Abstinence

Abstinence: self denial, restraint from indulging a desire for something, for example, alcohol or sexual relations

What Do All Drugs, Including Alcohol Have In Common?

The thing drugs and alcohol all have in common is that they impair judgment and many can do so even in small amounts.

Which is why small amounts often lead to the intake of more alcohol and drugs even in one sitting or period of use . . . One drink leads to two, two snorts to a run. . .

For what ever reason, when using it appears to the user that more is better.

Impaired Judgment Leads to a Higher Risk For Relapse For Drugs and Alcohol

If your judgment is impaired by lack of sleep and chronic fatigue, you are at higher risk for relapse
If your judgment is impaired by unmanaged depression or anxiety, you are at higher risk for relapse
If your judgment is impaired by drugs and alcohol, even those you may not have abused, you are at high risk for relapse

This is the reason why drinking a couple beers may lead to a relapse with cocaine even if alcohol was never a problem for someone. A little bit of alcohol may take that critical edge off of you thinking and allow you to start all the silly rationalizations that come before drug usage. “This will be the last time”, or “I’ve worked hard and I deserve it.” are common examples of this. After going through a rehab program you may feel like you could handle a little limited use, but can you? More on this tomorrow.

So what else do you have to do to handle cravings after you leave drug rehab?

You need to create a positive self image and change your lifestyle to include, exercise, healthy diet, healthy relationships

Be Aware of Your Cravings

You need to become aware of your cravings, feel them and don’t try to react, just feel them and note when they occur
You need to try different methods of dealing with your cravings and find those that work for you
Take time to exercise or use meditation or reading or walking when you feel a craving
Get to learn your craving stimuli or cues: is it because you are feeling lonely, sad, anxious, bored, angry, hungry? Then take action to change that state of being and manage that emotion

Remember the Common Faulty Belief Patterns That Lead To Giving In To
Cravings

Over sensitivity to your unpleasant feelings or emotions, that is low tolerance for normal mood fluctuations.

Highly value instant satisfaction.

Inadequate techniques and skill for controlling behavior and solving problems
A pattern of automatically yielding to impulses.

Low tolerance for frustration often linked to erroneous or faulty beliefs.

Focus on the here and now without goals or structure for tomorrow, next week, next month, next year.

How many of these describe you?

Cravings can be handled in a safe and sane manner. Cravings are a normal part of dealing with drug addiction, and are a part of life after leaving a rehab program. With practice and a good plan for other activities, cravings do not have to lead to a renewed drug or alcohol use and a relapse.

Two Sides of The Equation

As your goal is permanent abstinence, you need to implement enough durable change and improvement in your skills to give you a sufficient margin of safety to continuously increase your control and decrease your craving.

There are two basic ways to increase your control:

1. Reproduce craving stimulus situations and practice managing them
2. Improve your rational thinking to reduce and combat your permission to use thoughts

Reproduce Craving Situations and Practice: Take Ten Minutes

You need to identify conditions that are a stimulus to craving and rehearse control behaviors, over and over while you are drug or alcohol rehab.

Imagine a situation in which you are offered crack cocaine or alcohol or the drugs you were addicted to and write it down.

Now imagine ways to refuse the offer and write them down.

Turn to a friend next to you, share the situation, have them offer you the drug, you now turn it down.(Pg. 35-36, “Cognitive Therapy of Substance Abuse,” Aaron T. Beck, Fred D. Wright, Cory F. Newman, Bruce S. Liese, The Guilford Press, New York, 1993.)

Practice this while in a rehab and even after you leave rehab.

Reproduce Craving Situations and Practice, Practice, Practice

Total Loss of Control is a Myth

The notion of total loss of control is simplistic and does an injustice to the internal resources available to each of you.

In fact, people who abuse drugs and alcohol do exercise control most of the time.

When the urge is not strong or the substance is currently not available, you are able to abstain.

You do not go off in wild pursuit of the drug at the first sensation of craving.

There is a qualitative difference between the wish to use and the wish to control the urge.

Specialized Techniques To Develop Control

Developing control is a technical problem that all clients can learn to master.

Learning specialized techniques for reducing craving and establishing control is generally necessary for those who are truly addicted.(Pg. 34-35, “Cognitive Therapy of Substance Abuse,” Aaron T. Beck, Fred D. Wright, Cory F. Newman, Bruce S. Liese, The Guilford Press, New York, 1993)

Sources of craving also need to be explored and managed before you leave rehab. I’ll go though some of these techniques next.

