It is not enough to finally decide to change [although the decision is essential], nor is it enough to develop a plan [although thinking it through is important]. You must be able to execute effectively during the crisis!
Like the ability to perform well on stage ─ following your plan during a crisis requires the development of skill to such a level that it can be performed without conscious guidance. Remember, during the crisis the cognitive resources required to intentionally guide behavior will be occupied, so the intended action must be well rehearsed.
For a variety of reasons the rigid Impeccable Path may be a poor match for you. The more flexible OPEN Path is based on the scientific method. The focus of this approach is to learn the truth about cause and effect for your particular reality.
As your biography unfolds you may encounter situations where choices which now seem preposterous will seem like a good idea. During such times you will be at risk of behaving differently than you now intend. The challenge is to do something now ─ while you have access to good cognitive resources – that will help you to perform as you now intend. The Soul Illusion causes most people to underestimate this challenge; because they believe that during high-risk situations they will be motivated to avoid lapsing, just as they are now. Part of breaking free of dependence is learning to cope with this illusion.
To follow the OPEN Path you would develop an Implementation Intention such as – “When I encounter high-risk situation X, I will execute tactic Y.” Then like a scientist you observe what happens. If you get the expected outcome you are on the right track. However, if things did not work out as you expected, nature is telling you that cause and effect play out differently than you thought, and you must modify your plan to account for this new knowledge. Again, you will ask nature about this new tactic, and be nurtured by the feedback, and so forth. Over time you will develop a more sophisticated understanding of cause and effect in your universe, and a progressively more realistic and effective set of coping tactics.
The OPEN Path refers to: Outcome – Plan – Execute ─ Nurture:
o Chose an Outcome you want.
o Develop a Plan to achieve it.
o Execute the plan
o Nurture the plan through observation
Example of H’s plan: “At the wedding reception, whenever I think of drinking alcohol, I will take a sip of club soda. When I run out of club soda I will go the bathroom and review my reminder card.” At the reception H executes the plan. Later, he reviews his observations, asking himself: “What can I learn from this experience?” “What helped, what did not?”
________________________________________
The truth will set you free!
The objective of the OPEN Path is to improve your understanding of cause and effect through observation so you can continually improve your methods. If your predictions were good enough for you to create a plan that worked well: congratulate yourself and note what you did that was effective. Success has a lot of information value: There are many ways to fail, but few ways to succeed.
Alternatively, if things did not go as predicted, nature has taught you something you did not know before. The task now is to use this new information to improve your understanding of cause and effect, and modify your plan accordingly. You might make some adjustments, or abandon the tactic completely in favor of a different approach. As you continue to accept natural feedback and use it to improve your coping abilities, you will become progressively more effective.
________________________________________
Self-Forgiveness
The follower of the OPEN Path seeks truth as revealed by observation. Personal experiments are conducted primarily to ask a question of nature and receive an answer. These experiments are risky. Unexpected results are common; if we knew what would work we would not have to do the experiment.
Performing these experiments requires courage. Unfortunately, many people with addictive disorders are relentless promoters of self-hate. The inevitable setbacks and hard times are taken as proof of their intrinsic worthlessness, or the hopelessness of their situation.
To utilize the powerful tools of the scientific method you must be:
Open to the truth as revealed by direct observation
Capable of utilizing the disciplines of inductive and deductive reasoning
Free from attachment to any particular story of the truth.
Willing to rehearse your coping tactics so that you can perform them with little conscious guidance.
Flexible enough to Try something different when a tactic you are trying out produces bad results.
________________________________________
So far we have described two mutually exclusive paths to self-determination:
The Impeccable Path requires no decisions, because there are no options ─ no exceptions are permitted.
The OPEN Path requires you to be forgiving of errors and be flexible enough to modify your plan on the basis of new information.
