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Old 08-19-2006, 07:35 PM
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Just the facts

Excerpted from
The Surprising Truth About Addiction
By Stanton Peele
Full article in Psychology Today, May-June 2004, pp. 43-46, and at www. peele .net

• More people quit addictions than maintain them, and they do so on their own.
• More people overcome addictions than do not. And the vast majority do so without therapy.
• Successful treatment places the responsibility for change squarely on the individual and acknowledges that positive events in other realms may jump-start change.

Six Principles of Change
One. The belief that you can change is the key to change.
Two. The type of treatment is less critical than the individual’s commitment to change.
Three. Brief treatments can change longstanding habits.
Four. Life skills can be the key to licking addiction.
Five. Repeated efforts are critical in change.
Six. Improvement, without abstinence, counts…. all improvement should be accepted and rewarded.

Smoking is at the top of the charts in terms of difficulty of quitting. But the majority of ex-smokers quit without any aid [and] an even higher percentage of heroin and cocaine addicts and alcoholics quit without treatment.

In [the 1992 NIAAA study]….the vast majority of Americans who were alcohol dependent, about three-quarters, never underwent treatment. And fewer of them were abusing alcohol than were those who were treated.

• [T]he most successful treatments are nonconfrontational approaches that allow self-propelled change.
• The second most effective approach is motivational enhancement, also called motivational interviewing. This technique throws the decision to quit or reduce drinking—and to find the best methods for doing so—back on the individual.
• Self-help manuals were highly successful. So was the community-reinforcement approach….

People change when they want it badly enough and when they feel strong enough to face the challenge, not when they’re humiliated or coerced. An approach that empowers and offers positive reinforcement is preferable to one that strips the individual of agency.

Last edited by historyteach; 08-20-2006 at 12:19 AM.
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Old 08-19-2006, 07:44 PM
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Excerpted from What We Now Know About Treating Alcoholism and Other Addictions
By Stanton Peele
The Harvard Mental Health Letter, December 1991and at www .peele .net

• Whether people succeed in overcoming an addiction may not be determined primarily by the treatment they receive. [George] Vaillant notes that "the most important single prognostic variable associated with remission among alcoholics who attend alcohol clinics is having something to lose if they continue to abuse alcohol."
• As the decisive influence of these social circumstances proves, alcoholism is not a "primary" illness whose course is determined solely by some inexorable internal mechanism. The same is true of other addictions.

• The best way to discourage addictive behavior is to show people how to meet the demands of life without drinking or drug use.

• [The] most effective programs provided alcoholics with training in stress management and self-control, social and negotiation skills, job skills, and work habits.

• The most successful program for hospitalized alcoholics ever evaluated is the community reinforcement approach, which systematically trains alcoholics in job and marital skills while arranging a work and home environment that sustains and rewards sobriety.

Last edited by historyteach; 08-20-2006 at 12:19 AM.
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Old 08-19-2006, 08:13 PM
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Thank you. I am successfully de-toxing myself off benzos with medical supervision but no program as such. I read alot of different kinds of things about life. And life gets better all the time.
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Old 08-19-2006, 08:34 PM
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Thanks Don

Peele's approach has served me well in my recovery.

Keep well

Ron
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Old 08-19-2006, 08:49 PM
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Allergy, genetics....

Allergy, genetics….
Excerpted from The Implications and Limitations of Genetic Models of Alcoholism and Other Addictions
Journal of Studies on Alcohol, 47:63-73, 1986
Also on www. peele .net
By Stanton Peele

• [In the 19th-century] temperance movement… alcoholism was viewed as a danger inherent in the consumption of alcohol--one that could befall any habitual imbiber.

• The modern definition of alcoholism, as embodied by A.A. (1939), instead claimed that the alcoholic was a person who from birth was destined to be unable to control his or her drinking. The mechanism posited for this perpetual inability was an inbred 'allergy' to alcohol, one which dictated that from a first single drink the alcoholic was set on an inexorable path to intoxication and to an eventual diseased state.
• This … was readily investigated empirically and prompted a number of laboratory studies of the "priming effect," i.e., the result of giving an alcoholic a dose of the drug. These studies found no basis for believing that alcoholics lost control of their drinking whenever they tasted alcohol.

• Laboratory studies … showed that alcoholic behavior could not be described in terms of an internal compulsion to drink, but rather that even alcoholics--while drinking--remained sensitive to environmental and cognitive inputs, realized the impact of reward and punishment, were aware of the presence of others around them and of their behavior, and drank to achieve a specific level of intoxication.

