by Steve Rose | May 4, 2020 | Addiction and Recovery
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If you’re working in the helping professions like social work, addiction counseling, or the medical field, you’ve likely come across motivational interviewing and wondered how it works. If you’re not familiar, motivational interviewing is a collaborative counseling style, designed to evoke a person’s motivation for change.
Several studies confirm the efficacy of motivational interviewing, but many practitioners find it challenging to apply this technique and don’t understand how it works. Unlike cognitive-behavioral therapy, motivational interviewing appears much more passive.
On the surface, motivational interviewing is mostly invisible, yet it can powerfully facilitate change. Although motivational interviewing works, understanding how it works is just as important. It is not merely a set of techniques. Instead, it is a way of being with a client that facilitates change.
So how does motivational interviewing work?
Motivational interviewing works by supporting a client’s sense of intrinsic motivation, self-efficacy, and a sense of empathic connection to the counselor. Each of these factors leads to increased motivation to change.
Let’s take a look at each of these areas to understand more fully how motivational interviewing works.
Motivational Interviewing Builds Intrinsic Motivation
As described in my article on What Causes People to Change, intrinsic motivation is a leading cause of long term sustainable change.
Intrinsic motivation is the internal desire to make a change as opposed to extrinsic motivation, where external pressures or rewards cause change.
An example of intrinsic motivation would be having a deep enjoyment of playing a musical instrument. You feel drawn to practicing and enjoy the process.
If someone were to start paying you to practice (extrinsic motivation), then had authority over how and when you practiced, it could take away your intrinsic motivation, leading to less desire to practice in the long-term.
Motivational interviewing is designed to facilitate intrinsic motivation. Let’s take a closer look at how it does this.
Collaboration Rather Than Confrontation
Motivational interviewing emphasizes collaboration because it works. Collaboration works because it helps build intrinsic motivation.
Consider the classic example of your medical doctor telling you that you’ll need to lose weight. How many people can attribute significant life changes to this type of advice? This approach is not collaborative since it is advice from authority.
The medical field generally operates from the model of expert authority, giving direction to a passive patient. Expert advice and threats of health consequences are a form of extrinsic motivation, which is unsustainable in the long-term.
Motivational interviewing emphasizes approaching clients from a collaborative perspective, encouraging them to be active participants in their treatment plan, not merely a passive recipient.
Open-ended Questions
Open-ended questions are powerful tools for facilitating collaboration. These consist of questions that can’t be simply answered with “yes” or “no.”
Most open-ended questions generally start with the word “what.” For example, “what is the issue you want to discuss?”
These types of questions facilitate collaboration by putting the other person in an active position. Their participation is encouraged by the need to further elaborate their reasons for seeking treatment, what they want out of the working relationship, and what they’ve been trying so far that hasn’t been working.
Developing Discrepancy
This technique works to build intrinsic motivation by highlighting the gap between someone’s actions and their values.
As you ask someone what they want and what they’ve been doing up to this point, a gap between their actions and values might emerge. For example, someone might value community, yet they are self-isolating due to fear of social rejection.
Collaboratively pointing out this gap might consist of asking a series of open-ended questions about what they value and what they are doing, then simply reflecting back, “…on one hand you value community, but on the other, it looks like something is stopping you from socially engaging.”
Gently bringing someone’s attention to the gap between their actions and their values builds intrinsic motivation since it is highlighting their own values rather than externally imposed values.
Motivational Interviewing Builds Self-efficacy
Self-efficacy is the perception of one’s abilities to effectively handle a situation or overcome an obstacle.
Research on self-efficacy demonstrates the critical role it plays in motivation. Persons with high self-efficacy are more likely to maintain high motivation for goal attainment, especially when these goals are self-directed.
Motivational interviewing works by facilitating high self-efficacy. It does this through supporting client autonomy, encouraging “change talk,” and through a collaborative approach to treatment planning.
Supporting Autonomy
Supporting autonomy means maintaining the independence of the client. Rather than taking control, directing the conversation, and doing things for a client, supporting their autonomy means keeping them in control.
Although it may be tempting to take control and start doing things for someone, this takes away their sense of control and accomplishment.
When someone accumulates small wins over time, they begin to gain a sense of self-efficacy. This increasing sense of competence builds confidence in one’s abilities to effectively cope with future challenges.
Facilitating Change Talk
Change talk can be defined as positive statements about change. The amount of change talk by a client generally predicts the likelihood of change.