Neither of these paths seems sufficient, and yet each has their advantages. If only there was a middle way…
Sunday, December 23, 2007
Wednesday, December 12, 2007
3.1: The Impeccable Path
Few users of this kit have already tried to quit or control their incentive use. If you have ever lapsed despite your intention not to do so, then you have experienced the PIG’s ability to influence your perception and behavior in real-time. Nevertheless, you may still have insufficient respect for this challenge and so make shallow commitments that will fail because they are not sufficiently binding.
In the final analysis, the only thing preventing you from giving in to a temptation is your commitment not to. Failing to honor a commitment sets the precedent that you can make a commitment and then violate it. This precedent immediately weakens the ability of future commitments to restrain impulse. The critical error of making and then breaking a commitment can transform abuse into dependence. The transition is gradual and the individual is generally not aware of the process while it is happening.
The point of making a commitment is to freeze your current motivation, so that you behave in the future the way you now intend, rather than to yield to local temptations. A commitment is your guarantee that you will adhere to your plan no matter the local circumstance. But if you fail to honor your guarantee you have made a liar of yourself, and future guarantees are worth less.
Making a commitment is like making a bet. If you adhere to it you win, and what you win is the ability to do what you said you would do despite local conditions that would motivate you to lapse. But if you fail to honor it you lose this power of your word ─ willpower.
________________________________________
Odysseus and the Sirens
In a different era Odysseus had to sail within earshot of the Sirens. No sailor could resist their seductive call. The penalty for giving in to this irresistible temptation was death by drowning ─ the fate experienced by all who had come before. Appreciating the danger, Odysseus filled his men's ears with wax so they would not be able to hear the Sirens. Odysseus wanted to hear what the Sirens sounded like, but he knew that if he did he would be unable to resist its pull. The heroic solution: Odysseus pre-committed his future behavior by ordering him men to tie him to the mast of the ship.
The plan was successful ─ When the ship sailed past the island, the Sirens called, but the men could not hear them and kept rowing. Odysseus heard the Sirens, but did not [could not] give in to the temptation, because he was bound to the mast.
________________________________________
Four Lessons:
Odysseus made his plans in advance. He knew that once he heard the Sirens it would be too late to influence his own behavior – their call would have transformed him from a potent warrior to a helpless victim. You would do well to use Odysseus’ humility as a model. Understand this: when you encounter a high-risk situation you will not have the strengths available to you now, and you are not likely to come up with an effective response during the crisis. To succeed you must have a well planned, well rehearsed coping tactic already in place.
Engineer your environment to minimize your exposure to temptation, so avoid high-risk situations and people ─ at least until the healthy habits have strengthened.
Because no sailor had ever survived the temptation of the Sirens, some might take a defeatist attitude and passively accept the inevitable loss. But Odysseus was a hero ─ he had high self-efficacy ─ and so he approached the challenge as a problem to be solved. He devised a good plan, and executed it well.
But the most important lesson of this story: Even though Odysseus experienced irresistible temptation, he did not give in to it. Before reading on, think back to the story: . . . How did he do it?
Having respect for the power of the Sirens, he pre-committed his future behavior by having himself bound by strong rope. Likewise you can pre-commit your future behavior by being bound by your word. For example: "I am not experiencing temptation now, but I know that I will, and so I give my word that whenever I experience temptation I will move away from it." Willpower refers to your ability to adhere to your commitment regardless of local circumstance.
________________________________________
Willpower – the power of your intention to influence real world events – is a creation of the psyche and can be gained or lost according to how you actually perform.
Thought Experiment ─ You announce that you need to move some bulky furniture. Ernest, who owns a pickup, offers to help. You point out that he often makes such promises and has let you down many times. He replies, “But this time I really mean it.” He seems sincere, but he seemed sincere the other times too. The objective world demands that the furniture gets moved. Should you count on Ernest showing up, or make your plans assuming he won’t? Events in the objective world have not happened yet so we don’t know whether or not Ernest shows up. However, you have expectations based on your appraisal of Ernest’s likelihood of honoring his word when you need him.