• Genetic theories make little sense out of the enormous differences in alcoholism rates between social groups--like the Irish and the Jews--at opposite ends of the continuum in incidence of alcoholism ….

• [An] inherited, diminished sensitivity to alcohol only constitutes a contributory step toward the development of alcoholism.

• Whatever the nature of the process of alcohol addiction, given that it cannot be explained solely by repeated high levels of alcohol consumption, the slow, gradual nature of the …[progression] is borne out by the natural history of alcoholism. Vaillant's (1983) study, which covered 40 years of subjects' lives, offered "no credence to the common belief that some individuals become alcoholics after the first drink. The progression from alcohol use to misuse takes years."

• [Y]oung problem drinkers typically outgrow signs of alcohol dependence…, often in only a few years ….College students who display marked signs of alcohol dependence only rarely show the same problems 20 years later….

• Vaillant … put the matter even more succinctly. He indicated that finding a biological marker for alcoholism "would be as unlikely as finding one for basketball playing" and likened the role of heredity in alcoholism to that in "coronary heart disease, which is not due to twisted genes or to a specific disease. There is a genetic contribution, and the rest of it is due to maladaptive life-style.”

• Vaillant's quote is entirely consistent with his and other data in the field, all of which support an incremental or complex, interactive view of the influence of inheritance on alcoholism. No findings from genetically-oriented research have disputed the significance of behavioral, psychodynamic, existential and social-group factors in all kinds of drinking problems, and results of laboratory and field research have repeatedly demonstrated the essential role of these factors in explaining the drinking of the alcoholic individual.

Last edited by historyteach; 08-20-2006 at 12:19 AM.
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Old 08-19-2006, 09:12 PM
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How they do it...

How people do it

Excerpted from Spontaneous Remission from Alcohol, Tobacco, and Other Drug Abuse: Seeking Quantitative Answers to Qualitative Questions - )
American Journal of Drug and Alcohol Abuse, August, 2000 by Glenn D. Walters

• [Analysis] of untreated substance abusers confirms the reality of spontaneous remission from alcohol, tobacco, and other drug abuse.

• A broad definition of remission in which subjects either displayed abstinence or significantly reduced their usage and reported no substance-related problems produced a 26.2% …. rate. [A] more restrictive definition of remission based on total abstinence yielded a … rate of 18.2%. Both figures indicate that spontaneous remission from substance abuse is a relatively common event…observed across cultures….

• Despite claims that spontaneous remission occurs only in those who are not "seriously addicted", there were few meaningful differences between [people who quit on their own and those who didn’t].

• [Comparing people who quit smoking, alcohol, and illicit drugs]: Although health concerns were the modal initiating factor for all three groups, these concerns, along with feelings of disgust and the will to stop, were reported significantly more often by self-remitting smokers.
Alcohol/illicit drug self-remitters, on the other hand, were more apt to utilize changes in values and goals and concerns about drug-related social problems to initiate their spontaneous remission from substance abuse.
Social support, relationship changes, willpower, and identity transformation were the most frequently cited maintaining factors …..
[Smokers] relied more on self-confidence, substitute activities/addictions, and willpower to maintain their desistance, while alcohol/illicit drug abusers made greater use of social support, new relationships, and identity transformation strategies in maintaining desistance.

• Stall and Biernacki proposed a three-stage model of spontaneous remission: [emphasis added]

The initial stage of the model involves finding the resolve or motivation to [quit from….] a handful of initiating factors--medical problems, pressure from family and friends to stop using, extraordinary events, financial problems--that account for over half the reasons cited….

The second stage … consists of a public pronouncement to quit….public commitments, even when made to an imaginary audience, were more effective in promoting a change in identity than private commitments. Finding substitute activities, replacing old associations with new ones, developing nondrug recreational/leisure interests, and changing one's place of residence all signify a commitment to change that rests on a public pronouncement to live differently.

The third or maintenance stage [includes] ongoing social support, a growing sense of self-confidence and willpower, and the discovery of life meaning through religion, education, physical exercise, and identity.
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Old 08-19-2006, 10:28 PM
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The key word is 'self'

The Steps to Self-Cure
Excerpted from Out of the Habit Trap: Five Stages to Freedom
By Stanton Peele
www. peele .net
How does anyone manage to kick a habit after years of living with it?
The key word is self: taking charge of your own problem.
Some psychologists call this self-mastery; others, self-efficacy; others, the belief in free will.
It translates into three components necessary for change:
• an urge to quit,
• the belief that you can quit and
• the realization that you must quit—no one can do it for you.
Once you have quit, the rewards of living without the addiction must be great enough to keep you free of it.