The opposite of change talk is sustain talk. These are negative statements about change and language focused on being stuck.
Motivational interviewing works by amplifying the amount of change talk through focusing on these positive areas of competence and hope, rather than unnecessarily staying focused on what is not working. This is how evoking change talk builds self-efficacy.
Collaborative planning
Collaborative planning means being like a travel agent. This means working with the person to find out where they want to go and how they want to get there.
Travel agents work with you in a partnership rather than merely telling you where to go. Also, once you’re on the trip, the travel agent can be consulted, but it is not their job to go with you and carry your luggage.
A collaborative approach to treatment planning works by building self-efficacy. Making progress on a plan you create for yourself builds confidence in your ability to set goals and follow through.
Motivational Interviewing Builds Empathic Connection
Empathy involves deeply listening, showing an understanding of the other person’s perspective. Beyond sympathy, empathy requires fully being with the client and holding space for whatever they need to discuss.
The therapeutic relationship is one of the most important aspects of counseling, and empathy is fundamental to a strong therapeutic relationship.
Accepting Clients Where They Are
Acceptance is a core foundation of motivational interviewing. It means accepting a person where they are, recognizing their worth as a human being. We may not like every characteristic or behavior, but acceptance goes beyond these things.
Acceptance requires seeing a person’s common humanity, recognizing there are likely many reasons why they are in their current position.
Acceptance does not mean accepting bad behavior. Instead, it means treating someone with dignity while setting boundaries if lines are crossed.
Acceptance works to build an empathic connection since it allows you to see past surface characteristics so you can see the whole person in front of you.
Rolling with Resistance
Rolling with resistance works to build empathy, increasing the likelihood of change.
Rolling with resistance is like verbal judo. It means rolling with confrontational momentum rather than trying to stop the momentum through counter-confrontation. This means avoiding direct confrontation through argumentation.
If you think someone is wrong about something, does direct confrontation simply change their mind? If this approach worked, it would save the world many Facebook flame battles and frustrating political conversations over the holidays.
So how do you roll with resistance? When you feel like arguing with someone, hold back and keep listening… then listen some more. As Stephen Covey said, “Seek first to understand, then to be understood.”
How do you listen effectively, beyond merely not talking? The answer is reflective listening, one of the most important parts of motivational interviewing.
Reflective Listening
Reflective listening makes up the largest part of motivational interviewing and generally comprises around 75% of counselor responses.
Reflective listening works by building empathy, showing you understand, rather than simply telling someone you understand.
The most powerful form of reflection is the “complex reflection.” This consists of continuing the other person’s sentences or paragraphs by guessing what they mean. The key to this technique is that the dialogue should flow as if it were a single person speaking.
Example:
Client: “When I come to the casino, I find it difficult to control my spending.”
You: “the games are so engaging, and you lose track of time.”
Client: “yeah, and the other day I was here for six hours, and it only felt like one!”
You: “and before you know it, you’re spending a lot more money than you planned.”
Reflective listening is also a vital tool for rolling with resistance, collaborative planning, supporting client autonomy, and facilitating further change talk.
Conclusion
Motivational interviewing works because it uses various techniques and relational approaches that maximize intrinsic motivation, self-efficacy, and a sense of empathic connection. Each of these areas is associated with increased motivation for change.
If you are interested in further exploring how to use motivational interviewing, the British Medical Journal has a great free online course that gives practical video examples.
Hopefully, this article helped lay a foundation for understanding how motivational interviewing works and why it is an essential tool for conversations about change.
by Steve Rose | May 2, 2020 | Addiction and Recovery
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As an addiction counselor, I’ve spent quite a bit of time looking at what causes people to change. Although relapse is a normal part of recovery, most people can find long term stability. Many people can make long term changes, but there is still a significant number who do not make these changes.
Digging into the research on what causes people to change, in addition to years of observing human behavior, I’ve come to an understanding of the motivations leading to change. Hopefully, this general theory of change will be helpful if you are trying to make sense of someone’s behavior.
So what causes people to change?
People change when motivated by a sense of independence, a sense of competence, and a sense of connection to others. These motivations can be sparked in moments of extreme frustration when a person realizes their current approach is no longer working.
This answer is based on the empirically derived self-determination theory. This theory explains intrinsic motivation, meaning people change based on internal forces. Although people can be forced to change through external forces, these changes are not sustainable and don’t often result in real long-term change.
Can People Change?
The simple answer is yes.