When you make commitments for yourself are you earnest? If you fail to honor a commitment your expectation that you will honor your commitments in the future is diminished – telling yourself: “But this time I really mean it” is not an effective rescue. On the other hand, each time you honor a commitment your belief that you take your word seriously increases, and your willpower increases with it. Once you make a commitment you must permit no exceptions to occur!
Note that the word "decide" is derived from the root "cide," as in sui-cide, homi-cide, insecti-cide, and means "to kill." When, for example, an alcoholic makes the decision to quit drinking, it is understood that [s]he means to kill, once and for all, the option to drink alcohol, and thereby lock out drinking in the future. [The requirement of absolute adherence to the commitment is equally important for those who choose moderation rather than abstinence as an outcome goal].
Typically, one decides to control an impulsive behavior when its costs are more salient than its benefits. Your commitment is your promise to adhere to the plan even when the benefits of violating it are more salient than the benefits of adherence. Willpower is the measure of your ability to deliver on that.
Willpower is not static, and your ability to override the influence of the PIG can increase or decrease according to certain lawful principles. Local conditions such as anger, fatigue, or a run of bad luck can deplete this power. So, like an athlete it is important to train hard to develop this strength and be vigilant for circumstances that would deplete it.
Willpower Enhancement Notes:
• Making a commitment is like making a bet. Each loss weakens you; each win strengthens you. Honoring a commitment enhances willpower; failure to adhere to a commitment diminishes willpower.
• There is a difference between a goal and a commitment. A goal gives direction; if you lapse you can benefit from what you learned. A commitment is not a learning exercise; by making a commitment, you are foreswearing all excuses and explanations for failure.
• Since you cannot guarantee outcomes, do not commit to outcomes. Commitments must be procedural. For example, you can guarantee that you will perform a History Review [review of the sequence of events that led up to and followed a moment of decision] within 24 hours of the occurrence of a high-risk situation.
• Avoid bets you cannot win in your lifetime. "I will never again search the internet for porn” is such a bet. You don't get to win it until you are on your death bed. Better to go for one day at a time ─ even better is one hour at a time [see the delay method in Chapter 5.5: Coping Tactics].
• Make the commitments short and manageable, but once made, permit no exceptions to occur! Go for what you really want, but realize that more ambitious goals tend to come with a higher price. So be careful about over-committing. Remember, whatever you promise, you will have to deliver.
• Go for little wins. If you have had a history of violating commitments, you are starting out in a hole. Be especially conservative and make sure you honor every commitment without exception. If you do, you will over time re-establish the power of your word.
• People often do pretty well in the beginning, because their commitments are fresh in their mind and hence are salient. However, with the passage of time the salience of the original commitment decays. So periodically review your commitment and why you made it – see Hard Copy Page.
o As rule of thumb, once the crisis that originally motivated the commitment recedes into the past, your motivation becomes more a function of local circumstances than of the now distant commitment. The PIG, which at first supported the commitment ─ when you wanted immediate gratification of the desire to be free of the problem ─ must be overridden when the commitment is far away and the incentive is near.
• The more you exercise a behavioral sequence the easier it is to perform.
o For some individuals, vowing abstinence and then lapsing has occurred so often that they lose the ability in influence their own actions. Their life’s course is no longer determined by their intentions, but by the path of least resistance.
• Be aware that you are free to specify any commitment that you choose, so never make commitments unless you are certain that you will be able to adhere to them under all circumstances implied by the commitment. Because you are free to specify the details of the commitment, you have no excuse not to adhere to it.
o Remember, when you take this bet you are giving long odds; one loss overcomes many victories. It is critical that you adhere to every commitment you make. So specify clearly what you are committing to, and don't accept a commitment unless you are serious enough to bet your reputation that you will adhere to it on every occasion.