The stages of successful self-cure are remarkably similar, regardless of the addiction:

1. Accumulated unhappiness about the addiction. Before a change can take place, unhappiness with the addiction has to build to a point where it can't be denied or rationalized away. …
To break an addiction, you must believe the rewards you'll get … will surpass what you got from the habit.

2. A moment of truth. …. It is impossible to distinguish the real moment of truth from the addict's previous vows to quit, except in retrospect.
Epiphanies that work can be brought on by dramatic, catastrophic events….But most moments of truth seem to be inspired by trivial remarks or chance occurrences. Either way, they work because they crystallize the discrepancy between the addict's self-image and the reality.

3. Changing patterns. People successful at self-cure usually make active changes in their environment….

4. Changing the identity of addict. Once former addicts gain more from their new lives than from the old ways—feeling better, getting along with people better, working better, having more fun—the lure of the addiction pales.
5. Dealing with relapses. ….The addict who has successfully modified his or her life catches the slip, and controls it.

The steps out of addiction, therefore, are:
• to find a superior alternative to the habit you want to break;
• find people who can help you puncture your complacent defenses;
• change whatever you need to in your life to accommodate your new, healthier habits;
• celebrate your new, nonaddicted image whenever you can.

The common feature in all these steps is your action, your beliefs. Self-curers often use many of the same techniques for breaking out of an addiction that formal treatment programs do. But motivated people who have arrived at these techniques on their own are more successful than those in therapy.

Last edited by historyteach; 08-20-2006 at 12:22 AM.
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Old 08-20-2006, 12:33 AM
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Great thread Don - thanks a bunch!
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Old 08-20-2006, 01:02 AM
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Some widely held beliefs about substance abuse are questionable, debatable, or even provably false. Why does this matter? Because our beliefs can affect, effect, or otherwise shape our behavior.

The notion that any amount of alcohol will trigger more drinking behavior.
This belief is so widespread in popular culture that I first read it in Dear Abby or Ann Landers, many years ago. In Chapter 2 of Alcoholics Anonymous, we find this quote:
“ We are equally positive that once he takes any alcohol whatever into his system, something happens, both in the bodily and mental sense, which makes it virtually impossible for him to stop.”

But studies have shown that people who think they are drinking act drunk—even if they aren’t drinking alcohol. And people who don’t know they are drinking alcohol don’t act drunk. The behavior results from their thinking.
Studies have also shown that chronic drinkers will stop drinking even after they’ve started if they have to give up the drinking place or situation they have come to prefer in order to continue. Even people who are drinking can make partially rational decisions about their behavior.

Why is this belief potentially harmful? Because it can become a self-fulfilling prophecy. Cognitive approaches begin with the idea that our beliefs lead to our behavior. If you believe something will trigger a binge, it probably will. And this can be an intensifying belief when a lapse does occur.
--------
The notion that abstinence is the only successful approach to problem drinking behavior.
Obviously, most of us have come to that conclusion about our selves, based on our own past histories. I certainly believe it is my healthiest choice. And evidence suggests that most people gradually re-habituate to heavy drinking if they’ve done it before.

The problem comes when we project those experiences and statistics onto everyone. Some people do eventually drink moderately, or socially, or just reduce the harmful levels at which they were drinking. So the statement that “there is no such thing as making a normal drinker out of an alcoholic” is questionable at best (depending on how you define ‘alcoholic’).
Dire predictions are unproductive, possibly even counterproductive (think back to your junior high school drug ‘education’ classes). This is a pretty easy notion to test for ourselves anyway, and if someone wants to try moderate drinking the resources at Moderation Management (moderation . org) are very useful.

-------
The notion that substance abuse is incurable.
Recently a young man said to me, ‘Once a tweaker, always a tweaker.’ Just a variant of "Once an alcoholic, always an alcoholic."
Cognitive approaches such as SMART Recovery and Rational Recovery embrace the concept that one can move beyond any behavior. Since they are based on the concept that your beliefs cause your behavior, the logical extension of the principle is that your behavior has largely changed once you have firmly adopted new beliefs.
Relapses occur for some people. But they aren’t necessarily a full-blown return to the previous behavior. This is one of the reasons secular approaches resist the use of labels. ‘Alcoholic?’ ‘Recovering’ or ‘recovered’? You decide for yourself. If the fear of relapse motivates you, then the label and the notion that it’s incurable may be useful. But it’s a belief, and it’s individual: it’s not a fact applicable to everyone.

