOW.  You have thought long and hard about this decision and have decided to quit, either right now or at some date in the future.  If you let this temporary need determine your behavior you will be enslaved forever.

2.  You have stopped but think to yourself “I’ll just do the behavior a little (smoke a little, have only one beer, get on the computer and read porn rather than look at hard core porn).

• This “I’ll just give in a little” strategy almost NEVER works.  You have trained your brain to look for comfort and satisfaction in the addiction and when you give in “a little” you are just rewarding the same old behavior.  You are once again “Feeding the Wolf“, making it stronger and making the dog weaker!  You will either NOT do just a little, or you will be much more likely to go back to the behavior in the future.  If you feel relief, you are rewarding the behavior.  If you do not feel relief, then what’s the point of doing it?

3.  I’ve been abstinent for a few days (months, years).  I am cured.  I can engage in the behavior like a normal person.

• You have trained your brain like you probably trained yourself to ride a bicycle.  Thirty years after you have ridden a bicycle, you can get on one and you might be a little rusty, but you will know how to ride it and will shortly be the expert your were thirty years ago.

4.  Stopping this behavior is not really that important (or “The behavior’s not that bad”).

• You made your decision already.  You thought long and hard about it.  The only reason you are having second thoughts is because you are uncomfortable.  This discomfort will not last forever.  Urges will come for a short while and then subside.  See the Cravings section down below on this page for help getting through these urges.  Just determine to get through the next hour. Get through today.  Each minute that goes by puts you that much closer to the day you don’t think of the addiction at all.  It is not that many days away.  I promise you.

5.  Stopping is too hard.  I’ll never be able to do it.  I may as well give up now.

• Again, that is your Reptile brain talking.  Over half the population has given up some kind of addiction.  It is true that some addictions are harder to stop than others, but there are countless people who have successfully ended your specific addiction, whatever it is.

6.  I’ve tried to stop before and failed.  Why go through all this discomfort when I am doomed to failure.

• You clearly are not doomed.  You have learned from past “quit” attempts what to do and what not to do.  The fact that your are reading this and are looking at this site is evidence you are making a serious attempt to stop and are open  to learning how to stop. This is the last time you will ever have to feel this discomfort.

7.  If I stop now, I will not be able to (choose one or more) do my job; maintain my relationship with my kids/wife/husband/significant other; be functional for whatever is coming up in the future.

• If you continue with your addiction, you will almost certainly lose everything that your reptile brain is telling you to worry about losing.  It is the nature of addictions that continuing them leads to their becoming more important in our lives, and as they become more important, everything else becomes less important.

8.  If I stop now people will be able to see me going through withdrawal and they will know I’m addicted.

• I’m sorry, my friend, but I would be amazed if people did not already know of your addiction, or at the very least, know that something is radically, terribly, wrong.  Take control of your life.  The time is now.

9.  If I stop I could endanger my health.

• If ending your addiction could result in a dangerous health condition, then contact a doctor who understands withdrawal and stop with his oversight.

10.  I don’t know which program to go to.

• Get advice from friends.  Go to Yelp.  Do some research.  Do these things before you stop.  It’s time to get busy.  Despite all the influences that make this process so problematic, it is YOU, your logical, thinking brain, which must take responsibility for your behavior.

11.  I don’t have any (or the right) healthcare coverage.

• Many people quit on their own.  There are programs who will take you in without requiring that you pay them.  There may be somebody in your life who will help you.  Get creative.  The fact that you face a problem does not mean you are defeated.  It means you have something to overcome.

12.  I can’t afford to stop as (choose one) treatment is too expensive; I would lose money because I would be unable to work.

• You can’t afford NOT to stop.  Whatever you spend stopping is a pittance when compared to the time and money you spend on the addiction.

13.  You think about the addictive behavior with longing every once in a while, but you make no conscious decision to use (or do).  At some point, without ever really making a decision, you find yourself heading towards that which you have decided you want to avoid.

• This is the most insidious, and yet, the most common scenario.  You’re driving down the street, notice a liquor store and pull into the parking lot.  You’re not aware of thinking about it, your just doing it.  As soon as you become aware of what you are doing, STOP!  If you’ve pulled into the parking lot of a liquor, stop yourself and think for five or ten minutes. Do a Cost Benefit Analysis or think about why you want to stop. Take a moment and weigh the consequences.  There is no rush to get into the store to buy alcohol or rush into the dealer’s house to cop.  Just sit there and take out your Cost Benefit Analysis and look at all the things you hate about the behavior and all the negatives it has brought into your life and everything you are risking by continuing it.  If you don’t have it with you, then think about it.  You can always read that list (or think about it) and still decide to go in to buy something to drink (smoke, gamble, or whatever).  You have not given up some wonderful opportunity.  You have given  yourself time to make a considered decision and decide with your reasoning brain, what it is you truly want to do.

