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.