Why is this notion potentially harmful? Because IMO it fails to acknowledge the accomplishment of behavior change. Although fear is useful in early abstinence, I believe long term sobriety comes from recognizing and internalizing the benefits we’ve found.
-------

The notion that change is not possible on our own.
This one is incredibly common: that only in recovery groups, or rehab, or counseling (take your pick, or all three) will we be able to get sober.
We will be “unable to stop drinking on the basis of self-knowledge.”
(Chapter 3, Big Book) “The first requirement is that we be convinced that any life run on self-will can hardly be a success.” (Chapter 5).

This gets at the basic concept of where change comes from. People vary in this regard! ‘Self’ is at the core of cognitive behavioral approaches. The recovery jargon is ‘internal’ or ‘external locus of control’, and you can take online quizzes to see what your own beliefs are.
Secularists are likely, IMO, to believe change is internal. So sobriety is mostly a matter of learning new tools for changing behavior, and new ways to cope with life’s stress factors. People predisposed to believe in a god are likely to accept that change will be external.
This notion that we can’t get sober on our own ignores the beliefs and values of a significant percentage of the population. Cognitive approaches, by comparison, reinforce those beliefs.
-------
The notion that a higher power is necessary for change is a logical extension of the ‘external locus’ idea. No problem if you are predisposed to such a belief. But it’s a real stretch for agnostics, atheists, and secularists. Indeed, when taken as an absolute (“his defense must come from a Higher Power”—Chapter 3) it clearly states that failing to accept an ‘external locus’ of change is doomed to failure. Yet such people do achieve sobriety.

Note: secularists are often referred to the Big Book’s Chapter 4: We Agnostics. But the whole premise of that chapter is non-agnostic:
Actually we were fooling ourselves, for deep down in every man, woman, and child, is the fundamental idea of God.
We finally saw that faith in some kind of God was a part of our make-up….

Certainly no atheist would write that. Most agnostics wouldn’t. It seems to argue against our core theological beliefs by implying that they are character defects (there are numerous examples; just re-read the chapter if you don’t believe me).

Again, it is a vigorous defense of the notion of an ‘external locus’ of control. Again, it doesn’t recognize how people differ. There is no one-size recovery approach. “We have found” would be preferable to “must come from”.
-------
The notion that we must grapple with the urge to drink every day. One Day At A Time, and all that.

This certainly seems true in early sobriety. It really has to do with the immediacy and intensity of urges. Dr.Thomas Horvath, President of SMART Recovery, describes common misconceptions about urges:

• Urges are awful or unbearable.
• Urges are constant, and get worse.
• Urges force one to use or act, that we can’t control our behavior when we really want something.
• We will suffer serious mental anguish if we don’t act on our urges.

If you believe these things, each day may be an argument about using or drinking. But in fact, we CAN stand them, they are time-limited, they don’t MAKE us use or drink, and nobody goes crazy or dies because they want to drink or use drugs.

My own experience has been that the farther I have left drinking behind, the less I think about actually doing it. I have memories of drinking, and there are times when situations or smells or emotions make me recall what it was like. But those thoughts aren’t really urges. They’re memories. And they don’t happen every day.
-------
Progress can be celebrated even if it isn't perfect (seems to me there's a slogan about that somewhere). You can do it on your own, but the good news is you don't have to. Nothing is inevitable. You can find the power from within, or find comfort in seeking it elsewhere. What you believe is key. It's your recovery.
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Old 08-20-2006, 01:05 AM
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Originally Posted by Don S
• More people overcome addictions than do not. And the vast majority do so without therapy.
So a person has better than 50% chance of breaking an addiction? This is good news. Just today, I was wondering about the ratio of persons who break addiction as opposed to those who don't. I was thinking somewhere around 1 out of 10.

Smoking is at the top of the charts in terms of difficulty of quitting.
I often wondered why this is, since the social consequences of smoking aren't as great a motivating factor as with drug abuse. Then, as I was reading through this thread I answered my own question, more or less. Smoking doesn't have the same mind/mood-altering effects as psychotropic drugs! So it kind of balances out.

As someone who has quit both addictions cold-turkey, I can definitely vouch that the nicotine cravings were hard-core, beyond those of quitting alcohol. I had the shakes for awhile after quitting alcohol, didn't eat for two or three days, cried a lot, etc. Still, I wasn't agitated to the point of wanting to cut the cord on the fridge because the humming almost made me insane!

Interesting twist. It seems the detrimental effects of alcohol abuse were more visible. A lot of my behaviors while drinking were the primary motivating factor for quitting (emotional), while physical/health factors were secondary. The primary motivating factor for quitting nicotine was related to physical factors (lungs hurting in the morning, questionable circulatory function, etc.), while the psychosocial aspects were secondary.