Some people recommend you give yourself negative reinforcement every time you think about engaging in the addictive behavior.  Dr. Albert Ellis, psychologist, has suggested people wear a rubber band around their wrist and immediately after they think about the behavior they pull on the rubber and let it snap back onto their wrist. It doesn’t have to be a big pain, just a slight negative experience is enough. It’s a way of taking control of one’s conditioning.

To see other’s ideas about our ambivalence to stopping go here, and here.

From a Facebook post on Sober Janurary, or Sober (insert whatever month it is):

If you have decided the wolf has too much control over your life, that you are, in fact, dependent on a substance or activity that is having an unacceptable negative impact on you, then the next thing you need to decide is what should be done about it.  About half of all people who decide to take control over a dependency just stop the behavior. If you’re like me and have struggled for years to end an addiction, you’re thinking “WTF!”.  Of the half who struggle to stop, various degrees of effort will be required if progress is to be made towards recovery.

Why are we all so different, you may wonder?  We respond differently to exposure to addictive stimuli because of genetics and because of the things which have happened to us in our lives – our individual histories.

Like everything else about us, there is a range in the effectiveness of our neurotransmitter systems.  The eight basic neurotransmitters, “serotonin, dopamine, GABA, glutamate, opiate, noradrenergic, endocannabinoid, and acetylcholine” (see Brain In Balance by addictionologist Fred Von Stieff) come into play in various degrees for all of us, and for some of us there is an imbalance which makes us susceptible to addiction.  We just don’t get the same bang out of life as others do and as a consequence we are sitting ducks for some substances or experiences which provide that zest for life which we all want, or that peace we have trouble finding.

What are the causes of these variances in dopamine function?  Some people feel that genetics plays the major role while others feel prenatal and postnatal development are primarily responsible. There is a growing body of evidence which shows that women who experience high levels of stress during pregnancy will release cortisol, which negatively affects the number and density of dopamine receptors in the brain and has been shown to increase the susceptibility of women to nicotine addiction.

Some of us may have traumatic events in our pasts or troubling occurrences which cause us to use in order to cope with them, forget them or become numb to them. See the CDC study on Adverse Childhood Experiences (ACE Study) According to the National Institute of Alcohol Abuse and Alcoholism, the experience of uncontrollable trauma has been shown to increase both the risk of Post Traumatic Stress Disorder (PTSD) and alcoholism.

PINK FLOYD LYRICS

  

“Comfortably Numb”

 

Hello, Is there anybody in there Just nod if you can hear me Is there anyone at home Come on now I hear you’re feeling down I can ease your pain And get you on your feet again Relax I’ll need some information first Just the basic facts Can you show me where it hurts

There is no pain, you are receding A distant ship smoke on the horizon You are only coming through in waves Your lips move but I can’t hear what you’re saying When I was a child I had a fever My hands felt just like two balloons Now I’ve got that feeling once again I can’t explain, you would not understand This is not how I am I have become comfortably numb

O.K. Just a little pin prick There’ll be no more aaaaaaaah! But you may feel a little sick Can you stand up? I do believe it’s working, good That’ll keep you going through the show Come on it’s time to go.

There is no pain you are receding A distant ship smoke on the horizon You are only coming through in waves Your lips move but I can’t hear what you’re saying When I was a child I caught a fleeting glimpse Out of the corner of my eye I turned to look but it was gone I cannot put my finger on it now The child is grown The dream is gone And I have become Comfortably numb.

The problem is that while our coping strategies may work for awhile, over time they stop working and become destructive both to ourselves and to others.   What was once perceived as pleasure and relief has turned into enslavement, pain and dysfunction.  For most of us, our lives had become a shambles.

Addiction and trust: Marc Lewis at TEDxRadboudU 2013

SAMHSA Substance Abuse and Mental Health Services Administratin https://store.samhsa.gov/product/samhsas-working-definition-recovery?referer=from_search_result Working Definition of Recovery

Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.

Principles of Recovery

• Person-driven;
• Occurs via many pathways;
• Is holistic;
• Is supported by peers;
• Is supported through relationships;
• Is culturally-based and influenced;
• Is supported by addressing trauma;
• Involves individual, family, and community strengths and responsibility;
• Is based on respect; and
• Emerges from hope.

Furthermore SAMHSA’s Recovery Support Initiative identifies four major domains that support recovery:

• Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
• Home: a stable and safe place to live that supports recovery;
• Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
• Community: relationships and social networks that provide support, friendship, love, and hope.

There is no set time requirement for recovery as it is recognized that this is an individualized process whereby each person’s journey of recovery is unique and whereby each person in recovery chooses supports, ranging from clinical treatment to peer services that facilitate recovery.

There is also no set time requirement for deciding it is time to give up an addiction. Take as long as you want to make that decision, but once you have decided, it is time to act. Procrastination is not useful.

