|
"The successful person has the habit of doing things failures
don't like to do, they don't like doing them either
necessarily. But their disliking is subordinated to the
strength of their purpose." - E.M. Gray
Those who are successful at managing
addictive behavior most often utilize some of the tools
offered from the field of relapse prevention. Virtually
unknown a couple of decades ago, relapse prevention as a
component of behavior change came onto the map in 1985 with
the publication of
Relapse
Prevention: Maintenance in the Treatment of Addictive
Behaviors by G. Alan
Marlatt and Judith Gordon. Their pioneering research and
cognitive-behavioral model of relapse prevention
has stayed at the forefront of the treatment industry for
the past twenty years. Since its introduction, numerous
studies have been conducted to determine whether the model
works and how well. Most of the significant reviews have
concluded the following:
(1) There
is no optimum relapse prevention program or one ideal way to
prevent relapse. Instead, there appear to be numerous
methods that work equally well and doing something appears
better than doing nothing at all. This means it is worth
reviewing this material and having some kind of relapse
prevention plan in place.
(2)
Research questions the notion that relapse is an
"addiction-specific" event. Instead, relapse is best
understood as a human phenomenon that we all experience at
times. In this non-pathological view relapse is simply an
aspect of being human. We make New Year's resolutions and
break them. We relapse on diets, exercise programs (by going
off them), relationships (going back to a person we swear we
will never date again) and the list goes on. A good
illustration of relapse can be found in the
movie Chocolat. One of the characters does an amazing job of
resisting chocolate despite incredible temptations - but
only for so long. When he finally indulges it is a wonderful
depiction of human relapse.
(3) Relapse
is not so much a moment in time but a process where a number
of interconnected events ultimately lead to a slip in
behavior. The earlier a person can become aware they are in
the process, the better chance they have of getting out of
the process before a slip occurs. Most of the relapse
prevention strategies developed over the years are aimed at
developing increased awareness of the process and having a
toolbox of methods specifically targeted at different points
in the process.
In the May-June 2004 issue of the
American Psychologist, Katie Witkiewitz and G. Alan Marlatt
published the article
Relapse
Prevention for Alcohol and Drug Problems: That Was Zen, This
is Tao where they provide a
nice summary of the evidence for the model twenty years
after its introduction. Even more, they address the
criticisms of the model and offer a new improved version
that incorporates systems thinking (Yea!). In the new model,
no factors are given more influence than other factors (as
was the case in the original model). The authors incorporate
nonlinear situational dynamics that illustrate how seemingly
insignificant changes in levels of risk can quickly lead to
a relapse. The new model is more complex and introduces new
language (tonic processes, phasic responses, distal risks)
that in time will have to be refined if it will become
adopted by clinicians and those struggling with addiction.
At the root of preventing relapse is gaining an accurate
picture of prior relapse behavior patterns, and using this
information along with current contextual data to predict
future slips. But like other aspects of the field of
addiction, there is still significant ground to travel in
regards to a systems approach to relapse prevention. For
researchers it is an exciting time.
For those
who struggle with addiction and are after a solid approach
to preventing relapse, the above links to both the old and
new models will provide significant insight. Also, in my
opinion, there are two other avenues that are well worth
exploring.
Preventing
relapse by increasing emotional intelligence
Significant research points to the
role of emotions in the relapse process. In my work with
addicts I have come to recognize that although there may be
many factors involved in a relapse, more often than not, at
the root is an inability to manage emotion in the body.
Feelings, both positive and negative, get amplified to a
level where they become overwhelming and need to be calmed.
Addicts know that addictive behavior, despite the
consequences, is the perfect antidote for disconnecting from
the body. And unfortunately over time, the real cost is
becoming developmentally constricted in managing the
emotional context of life (see
Core
Issues - Developmental Deficits and Constrictions).
So, it seems fairly straightforward that one of the best
ways to prevent relapse is to become more equipped to deal
with emotions - particularly when they become intense. What
we are really talking about is increasing ones emotional
intelligence or developmental maturity in managing
emotions.
