Addiction Management Blog

Archive for the ‘Action 3: Manage’ Category

Ah-hah moments to move beyond addiction

Saturday, May 11th, 2013

Not long after my wife and I were married, we decided to proactively increase our chances of staying together by enrolling in one of Dr. John Gottman’s weekend couples workshops in Seattle. At the time I was deeply immersed in my graduate studies in counseling and was excited to spend some time with the world-famous marriage guru. What I had not realized was that 1000 other people would be crammed into the Seattle Center taking the workshop as well, so my chances of a little one-on-one time were not so good. Fortunately, he circulated around while we all were doing exercises and I told my wife that if he ever came within 200 yards we should wave our hands wildly and grab his attention.

The moment came and sure enough my plan worked. He sat down and we began talking about some martial issue that escapes me now. During our conversation I began challenging him a bit about how people really change behavior, at which point he brought up focusing. Because I had told him I was nearing completion of my graduate program he assumed I would know all about focusing, but my deer-in-the-headlights response gave me away. I had to admit that never in any of my classes had the word focusing ever been mentioned. I was clueless and a bit embarrassed. He said it was the key to behavior change and I needed to know about it.

focusing_book_2007_medCoincidentally, the relative I mentioned a couple of blog posts ago who had given me a bunch of psychology books, had included the book  Focusing! Written in the 1970s by Eugene Gendlin, the book is based on about two decades of research analyzing what happens in therapy sessions that explain good outcomes. What Gendlin found is that it has little to do with the therapist or the specific type of therapy one gets, and far more to do with what happens inside the client. In essence, he discovered that positive outcomes occur when clients have “ah-hah” moments during sessions that awaken them to deeper truths about themselves and life. These moments occur when we (and clients) go inside and connect with what he calls a felt sense – a pre-verbal inner knowledge or awareness that comes from paying attention to an integrated and holistic aspect of our being that we can access at any time. If this sounds a little new-agey it really is not, it is just hard to describe something that cannot be easily put into words.

Have you ever lost your keys and banged your head against a wall trying to remember where you left them? No matter how hard you try nothing seems to work. So you go on to something else and then, in the middle of folding laundry, it hits you. You remember exactly where you left them! That moment of remembering is what Gendlin would call a felt-sense, an ah-hah moment that awakened you to an answer that previously was outside your awareness. While focusing can help you find your keys, it really has the power to change your life.

Focusing is the name Gendlin uses to describe the six-step process he developed for helping people – both and in out of therapy – have felt-sense experiences to solve a multitude of life problems, including addiction! If you have never heard about it, I really encourage you to check out the focusing website and read one of the many books written on the topic. What started as a little research project in Chicago in the 1950s has evolved into one of the greatest tools we have for overcoming addiction.

Mark Girard, LCSW & Certified Jungian Analyst: Working with Altered States

Tuesday, December 7th, 2010

For the past few years I have taught a foundations course on addiction treatment to graduate students. An important aspect of the course is helping students understand that longterm successful outcomes  necessitate resolving underlying drivers of addictive behavior, namely, adverse childhood experiences. In an effort to illustrate concretely how this may be done, I enlisted the help of a good friend and colleague, Mark Girard, who is a master at knowing how to help people heal from deep, traumatic wounds. As a Licensed Clinical Social Worker and certified Jungian Analyst with years of experience, he is incredibly skilled at working with a wide range of altered states, or emotional constrictions due to trauma. What impresses me most about Mark is how he uses himself as a tool in therapy. He walks his talk and maintains a presence with patients that is the essence of what a good therapeutic relationship is all about. During his recent visit to my class he agreed to have me videotape his lecture. The approximate 35 minute presentation is a gift to us all. I encourage you to take the time – quiet, focused time – to sit and hear what he has to say.

In the presentation, Mark mentions an article by Dr. Bruce Perry from the ChildTrauma Academy that was required reading in class. The article is titled Applying Principles of Neurodevelopment to Clinical Work with Maltreated and Traumatized children and is a nice adjunct to his lecture. He also makes reference to Babette Rothschild’s wonderful book on trauma, The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment, and the classic article on trauma by Bessel van der Kolk, The Body Keeps Score – both among the very best reads on the topic of trauma.

“Calm Energy” as an antidote to addiction

Monday, October 18th, 2010

I have mentioned Dr. Robert Thayer before on this site, but have not dedicated a blog entry to his ideas until now. When I first read his book, Calm Energy: How People Regulate Mood with Food and Exercise, I was immediately impressed by the implications of his  work for those struggling with addiction. In a nutshell, he provides a very strong case that many of our moods and unhealthy eating habits have in common two biopsychological dimensions that he calls energy and tension. In an earlier book (The Origin of Everyday Moods, 1996) he describes how the dimensions can be used to create the illustration below.