• A commitment may be stated formally as an implementation intention [form: Whenever I encounter X, I will Y] – for example, "Whenever I experience an urge, I will visualize the penalties of lapsing.” Note: coding the intention as a negative, e.g., "I will not think about sex" is poor form [see The Imp of the Perverse].
The true goal of this effort is for you to exercise your intended reactions to stress and temptation until they become your defaults. The Impeccable Path is the most straightforward and direct way to achieve this end. Conceptually it is simple, and for some individuals this direct approach is an excellent option: Change your lifestyle and permit no exceptions, and after a while you will have become familiar with your new, but nevertheless idiosyncratic, path: Your path of greatest advantage.
The problem with this approach becomes evident if there is a single lapse. This is a brittle method! Once a commitment is broken the ability to honor future commitments is compromised, and there is no longer a defense against complete loss of control.
In contrast to the rigid path of no exceptions, The Open Path is flexible. At each point, you are free to make decisions on the basis of local circumstances, and what you consider to be in your best interests at the time. Needless to say, anything as valuable as freedom comes at a price.
In the final analysis, the only thing preventing you from giving in to a temptation is your commitment not to. Failing to honor a commitment sets the precedent that you can make a commitment and then violate it. This precedent immediately weakens the ability of future commitments to restrain impulse. The critical error of making and then breaking a commitment can transform abuse into dependence. The transition is gradual and the individual is generally not aware of the process while it is happening.
The point of making a commitment is to freeze your current motivation, so that you behave in the future the way you now intend, rather than to yield to local temptations. A commitment is your guarantee that you will adhere to your plan no matter the local circumstance. But if you fail to honor your guarantee you have made a liar of yourself, and future guarantees are worth less.
Making a commitment is like making a bet. If you adhere to it you win, and what you win is the ability to do what you said you would do despite local conditions that would motivate you to lapse. But if you fail to honor it you lose this power of your word ─ willpower.
________________________________________
Odysseus and the Sirens
In a different era Odysseus had to sail within earshot of the Sirens. No sailor could resist their seductive call. The penalty for giving in to this irresistible temptation was death by drowning ─ the fate experienced by all who had come before. Appreciating the danger, Odysseus filled his men's ears with wax so they would not be able to hear the Sirens. Odysseus wanted to hear what the Sirens sounded like, but he knew that if he did he would be unable to resist its pull. The heroic solution: Odysseus pre-committed his future behavior by ordering him men to tie him to the mast of the ship.
The plan was successful ─ When the ship sailed past the island, the Sirens called, but the men could not hear them and kept rowing. Odysseus heard the Sirens, but did not [could not] give in to the temptation, because he was bound to the mast.
________________________________________
Four Lessons:
Odysseus made his plans in advance. He knew that once he heard the Sirens it would be too late to influence his own behavior – their call would have transformed him from a potent warrior to a helpless victim. You would do well to use Odysseus’ humility as a model. Understand this: when you encounter a high-risk situation you will not have the strengths available to you now, and you are not likely to come up with an effective response during the crisis. To succeed you must have a well planned, well rehearsed coping tactic already in place.
Engineer your environment to minimize your exposure to temptation, so avoid high-risk situations and people ─ at least until the healthy habits have strengthened.
Because no sailor had ever survived the temptation of the Sirens, some might take a defeatist attitude and passively accept the inevitable loss. But Odysseus was a hero ─ he had high self-efficacy ─ and so he approached the challenge as a problem to be solved. He devised a good plan, and executed it well.
But the most important lesson of this story: Even though Odysseus experienced irresistible temptation, he did not give in to it. Before reading on, think back to the story: . . . How did he do it?
Having respect for the power of the Sirens, he pre-committed his future behavior by having himself bound by strong rope. Likewise you can pre-commit your future behavior by being bound by your word. For example: "I am not experiencing temptation now, but I know that I will, and so I give my word that whenever I experience temptation I will move away from it." Willpower refers to your ability to adhere to your commitment regardless of local circumstance.