Natural regression is an intriguing subject to me. I gave up three addictive substances within a six-month period of time, and I'm still in the process of making some changes.

Facts! And keep 'em comin'.

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Old 08-20-2006, 01:12 AM
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A good friend of mine told me that quitting smoking had been harder for her than quitting heroin.
I was the only non-smoker in my family for years. So I haven't had to deal with that one. But it's definitely becoming a hard habit to sustain in California, where you can't smoke really anywhere. The social stigma is increasing, for sure.
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Old 08-20-2006, 01:14 AM
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Originally Posted by Autumn
...I gave up three addictive substances within a six-month period of time, and I'm still in the process of making some changes.

Wow!
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Old 08-20-2006, 01:14 AM
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Yes, it is Don. I used to want to hide under the dashboard whenever I flicked a butt out the car window, and I NEVER did it at a red light!
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Old 08-20-2006, 05:10 AM
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Thanks again Don, there'e some really good reading in this thread.

I am poised to quit smoking, again. I did quit in 1991 for five years, and yes it was pretty tough. I do remember that after a few months of no nicotine, I rarely thought about it anymore, and I do hope that I won't think of alcohol after an extended period of abstinence as well.

One thing I did not have in 1991 was an awareness of CBT and an understanding of recovery methods like I do today. I did it then, which proves to me I can do it again, and with these additional resources available, including internet support groups, I believe I can do it now.

The posts I've read here confirm my beliefs that alcohol abuse is not a life-long sentence, and that it is not some sort of incurable disease. My choices and behaviour are the culprit, and these can be changed. This gives me hope. If I believed that I was never going to be capable of modifying something that was causing me pain and anguish without devoting my life to meetings, or looking to a higher power, I would truly despair.

Please note that when I reject a disease concept or higher power I am not "bashing AA". I am merely relating what is working for my DIY recovery. This is what works for me and I welcome the opportunity to discuss recovery methods in this forum for my benefit, and perhaps others as well.

Just my thoughts.

Keep well

Ron
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Old 08-20-2006, 06:10 AM
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Originally Posted by Don S
A good friend of mine told me that quitting smoking had been harder for her than quitting heroin.
I was the only non-smoker in my family for years. So I haven't had to deal with that one. But it's definitely becoming a hard habit to sustain in California, where you can't smoke really anywhere. The social stigma is increasing, for sure.
I believe your friend. It was a lot harder for me to quit than my DOC which can cause sezures and other nasty things including messing up my mind during W/D. Cigs were still harder. And that's with the gum!
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Old 08-20-2006, 03:59 PM
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On Self-control

On Self-Control - by Hank Robb

[Slightly abridged and edited by Henry Steinberger]
from the SMART Recovery web site.

'self-control' is:
a) what you build up, develop, create, learn by controlling your behavior repeatedly - regard self-control as a skill;
b) NOT a THING you have [or don't have] that lets you control your behavior [or not].

When some one says:
'I have no self-control over my drinking,' or whatever, I can ask:
'Are you well practiced at resisting urges or opportunities to use.' The answer is 'no'.
This person is well practiced in giving in to those urges and opportunities.

Self-control over urges and opportunities is like self-control over bicycles and roller skates -- you get it by practicing. The reason individuals, correctly, feel they don't have it is because they haven't been practicing that which gives it to them. In this case, the SKILL not well practiced is resisting urges and resisting opportunities to use.

That is why those who do practice resisting urges, after awhile, report that it becomes easier and easier to continue. They have been exercising and building their self control and now have begun to show a fair bit of this skill.

In every day language, thinking you must first have self-control before you acquire a change in your behavior is 'putting the cart before the horse.' Self- control comes from making the change in your behavior and then practicing the things you did that helped make that change. Self-control may involve learning new strategies to bridge the difficult initial learning period.

In one famous study, children were left with a candy bar and told that if they didn't eat it they would get two candy bars. The children who resisted the temptation while alone were secretly observed and found to use verbal self-
reminders and distracting activities. Children who didn't resist were later able to do so after being taught strategies for better self-control. We have a toolbox of such techniques, but they all require using them.
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Old 08-20-2006, 05:05 PM
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What Works?

What works?
Excerpted from "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.
In an extensive review of studies of different approaches to sobriety, the authors found the following 5 treatments had the highest success rates:

Brief interventions
Your … personal physician … can screen you for possible alcohol problems and assess whether your drinking or drug use is putting your health at risk or causing problems of which you might not be aware [and may] suggest a more comprehensive assessment.