Song by Damien Rice

1

 

Whatever is problematic about our genetics or our pasts, we have arrived at that unpleasant destination:  we have a problem and we need to figure out what to do about it.

If we are among that half of the addicted population which cannot stop just by deciding to, we will need help, guidance and education. Traditionally, people have turned towards various and sundry peer-support recovery groups, rehabs or psychotherapy/mental health therapy.  This is not a one size fits all situation and people are encouraged to look around and find what works for them.  Twelve-step groups have been around a long time, since 1935, and have helped many, but they are not for everyone. Incorporating a belief in a Higher Power is central to the recovery process in AA, but each meeting is different. They are not  all necessarily Christian-centric like it’s predecessor, The Oxford Group. The wisdom of the group, as expressed by meeting attendees, is a key part of recovery for AA, and this can be either good or bad, depending on the group.  Their strength is that they have name recognition and are ubiquitous.  You can find meetings almost anywhere and, depending on your area, usually multiple meetings on every day of the week.  Their weakness is that twelve-step is not an evidence-based program and it’s precepts rely, for the most part, on tradition and hearsay guided by the wisdom and scientific understanding which was available in 1935.

The following information is from the New York Times (https://www.nytimes.com/2014/07/06/nyregion/a-different-path-to-fighting-addiction.html) and original studies are sourced:

The Cochrane Library, a health care research group, reviewed four decades of global alcohol treatment studies and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.” 

From a study involving eight trials which included 3417 people:

Abstract

A good rule to go by can be found in the prologue of Project Match: “No single treatment approach is effective for all persons with alcohol problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients.”  Project Match, which began in 1989, was an eight year study funded by the National Institute on Alcohol Abuse and Alcoholism which compared the effectiveness of different types of recovery methods. Many find the results flawed and one-sided and treatment alternatives have proliferated since that time, but here is an excerpt from the Hazelden report on Project Match.

The three treatment approaches were: 

1. Cognitive Behavioral Therapy (CBT), 2. Twelve Step Facilitation (TSF), and 3. Motivational Enhancement Therapy (MET).   Study Results—Few “Matches” Found

Outcomes were measured in terms of percent of days abstinent (PDD) and drinks per drinking day (DDD). There were no significant differences across treatment approaches during and after reatment; patients in all treatment groups reported considerable reduction in drinking.

Post treatment Drinking Outcomes Patients in all three treatment groups reported significant reductions in drinking during the one year, post treatment follow-up period. Differences across treatment groups were not significant, although TSF showed a slight advantage.

At three years follow-up, however, a significantly higher abstinence rate was found with TSF clients. Among TSF clients 36% were abstinent, compared with 27% of MET and 24% of CBT clients (p< 0.007).

. . . . .

And Nothing Was Revealed

Unfortunately, Project Match did not look at competing peer support groups. It just compared Twelve Step Facilitation Therapy coupled with 12-Step attendance to Cognitive Behavioral Therapy and Motivational Enhancement Therapy, so all the study really proved was that therapy coupled with peer support groups is better than just therapy by itself. There needs to be many more studies to get a true picture of what works and what doesn’t.  In the mean time, I encourage the people I talk with to go with what works for them. Try something for a while and if it’s not working, try something else. The main thing is, once you have decided to end an addiction, don’t give up. It is worth the struggle and once you have succeeded, you will not regret your efforts.

A more balanced and complete look at 12-step effectiveness can be found at the National Institute of Health Public Access site. One of the best studies was the Cochrane Review.  Please take a look at their conclusions. Per Wikipedia: Cochrane (or Cochrane Collaboration as they were formally known) is a British non-profit, non-governmental organization formed to organize medical research findings so as to facilitate evidence-based choices about health interventions faced by health professionals, patients, and policy makers.^[4][5] Cochrane has more than 37,000 volunteers in more than 130 countries.^[3]The group conducts systematic reviews of randomized controlled trials of health-care interventions and diagnostic tests and publishes them in The Cochrane Library. A few reviews, in occupational health for example, incorporate results from non-randomized, observational studies.

The Cochrane Collaboration is pretty much the gold standard in matters of physical and mental health.

If you are considering a for-profit facility, either inpatient or outpatient, make sure they have a good success rate. What that means is they should be able to tell you what percentage of people who enter their program are able to enjoy sustained periods of abstinence. If they are not tracking this information, and most do not, they are not engaging in an evidence-based procedure. They don’t know whether what they are doing is working or not. Some programs may claim graduates who have a good success rate (about a 90% to 95% clean rate over a five year period). However they may have just found a way of putting people through an experience that was so stressful that only the people who were willing to do almost anything to stay clean were able to graduate. Would those people have stayed clean no matter what program they entered? When you looked at people who walked through the door, typically only around 5% of them actually stay clean for five years. Graduates of some programs may have a much higher success rate while the success rate of people who entered the program may be much lower, because many of them either left the program or were forced to leave because they were breaking program rules. These numbers may sound discouraging, but once a person decides to end their addiction, they usually keep trying until they succeed, and if you look at that success rate it is much, much higher. I do believe that one of the good things about either inpatient or outpatient programs is that people go through a really intense, extended period of self-examination, learn about addiction, get a good introduction to peer support groups, and will generally stay clean for the duration of the program. This allows a person’s brain to become somewhat normalized so that they are able to make much better decisions about their futures.