________________________________________
Willpower – the power of your intention to influence real world events – is a creation of the psyche and can be gained or lost according to how you actually perform.
Thought Experiment ─ You announce that you need to move some bulky furniture. Ernest, who owns a pickup, offers to help. You point out that he often makes such promises and has let you down many times. He replies, “But this time I really mean it.” He seems sincere, but he seemed sincere the other times too. The objective world demands that the furniture gets moved. Should you count on Ernest showing up, or make your plans assuming he won’t? Events in the objective world have not happened yet so we don’t know whether or not Ernest shows up. However, you have expectations based on your appraisal of Ernest’s likelihood of honoring his word when you need him.
When you make commitments for yourself are you earnest? If you fail to honor a commitment your expectation that you will honor your commitments in the future is diminished – telling yourself: “But this time I really mean it” is not an effective rescue. On the other hand, each time you honor a commitment your belief that you take your word seriously increases, and your willpower increases with it. Once you make a commitment you must permit no exceptions to occur!
Note that the word "decide" is derived from the root "cide," as in sui-cide, homi-cide, insecti-cide, and means "to kill." When, for example, an alcoholic makes the decision to quit drinking, it is understood that [s]he means to kill, once and for all, the option to drink alcohol, and thereby lock out drinking in the future. [The requirement of absolute adherence to the commitment is equally important for those who choose moderation rather than abstinence as an outcome goal].
Typically, one decides to control an impulsive behavior when its costs are more salient than its benefits. Your commitment is your promise to adhere to the plan even when the benefits of violating it are more salient than the benefits of adherence. Willpower is the measure of your ability to deliver on that.
Willpower is not static, and your ability to override the influence of the PIG can increase or decrease according to certain lawful principles. Local conditions such as anger, fatigue, or a run of bad luck can deplete this power. So, like an athlete it is important to train hard to develop this strength and be vigilant for circumstances that would deplete it.
Willpower Enhancement Notes:
• Making a commitment is like making a bet. Each loss weakens you; each win strengthens you. Honoring a commitment enhances willpower; failure to adhere to a commitment diminishes willpower.
• There is a difference between a goal and a commitment. A goal gives direction; if you lapse you can benefit from what you learned. A commitment is not a learning exercise; by making a commitment, you are foreswearing all excuses and explanations for failure.
• Since you cannot guarantee outcomes, do not commit to outcomes. Commitments must be procedural. For example, you can guarantee that you will perform a History Review [review of the sequence of events that led up to and followed a moment of decision] within 24 hours of the occurrence of a high-risk situation.
• Avoid bets you cannot win in your lifetime. "I will never again search the internet for porn” is such a bet. You don't get to win it until you are on your death bed. Better to go for one day at a time ─ even better is one hour at a time [see the delay method in Chapter 5.5: Coping Tactics].
• Make the commitments short and manageable, but once made, permit no exceptions to occur! Go for what you really want, but realize that more ambitious goals tend to come with a higher price. So be careful about over-committing. Remember, whatever you promise, you will have to deliver.
• Go for little wins. If you have had a history of violating commitments, you are starting out in a hole. Be especially conservative and make sure you honor every commitment without exception. If you do, you will over time re-establish the power of your word.
• People often do pretty well in the beginning, because their commitments are fresh in their mind and hence are salient. However, with the passage of time the salience of the original commitment decays. So periodically review your commitment and why you made it – see Hard Copy Page.
o As rule of thumb, once the crisis that originally motivated the commitment recedes into the past, your motivation becomes more a function of local circumstances than of the now distant commitment. The PIG, which at first supported the commitment ─ when you wanted immediate gratification of the desire to be free of the problem ─ must be overridden when the commitment is far away and the incentive is near.
• The more you exercise a behavioral sequence the easier it is to perform.
o For some individuals, vowing abstinence and then lapsing has occurred so often that they lose the ability in influence their own actions. Their life’s course is no longer determined by their intentions, but by the path of least resistance.