Motivational enhancement
….Done by a psychologist, counselor, or therapist … also known as a brief motivational intervention. [Usually 1 – 4 sessions, which include:]
* A thorough assessment….
* Objective feedback … provided in a low-key way that does not label you or push you into doing anything you don't want to do
* Motivational enhancement that helps you consider the good things and not-so-good things…to help you resolve your ambivalence.

GABA agonist (Acamprosate)
Acamprosate is a medication that reduces urges and cravings to drink.

Community Reinforcement
…a treatment program provided by psychologists and counselors. …to help the problem drinker or drug user's environments (family, social, work) so that the environment reinforces sobriety and withdraws those reinforcers if the person drinks or uses drugs.

Self-change manual (Bibliotherapy)

… mostly oriented towards moderate drinking as a goal of change. [Examples:]
-- Responsible Drinking: A Moderation Management approach for problem drinkers.
--A good self-help manual for addictions in general and for abstinence from alcohol is Sex, Drugs, Gambling, and Chocolate, by Thomas Horvath

The opiate antagonist (Naltrexone), and a technique called behavioral self-control training, ranked next. Aversion therapy via nausea (Antabuse) ranked 11th.

Some selected other treatments and how they ranked:
• Family therapy: 16th
• Acupuncture: 17th
• Antidepressants (SSRI): 23rd
• Hypnosis: 31st
• Psychedelic medication: 32nd
• Twelve-step facilitation (guided 12 step): 37th
• Alcoholics Anonymous: 38th
• Psychotherapy: 46th
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Old 08-20-2006, 05:11 PM
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Originally Posted by Don S
Some widely held beliefs about substance abuse are questionable, debatable, or even provably false. Why does this matter? Because our beliefs can affect, effect, or otherwise shape our behavior.

The notion that any amount of alcohol will trigger more drinking behavior.
This belief is so widespread in popular culture that I first read it in Dear Abby or Ann Landers, many years ago. In Chapter 2 of Alcoholics Anonymous, we find this quote:
“ We are equally positive that once he takes any alcohol whatever into his system, something happens, both in the bodily and mental sense, which makes it virtually impossible for him to stop.”

But studies have shown that people who think they are drinking act drunk—even if they aren’t drinking alcohol. And people who don’t know they are drinking alcohol don’t act drunk. The behavior results from their thinking.
Studies have also shown that chronic drinkers will stop drinking even after they’ve started if they have to give up the drinking place or situation they have come to prefer in order to continue. Even people who are drinking can make partially rational decisions about their behavior.

Why is this belief potentially harmful? Because it can become a self-fulfilling prophecy. Cognitive approaches begin with the idea that our beliefs lead to our behavior. If you believe something will trigger a binge, it probably will. And this can be an intensifying belief when a lapse does occur.
--------
The notion that abstinence is the only successful approach to problem drinking behavior.
Obviously, most of us have come to that conclusion about our selves, based on our own past histories. I certainly believe it is my healthiest choice. And evidence suggests that most people gradually re-habituate to heavy drinking if they’ve done it before.

The problem comes when we project those experiences and statistics onto everyone. Some people do eventually drink moderately, or socially, or just reduce the harmful levels at which they were drinking. So the statement that “there is no such thing as making a normal drinker out of an alcoholic” is questionable at best (depending on how you define ‘alcoholic’).
Dire predictions are unproductive, possibly even counterproductive (think back to your junior high school drug ‘education’ classes). This is a pretty easy notion to test for ourselves anyway, and if someone wants to try moderate drinking the resources at Moderation Management (moderation . org) are very useful.

-------
The notion that substance abuse is incurable.
Recently a young man said to me, ‘Once a tweaker, always a tweaker.’ Just a variant of "Once an alcoholic, always an alcoholic."
Cognitive approaches such as SMART Recovery and Rational Recovery embrace the concept that one can move beyond any behavior. Since they are based on the concept that your beliefs cause your behavior, the logical extension of the principle is that your behavior has largely changed once you have firmly adopted new beliefs.
Relapses occur for some people. But they aren’t necessarily a full-blown return to the previous behavior. This is one of the reasons secular approaches resist the use of labels. ‘Alcoholic?’ ‘Recovering’ or ‘recovered’? You decide for yourself. If the fear of relapse motivates you, then the label and the notion that it’s incurable may be useful. But it’s a belief, and it’s individual: it’s not a fact applicable to everyone.