, “A Humanist Alternative to A.A.’s 12 Steps” by B. F. Skinner (Harvard University Scientist) From July/August 1987 Humanist Magazine.

 1. We accept the fact that all of our efforts to stop drinking have failed.

2. We believe that we must turn elsewhere for help.

3. We turn to our fellow men and women, particularly those who have struggled with the same problem.

4. We have made a list of the situations in which we are most likely to drink.

5. We ask our friends to help us avoid those situations.

6. We are ready to accept the help they give us.

7. We earnestly hope that they will help.

8. We have made a list of the persons we have harmed and to whom we hope to make amends.

9. We shall do all we can to make amends, in any way which will not cause further harm.

10. We will continue to make such list and revise them as needed.

11. We appreciate what our friends have done and are doing to help us.

12. We, in turn, are ready to help others who may come to us in the same way.

—–

You can’t force anybody else to change, but you can change yourself.

In The Dark

Overly attached, the flashlight of my desire gave me confidence and direction while walking at night in the woods. The torch seemed to reveal a path that I could see before me but it proved to be an illusion, for what I could not see was as much a path as what I could see. I sat down and listened to the insects buzzing around my head whispering thoughts of calmness and acceptance and patience. When daylight came, I found I was surrounded by the world and that in each and every direction I looked was a path, and I knew that each path would lead me from where I was to where I knew not. I realized that my situation was exactly as it was when I traveled in the dark, except now I traveled without fear. It was not desire that had lit my way, it was ignorance.

Copied from their website:

Cherry Hill Detoxification Program Services

Cherry Hill’s Sobering Unit is a 50 bed, co-ed facility, staffed 24 hours a day, 7 days a week, and 365 days a year. Our sobering Unit was specifically designed to assist those needing immediate sobering services for a briefer visit of 23 hours or less. At our sobering Unit we have a central telephone screening process for both detoxification and sobering services. The central telephone screening process is designed to allow trained staff to assess appropriate placement of individuals to sobering or detox services.

Cherry Hill’s Detox Unit is a Social Model 32 bed residential program serving men and women who are withdrawing from the effects of alcohol or drug use. Clients are constantly monitored by trained staff and are referred for medical or psychiatric services as needed. Approximately 50% of Cherry Hill’s clients have co-occurring mental illness. In addition to ensuring the client’s safe withdrawal our staff will work with each client to assess the clients needs and goals. The client is then referred to the appropriate level of treatment and supportive services which may include, housing, medical or psychiatric services, job training, etc. The average stay is from 4 to 6 days.

Cherry Hill Detoxification Services Program is specifically designed to meet the needs of Alameda County Communities, including Law Enforcement, Hospital Emergency Departments, Alcohol and Drug Treatment Programs, Medical/Psychiatric clinics, Community CBO’s and individual community members.

Cherry Hill Detoxification Services Program has a toll free telephone number 1-866-866-7496 and can be called 24 hours a day for assessment to our services, crisis support and telephone referral services.

Other Alameda County services:

Alameda County Network of Care – Listed as being for service members, veterans and their families but almost every place listed will take the general public.

Behavioral Health Care Services (BHCS) – Mental health and substance services

ACCESS Program – Acute Crisis Care and Evaluation for System-wide Services.                                                                                                       1900 Embarcadero, Suite 208, Oakland 94606 Tel: (800) 491-9099, Fax: (510) 346-1083

Asian Community Mental Health – Offers multilingual and multicultural counseling care such as crisis stabilization, individual/family therapy, and substance abuse.                                         310 8th Street Suite 201 Oakland, CA 94607                                                                                                           Phone: 510-869-7200 asian access line Alt. Phone: 510-451-6729

Dial 211 for access to all county social services —–

To know is not enough. One must do.

Understanding the mechanics of addiction is like becoming familiar with the framing of a house. The frame provides strength and structure and it is what everything is built on. However, you can’t live in it. To have a home to live in, you must retrain your brain. You must build walls and then paint them and fill the home up with pictures, and furnish it with couches, tables, beds, chairs and books so that you will be comfortable there. Making a house a home takes work. Moving on from an addiction is the same. Willpower is useful but it is not enough. We must retrain our brains so that when we feel anxious, angry, hopeless, or any of the other uncomfortable emotions, we will turn to a different, healthier behavior – not the addiction. Many of the tools in SMART Recovery accomplish exactly this goal. They help us to rebuild ourselves and to create an environment where we can be comfortable. A home is a place where one has the opportunity to be happy and to grow and raise a family and evolve. To know is not enough. One must do.

