Dropping the Rope of Addiction

Individuals seeking help in overcoming substance abuse often fall into three categories: the perpetual quitter, the negative and bitter, and the home run hitter. The home run hitter does just that – tries to quit and hits a home run, quitting right away. The negative and bitter don’t believe that they will overcome their addictions and they try to blame other people or entities for their problems; they play the victim card, often without facade of personal responsibility. The perpetual quitter always quits but never succeeds. It is those people I want to address.

Erase Addiction
Photo by alancleaver_2000: http://www.flickr.com/photos/alancleaver/4104954991/

The following vignette is fictional but not atypical of people seeking smoking cessation treatment. Ralph was a 53 year old male with a 35 year history of smoking 1-2 packs of cigarettes per day. He recently had a chest scan that revealed a spot on a lung. His doctor told him he needed to stop smoking. Ralph wanted to quit – cigarettes were becoming just too expensive. He had a daughter he was trying to help through college and as he neared retirement he not only wanted to have more money upon which to retire but he also wanted to live long enough to retire. Ralph had been trying to quit for years; he was successful in reducing his pack consumption from 2 packs a day down to around 1 pack. Ralph had tried patches, pills, and going cold turkey. Each time he slipped and started smoking. He meant well but Ralph could never quite quit.

Ralph believed that he could win the battle over smoking on his own; yes, he would supplement his efforts with patches or pills but he thought he would be able to slay the giant himself. He couldn’t. Few people have that strength and willpower and those who do, usually developed it through practice of self-control.

Addiction is like playing tug-of-war with a monster on the other side of a gorge. We think we can pull it in but it’s stronger than we are. We might even think that we can cross the chasm and fight it (maybe the other side looks greener) – we will lose. The only way to conquer it is to let go of the rope and live our lives on our side of the chasm. Then the monster will walk away as we stop fighting it. In this we are not just ignoring it, we are simply choosing to stop fighting it so that we can move on to greater goals.

This concept of overcoming addiction can be quite successful because when we fight things, we dwell on them. If we play tug-of-war with the monster of addiction we focus all our energy on it. In doing so, we allow it to have power over our lives. That’s the irony of fighting the monster; we might think that we are choosing to battle it, that it is a fight on our chosen ground and at our chosen time, but the monster stands there, waiting for us to fight it – it enjoys the contest. This is a fight few can win.

Should we cross over the bridge to attack the enemy there? No. Once again, that places our focus on the monster; plus then we are in its territory. That is not the way to win. Once again, by striving to do so we focus on the monster. It’s like me telling you to not think about purple bunnies. Of course, the first things you think about are purple bunnies. The more you try to suppress the thought, the worse it gets. Addictions are the same way.

We need to drop the tug-of-war rope and walk away. We acknowledge the monster, we do not ignore it. Ignoring it does not solve our problems either because then we are in denial and in the river of denial we usually end up eaten by crocodiles. So instead of just ignoring the monsters we say, “I know you are there; I know that you are a terrible thing in my life; I know that you want to fight me and I want to fight you but I cannot win. I embrace you and let you go.” Instead of straining and putting all our efforts on fighting the bad in our lives, we acknowledge it, and then fill our lives with good.

That’s really the key to overcoming the monster of addiction – establishing positive goals and working towards those goals more than fighting against the monster. The goals could be family, work, hobby, service, church, or community related for a start. It is in striving towards good goals that the monster of addiction finally goes away.

For all the perpetual quitters out there – if you are trying to overcome addiction of any sort (and it could be anything physical or emotional) but find yourself constantly quitting with little success, it is time for a shift in tactics. That shift could be to acknowledge the monster, drop the rope, walk away, and work towards positive goals in your life. In this manner does the addiction no longer have any power over you. This is not an easy thing to do if there are years of addictions to overcome but it is a simple process.

Carl Rogers’ Therapy

Here’s an old but good video of Carl Rogers giving an explanation of his Person Centered Therapeutic approach.

Here is the second part of the video where you can see Rogerian therapy in action:

Notice how Person Centered Therapy is non-directive. This means that the therapist does not provide answers for a client, the therapist helps clients work towards their own answers while being as supportive and reflective as possible.

There are more parts to the video, which can be found on YouTube.

Patient Presentation and Mood States

When writing or talking about medical patients or therapy clients, it is helpful to describe their presentation. You cover things such as appearance and grooming, mood, openness, language, and thought process. How a client looks can reveal a lot about their lives, stressors, and their overall cognitive functioning. How open they are with you as a doctor or therapist is also important to note. Sometimes people are reticent to talk about themselves (which is understandable) and distrustful in general. Some people also don’t know how to talk about themselves, so they don’t.

The language people use also reveals their underlying cognitive functioning. Tangential language, disjointed speech, and slowed speech, for example can mean different things – a thought disorder, depression, acquired brain injury, and so forth. Related to language is a person’s thought process; this is apparent from their language but also in how they describe their problems or their lives.

When discussing mood, there are three general terms doctors use. The first is euphoric – extremely happy. Sometimes it is appropriate for people to exhibit this emotion but it can also be a sign of mania, especially if the positive mood was not seemingly triggered by anything. The next term for a mood state is euthymic, meaning normal, slightly positive mood. This is the mood that most people exhibit most of the time. It is neither positive nor negative (although often interpreted as having a slight positive lean). The last descriptor for mood is dysthymic, which means depressed or having negative affect.

Using these labels when describing patients provides a common, concise set of terms. It is, however, usually better to describe behaviors than just give a label. This means when writing about a patient or client, a report might state, “[The patient] presented as dysthymic, not smiling, becoming tearful at times….” Labels are concise, descriptions are precise.

Underlying Assumptions of Cognitive-Behavior Therapy

Cognitive behavior therapies (CBT) all have (or should have) the general underlying model of: Activating Event –> Schemas –> Thoughts –> Behavior/Emotions –> Outcome. In other words, there is a specific and precipitating event that is mentally interpreted, thought about, and acted (or not) upon; all of the steps following the precipitating and activating event lead to a consequence, or outcome. More specifically, our thoughts are really the cause of our behaviors and emotions – our behaviors are internally driven, even in the face of powerful external events. In order for this model to work there are a few basic assumptions that serve as the foundation for cognitive-behavior therapy.Psychotherapy Room

One of these assumptions is that cognitions affect and cause behavior. This goes beyond traditional behavior therapy because cognitions serve as mediating responses between the initial stimuli and behavioral responses. So in effect, it is our cognitions that cause behavior because how we interpret events determines how we react to them. Behavior also can affect cognitions but the general point is that cognitions are not only involved in the behavioral process but necessary to it.

Another assumption is that cognitions are not simply mysterious ephemeral processes – they can be measured, monitored, and altered. Asking people how they think and feel is thus a potentially effective way to understand their behavior. If cognitions can be measured they can also be altered. This means that the way that people think about the world and think about themselves can be changed, which is the goal of CBT when there is maladaptive behavior and cognitions.

As cognitions change, behavior may change. CBT does not ignore the role that changing behaviors (separate from cognitions) has in the therapeutic process but it is important to change cognitions to exact lasting behavioral change. Also, cognitive change is important in cases where situations and external influences on behavior do not, cannot, or will not change.

Image by Dinovitch.