Why is this notion potentially harmful? Because IMO it fails to acknowledge the accomplishment of behavior change. Although fear is useful in early abstinence, I believe long term sobriety comes from recognizing and internalizing the benefits we’ve found.
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The notion that change is not possible on our own.
This one is incredibly common: that only in recovery groups, or rehab, or counseling (take your pick, or all three) will we be able to get sober.
We will be “unable to stop drinking on the basis of self-knowledge.”
(Chapter 3, Big Book) “The first requirement is that we be convinced that any life run on self-will can hardly be a success.” (Chapter 5).

This gets at the basic concept of where change comes from. People vary in this regard! ‘Self’ is at the core of cognitive behavioral approaches. The recovery jargon is ‘internal’ or ‘external locus of control’, and you can take online quizzes to see what your own beliefs are.
Secularists are likely, IMO, to believe change is internal. So sobriety is mostly a matter of learning new tools for changing behavior, and new ways to cope with life’s stress factors. People predisposed to believe in a god are likely to accept that change will be external.
This notion that we can’t get sober on our own ignores the beliefs and values of a significant percentage of the population. Cognitive approaches, by comparison, reinforce those beliefs.
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The notion that a higher power is necessary for change is a logical extension of the ‘external locus’ idea. No problem if you are predisposed to such a belief. But it’s a real stretch for agnostics, atheists, and secularists. Indeed, when taken as an absolute (“his defense must come from a Higher Power”—Chapter 3) it clearly states that failing to accept an ‘external locus’ of change is doomed to failure. Yet such people do achieve sobriety.

Note: secularists are often referred to the Big Book’s Chapter 4: We Agnostics. But the whole premise of that chapter is non-agnostic:
Actually we were fooling ourselves, for deep down in every man, woman, and child, is the fundamental idea of God.
We finally saw that faith in some kind of God was a part of our make-up….

Certainly no atheist would write that. Most agnostics wouldn’t. It seems to argue against our core theological beliefs by implying that they are character defects (there are numerous examples; just re-read the chapter if you don’t believe me).

Again, it is a vigorous defense of the notion of an ‘external locus’ of control. Again, it doesn’t recognize how people differ. There is no one-size recovery approach. “We have found” would be preferable to “must come from”.
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The notion that we must grapple with the urge to drink every day. One Day At A Time, and all that.

This certainly seems true in early sobriety. It really has to do with the immediacy and intensity of urges. Dr.Thomas Horvath, President of SMART Recovery, describes common misconceptions about urges:

• Urges are awful or unbearable.
• Urges are constant, and get worse.
• Urges force one to use or act, that we can’t control our behavior when we really want something.
• We will suffer serious mental anguish if we don’t act on our urges.

If you believe these things, each day may be an argument about using or drinking. But in fact, we CAN stand them, they are time-limited, they don’t MAKE us use or drink, and nobody goes crazy or dies because they want to drink or use drugs.

My own experience has been that the farther I have left drinking behind, the less I think about actually doing it. I have memories of drinking, and there are times when situations or smells or emotions make me recall what it was like. But those thoughts aren’t really urges. They’re memories. And they don’t happen every day.
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Progress can be celebrated even if it isn't perfect (seems to me there's a slogan about that somewhere). You can do it on your own, but the good news is you don't have to. Nothing is inevitable. You can find the power from within, or find comfort in seeking it elsewhere. What you believe is key. It's your recovery.

These beliefs are often presented as fact to people seeking help for substance abuse, and as Don said:

"Some widely held beliefs about substance abuse are questionable, debatable, or even provably false. Why does this matter? Because our beliefs can affect, effect, or otherwise shape our behavior."
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Old 08-20-2006, 06:03 PM
  # 19 (permalink)  
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WHAT IS REBT?

Excerpted from the web site of the Albert Ellis Institute, rebt . org
[REBT = Rational Emotional Behavioral Therapy]

REBT places a good deal of its focus on the present: on currently-held attitudes, painful emotions and maladaptive behaviors that can sabotage a fuller experience of life.

• But don't you need to uncover the past in order to really understand people's problems?

… we may be strongly influenced by events in early life. … But the past is with us in the form of beliefs that we carry in our head in the present. … we can change how we let the past influence the way we are today and the way we want to be tomorrow.

• I've heard that REBT tries to do away with negative emotions altogether by making people think logically and objectively. Is that true?
… REBT emphasizes the involvement of emotions in just about every aspect of our thinking and actions. REBT proposes that when our negative emotions become too intense (e.g., rage, panic, or depression), not only do we feel very unhappy, but our ability to manage our lives begins to deteriorate.

• But aren't feelings such as anger and anxiety normal and appropriate?