The above four states represent different expressions of our energy and level of stress. Calm Energy is the quadrant where we find our best moods. We have energy and no tension. It is similar to the states people call flow or being in the zone. It is a place we want to be, where our attention is focused, we are productive, and we feel good about life. It is not a place where addiction is found, and in fact, is really the antidote to cravings and addictive appetites. The opposite of Calm Energy is Tense Tiredness. This unfortunately is the place many of us find ourselves these days, in large part due to the speed of life, decreases in sleep, and increases in stress. It is a place of low energy, bad moods, anxiety and depression. It is also the state where addiction thrives. When we feel tense and tired there is a natural tendency to want move away from this state, and addictive behaviors are among the most powerful, reliable, quick, and easy ways to disconnect from Tense Tiredness. I say disconnect because engaging in addictions does not really provide an antidote to this state. Instead, it may in the short run give us more energy, and change our mood, but only temporarily. When the addictive behavior ceases, chances are good that what follows will be more tension and lack of energy, perpetuating the relapse cycle.

I like to think about Calm Tiredness as a lazy Sunday afternoon. In general, it is a pleasant state, but often not as productive or positive as Calm Energy. Nothing wrong with it, and in fact we need down time to recharge our batteries. The final state, Tense Energy, is a state where we are quite productive and busy, often due to deadlines and being rushed for time. Many Type A personalities fit this state, as well as those who like to live on the edge and seek out thrills.

In my own life I find the model incredibly useful in helping me understand my own eating, exercise, sleep, and mood patterns. One of the best things you can do for yourself is take a day (or two) and track your level of energy and tension by the hour. Rate each on a scale of 1 to 10 and then plot the results on a graph. It is revealing to see just how significantly these states change in the course of an average day. The graph also helps to identify intervention points for: (a) preventing relapse, (b) developing optimal times for exercise, and (c) determining whether we are getting enough sleep. In addition, the graph can help you understand how time of day subtly influences how we think about life problems.

In sum, addiction most often shows up when we are tense and tired, but can also occur in the other states as well. Among the most significant points Dr. Thayer makes in his book is that the single best way to cultivate a life of calm energy is by developing a regular habit of exercise. Perhaps that is why the National Institute of Drug Abuse has already invested over 4 million in research into the connections between addiction and exercise.

The end of Mr. Roger’s neighborhood

Friday, October 8th, 2010

As a young boy, I remember venturing out on summer evenings to play hide-and-seek with the other neighborhood kids. We made up teams, sought out secret hiding places, and took full advantage of the local woods that surrounded our corner of the world. Our parents all knew each other, and while we were expending our energy running around in the dark playing games, they were talking around tables and sharing food and drink. There was no internet, cell phones, or other multimedia distractions competing for time. Life was simpler, slower.

Now, more than thirty-five years later, I find myself married with a young son and challenged to provide him the same care-free childhood that I experienced. Despite living in a pleasant, middle-class neighborhood, it is rare to see large groups of kids playing together outside. There are no local woods within walking distance, and even if there were, most parents (myself included) would be hesitant to allow their children to play unsupervised. Although everyone I encounter on my daily dog walks is friendly, there is a lack of deep intimacy among neighbors. Some have never even met despite living within blocks of each other for decades.

The stark contrast between life today and just a few decades ago is surreal. The year I was born the handheld calculator was invented, and today, handheld devices are minicomputers capable of video-conferencing around the world. But for all the benefits technology affords, there is a cost that gets lost in the frenzy of Facebook, YouTube, and Amazon.

In 1985, researchers set out to understand the degree to which people have family and friends they can rely upon to discuss matters that are personal in nature. A national survey was done, and in 2004, the same group decided to repeat the study to determine how core discussion networks had changed over two decades. The results are frightening.

  • 25% of all Americans in 2004 reported they had no one in their life to discuss personal issues, compared to 10% in 1985
  • The modal (most frequent) number of discussion partners in 1985 was three, but in 2004 that number plummeted to zero
  • The average social network size has dropped from 3 confidants to 2
  • The number of people who reported that their spouse was the only person they trust with personal issues increased by almost 50 percent since 1985

These outcomes paint a sobering picture of the price we may be paying for our technology-enhanced life. The lead researcher has said, “we know these close ties are what people depend on in bad times. We’re not saying people are completely isolated. They may have 600 friends on Facebook.com and email 25 people a day, but they are not discussing matters that are personally important.”