What Happens After You Stop Drinking Alcohol Is Up To You

What Happens After You Stop Drinking Alcohol Is Up To You from Kevin O’Hara.

Your brains have evolved to repeat pleasurable experiences (see The Compass of Pleasure by David Linden and The Biology of Desire: Why Addiction is not a Disease by Marc Lewis). The mechanisms are well understood. A behavior which is interpreted as pleasurable releases dopamine which has the effect of linking the pleasure-producing behavior to the desire to repeat that behavior. The motivational centers of our brains, the nucleus accumbens, the ventral tegmental area and the striatum, among others, create the desire to engage in the behavior again.

The greater the amount of dopamine, the sooner the release of dopamine which follows the behavior and the more often the behavior is linked to the dopamine release all determine the strength of the habit/addiction. Cigarettes are a pretty good example of this pattern. The logical fallacies we tell ourselves in order to continue our addictions are all justifications to continue the addictive behavior after it has already been established. They come after addictions or habits are noticed. They are products of our prefrontal cortex, the logical, problem solving area of our brain, and they serve to reduce the tension which results when there is dissonance between what we do and what we think we SHOULD do.

Here is a list of the fallacies we use to avoid change. It was created to help people quit smoking by Dr. Michael Edelstein, a licensed clinical psychologist in San Francisco, a SMART Recovery facilitator and author of Three Minute Therapy: Change Your Thinking, Change Your Life (1997):

• Circular thinking: If you believe the impulse to smoke is irresistible, you don’t attempt to resist the impulse. Then, having failed, you begin to view failing to exercise control as confirmation that you have no power to quit, thus using your failure as “proof” the impulse is irresistible.
• Self-fulfilling prophesy: Because of the circular thinking above, you may continue to smoke as if you were powerless to quit.
• Illogical conclusion that you’re a special case who can’t quit: People quit regularly. According to the Centers for Disease Control and Prevention, since 2002 the number of former U.S. smokers has exceeded the number of current smokers.
• “I just haven’t gotten around to the effort of quitting.” When you’re doing nothing to quit, you’re not doing nothing! Smoking involves this complex chain of behaviors: determining the type of business carrying cigarettes, locating a store that sells them, mapping out a route to the store, driving or walking to the store, obtaining money to purchase the cigarettes, making the transaction, finding a place to smoke, opening the cigarette pack, removing the cigarette, lighting up, inhaling. Quitting involves doing nothing.
• “I can’t resist them.” Cigarettes cannot force you to smoke: cigarettes are inanimate objects. They have no will or power of their own to force you to smoke. The only irresistible human behaviors do not involve tobacco: blinking, sneezing, convulsing, falling asleep, twitching, and others. Even a starving individual’s strong urge to eat can be resisted. In 1981 Bobby Sands, an IRA hunger-striker, died of self-imposed starvation in prison after choosing to refuse food for 66 days as part of a political protest. Certainly, then, a person experiencing the urge or craving to smoke can resist.
• “I must have the nicotine.” Smoking cigarettes is still a choice even in cases where an individual requires the regular ingestion of nicotine for some reason: It can be obtained from nicotine patches, nicotine gum, nicotine sprays, nicotine inhalers, and e-cigarettes.

If we examine this list of fallacies we will see they come into play after the habits and addictions are already in place. These fallacies must be refuted if we are to change, and executive control must be established, or at least must have a dominant influence for a period of time, if we are to change our addictive behaviors, but I also think that we must retrain the primitive areas of our brains which control those behaviors, so that triggers will lead to new behaviors.

We cannot “think” our way out of addiction, but we can use our thinking to help us change. Using logic to change is a short term solution but the problem is it leads to “ego fatigue. Telling yourself “No!” when trying to end a desired behavior does work for a short period of time but eventually willpower lessens (ego fatigue) and relapses occur. Study after study has proven this. This is the reason people who engage in restrictive diets will, over a long period of time, actually GAIN weight. When compared to people who just change the foods they eat to healthier fare as opposed to limiting intake, it is clear that the latter strategy is statistically doomed to failure. See The Willpower Instinct by Kelly McGonigal. Real change comes when we feel disgust at the thought of the actions which resulted from our addictions and choose, at both a logical and emotional level, to engage in alternative behaviors. This is what I mean when I say that “To know is not enough. One must do.” So now that you’ve read some more eye-opening biological and neurological information about what happens during your phases of urges and then using in your addictions, you probably feel a sense of accomplishment… the great aha moments of learning more!! Maybe you feel like you’re one step closer to recovery from your addiction with this great knowledge! That’s what I’m talking about! “To know”  is never enough! Recovery does not impart itself through osmosis in the explanatory books, videos and even from speakers” You must Do!!!! Changing addictive behaviors involves retraining your brain, and this takes time, repetition and work. The next time you feel anxious or sad, your first choice for relief can be an ingrained alternative response of your choosing, NOT the old addiction. You’re painting your home and furnishing it; you are making it worth living in.

