Kicking Addictions: Commentary on What It Takes and What Helps

A few weeks ago, Daniel Fincke did a post on what it takes to  kick an addiction such as alcoholism. Factors considered include self-discipline, humility, support and substitutions (i.e., replacements to fill the life-space previously filled by the addictive substance). Based on education and experience gained via an undergrad degree in Psychology, years of practicing and studying mindfulness meditation and related philosophy, a Masters degree in Occupational Therapy, and an outpatient mental health placement in which one of the focuses is on assisting people in managing addictions (e.g., smoking, alcohol, marijuana, hard drugs, impulsive spending, self-destructive sexual promiscuity), I would like to offer additional perspective on the issue of what it takes and what can help in kicking addictions. Concepts to be addressed include:

• Reasonable goal setting;
• Commitment and discipline;
• Tolerance for lapses;
• Support;
• Substitutions, Distractions and Strategies; and
• Mindfulness and insight into the nature of one’s emotions and thought.

I. Setting Challenging But Attainable Goals

A good way to get off to a poor start in any attempt at personal improvement is setting goals that do not match the individual in his or her current circumstances. If one sets goals that are too high, they are setting themselves up to be overwhelmed, discouraged and defeated. On the other hand, if they set the bar too low they may succumb to boredom and discouragement and may rob themselves of the excitement that comes from observing meaningful change happen in real-time, all because improvement is so slow-going. A common acronym for effective goal setting in healthcare settings is SMART. Goals should be:

S – Specific. Rather than saying “I’m going to decrease my smoking”, a more specific goal would be “I am going to smoke only 20 cigarrettes a day for the first 2 weeks, 19 for the next 2, 18 for the next 3, and so on”.

M – Measurable. Progress toward the goal needs to be trackable. The example given for Specific is trackable. By contrast, if the goal is to decrease judgmental thinking, it is only trackable if the person is keeping track of the number of judgmental thoughts they have (e.g., by adding a check to a running tally each time the person realizes they’ve had a judgmental thought).

A- Attainable; and R- Realistic. I’ve always found these two to be significantly overlapping and suspect that they were both included just to fill the SMART acronym. Anyhow, goals should be realistic and attainable. They should challenge but not overwhelm one’s abilities and personal orientation with regard to goal pursuit. For example, some people may do well quitting smoking cold turkey. For others, this type of approach would guarantee failure from the very beginning. Goal planning should also be considerate of one’s current circumstances. If the individual is already engaged in a variety of other very personally taxing endeavors (e.g., working two jobs, family difficulties), then they may want to work on kicking their addiction at a slower pace; depending on the type of addiction that they are dealing with, they may even want to delay getting started if some of their other endeavors are going to be winding down soon.

T- Timed. Goal pursuit – e.g., attainment of specific milestones – should be scheduled. Setting challenging but achievable milestone achievement dates is motivating and keeps one on track.

II. Commitment & Discipline

In order to attain a challenging goal, unless the goal is extraneously imposed on the person by a whip-cracking disciplinarian, the person needs to be committed to the goal. How is one to climb a challenging mountain if they couldn’t care less whether they make it up or not? What’s the point of exercising the self-discipline to fore-go immediate gratification when one doesn’t particularly care about the end result?

III. Tolerance for Lapses

Sometimes we slip up. For any number of reasons – e.g., being tired due to too little sleep or two much work, being overwhelmed by various difficult life events, being tempted by environmental triggers (e.g., Friday night at the bar with one’s friends, all of whom are drinking, smoking and having a great time) – most of us will occasionally give in to the behaviours we’re trying to reduce.  While working for Peter Herman, research psychologist specializing in eating (e.g., eating disorders, dieting)  at the University of Toronto, I learned that a major precipitant of failed diets for many is equating lapses with all-out failure. Lapses and failure are not the same thing. Effective goal pursuit requires discipline, but also the humility and compassion for self that recognizes that sometimes we will slip, but that doesn’t mean that we cannot get up again.

IV. Support

Support is very important. Support from family, friends, a support group, and so on. Change is tough. It helps to have people that will cheer you on when you have successes and that will encourage and empathize with you during struggles. Supports can also help provide one with strategies for dealing with and reducing urges, and can serve as substitutions and distractions.

V. Substitutions, Distractions and Strategies

Addictive behaviours fill roles in the life of the engager. For some, they are means of regulating emotions and/or reducing distress. For others they are social/community centrepieces or rituals. They can also simply be aspects of daily routines. When planning and managing goal pursuit, it’s important to figure out what sorts of roles and associations addictive behaviours have in one’s life, and to figure out how to fill these roles with something else.

If the individual uses a drug to help them regulate their feelings, what are some other ways that they can deal with their emotions? A central facet of Dialectical Behavioural Therapy (DBT), a leading cognitive-behavioural therapeutic approach for people with difficulty regulating emotions, is skills training. Emotion Regulation and Distress Tolerance are key skill sets. Having tools other than the addictive behaviour for emotion regulation and distress tolerance are critical to kicking the habit. Otherwise, it will often simply be a matter of time before the individual succumbs to distress and lapses, often resulting in feelings of helplessness, weakness and hopelessness.