Research shows 40% – 60% of individuals in recovery from addictions will relapse. Although relapse is a normal part of recovery, most people can find long term recovery, even after several relapses.
People can change for the better, and people can change for the worse.
The idea that someone has a fixed set of personality traits that determines their behavior is a myth. Personality traits are generally considered to be relatively fixed, but they do not determine behavior.
Personality traits only increase the chances of certain types of behavior. For example, someone who is high in novelty-seeking may be more likely to travel, but it does not mean they will become an avid traveler.
The idea of an “addictive personality” is also largely a myth. Although there are certain personality traits often associated with addiction, there is no standard definition of an addictive personality in the literature.
Even if certain traits can be associated with addiction, they do not mean the person is destined to develop an addiction.
Therefore, people can always change. No set of personality traits or past behaviors completely determine how someone will behave in the future.
What Causes People to Change for the Better?
People often change for the better when they encounter a great deal of pain or frustration and realize the way they are behaving is not working.
In the case of addiction, this is often referred to as hitting rock bottom. Though everyone’s rock bottom looks different. One person may need to experience years of hardship before deciding to change, whereas others may only need to experience a single painful event.
When someone develops the humility to admit that their current behavior is not working, they are at a turning point where it is now possible to make the required changes.
The motivation to pursue a new direction comes from a sense of independence, a sense of competence, and a sense of connectedness to others.
As described in self-determination theory, a sense of independence means the person is making the decision to change for themselves, not due to external forces. This is also referred to as intrinsic motivation and is one of the major factors predicting long-term change.
External pressures, otherwise known as extrinsic motivation, can assist in the short-term, but the person eventually needs to develop their own internal desire before long-term change is possible.
Another major factor leading to change is a sense of competence. A person gains motivation by seeing the rewards of their efforts. Accumulating small wins kindles the desire to continue efforts to change. Building a sense of competence develops hope that change is possible.
Lastly, change is motivated by a sense of meaningful connection to others. In the case of addiction, many people join support groups, seek the support of family, or find support in a counseling relationship. Human beings are social creatures who thrive in supportive social contexts and deeply suffer in isolation.
To read more about this phenomenon, check out my article, The Impact of Isolation on Addiction.
How Do You Help Someone Change?
There is nothing you can do to make someone change, but there are several things you can do to increase the odds of someone changing.
Before helping someone change, it is important to have firm personal boundaries. We might be tempted to overextend out support to people who are not ready to change or who are merely taking advantage of our help.
When talking to someone about change, the first step is to listen. Listening builds a sense of engagement and trust, allowing you to understand where the person is coming from, in addition to understanding the underlying reasons for their behavior.
Seeking your own support is also important when helping someone change, especially if their behavior directly impacts you. Spouses of persons with addictions may participate in support groups like Al-anon, seek the support of friends or extended family, and even seek the support of a professional counselor.
If you are interested in an in-depth look at how to help someone change, you can check out my comprehensive article on the topic: The Ultimate Guide to Helping Someone Change.
In that article, I go into a great deal of detail on effective communication and interpersonal techniques, accompanied by personal examples.
Conclusion
People change when they come to a place of deep frustration and pain. When they develop the humility to admit their current approach is not working, they are ready to take the first steps to change.
Long-term change is motivated by intrinsic motivation. External forces can spark initial short-term change but is not sustainable in the long-term. Long-term change ultimately depends on a person developing their own internal reasons for change.
As change occurs, motivation is built through small wins and accomplishments, building a sense of competence and hope that change is possible.
Lastly, a sense of social connection supports long-term change.
If you or someone you know is thinking about change, just know that change is always possible. If you are suffering from an addiction, it is important to remember that relapse is a normal part of recovery.
Turning back toward your internal values and motivations requires a simple decision. Although it is simple, it is not easy.
by Steve Rose | May 1, 2020 | Addiction and Recovery
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Lately, I’ve been thinking about the meaning of the Serenity Prayer. Although I was raised Roman Catholic and still practice occasionally, I appreciate the depth of the Serenity Prayer from a psychological perspective.
The Serenity Prayer is packed full of meaning and psychologically validated wisdom in just a few short lines. It is useful for persons in recovery from addiction, but also for anyone struggling with situations beyond their control. If you or someone you know is struggling, check out my resource page for suggestions on how to find help.
What is the meaning of the Serenity Prayer?
The Serenity Prayer means letting go of situations beyond your control and taking action toward things within your control. It also means being able to know when things are within your control and when things are beyond your control.