How does one start? It starts with a giant commitment! As Eckhart Tolle says, “Every addiction starts with pain and ends with pain!” If you think you kept on smoking, drinking and/or drugging just to relieve a little stress, you probably justified continuing your addiction just to providing relief! Then the relief turns into a love affair! How do we turn our love of an addictive behavior into disgust? My favorite tool is SMART Recovery’s Cost Benefit Analysis (CBA) which is explained here:

https://www.reptiledysfunction.org/why-them/#cba.

How do we build our virtual homes to live in? We develop coping skills to deal with problematic emotions: skills such as exercise, meditation, SMART’s ABC tool, mindfulness, unconditional self acceptance (USA, UOA, and ULA) and by connecting deeply with others and with life. These and many other helpful tools and blogs, as well as online meetings, can be found at https://www.smartrecovery.org . At the end of your days do you want to look back over your life and see only enslavement to an addiction? Do you want to have loved only that which could never love you back? Or do you want to have truly  connected with life and others? Your old home has turned to dust and disappeared. Look around and find a place to build your new home . . . . then build it!

Peer Support Groups

A person who is addicted or very new to recovery and is stuck alone inside their own head lives in a dangerous neighborhood. Many of us feel we should be able to solve our own problems and to seek help shows weakness. Seeing that our addictions are causing problems in our lives is fairly easy, but developing stratagems to successfully end the behaviors and to continue our lives in abstinence is much more difficult. Our brains evolved to value short term pleasure over long term satisfaction and fighting this programming can be quite a problem, especially when the tools we bring to the table are the same tools we had when we were slipping into addiction. There is nothing that is more helpful than sitting with a group of people who have been through what we are going through and who have made a commitment to constructively help one another.

When people first come to a peer support group, they think both more highly of themselves than is warranted, and less highly of themselves than is called for.

From The Fix

Blue October, “Hate Me”

After toiling away for over a decade, Houston rock band Blue October finally broke through in 2006 with this angst-y single off their Foiled album. The song starts with an actual answering machine message the mother of lead singer Justin Furstenfeld left her son at the height of his drug addiction

What is needed when people are new to recovery is to help them see who they realistically are and help them accurately assess their situation. Realistic, honest feedback is the key. Cross-talk and feedback are staples at most alternative peer support groups and at the SMART Recovery meetings I facilitate we all help one another in our recovery and in our lives.

Sitting in a ring,

we help one another to

get past and over

From Song Facts

This is a track from Blue October’s seventh studio album, Sway. Frontman Justin Furstenfeld penned the record in an upbeat frame of mind after years of struggling with a crippling alcohol addiction and marital problems. “Sway is about trying to find solutions to problems instead of dwelling in the problems,” Furstenfeld told Radio.com. “It’s about recognizing that you have to be proactive with your life if you really want to make it through to the other side and enjoy it.”

Whatever our bottom was, whatever difficulties brought us to the point where we decided it was time for change, it is important that we remember we are not bad people, we are not immoral, we are not defective. We are just susceptible to addictions.

A few words about the mythology surrounding the word “bottom”. In 12-Step circles there is a belief by many that addicts must hit a bottom before they are ready to stop. This is a strange concept, as we only know what a person’s bottom is after they have stopped. For some people, their bottom is the realization that their drug is no longer giving them what they need and want so they decide to stop. Some people stop and are not aware of having hit any bottom at all. Some people get clean, and feel they understand what their bottom was because they remember something bad happening near the end of their using, only to relapse after a period of time. Everyone then says “Oh, they must not have hit their bottom.” A person who wants to stop using drugs does not have to wait for a “bottom” to appear. They can just decide to stop because they think stopping is the sensible thing to do. As my friend Diane says ” In the end, my opinion is that it is not the “bottom”  (which bottom?) that does it……as many people think,  it is the work that you strongly commit yourself to do, where maybe something knocks you on you’re ass to get started, then there’s the work to make a plan and a do or die promise to self and to stick to it when tempted,  then the work to maintain till it becomes habit and then the work to increase self-awareness to counteract the normal tendency to think one is cured after any length of sobriety.”

We are people with values and hopes who have been living under the extraordinary stress and pressure of active addiction; people who, frequently, have done things we would never do under ordinary conditions. It makes sense to feel bad about some of the things we have done. It is not helpful, however, to feel bad about who we are.