Of course! But it is the quality of feelings that is important. Experiencing intense irritation and displeasure when things go wrong can motivate you to change frustrating conditions. Feelings of rage, on the other hand, often [lead you] to act in ways that are impulsive and self-defeating.

• With REBT's emphasis on reducing emotional upsets in the face of unfairness or misfortune, doesn't it encourage the preservation of the status quo? (Not to mention take away energy to make things better?)

One of REBT's favorite maxims (first expressed by Reinhold Neibuhr) is: "Grant me the courage to change the things I can change, the serenity to accept those that I cannot change, and the wisdom to know the difference." REBT seeks to empower individuals both by helping them more effectively handle their own painful emotions, and by enabling them to change their own behavior and improve their world where possible.

• With all this emphasis on "me," doesn't REBT encourage selfishness? Don't we already have too much selfishness in this world?

… REBT teaches what Albert Ellis calls the value of rational self-acceptance. According to Ellis, healthy people are usually glad to be alive and accept themselves just because they are alive and have some capacity to enjoy themselves. They refuse to measure their intrinsic worth by their extrinsic accomplishments, materialistic possessions and by what others think of them. They frankly choose to accept themselves unconditionally; and then try to completely avoid globally rating themselves—meaning their totality or their "essence." They attempt to enjoy rather than prove themselves. Thus, rather than acting out of selfishness, they learn to operate from responsible self-interest.


• Does REBT force its own beliefs about what's rational on people?

REBT defines rational beliefs as those which help people live satisfying, healthy, and fulfilled lives.
--rational self-acceptance—which involves people giving up the self-rating game—seems to help people significantly reduce anxiety and increase feelings of self-acceptance.
--high frustration tolerance, which encourages people to accept (not like) life's hardships and other people's imperfections, leads to greater perseverance, patience, and the ability to get along with others.

• By emphasizing the individual's beliefs and values and eliminating "shoulds," isn't REBT incompatible with religious values?

… when people impose rigid expectations on themselves, other people, and the world they are likely to experience unnecessary emotional distress. In REBT, these expectations are expressed as absolutistic "shoulds," "oughts," and "musts."
…. REBT advocates instead a more preferential system of values: one which encourages people to work toward their professional goals, but never to condemn and damn themselves when they fail to achieve them. In a similar way, REBT is useful in helping people from diverse religious backgrounds to be more self-accepting, as well as more accepting of other people who may not share their particular values.

• REBT makes sense, but I can't seem to apply it to myself—I understand it "intellectually," but not "emotionally."

[The] goal is no less than changing core irrational beliefs that you've spent your whole life rehearsing, living, and "feeling." For many people, it takes some time before the emotional "gut" follows what their head already "knows." … The positive aspect of the strain you may experience in using REBT is that it shows you are learning new ways of feeling and behaving and that you are taking charge of your own direction in life.
Don S is offline  
Old 08-24-2006, 12:12 AM
  # 20 (permalink)  
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Join Date: Sep 2005
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Hey Mongo!

Originally Posted by Mongo
Thanks again Don, there'e some really good reading in this thread.

I am poised to quit smoking, again. I did quit in 1991 for five years, and yes it was pretty tough. I do remember that after a few months of no nicotine, I rarely thought about it anymore, and I do hope that I won't think of alcohol after an extended period of abstinence as well.

One thing I did not have in 1991 was an awareness of CBT and an understanding of recovery methods like I do today. I did it then, which proves to me I can do it again, and with these additional resources available, including internet support groups, I believe I can do it now.

The posts I've read here confirm my beliefs that alcohol abuse is not a life-long sentence, and that it is not some sort of incurable disease. My choices and behaviour are the culprit, and these can be changed. This gives me hope. If I believed that I was never going to be capable of modifying something that was causing me pain and anguish without devoting my life to meetings, or looking to a higher power, I would truly despair.

Please note that when I reject a disease concept or higher power I am not "bashing AA". I am merely relating what is working for my DIY recovery. This is what works for me and I welcome the opportunity to discuss recovery methods in this forum for my benefit, and perhaps others as well.

Just my thoughts.

Keep well

Ron
I actually wrote this the other day just before the forum was shut down, and when I hit "submit", !bing! the thread was gone. I'm glad to see it back. It's a really good one.

This is a nice post Mongo. Your hard work shines through, and it's been interesting reading your posts over the months and observing your progress.

I saw your post on Don's thread in Alcoholism. A big fat way to go and congrats on 100 days abstinent!! It's worth it, isn't it?

Anyway, the whole reason I'm writing this is to let you know if you need any help quitting smoking, I will be more than happy to send you the details (best of all, it's free).

Peace!
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