Continual Repetition of Drug Use

Through continual repetition of drug or alcohol use, the chain between craving and urges becomes stronger.

Skilled acts are based on conscious decisions while drug-taking exhibits less and less conscious
control.

Stimulus Generalization

Gradually with increasing use, the individual responds with craving to an increasingly broader range of stimulus situations.

With the linking of craving to more and more stimuli, there is an expansion of dysfunctional beliefs about drug use.

Expansion of Dysfunctional Beliefs

The individual’s original belief might have been “I should drink or use to be part of the group,” the beliefs build up to “I need to drink or use to be accepted” and later “ I have to take a snort to relieve my loneliness and distress”.

The rebound depression or sadness experienced after cocaine, heroin or alcohol use results in a renewal of craving to counteract this “low” feeling.

Now the beliefs are expanded to “I need a hit in order to feel better”.

When drugs or alcohol are taken to relieve stress related anxiety or sadness or naturally occurring tension or anxiety or sadness, it tends to reinforce the belief that “I need the drug,” or “I can’t tolerate unpleasant feelings”.

The Most Common Erroneous Belief

There is a common erroneous belief that addicted individuals have little or no control over their urges and behavior or that craving is irresistible.

(. 34-35, “Cognitive Therapy of Substance Abuse,” Aaron T. Beck, Fred D. Wright, Cory F. Newman, Bruce S. Liese, The Guilford Press, New York, 1993.)

If you are going to make permanent change in your drug addiction treatment you have to attack and change the beliefs that are wrong or don’t support you. Do it while you are in rehab or as soon as come back, but do it.

Breaking Down Your Erroneous Beliefs

People struggling with their addiction often ascribe their drug and alcohol use to “uncontrollable cravings and urges”

However, it is certain dysfunctional beliefs that tend to fuel these cravings and the actions.

Abusers tend to ignore, minimize or deny problems arising from their drug use or attribute these problems to something other than the drugs or alcohol.

Another core set of beliefs centers around the individual’s sense of hopelessness in controlling craving.

Cognitive therapy reduces self defeating behaviors by modifying erroneous thinking and maladaptive beliefs and teaching techniques of control

Cognitive Therapy In Drug Addiction Treatment

Is collaborative and builds trust.

It views drug taking or drinking as a technical problem for which there is a technical solution.

You can learn to interrupt the craving and urge cycle.(Pg. 41, “Cognitive Therapy of Substance Abuse,” Aaron T. Beck, Fred D. Wright, Cory F. Newman, Bruce S. Liese, The Guilford Press, New York, 1993.)

If you seek a more permanent solution to your addiction problems you may require some competent Cognitive therapy. If the rehab facility did not have this as part of their program, just find a therapist to deal with this as you leave rehab. It is just one more important piece of the sobriety puzzle and the keys to a great life.

After alcohol or drug rehab the control of urges is essential to sobriety.

Urges Are About Anticipation

Urges are governed by the anticipated consequences that is the reward for doing something or the pain for not doing it.

The urge may be accompanied by a positive feeling when it is driven by a positive expectation or a negative feeling when it is driven by expectation of unpleasantness unless the urge is acted upon.

Some people confuse an urge with a “need”.

They will say “I need a drink” as though they cannot survive or at least function without it.

Such a belief is spurious, not genuine, that is different from what it claims to be.

The Role of Beliefs

Dysfunctional beliefs play a huge role in the generation of urges.

Dysfunctional beliefs fail to perform the function that is normally expected of a belief, that is to guide us in acting or responding in a way that supports our goals.

The beliefs help to form the expectation, which then molds the urge

Beliefs about the positive effect of using drug or alcohol

Research has shown that many addicted individuals hold a set of beliefs that predispose them to continued use:
General exaggerated sensitivity to unpleasant feelings
Low motivation to control behavior
Impulsivity
Excitement seeking and low tolerance for boredom
Low tolerance for frustration
Insufficient social alternatives for gaining pleasurable feelings and a sense of hopelessness for ever achieving the goal
Each of these factors is addressed in cognitive therapy and in the structure of a good rehab program
(Pg. 33, “Cognitive Therapy of Substance Abuse,” Aaron T. Beck, Fred D. Wright, Cory F. Newman, Bruce S. Liese, The Guilford Press, New York, 1993.)