If only

If only the past

If only I could change it

If only I could change the present

I can

We are not what we did, but we are also not yet who we are becoming. We are in transition and our job is to learn from our past and to discover how to transcend it and become the best version of ourselves we can imagine. Whatever interferes with that process is our enemy.

The past is a book

The book has been burned

We foolishly try to divine the smoke’s meaning 

The future is a vague cloud

It comes with tea leaves

Ready to be interpreted with great imperfection 

The present is jazz

The only way to hear music

Is to play your song

Mistakes are not the problem. They are the past. We can learn from them and become wise. If there is a problem, it is in the now. Look around yourself with as much empathy and understanding as you can muster. A life worth living is lived with all the connection you can fit into it.

.—–

What Works and What Doesn’t

What works? A summary of alcohol treatment research The following is a copy of a table from Chapter 2, “What works? A summary of alcohol treatment research” in R. K. Hester & W.R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.), 2003, Allyn & Bacon. To order this book, click here. Information on what each column means is at the bottom of the page. Treatment Modality Rank order Cumulative Evidence Score Number of studies %+ Mean Methodological Quotient Score Mean Severity of Treatment Population % Excellent Brief interventions 1 390 34 74 13.29 2.47 53 Motivational enhancement 2 189 18 72 12.83 2.72 50 GABA agonist (Acamprosate) 3 116 5 100 11.60 3.80 20 Community Reinforcement 4.5 110 7 86 14.00 3.43 71 Self-change manual (Bibliotherapy) 4.5 110 17 59 12.65 2.59 53 Opiate antagonist (Naltrexone) 6 100 6 83 11.33 3.17 0 Behavioral self-control training 7 85 31 52 12.77 2.91 52 Behavior contracting 8 64 5 80 10.40 3.60 0 Social skills training 9 57 20 55 10.9 3.80 25 Marital therapy-Behavioral 10 44 9 56 12.33 3.44 44 Aversion therapy-Nausea 11 36 6 50 10.50 3.83 17 Case managment 12 33 5 80 10.50 3.75 0 Cognitive Therapy 13 21 10 40 10.00 3.70 10 Aversion Therapy, Covert Sensitization 14.5 18 8 38 10.88 3.50 0 Aversion therapy, Apneic 14.5 18 3 67 9.67 3.33 0 Family therapy 16 15 4 50 9.25 3.25 0 Acupuncture 17 14 3 67 9.67 3.67 0 Client-centered Counsling 18 5 8 50 11.13 3.38 13 Aversion therapy, Electrical 19 -1 18 44 11.06 3.78 17 Exercise 20 -3 3 33 11.00 2.00 0 Stress Management 21 -4 3 33 10.33 2.67 0 Antidipsotropic- Disulfiram 22 -6 27 44 11.07 3.69 26 Antidepressant-SSRI 23 -16 15 53 8.60 2.67 0 Problem Solving 24 -26 4 25 12.25 3.75 50 Lithium 25 -32 7 43 11.43 3.71 29 Marital therapy- Nonbehavioral 26 -33 8 38 12.25 3.63 25 Group process psychotherapy 27 -34 3 0 8.00 2.67 0 Functional analysis 28 -36 3 0 12.00 2.67 33 Relapse prevention 29 -38 22 36 11.73 3.23 31 Self-monitoring 30 -39 6 33 12.00 3.17 50 Hypnosis 31 -41 4 0 10.25 3.75 0 Psychedelic medication 32 -44 8 25 10.13 3.63 0 Antidipsotropic-calcium carbimide 33 -52 3 0 10.00 4.00 0 Attention Placebo 34 -59 3 0 12.33 3.33 33 Serotonin agonist 35 -68 3 0 11.33 2.33 0 Treatment as usual 36 -78 15 27 9.07 3.07 13 Twelve-step facilitation 37 -82 6 17 15.00 3.67 83 Alcoholics anonymous 38 -94 7 14 10.71 3.14 29 Anxiolytic medication 39 -98 15 27 8.13 3.40 0 Milieu therapy 40 -102 14 21 10.86 3.64 29 Antidipsotropic-metronidazole 41 -103 11 9 9.73 3.73 0 Antidepressant medication (non-SSRI) 42 -104 6 0 8.67 3.17 0 Videotape sefl-confrontation 43 -108 8 0 10.50 3.34 13 Relaxation training 44 -152 18 17 10/56 3.06 17 Confrontational Counseling 45 -183 12 0 10.25 3.00 33 Psychotherapy 46 -207 19 16 10.89 3.26 21 Gerneral alcoholism counseling 47 -284 23 9 11.26 3.22 22 Education (tapes, lectures, or films) 48 -443 39 13 9.77 2.44 1.5

Cumulative Evidence Score (CES). For each study, the Methodological Quality Score is multiplied by the Outcome Logic Score (not shown). Then they added up all these scores for a particular modality. So the CES is a function of the number of studies, the scientific rigor of each study, and the outcomes for a treatment within each study.