• Be aware that you are free to specify any commitment that you choose, so never make commitments unless you are certain that you will be able to adhere to them under all circumstances implied by the commitment. Because you are free to specify the details of the commitment, you have no excuse not to adhere to it.
o Remember, when you take this bet you are giving long odds; one loss overcomes many victories. It is critical that you adhere to every commitment you make. So specify clearly what you are committing to, and don't accept a commitment unless you are serious enough to bet your reputation that you will adhere to it on every occasion.
• A commitment may be stated formally as an implementation intention [form: Whenever I encounter X, I will Y] – for example, "Whenever I experience an urge, I will visualize the penalties of lapsing.” Note: coding the intention as a negative, e.g., "I will not think about sex" is poor form [see The Imp of the Perverse].
The true goal of this effort is for you to exercise your intended reactions to stress and temptation until they become your defaults. The Impeccable Path is the most straightforward and direct way to achieve this end. Conceptually it is simple, and for some individuals this direct approach is an excellent option: Change your lifestyle and permit no exceptions, and after a while you will have become familiar with your new, but nevertheless idiosyncratic, path: Your path of greatest advantage.
The problem with this approach becomes evident if there is a single lapse. This is a brittle method! Once a commitment is broken the ability to honor future commitments is compromised, and there is no longer a defense against complete loss of control.
In contrast to the rigid path of no exceptions, The Open Path is flexible. At each point, you are free to make decisions on the basis of local circumstances, and what you consider to be in your best interests at the time. Needless to say, anything as valuable as freedom comes at a price.
Monday, December 10, 2007
3.0: Matching Strategies
Hedonism makes sense: One wants the maximum amount of pleasure and good experiences and the minimum amount of pain and bad experiences. You probably decided to end your relationship with the incentive when you realize it was a bad deal – it was causing more pain than pleasure. But breaking fee is trickier than it seems. The purpose of this kit is to give you the tools that will enable you to follow your path of greatest advantage, as you define it.
Good outcome is rare because of the high rate of relapse, and so you will have to develop the ability to prevent relapse, even in the face of the stressors and temptations that life deals you.
Section 1 focused on establishing a vocabulary and intellectual foundation that will enable you to utilize the tools provided by this kit. Section 2 described the traps responsible for most relapses. You should by now have some hypotheses about your particular traps, and so you are ready to consider solution strategies.
Matching
Part of the complexity of this challenge is that there are different approaches to treating addictive disorders, and each is helpful to at least some individuals. Some institutions tout one or another treatment orientation as the only real solution. In fact there is no single solution, because each individual is unique. Some people are well matched with behavior change strategies that for others are worth less.
This kit is based on the bio-psycho-social model rather than the disease model, and is best matched with inner directed, high-functioning individuals. Anyone who has made it this far through this dense material is almost certainly to be in this group. But even among this relatively small sub-group, there remains tremendous variation in temperament and circumstance. The key to good long-term outcome is matching treatment to the attributes of the individual.
Disease Model of Addictive Disorders
Many people with addictive disorders are impaired and require external structure or supervision to lead functional lives. There are, however, some individuals who function quite well in most domains, save their relationship with a particular incentive. For them, the disease metaphor and the idea of the passive patient being cured by the active treatment agent complicates good long-term outcome and fosters dependence on external agency. As a rule of thumb, the more impaired the individual, the greater the external control required to maintain incentive free periods. Some operational definitions of "impairment" are listed below:
• Cognitive impairment resulting from chronic substance abuse.
• Cognitive impairment due to other factors such as: Head injury, other organic causes, low native intelligence.
• Psychiatric impairment such as: Mood disorder, thought disorder, malevolent narcissism.