Source: Social Isolation in America: Changes in Core Discussion Networks over Two Decades, American Sociological Review, June 2006 71:353-375

Dr. Gabor Mate, continued…

Monday, July 5th, 2010

The following interview with Dr. Mate provides additional context for his work and beliefs about addiction. One surprising statement he makes is that less than five percent of his patients overcome their addictions - not the best of outcomes. Of course what “overcome” means and how to define outcomes are messy topics, but I am far more optimistic about  the tenacity of the human spirit to change. Addiction is most definitely a challenge, but one reason for poor outcomes has been the lack of understanding about the nature of addiction, and the need for a comprehensive solution like MRC. Watch the interview, and then let me know your thoughts about Dr. Mate’s conclusions.

Who is the best at living the longest?

Saturday, March 20th, 2010

This past week I had a few minutes to spare in Washington DC, so I dropped by the National Geographic Society headquarters and discovered a project that has significant relevance to successfully solving the problem of addiction. Writer and photographer Dan Buettner embarked on a journey around the globe in search of communities that optimized lifestyle for longevity and happiness, places he calls blue zones.  He boiled down his research for the book Blue Zones into principles for living a long and prosperous life. Here is a great summary of the book he did for TED:

For those who struggle with addiction, the keys outlined in the book (and the speech above) provide a road map for translating the MRC solution into reality. Let’s look at how they line up:

Manage
Successfully dealing with addiction requires identifying those things in your life that are chronic issues, and then developing strategies that appropriately keep these things in-check. When we expect to permanently solve a chronic problem we set ourselves up for failure because there is no cure or end to these issues, they require ongoing attention. Addiction, diet, chronic medical issues, time and exercise are all things we must learn to successfully manage. In Blue Zones, the keys that line up with manage include:

  • Learn to move naturally. Those who live to be 100 rarely engage in rigorous exercise. Instead, they incorporate  walking, gardening, yoga and other less body-stressful movements into their daily routine. Developing a healthy lifestyle free from addiction necessitates learning to move in the world in a new way, in a natural, physically and emotionally pain-free way.
  • Slow down. Our culture perpetuates addictive behavior by encouraging lifestyles where multi-tasking, reliance on technology, and instant gratification become packaged in a speedaholic existence. Not so for those who live in blue zones. An important aspect of successful long-term management of addiction is learning to slow down, become conscious of how you spend your time, and align it with what is most important in your life.
  • Eat and drink wisely. Food and drink are common objects of addiction, and although abstinence from alcohol is possible, we cannot stop our relationship with food. The same goes for those who struggle with sexual addiction. It is not possible to remain abstinent from sex, we are sexual beings by nature and healing requires finding healthy ways to express our sexuality. The key is moderation, balance, and of course, eating more fruits and vegetables. Red wine has also been shown to increase longevity, but if it creates more problems than benefits (e.g., abuse, relapse) it should not be on your list.

Resolve
There are some life problems that we should not manage, but solve, permanently. Homelessness, debt, acute pain, many developmental constrictions/deficits, legal problems, and suicide ideation. None of these things are healthy to manage over a long period of time, and our work should focus on resolution. Two significant problems most addicts need to resolve are lonliness and isolation. The key that lines-up with resolve is:

  • Be Connected to Others. Those who live the longest put family and loved ones first. They belong to communities that nurture and protect each other. Many share their spiritual faith in community, and hang out with people that have healthy habits, both physical and emotional. I have written a lot about how the essence of solving the problem of addiction is disconnecting from object-relationships and learning to engage in healthy, intimate connections with people. But to do this very often requires resolving barriers to human relationships. These barriers include unresolved trauma that lead to isolation, developmental stuck points, and debilitating shame and grief. This work is not easy, but necessary for relationships to blossom.

Create
Many who struggle with addiction spend all their time on the pathological side of the equation. Treatments, interventions, fixes, cures, treatments….all intended to reduce or stop addictive behavior. This stuff is important, but at the same time it needs to be integrated with actions that optimize life.  Sometimes taking a break from intervening on addictive behavior and directing energy to what we want out of life can actually produce the outcomes we seek. Those who live in blue zones:

  • Have a clear purpose. They call it “ikigai” – the reason for which you wake-up in the morning. If your ikigai is that you don’t want to drink, smoke,  or act-out today, well…this is not a very compelling reason to get out of bed, it just gets you to focus on what you don’t want! The key is redirecting your life energy towards creating what you do want.

For additional information on blue zones, checkout the author’s website: bluezones and the book.

Managing Addictive Behavior in Practice

Tuesday, December 29th, 2009

food-safety2There are many things I struggle to manage in my life, including time, food (or more correctly my weight), exercise and making sure my dog gets her heart medicine every eight hours. I have other vices as well, but what links all of these things together is that they are ongoing issues that come and go in my life. At times I eat healthy, exercise regularly, and use my time well. Yet at other times I find myself scarfing down junk food, skipping workouts all together, and feeling like a mouse on a never-ending treadmill.