First used in a dissertation by Payne
in 1985, the term emotional intelligence really
gained momentum when two American university professors,
John Mayer and Peter Salovey began publishing research on
the topic in academic journals. It was popularized in 1995
by Daniel Goleman in his book
Emotional Intelligence: Why it can matter more than IQ,
but some have argued that
his work
has strayed from research
and does not accurately reflect current scientific evidence.
Nevertheless, he deserves credit for popularizing the idea
of emotional intelligence. Although there is a lot more to
be said about this topic, the bottom line is that if you
struggle with addiction you need to know how to manage
emotions effectively. The best way to gain this knowledge is
through direct experience, often with the help of a
therapist skilled in
emotion-focused therapies and
experiential work. In addition to
working with a good therapist, check out the following
links:
John
Mayer's Web Site titled Emotional Intelligence Information:
Here you will find a wealth of information that is grounded
in scientific research. It is a good starting point but
limited in providing direct methods for increasing emotional
intelligence. Thus the additional sites.
Steve
Hein's Web Site: Author of
EQ for Everybody, this site is a great resource for
learning more about emotional intelligence. Some great stuff
including the most comprehensive list of feeling words I
have seen to date and specific examples of how to go about
increasing emotional intelligence.
Preventing
relapse by becoming more optimistic
Although emotion appears to be the lead instigator in
relapse, it is also clear that how and what we say to
ourselves (i.e. the ongoing dialogue in our head) can also
play a significant role in the process. Much of the work of
Marlatt and his colleagues discussed above targets this idea
and is very helpful. Here, I want to provide another avenue
for thinking about this issue. In the book
Learned
Optimism: How to change your mind and your life
by Martin Seligman, he provides a strong case for why those
who are optimists have much better outcomes in life across
the board: better health, athleticism, academics,
relationships...and the list goes on. He defines optimists
as those people who when faced with problems see them as
temporary, specific and external. For example, if
you relapse and are an optimist you might say to
yourself..."I didn't gamble for eight months and my recent
slip is really just a very unusual situation (temporary)
brought on by a combination of stressors including the death
of my friend, my diagnosis of asthma and the recent fight
with my boss at work (specific). And, if the store
across from apartment had not installed new video poker
machines I may have been able to avoid the slip (external).
The last eight months have been good and I am not going to
let this one slip get in the way of the next eight months."
But unfortunately, many who struggle with addiction become
quite pessimistic about life and their ability to manage
their addictive behavior. According to Seligman, the recipe
for a pessimist is that they view problems as permanent,
pervasive and internal. So in our example above,
I might hear a clients say..."I have been to so many
treatment programs and I have tried everything. Nothing
seems to work and I am convinced that I will struggle with
gambling the rest of my life (permanent). This last
time I blew all my rent money and what I had saved for my
vacation. I am tired, lonely, have nothing to show for my
life, and depressed (pervasive). In the end, I just
can't seem to get it right...I always screw up (internal).
In fact, those who adhere to the classic disease concept of
addiction most often believe that there is no cure for
addiction (permanent), it impacts all aspects of life
(pervasive), and is the result of character flaws (internal).
In my work with clients it is interesting that those who
have struggled the longest (through many relapses) often
become quite pessimistic about the idea of permanent change
or successful long-term management. The addiction over time
very often gets intertwined with a pessimistic outlook on
life. I have found that I can gain significant mileage
helping clients successfully manage their addictions and the
rest of their life by focusing on interventions that move a
person from a pessimistic to an optimistic outlook on life.
Much of this work is straight cognitive therapy, and much of
it can be done without professional assistance. If what I am
saying makes sense here then I suggest you investigate the
following sites and read Seligman's book on Learned
Optimism.
Book
review of Learned Optimism specific to addiction
Another
good review of the book
Take the
Learned Optimism Test: Here
you will find out just how badly you need to read this book!
Cliff
notes of the book
|