Mean Methodological Quotient Score. This is the average score of the scientific rigor of each study in a particular modality. Scores can range from 0 to 17.

Mean Severity of Treatment Population. This reflects the average of how severely dependent the population studied was. Scores range from 1 (less severe alcohol related problems and dependence) to 4 (severe alcohol dependence).

% Excellent This is the percent of studies in each treatment category that had high Methodological Quotient Scores (>13 on scale of 1-17).

Copyright 2003. Reprinted with permission from Allyn & Bacon.Last revised April 4, 2013.

November/December 2013 Issue Alternatives to 12-Step Addiction Recovery By Christina Reardon, MSW, LSW Social Work Today Vol. 13 No. 6 P. 12

. . . AA and its various successors are not the only mutual-aid groups available to support people in recovery. For the past few decades, several other groups have tried to offer alternatives to those who want something other than a 12-step approach. These alternative groups historically have struggled to gain a significant following, but with the advent of new technologies and the rise of a new generation of people in treatment who want more control over their recovery, these groups believe the time has come for social workers and other behavioral health professionals to accept them as part of the mainstream continuum of recovery services.

“A big part of what I believe in is choice,” says Robert Stump, executive director of LifeRing, a group based in Oakland, CA. “One shoe does not fit all people. Every day that goes by, there are more and more people who are demanding that choice. [Alternative groups] may not cater to a large section of the American public, but we do appeal to a subset of Americans, and professionals should be aware of that.”

Different Roads to Recovery LifeRing is one of five organizations often cited as the largest national groups that provide an alternative approach to the 12 steps, according to the Substance Abuse and Mental Health Services Administration. The others are SMART Recovery, SOS (Secular Organizations for Sobriety/Save Our Selves), Women for Sobriety, and Moderation Management.

Representatives of these organizations stress that it is not their goal to bash 12-step programs, and they acknowledge that such programs have helped countless people, including many who use the 12 steps to supplement their involvement with alternative organizations.

However, there are several important differences that may make alternative groups attractive to people in recovery who do not want to use a 12-step approach. These differences generally fall into the following four categories:

• Secularity: The 12 steps as originally outlined by AA are overtly spiritual, with references to “a power greater than ourselves,” God, and prayer. Other 12-step groups have retained the same or similar language. The alternative groups, on the other hand, promote themselves as secular in nature. A secular approach makes the groups more open and comfortable not only to atheists and agnostics but also to Buddhists, Muslims, and others who do not share a Western, Christian tradition, Stump says. The alternative groups are not antireligion, however, and many of their members belong to a religious denomination or identify as spiritual.

• Emphasis on internal control: Twelve-step programs emphasize the recovering individual’s powerlessness over alcohol, other substances, or behaviors and the need to rely on a higher power for assistance in overcoming addiction. Alternative groups reject this view and instead see individuals as having adequate power within themselves to overcome addictions. This view is evident in the language of alternative organizations, which emphasize phrases such as “empowering our sober selves,” “saving our selves,” and “self-management and recovery.”

• Evolving approaches: Although the number of 12-step groups has grown over the decades, the basic language and methods of the 12-step approach have not changed significantly since AA’s founding nearly 80 years ago. Alternative groups tend to be more open to changing their techniques in response to the development of evidence-based approaches to addressing addictions, such as cognitive behavioral therapy. The commitment to stay abreast of current research in the field of addictions is one of the main factors that attracted Brett Saarela, LCSW, to get involved in SMART Recovery. “It’s open to change. There’s no dogma about it,” says Saarela, vice president of SMART Recovery’s board of directors. “As new techniques are being produced, they’re evaluated and then incorporated. Nothing is frozen in time.”

• Shedding of lifelong labels: AA and other 12-step groups portray the battle against addiction as a lifelong one that requires constant vigilance and at least periodic attendance at meetings, even for people who have been in recovery for years. Alternative groups take a shorter-term approach, presenting themselves as tools that people in recovery can use until they no longer see the need for them. Women for Sobriety, for example, refuses to give its participants lifelong labels based on past behavior and instead focuses on the present and the future, says Laura Makey, one of the organization’s facilitators and treasurer of its board of directors. “If I quit smoking, I wouldn’t say I was a smoker for the rest of my life,” she says. “We are not defined by our past. The idea of having to label yourself as an alcoholic or an addict for the rest of your life, that is disempowering, especially for women.”

Alternatives to 12-step peer support can be found at About.com

Certain groups have multiple links (SMART Recovery, Rational Recovery, Moderation Management and Women For Sobriety) but one link will take you to an About.com web page which describes the group and the other link will take you directly to the group’s website..

Non-Step Support Groups