Let’s take a look at the Serenity Prayer, itself.
Written by the American theologian Reinhold Niebuhr, It is most commonly quoted as the following:
“God, grant me the serenity to accept the things I cannot change,
courage to change the things I can,
and wisdom to know the difference.”
The Serenity Prayer is based on four virtues:
- Serenity
- Acceptance
- Courage
- Wisdom
Let’s take a closer look at the meaning of these virtues from the Serenity Prayer and how you can apply them to your own life.
The meaning of serenity
Serenity is the first virtue mentioned in the Serenity Prayer and is presented as the primary goal.
Serenity comes from the root, serene, meaning calm, tranquil, peaceful, and clear/ unclouded. Serenity is a state of mental calm and clarity, where you feel at peace in the present moment, able to focus on what matters.
Being in a state of serenity is the opposite of a state of anxiety.
Anxiety pulls you out of the present moment, clouding your mind with thoughts of the past, and worries about the future. It is a state of tension and chaos.
Like anxiety, serenity is a perspective through which you view the world. The world does not need to be perfect to have mental clarity. With practice, we can approach uncertain situations through the mental lens of serenity.
As described by Kelly G. Wilson in the book, Things Might Go Terribly, Horribly Wrong:
“Learning to sit with ambiguity can be a very important start at a life liberated from anxiety—and the way to do it is to resist the urge to chase answers to questions that may actually be unanswerable.”
Learning to adopt a serene perspective takes practice. Although it takes work, the Serenity Prayer gives us direction on how to develop it.
The first step in developing serenity is acceptance.
The meaning of acceptance
In the Serenity Prayer, acceptance means letting go of things outside of your control.
We spend a lot of our lives worrying about things outside our control. A state of anxiety pulls us into not accepting reality as it is and trying to change it through constant worrying.
Mary Schmich illustrates this when she states:
“…worrying is as effective as trying to solve an algebra equation by chewing bubble gum.”
Worrying about things outside of our control does not actually help solve the problem. Instead, it can further entrench the problem by putting us into a state of anxiety rather than a state of serenity.
Which state is more useful amid chaos?
Although anxiety does help keep us safe by maintaining high alert for threats, it is no longer useful when spinning out of control.
If you find yourself spinning out of control, fighting with your anxiety is also counterproductive.
“I can’t feel this way!… I need to feel happy… oh no, am I getting anxious!?”
These thoughts only serve to strengthen the anxiety. Fighting with something only gives it more power over you.
So what is the most helpful approach?
Acceptance.
Russ Harris, one of the key thinkers in the practice of Acceptance and Commitment Therapy (ACT), states:
“Stop trying to control how you feel, and instead take control of what you can do”
This is where the third virtue in the Serenity Prayer comes in. Let’s take a closer look at courage.
The meaning of courage
In the Serenity Prayer, courage means having the strength and determination to do what is within your control.
When faced with an obstacle, we can have one of two reactions. We can claim we are a helpless victim of circumstance, or we can take ownership of the things we do have control over.
Have you ever found yourself complaining about a bad manager? This outwardly directed blame keeps us focused on the things we do not have control over – the manager’s behavior.
Rather than pointing fingers, having the courage to look inward allows you to take responsibility for the things you do have control over. You cannot control the actions of a bad manager, but you can control how you respond. You can also control whether or not you stay in that job.
The courage to take an appropriate action does not mean the absence of fear. It means noticing the fear and carrying it with you as you take action, despite it.
Courage means living on purpose.
Not taking action is its own form of action. By not taking action, you’re allowing your life to be dictated by external forces.
As Kelly Wilson states:
“Many people live their lives by circumstance rather than on purpose.”
Courage is about taking responsibility.
See my article on Why Responsibility Is So Important for an in-depth exploration of the meaning of responsibility.
Although responsibility is important, not everything is your responsibility. In the workplace example above, it is not your responsibility to change your manager.
Also, many people have experienced traumas, marginalization, and injustices that were not their responsibility.
But as I state in my article on responsibility:
If you’ve experienced trauma leading to mental health issues, you are not responsible for the problem, but you are responsible for being part of the solution.
The key is knowing the difference between something that is your responsibility and something that is not.
This brings us to the final virtue in the Serenity Prayer: wisdom.
The meaning of Wisdom
In the Serenity Prayer, wisdom means knowing what is within your control and what is not within your control.
Therefore, wisdom allows you to know when to practice acceptance and when to practice courage.