I have said in previous posts the key to sobriety and success in drug rehab is changing core beliefs. By changing your beliefs about urges and what they mean, while you are in rehab or addiction treatment is another of the essential steps in relapse prevention.

Craving

In addiction, craving refers to the desire for the drug
An urge refers to the internal pressure or mobilization to act on the craving
In short, craving is associated with wanting and an urge with doing
An urge is the instrumental sequel to a craving
A person feels the desire to experience a “high” or relief from discomfort and feels a pressure to act to obtain this experience

Urges

An urge is the behavioral intention to engage in a specific behavior
Urges may be regarded as compulsions when the individual feels incapable of resisting them
The urge is instigated by an unpleasant feeling state such as anger, frustration or anxiety, or the anticipation of an unpleasant stressful event
The ultimate goal of consummating the urge is a reduction of the original feelings whether it be craving for excitement or a desire to relax(Pg. 31, “Cognitive Therapy of Substance Abuse,” Aaron T. Beck, Fred D. Wright, Cory F. Newman, Bruce S. Liese, The Guilford Press, New York, 1993.)

Between Craving And Urge To Use Lies The Opportunity For Action

Here is the space that must be developed and practiced in a rehab. Rehabs have the opportunity to remove the ability to use drugs or alcohol so they artificially increase the time between craving and the urge and then actual use. In this unusually large space that rehab creates is the place to practice some of the suggestions I will post in the following days. By practicing these techniques in rehab or on your own you can insure that cravings do not lead to renewed substance abuse and relapse.

Which is the best policy for a drug or alcohol rehab program? How does a residential program deal with on-site illicit use? Obviously there are 2 different rooute that can be taken. One is some sort of punitive action but essentially allows people back in or continue if they have a slip. The other is a zero tolerance policy that with any useage or drugs or alcohol the person is removed and not allowed back in.

The risk with the forgiveness policy is that it make the consequences of using not as great and it may actually allow clients to plan a “relapse” because if they get caught it is not that big a deal. This of course leads to a facility that ends up with more drugs and alcohol being smuggled in. This puts the other clients at greater risk as they may relapse if exposed to drug or alcohol early in their rehab treatment. Sometimes if someone has a slip they will decide to leave the facility and lead to a full blown relaspe. So a lack of a zero tolerance policy may lead to a greater risk for more clients in a rehab.

The risk of an absolute zero tolerance policy is that it may appear to be cruel and unforgiving. By expecting clients who have admitted they have a problem to have a perfect record in rehab treatment, are we expecting too much? However if someone knows the consequences will be immediate and final it will discourage people from trying to use alcohol or drugs and is that not the main purpose of a rehab? There is also the question of the law. Many of the substances abused are illegal and does a rehab even have the “right” to forgive illegal action?

Tough questions but I tend to fall on the side of zero tolerance. The people who go to a rehab and actually do not try to smuggle or find drugs or alcohol deserve the safety that zero tolerance affords them. It is also the only sane way to deal with the legal issue. The research also tends to favor zero tolerance rehabs with a lower relapse rate. Zero tolerance also aids people in regaining their boudaries, another treatment goal. Before you go to any rehab treatment center though, ask what their policy is and make sure you understand it.

The best reason to go to a drug or alcohol rehab program is the you truly want to change and are willing to do whatever it takes to make this change happen. Many people go to rehab to get family members or employers off their back, but they don’t really want to quit. Some people go because they want to stop using just enough to gain some control back in their life but don’t really want to quit drugs or alcohol entirely. Some go to rehab because it is a choice of rehab or jail. Again they may not really want to quit, but it beats the alternative.

Some individuals that go to rehabs for reasons not of the own choosing do succeed and become sober but many do not. The highest success rates are obviously with those individuals who have decided that drugs and alcohol are destroying the quality of their life and they are unwilling to live another day in their old patterns. Those are the ones who get the best bang for their buck, and make the most change. If you really don’t want to change the best drug rehab program in the world will still come up short.

Some say the success rates of rehab programs are poor in the long term. This may be true. It may also be true that if you were able to measure the rates for those who showed up truly because they wanted to change and not because some external force was forcing them to change the picture might look somewhat brighter. People who change only because of external force in a rehab program tend to revert to their previous behavior once that force is removed. Rehabs offer a lot to someone really seeking treatment, they offer a lot less to those who really don’t want to be there.