Distraction is also key. When one is having an urge, what are some things that they can do to divert their attention? In the mental health unit that I am currently on placement at, clients are supported in developing lists of activities that they can engage in when they are having an urge. It is key to develop such lists when not in the middle of an urge, and to make them easily accessible for when an urge comes up. In the midst of an urge, strong emotions can reduce one’s ability to think clearly and to muster will-power. The idea behind such lists and other such preparations is to do as much of the leg-work as possible when not experiencing the urge so that when the urge arrives it is as easy as possible to engage in something other than the addictive behaviour.

Developing substitutions and distractions are types of strategies for kicking addictions. There are others. As mentioned above, one of the roles that addictive behaviours can play is simply being a facet within broader life routines. A good example of this – and adaptive strategy – that I heard a while back has to do with cutting back on smoking. A person working on quitting and told me about how she used to smoke while walking to and from work each day. Her way of literally getting around this was to start taking a different route to and from work, a route that didn’t inherently trigger her smoking urge like her typical route had. Brilliant! Not all strategies are as easy, however. If one always smokes while they drink, or if all of one’s closest friends smoke, adaptation can be much more difficult than taking a parallel street to work.

VI. Mindfulness & Insight into One’s Emotions and Thought

I am a strong advocate of mindfulness/insight meditation and any practice that helps one gain insight into the nature of one’s emotions, thought and how they relate to each other, to behaviour, and to the self.

What is Mindfulness Meditation?

There are various approaches to meditation. The form that I practice involves focusing on the breath. Because it is a dynamic process that happens *right now*, the breath can serve as an anchor to the present moment. By practicing maintaining an attention to the breath, one develops a recognition of what it feels like to be mindful of the present moment. As this recognition becomes more learned, the individual gets better and better at noticing when their mind has wondered off to thoughts about the future, the past, hypothetical wondering, judgment, and so on. The individual likewise becomes more adept at returning their attention to the present moment. What is more, the individual gets better at recognizing thoughts as thoughts, and emotions as emotions, and learning that neither are synonymous with either the self or reality.Relatedly, a terrific adjunct to mindfulness is cognitive behavioural therapy (CBT), which comprises strategies for rational thought/emotion analysis and behavioural modification.

How Mindfulness of One’s Emotions and Thought Can Facilitate Addiction Recovery

Recognizing an emotion as simply being an emotion, and a thought as simply being a thought is key to kicking an addiction. Without this sort of mindful recognition, a person may feel a strong emotional urge to smoke along with the thought “I NEED A SMOKE!”. It’s like the entire force of one’s being is screaming “SMOKE!”. Consider the following alternative framing: “I am experiencing the feeling of a strong urge to smoke”. What is more negotiable: “I NEED A SMOKE!” or “I am experiencing the feeling of a strong urge to smoke”? Recognizing that feelings and thoughts are just feelings and thoughts, that they are not the same as reality or the self, and that they can be helpful or hurtful, right or wrong, gives one an ability to negotiate with them that they often do not have when they are experienced without such mindfulness. Without mindfulness, thoughts and emotions can be confused with self and reality.

Mindfulness can also help one reduce and cope with the distress of urges. Consider this fundamental truth: life is lived one moment at a time. As time marches on, we experience life moment-by-moment, each preceding moment forever behind us and each future moment a mere possibility that may be experienced directly as the present in due course. Leading mindfulness researcher Jon Kabat-Zinn has demonstrated that an excellent means of reducing suffering in those suffering from chronic pain is to be mindful of the pain, moment-by-moment. What is worse: simply experiencing the pain present in a single moment, or experiencing that pain plus also experiencing the suffering that comes from dwelling over all of the pain that one has previously felt and all that will come in the future? By endeavoring to simply be with this moment and its pain, rather than supplementing the moment’s pain with ruminations of all the pain that came before and will come eventually, total negative affect is significantly reduced.

What is more, have you ever noticed that ruminating over or, alternatively, attempting to suppress negative feelings – physical or more psychological – have the effect of intensifying and prolonging them? As I and many others have personally experienced, simply being with the pain moment-to-moment, observing it and letting it do what it will like a wave on the ocean typically has the effect of reducing its potency and duration. It’s one of life’s many ironies. Just as often finding love comes when we stop trying to find it, reducing emotional suffering can come from facing it head-on, rather than trying to fight or flee from it.

This same type of reasoning can be applied to the pain and suffering that comes from fighting withdrawal from and urges for addictive behaviours. What is more draining and intimidating: experiencing the urges/withdrawal of this moment or of all time? Has ruminating over, being angry at or attempting to suppress an urge or withdrawal made it go away or abate, or does it usually just compound the pain? Withdrawal is painful and, for a time, compulsory. The rest is optional. Lighten your load.

Paraphrasing Jon Kabat-Zinn,

Your mind is like an ocean. Thoughts and emotions are waves.  You can’t stop the waves but you can learn to surf. That’s what mindfulness is all about.

Feedback

How do the ideas expressed here jibe with your personal experiences, things that you have read, and so on?

Let readers know in the Comment section.

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