You can ask yourself, “Is this something within my control?” If not, you can then ask yourself, “what is within my control?”
The wisdom to know the difference is often clouded by anxiety when we are immersed within our thoughts. Rather than having the wisdom of clarity, our thoughts might lead us astray.
Our minds often lie to us, leading to what is referred to by psychologists as Cognitive Distortions. One of the most common includes black and white thinking. This means the tendency to overgeneralize, having thoughts consisting of “always” or “never.” For example, “I’m always treated unfairly by my manager.”
The key to wisdom is the ability to look at your thoughts as if you are a third-party observer.
As stated by ACT founder Steven C. Hayes:
“What we need to learn to do is to look at a thought rather than from thought.”
Having the wisdom to know when a thought is clouding your judgment requires being present to the moment.
As Daniel J Siegel states:
“Mental presence is a state of being wide awake and receptive to what is happening, as it is happening in the moment, within us and between the world and us. Presence cultivates happiness.”
Presence gives you the clarity to step back from your thoughts and see the bigger picture. Wisdom allows you to then distinguish what is your own responsibility in the matter.
by Steve Rose | Apr 18, 2020 | Addiction and Recovery
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When I share that I work in the addiction field, particularly focused on gambling, gaming, and technology use, people often immediately consider their own relationship with these things.
“I’m super addicted to my phone… I think my son is addicted to video games… my husband is addicted to work!”
I immediately want to take a step back and talk about what it means for something to be classified as an addiction while also compassionately being open to the possibility of these things actually being true.
Most likely, addiction is not an appropriate word for most of these daily activities.
It is important to distinguish between frequent use of something and an addiction. Pathologizing everything only diminishes the real struggle some people face. So when does something become an addiction?
Something becomes an addiction if it begins to have significant harmful impacts on other areas of your life. In addition, the individual experiences craving, loss of control over the substance or behavior, and is unable to stop despite these harms.
Let’s take a closer look at the difference between recreation and addiction.
When is something a form of recreation?
Recreational use of something such as gambling, gaming, technology use, alcohol, or substances is a balanced part of someone’s life. It does not have a harmful impact on any other area and the person has full control over its use.
For example, a recreational gamer could be compared to a recreational craft beer enthusiast. Just because they enjoy it regularly does not make them an alcoholic.
Addiction is a problematic relationship to a behavior or substance, not the use of a particular substance or behavior in itself. To suggest so would be an overgeneralization that only serves to stigmatize persons within that specific demographic.
Most gamers don’t have a gaming addiction, just as most beer drinkers are not alcoholics, and most cannabis users are not addicted to cannabis.
But what about powerful substances like crystal meth? Is there such a thing as casual crystal meth use?
Although the concept sounds ridiculous, it is actually possible to engage in recreational crystal meth use. According to David Sack M.D., many people will try meth, and only a small percentage will become regular users.
Despite this, I would never recommend dabbling with powerful substances such as crystal meth, since the risk of addiction is significantly higher. David Sack, M.D., states:
Most crystal meth addicts have a brief period of “casual” or “recreational” use. This can quickly escalate to abuse and dependency. Attempting to use meth (or any other addictive stimulant, such as cocaine) in a casual/recreational fashion is a bit like playing with matches in a room filled with dynamite. No matter how careful you are, you’re likely to blow the place up.
Use of any substance or behavior should never be conflated with addiction, but some things carry a higher risk, such as powerful stimulants and opioids.
When does something become an addiction?
Something becomes an addiction if it begins to have significant harmful impacts on other areas of your life. In addition, the individual experiences craving, loss of control over the substance or behavior, and is unable to stop despite these harms.
Recreation is about pleasure, whereas addiction is about coping.
When using a substance or behavior for recreation, a person is coming from a place where they are already feeling whole. Their chosen form of recreation adds to their life.
When using a substance or behavior to cope, a person is coming from a place where they feel like they are not whole. They may feel like they are not enough, using a substance or behavior to inflate their confidence. They may be suffering from anxiety, using a substance or behavior to stay calm and get out of their head. They may be carrying shame, using a substance or behavior to distract them from the underlying pain.
Addiction means using something to cope, requiring it to feel “normal.”
Many persons with an addiction report feeling a sense of wholeness when they began using a substance; a sense that the world now has color; a sense of warmth imitating the feeling of love.
Eventually, tolerance and physical dependence may develop, leading to the need to increase usage and an inability to discontinue use due to withdrawal. At this point, the person may need the substance to feel physically normal. This is particularly relevant for opioid use.