In North America, failing to control incentive use is viewed as a disease: The patient is treated and hopefully cured by an external agent such as a physician or treatment provider. The 12-Step Model of Alcoholics Anonymous, the version upon which most treatment programs for addictive disorders are based, is contrasted with the Bio-psycho-social Model upon which this kit is based:
According to the 12-Step Model, impulse control problems are diseases. Treatment emphasizes admitting powerlessness over the problem, complying with a plan developed by treatment providers, and adopting the norms and values of a new social group ─ the support or self-help group ─ in order to achieve total abstinence, which is the only acceptable outcome goal. The victim of the disease is responsible for neither the cause nor the resolution of the problem.
There are many excellent 12-Step treatment programs. In most communities virtually all treatment programs are based on this orientation. These programs will provide the best match for many individuals with addictive and compulsive disorders, especially those who benefit from the support of a self-help group, have a religious orientation, or are not well matched cognitively or philosophically for the demands of a self-directed approach.
The Relapse Prevention Model is based on the disciplines of neural and cognitive science. According to this view, substance abuse problems are the product of biological, psychological, and social factors. Rather than encourage the individual to accept powerlessness over a disease, the individual is encouraged to accept responsibility for changing behaviors that are excessively costly. Individuals who do not feel comfortable with the 12-step philosophy, or those who have attempted 12-step programs without success, often find these cognitive and behavior change techniques to be practical and direct.
Total Abstinence vs. Moderation
The disease model and 12 step programs assume that the individual is powerless to control incentive use, and so do not permit moderation as a treatment goal. The Relapse Prevention model does permit such a goal, which for many individuals is a weakness of this approach. Most individuals with an impulse control problem have tried moderation at least once and did not achieve good outcome. Even though the author does not know anything about you he asserts that choosing moderation as a goal rather than complete abstinence is probably a mistake. Nevertheless, you are an adult and it is your call. Be aware that your relationship with the incentive can take three forms: 1) abstinence, 2) controlled use, and 3) uncontrolled use. If you cannot control your use of the incentive, you have two options.
The desire to maintain some access to the incentive is certainly understandable; it does have its benefits. But incentives that can deliver immediate gratification have such an impact on the Psyche that attempting to control its use is often a fool’s errand. However, if you still want to pursue moderation rather than abstinence as a goal, take the PIG’s wager. If you win you get to be a controlled user, if you lose you must admit you have only two options regarding this incentive.
The PIG’s Wager:
Establish whatever rules you think are appropriate regarding incentive use.
Whatever these rules are, the PIG bets that you can’t follow them.
Take the PIG’s wager – that is, you bet that you will adhere impeccably to your rules.
If you win the bet you get to continue to use the incentive under the terms of your rules.
But if you lose the bet you must admit that you cannot be a controlled user. You don’t get a second chance. Any violation of the rules means you lose, so bear this in mind when you make your rules.
Controlled use means that you are following your own rules, so there must always be rules pertaining to this aspect of your life. You may modify your rules over time – never on the spur of the moment.
How Rigid or Flexible Should I Be?
The remaining chapters of this section address this strategic issue. Three approaches are described; it is important that you understand all three.
Good outcome is rare because of the high rate of relapse, and so you will have to develop the ability to prevent relapse, even in the face of the stressors and temptations that life deals you.
Section 1 focused on establishing a vocabulary and intellectual foundation that will enable you to utilize the tools provided by this kit. Section 2 described the traps responsible for most relapses. You should by now have some hypotheses about your particular traps, and so you are ready to consider solution strategies.
Matching
Part of the complexity of this challenge is that there are different approaches to treating addictive disorders, and each is helpful to at least some individuals. Some institutions tout one or another treatment orientation as the only real solution. In fact there is no single solution, because each individual is unique. Some people are well matched with behavior change strategies that for others are worth less.
This kit is based on the bio-psycho-social model rather than the disease model, and is best matched with inner directed, high-functioning individuals. Anyone who has made it this far through this dense material is almost certainly to be in this group. But even among this relatively small sub-group, there remains tremendous variation in temperament and circumstance. The key to good long-term outcome is matching treatment to the attributes of the individual.