Addictive behavior is similar in that it also comes and goes to varying degrees over time, it is not a constant. Although some can find permanent solutions to end particular behaviors (“I just stopped smoking and never went back to it”), for most people, even if one behavior goes away, another usually takes its place perpetuating the problem of addiction just in a different form. Because objects of addiction can also come and go, it is easy to see why dealing with addiction can become so hard – different addictions, different times, different problems, but most often sharing many underlying traits. As a result, I believe that the most humane way of dealing with addiction is by utilizing a management approach that aims to decrease harm for all behaviors over time, and improve ones quality of life. Too often I see people going in and out of treatment, attempting desperately to put a lid over the behavior and banish it forever, only to get depressed and frustrated when it returns in its original form, or surfaces in another addiction. So how do we manage behavior? Whether it’s addiction or giving my dog her pills, I have found four key things that make a difference:

meditationAwareness: You cannot manage anything if you are not aware of it and how it plays out in your life. Awareness is not so easy these days because we are bombarded from every side with people vying for our attention. But you must increase your awareness of the behavior you wish to change if you have any chance of success. How do we do this? (1) utilize reminder messages on your computer, phone, on sticky notes, put them on electronic calendars that email you reminders, set alarms to go off at critical times, (2) talk with someone about the behavior on a regular basis and process your progress – could be a therapist, friend, pastor, mentor, coach, spouse – who does not really matter so much as just having an ongoing connection and doing it, (3) utilize a form of meditative practice to help clear away psychic junk and make more room to help you stay aware of what is truly important to you, and (4) set-up your environment in such a way as to increase awareness: find new routes to work that avoid high-triggery places, get rid of the extra refrigerator in the garage where you store beer, add things that you want to focus on instead of the addiction like an easel for painting, a musical instrument, or perhaps a pet if you don’t have one.

KISS: Yes, the tried and true Keep It Simple Stupid (OK, maybe the stupid needs to go) applies to managing behavior change. The more complicated you make it, the less likely you will succeed. Simple means we don’t try to change too many things at once, and we do our best to find the simplest and easiest way to accomplish our goal. Earlier this year I significantly changed my diet and felt great. More energy, better sleep, all the things promised from this new way of eating materialized. Yet a few weeks later I was back to my normal, disappointed that I could not maintain what I started. But I shouldn’t have been. I changed too much too fast. We humans live so much by habit, and the many routines our brains lock into very often determine our behavior even when we desperately want to behave differently. In a recent post I mentioned how the environment also sets us up, particularly for making it difficult to eat healthy. We have to be begin by making small incremental changes that support new brain connections, new habits. Change is a process with many different drivers, the key is finding the one that works best, and just staying on the road.

statisticsStatistics. For many statistics is a foreign language, existing in a country you never want to visit. But in truth, we live statistics every day of our life. We read sports statistics, check weather reports, listen to stock updates, and hear percentages thrown around in the news. Statistics is the science of making effective use of data, and in the case of managing behavior, there are many things that can be helpful to track over time: days abstinent, relapses, weight, money lost, time spent on particular activities, etc. We track things because of our limited ability to keep a lot of this in our head, to remember the specifics. Keeping a record of progress provides a clear indication of how well we are staying on the road. It provides us feedback that is critical to successful change. Our tracking methods can be as simple as keeping a tally on a notepad, or creating more elaborate outcomes on spreadsheets. I have seen a number of those struggling with addiction get very caught up in statistics, particular days abstinent, where relapses become devastating events instead of opportunities for growth and learning. Statistics should always be used to help us grow, learn, and better manage our behavior over time.

group-hug2Social Support: You’re aware of what you want to manage, you put a program in place that is simple, easy to stick with, and does not change too much too fast, and you begin to track your progress. The final key and perhaps the most important is understanding that managing any behavior change we make is embedded within the social systems in which we exist: family, school, work, clubs, self-help groups, church, sports, neighborhoods. We are social creatures by nature and influenced greatly be those around us. Successful change requires taking stock of our social connections, both those that support our change and are positive, and those that clearly contribute to perpetuating problems we wish to stop. I have said many times that addictions are ultimately about relationships, and the goal is to replace unhealthy relationships with objects with healthy relationships with people. This is an ongoing process of learning how our past relationships influence our present ones, and how we can heal past wounds and emotionally mature in a way that allows to both receive and give love.

As we begin a new year (and a new decade), many of us will set goals to better manage behaviors in our life. Whether the desire is to reduce drinking, drug use, or have a more fulfilling relationship with food or sex, we stand a much better chance of succeeding when we utilize the above four keys. Happy New Year!