For stimulants, physical dependence generally refers to the brain’s downregulation of dopamine production, leading to the inability to normally experience pleasure while not using the substance.
Also, after writing a previous article on why video games are addictive, I received some questions on how to determine if you are using gaming as a form of recreation or if it has become an addiction.
In 2018, the World Health Organization classified Gaming disorder as an official form of addictive behavior. It consists of three components:
- The loss of control over one’s gaming
- Gaming taking priority over other areas of life
- Continued use despite negative consequences and impaired functioning in other areas of one’s life.
The key difference between someone who has a video gaming addiction and someone who plays a lot of games is the lack of control and negative impact it has on the person’s life. This negative impact can include dropping out of schooling, loss of employment, loss of contact with in-person friends or family, in addition to physical health issues.
What about binging?
Although there is no shortage of Netflix binging right now, addictive binging is different than recreational binging.
If you have extra free time and have taken care of your basic responsibilities, binging on Netflix, having a wild night with too many cocktails, or partaking in too much of the devil’s lettuce may be a form of recreation.
Addictive binging is distinct since it is used to cope with underlying pain, stress, or anxiety. Beyond merely letting off steam, this form of binging comes in somewhat regular intervals and has negative impacts on other areas of life.
This form of addiction is tricky since the individual can appear to have the substance or behavior under control most of the time, even convincing themselves they have it under control.
Some people who binge on alcohol may even be able to drink recreationally in certain situations.
Recall the key difference between recreation and addiction is the loss of control and the harmful impact on their life.
Conclusion
The word “addiction” is often used casually to explain the frequent use of a substance or behavior such as gaming. Addiction and recreation are different since recreation is about pleasure, whereas addiction is about coping.
All substances and behaviors can be used recreationally, but some carry more risks than others.
Persons who develop addictions are often coping with underlying pain or anxiety, eventually becoming dependent on the substance or behavior. This is a form of short-term coping with long-term costs.
Addictions consist of the loss of control and the inability to stop a substance or behavior despite the negative consequences.
by Steve Rose | Apr 17, 2020 | Addiction and Recovery
In the thick of the current global pandemic, I thought it would be helpful to revisit the timeless wisdom in Robert Frost’s poem, A Servant to Servants: “…the best way out is always through.”
I would go even further to argue that the only way out is through. In light of the current crisis, what does this mean?
“The only way out is through,” means facing the pain of a situation head-on rather than avoidance through distractions, including alcohol, drugs, or other behaviors such as gambling, gaming, and work.Â
Let’s look at how this is currently playing out and how we can use the lesson to move through difficulties.
Coping During Difficult Times
A recent Forbes article describes the current situation in the title: .
According to Market Watch U.S. alcohol sales are up 55%, with online alcohol sales up 243%.
A report commissioned by the Canadian Centre on Substance Use and Addiction recently released data stating the following:
“25% of Canadians (aged 35-54) are drinking more while at home due to COVID-19 pandemic; cite lack of regular schedule, stress and boredom as main factors.”
From long lines outside liquor stores to a recent report of more than 120 cars lined up outside of a Krispy Kreme in Mississauga, people are looking for relief.
Is it really all that bad to want an extra cocktail or a doughnut amidst all of the stress and boredom? Probably not.
But it is also probably something to keep an eye on.
Are these becoming habitual short-term solutions with long-term consequences?
If so, consider how the substance or behavior is serving as a way to avoid dealing with painful underlying thoughts or emotions.
Avoidance Makes Things Worse
This brings us to the lesson that the only way out is through.
The tiger metaphor from my previous article, Why Responsibility Is So Important, seems fitting, so I will restate it here. Besides, everyone is talking about the Tiger King, so I’ll just stick with the theme. Note that this tiger metaphor is adapted from Steven Hayes, founder of Acceptance and Commitment Therapy (ACT).
Imagine you adopted a tiger cub into your home. It is cute, cuddly, and harmless. You notice it begins to purr loudly, and the only way you can make it stop is to feed it red meat. Over the months and years, you keep doing this, but the tiger is now several hundred pounds, requiring whole sides of beef. Rather than a cute purr, the tiger roars ferociously for its meat. You are terrified, so you keep giving him the meat so he will leave you alone. The more you feed it, the larger it gets, and the more trapped you become.