Disease Model of Addictive Disorders
Many people with addictive disorders are impaired and require external structure or supervision to lead functional lives. There are, however, some individuals who function quite well in most domains, save their relationship with a particular incentive. For them, the disease metaphor and the idea of the passive patient being cured by the active treatment agent complicates good long-term outcome and fosters dependence on external agency. As a rule of thumb, the more impaired the individual, the greater the external control required to maintain incentive free periods. Some operational definitions of "impairment" are listed below:
• Cognitive impairment resulting from chronic substance abuse.
• Cognitive impairment due to other factors such as: Head injury, other organic causes, low native intelligence.
• Psychiatric impairment such as: Mood disorder, thought disorder, malevolent narcissism.
In North America, failing to control incentive use is viewed as a disease: The patient is treated and hopefully cured by an external agent such as a physician or treatment provider. The 12-Step Model of Alcoholics Anonymous, the version upon which most treatment programs for addictive disorders are based, is contrasted with the Bio-psycho-social Model upon which this kit is based:
According to the 12-Step Model, impulse control problems are diseases. Treatment emphasizes admitting powerlessness over the problem, complying with a plan developed by treatment providers, and adopting the norms and values of a new social group ─ the support or self-help group ─ in order to achieve total abstinence, which is the only acceptable outcome goal. The victim of the disease is responsible for neither the cause nor the resolution of the problem.
There are many excellent 12-Step treatment programs. In most communities virtually all treatment programs are based on this orientation. These programs will provide the best match for many individuals with addictive and compulsive disorders, especially those who benefit from the support of a self-help group, have a religious orientation, or are not well matched cognitively or philosophically for the demands of a self-directed approach.
The Relapse Prevention Model is based on the disciplines of neural and cognitive science. According to this view, substance abuse problems are the product of biological, psychological, and social factors. Rather than encourage the individual to accept powerlessness over a disease, the individual is encouraged to accept responsibility for changing behaviors that are excessively costly. Individuals who do not feel comfortable with the 12-step philosophy, or those who have attempted 12-step programs without success, often find these cognitive and behavior change techniques to be practical and direct.
Total Abstinence vs. Moderation
The disease model and 12 step programs assume that the individual is powerless to control incentive use, and so do not permit moderation as a treatment goal. The Relapse Prevention model does permit such a goal, which for many individuals is a weakness of this approach. Most individuals with an impulse control problem have tried moderation at least once and did not achieve good outcome. Even though the author does not know anything about you he asserts that choosing moderation as a goal rather than complete abstinence is probably a mistake. Nevertheless, you are an adult and it is your call. Be aware that your relationship with the incentive can take three forms: 1) abstinence, 2) controlled use, and 3) uncontrolled use. If you cannot control your use of the incentive, you have two options.
The desire to maintain some access to the incentive is certainly understandable; it does have its benefits. But incentives that can deliver immediate gratification have such an impact on the Psyche that attempting to control its use is often a fool’s errand. However, if you still want to pursue moderation rather than abstinence as a goal, take the PIG’s wager. If you win you get to be a controlled user, if you lose you must admit you have only two options regarding this incentive.
The PIG’s Wager:
Establish whatever rules you think are appropriate regarding incentive use.
Whatever these rules are, the PIG bets that you can’t follow them.
Take the PIG’s wager – that is, you bet that you will adhere impeccably to your rules.
If you win the bet you get to continue to use the incentive under the terms of your rules.
But if you lose the bet you must admit that you cannot be a controlled user. You don’t get a second chance. Any violation of the rules means you lose, so bear this in mind when you make your rules.
Controlled use means that you are following your own rules, so there must always be rules pertaining to this aspect of your life. You may modify your rules over time – never on the spur of the moment.
How Rigid or Flexible Should I Be?
The remaining chapters of this section address this strategic issue. Three approaches are described; it is important that you understand all three.
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