In this metaphor, feeding the tiger symbolizes avoidance. There is temporary relief, but a long term cost. Each time you avoid difficulties, you are feeding the tiger, making the problem larger, giving up long term freedom and control.
Responding Rather Than ReactingÂ
Since avoidance keeps you stuck, going through difficult situations is the only way out.
Going through situations requires acceptance of what you cannot control and a degree of distance from your thoughts.
In acceptance and commitment therapy, this technique is called cognitive diffusion.
Although it has a fancy name, it is relatively simple, but not necessarily easy.
Throughout our daily life, we see the world through the lens of our thoughts. Cognitive diffusion allows us to step back from our thoughts, seeing the thoughts themselves.
We are either seeing the world through our thoughts, or we are looking at our thoughts. The former comes naturally, whereas the latter takes practice.
The purpose of taking a step back from our thoughts is that it allows us to intentionally respond to a situation rather than simply react to it.
As stated in my article on Why Responsibility Is So Important, responsibility is the ability to respond. Reaction is the opposite of responsibility. Rather than choosing an appropriate response, reactions consist of a habitual way of coping, such as reaching for a drink, logging onto a gambling site, or escaping through compulsive working.
When we are stripped of our regular ways of avoiding difficult thoughts or emotions, we find other ways to avoid them.
For example, if compulsive working was used as a way to avoid facing the underlying thought that you are not good enough, job loss could result in replacing this avoidance strategy with alcohol to calm the anxiety stemming from this underlying thought.
Although working and drinking look like very different kinds of behavior on the surface, they could both be potentially used for the same purpose.
Gaining distance from your thoughts gives you the ability to choose a valued way forward rather than coping through reactive behaviors.
How To Go “Through” DifficultiesÂ
One exercise I find helpful in gaining distance from your thoughts is called “leaves on a stream.”
It consists of closing your eyes, focusing on your breath, and imagining you are sitting beside a stream. As you watch the stream, you also notice leaves floating by. Remain focused on your breath, and as any thought comes into your head, simply put it on a leaf and let it go.
This is difficult to do when you are reading, so here is an audio recording: Leaves on a Stream Exercise.
The purpose of this exercise is to gain skills in looking at thoughts rather than through thoughts, giving you the ability to choose to move through difficult situations rather than staying stuck in short-term coping.
ConclusionÂ
During these difficult times, many of us are turning to the comforts of alcohol, sweets, or Netflix binging. Although these behaviors are reasonable and may not be an issue, they are something to keep an eye on.
Noticing patterns of short-term coping that come at a long-term cost allows you to gain further control and freedom to move through difficult situations rather than staying stuck in reactive patterns.
As we move through this pandemic and out the other side, it is helpful to remain focused on things within our control and let go of things we cannot control.
One way to practice letting go consists of the leaves on a stream exercise. This exercise allows you to gain distance from your thoughts and choose a valued path forward, rather than reacting in ways to avoid dealing with underlying issues.
by Steve Rose | Apr 2, 2020 | Addiction and Recovery
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In light of recent social distancing measures, I’ve been thinking about the impact of isolation on persons with addiction.
Isolation and addiction go hand-in-hand. Isolation causes addiction, and addiction causes isolation. Therefore, I thought it would be helpful to dive into the topic in further detail.
As a sociologist and addiction counselor, this is a topic I have thought about quite a bit over the years.
So what is the impact of isolation on addiction?
Isolation increases the risk of addiction among individuals using a substance or behavior to cope with the loneliness, boredom, or loss of purpose due to isolation.
It is important to note that isolation and loneliness are not synonymous. You can be living in an isolated situation, yet feel connected to others. You can also be living in a highly social situation, yet feel alone.
This article focuses on persons experiencing loneliness due to isolation, feeling a sense of social disconnection or displacement.
Isolation Causes Addiction
Addiction is caused by various factors: biological, psychological, social, and spiritual. Mainstream medical discussions of addiction tend to focus on the biological realm and the addictive nature of chemical properties within a substance.
Although certain substances can be risky due to their chemical makeup, this perspective does not explain addiction. Many people consume substances without developing an addiction.
Besides, it doesn’t explain addictive behaviors like gambling and gaming, since behavioral addictions develop without necessarily consuming a chemical compound.
This is why the social realm is so important.
Dr. Marvin Seppala, chief medical officer at the Hazelden Betty Ford Foundation, recognizes this in the statement:
“We consider addiction a disease of isolation…”
Bruce Alexander is a major advocate for this perspective, with his famous Rat Park Study.
Researchers typically conducted rat studies on addiction with a single rat in a metal cage. If you leave the rat with drug-infused water and regular water, the rat will continue taking the drug until it overdoses.
The rat park study did the same experiment but took the rat out of isolation, putting it into rat park, a large rat amusement park with the company of several other rats.
Rather than overdosing on the drug-infused water, the rats in rat park moderated their consumption, balancing it with the regular water.
Although there have been some unsuccessful attempts to replicate the study, there have been some successful attempts as well.
A more recent study reported by the National Institue on Drug Abuse reinforces the rat park findings:
“The new study, led by NIDA’s Dr. Marco Venniro, required rats to choose between social interaction with another rat or access to a drug (heroin or methamphetamine). The animals consistently chose social interaction when given the choice, and this was true when they were first given access to the drug or when they were experienced drug takers.”
The fact that the rats chose interaction over addictive substances reinforces the power of social connection and the risk of addiction when it is not present.
Addiction to Social Media ‘Likes’
Since rats choose interaction over addiction, what if the addiction is the social interaction.
As humans, our social realm is extremely complex, especially in the midst of social media technology. This form of social interaction, itself, can be an addiction.
How social is social media? If it is social, then how is it encouraging addiction? Shouldn’t it be helping reduce isolation?
In my article, Is Social Media Making Us Less Social? I concluded:
“Social Media is making us less social when used to compare oneself to others, contributing to higher levels of loneliness and lower levels of well-being among frequent users. It can be social when used to meaningfully connect with others.”
Using social media in a way that connects us with others can make us less isolated and more socially engaged, especially in times we are unable to meet in person.
Using social media in this way to reduce isolation can, therefore, reduce the risk of addiction. When used to compare ourselves to others, it facilitates further isolation, leading to the risk of compulsive consumption and ‘like’ seeking.
Why Social Connection is Important
Social isolation is as dangerous as smoking.
In a TED Talk on the study, Robert Waldinger emphasizes the dangers of social isolation, stating:
Loneliness kills. It’s as powerful as smoking or alcoholism.
Physical health issues are intertwined with social and mental health issues. Like addiction, we need to consider the full spectrum of factors contributing to health and wellness.
Luckily, social determinates of health are gaining traction in the scientific literature. Recent research looked at the impact of loneliness as a risk factor for mortality and found:
Current evidence indicates that heightened risk for mortality from a lack of social relationships is greater than that from obesity.
The researchers also found loneliness is comparable to other health indicators, including substance abuse, irresponsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care.
Although studies are now mounting regarding the risk of social isolation, it is a relatively neglected issue. The researchers note:
The current status of research on the risks of loneliness and social isolation is similar to that of research on obesity 3 decades ago.
If we want to understand human thriving, the social component is essential.
According to an 80 year long Harvard study that followed a group of individuals since their college years, the quality of our close social relations is the best predictor of health and happiness:
…people’s level of satisfaction with their relationships at age 50 was a better predictor of physical health than their cholesterol levels were.
Modern conveniences allow us to live more independently than ever. We can connect with family and friends during times where distance and isolation would normally reduce interaction.
With the increased convenience, we also need to also consider the potential costs when technology is used in ways that further contribute to isolation. This does not necessarily mean using less technology. It means using technology in smart and innovative ways to maintain connections.
Dealing with Isolation to Reduce the Risk
During this unique time of self-isolation and social distancing, it is necessary, more than ever, to consider the quality of our close interpersonal relations and use technology in ways that bring us together.
Persons suffering from addiction or those in recovery are at increased risk during this time. Addiction programming and in-person supports have largely shut down. Residential treatment programs are not operating and withdrawal services are limited.
As the serenity prayer states, we need the serenity to accept the things we cannot change and the courage to change the things we can.
Although we cannot change the current situation, we can recognize the things we do have control over and take the necessary steps to reduce the risk of loneliness due to isolation.
Consider reaching out to supportive family or friends, catching up like-minded people you haven’t talked to in a while, using the phone, email, or scheduling online video chats.
If you find yourself feeling like a disengaged social media spectator, consider engaging in ways that fit your personal style. This could include making meaningful comments, sending private messages, or creating your own content. Personally, I prefer private messages and engaging with people through my website platform.
Lastly, if you’re in isolation with other family members or roommates, it is easy to feel disengaged from one another while in the same household. If you find yourself in the same rut of social media scrolling and Netflix binges, consider pulling out some classic board games, eating together, or exercising.
