Behavioral Addiction Recovery
What is "recovery" from behavioral addiction?
First of all, the term “recovery” comes out of the 12-Step disease model notion. Recovery, of course, comes out of the medical model, where you're in a healthy state, you catch a disease, and you recover from the disease. Now, that fits very nicely within the disease model of the 12-Step community. Within the cognitive-behavioural model, the recovery term is used rarely or substantially less. Again, it's used more for practical reasons. I don't use it at all. I think it has an implied presumption that you're sick or you're ill. I think it has a further implied presumption that the best outcome is to return to the prior state of pre-recovery. When you have an addiction, in my professional opinion, the best goal is not to return to this prior state. Generally speaking, people should never return to that prior state, because all that is doing is setting the stage for them to get back into the addiction themselves. People must not only get back to the state that they were in before they got into it, they've got to go higher. They've got to be functioning higher than they've ever functioned for them to really “recover” and go on to live a life without fearing the fall back into their addiction. So recovery is an illusionary concept. There's even further controversy within the field. “Recover” versus “recovering.” In the 12-Step disease model, they call people “recovering,” implying they never get over it. Within a cognitive-behavioural model, they will talk about “recovered,” meaning the idea that they're pretty much through with the worry and things like that. It's a very empowering belief to believe that you can recover and not have to worry about this thing shadowing you for the rest of your lives. Yes, like anything that we've learned, like a bicycle, we're never going to fully forget how to ride that bicycle. However, the notion that we're constantly on the edge of falling back into that diseased state or addictive state is a very painful way to live life, and is living in a state of fear. I've worked with people who can't take a little trip over to Catalina for the weekend because there's not a meeting over there; because they've been taught that they should fear this disease that never goes away. They should fear themselves being on their own. They should fear thinking on their own. I think those are very destructive ideas and therefore I sort of avoid the word “recovery.”
How can family and friends support a recovering behavioral addict?
In order to support a recovering behavioural addict, the family needs to understand that they need to pull back and give the person that's working on their behaviour the time and the space to go to meetings, to go to treatment, to go do homework, to go and take on things at, perhaps, their own pace, to not necessarily expect them to finish a treatment programme and go back to work the first day, and to not necessarily see that they (meaning the family) are innocent and have no ability to contribute. "It's all the addict's fault"; the reality is all the family have colluded, enabled, whatever term you want to use, in some way to bring about this phenomenon, and the family should sort of back away a little bit and be willing to talk more openly and own some degree of the problem that has evolved, but looks like it all exists in the addict himself.
What is an "external trigger" for behavioral addiction?
An external trigger for behavioural addictions is nothing more than a stop light. It works in the same way. When we drive our car and we notice that the light has turned red, we know in our brain that that means we have got to bring the car to a hault and it's external, it's outside of us, it brings about a notion in our brain that says we're supposed to stop or we're going to get a ticket or get into an accident. In the behavioural addiction field, it's not quite as obvious, but there are lots of triggers in the behavioural addiction field such as seeing pornography if that were your addiction. Advertising is nothing more than external triggering. What do you see on TV around six o'clock? Pizza commercials. What are those? External triggers. It's a way that a medium or methods have come to be associated with certain behavior. And for an addict, it's much more complex.
What is an "internal trigger" for behavioral addiction?
Internal triggers are anything, such as a thought or a feeling, that resides primarily inside, that is associated with these addictive behaviors of some type. For example, let's say I felt depressed today. That might be an association that when I feel depressed, I go and I gamble to lift my spirits out of the doldrums. Or I might feel lonely, and when I feel lonely I'm going to go look for someone to pick up and maybe have sex with or maybe get into some sort of relationship. Anything inside or a memory of a time and a place that has once been solved through your addictive behavior can surface as a trigger. These are not something that happen through one involvement with this internal or external trigger, but rather a repetition of "When I feel this, I do this; and it makes it feel better."
What is a "combination trigger" for behavioral addiction?
There are both internal and external, and there's both of them involved in the triggering incident. It may be like a smell, a perfume, in an individual, which brings up a sort of a feeling, a memory, a thought. And they sort of hit you like a double-whammy and trigger several urges to engage in your addictive behaviors.
How can time be a trigger for behavioral addiction?
Time can be a trigger in at least two different ways. One is, when you're successful away from your addictive behavior for a long enough time, you're going to get a little confident. And a little, well, "there's no big deal, I haven't engaged in it in six months or a year and I can get a little optimistic" and a little it won't hurt you just do it once and go on the web and go look up some pornography no reason not to look, at all the time I have under my belt. Another way time can be a trigger is sort of like too much time where you have a Friday afternoon or a day off from work and you don't have anything planned and you go and engage in one of your addictive behaviors. Time is an extraordinarily important dimension in addiction and recovery. Many people speak of they started down the path of addiction because they had time and they were bored and why not and over time and they started to get associated and it built up and built up.
How can "ease of availability" be a behavioral addiction trigger?
The ease of availability can be a big trigger for someone who has a behavioural addiction. That's what makes something like computer or internet addiction so difficult, because for the most part in our modern society, most people live with or occasionally use a computer or the internet. Availability is a central issue for addicts, especially during the early months. This can be the medium for some behavioural addicts to feel good inside. It would be ideal if, let's say a computer addict, did not have to contend with a computer on a daily basis for a couple of months, but that isn't really practical. The reality is, ease of availability can be a behavioural addiction trigger and it is suggested that addicts try to limit their contact with their addiction or limit their availability.
What is "magical thinking"?
Magical thinking is something that we all do. Those with addictions just do it maybe a little bit more. Magical thinking is something that we evolve as children, and we look and we think about the world around us sort of in a magical way, not in a reality context. People, for example, who have gambling problems, engage in a lot of magical thinking i.e. that the odds really aren't what they are - that magically they're going to make the big win this time. With magical thinking it is very common to think that if I play this video game, and I'm winning the war, that in some way that I have become a more powerful person, a more confident person, when it only has come about in this virtual world.
How can behavioral addicts become motivated to change?
Propelling yourself, motivating yourself, is not an easy thing to do. Let's start talking about motivating ourselves to change by acknowledging something called ambivalence. Okay, you have an addiction, or you've decided you think you have an addiction, and you know it's not good for you, you know you're spending too much money or spending too much time with pornography, even though you know all that. I've never met anyone with a behavioral addiction who is truly behind changing. I mean, the truth is we're all ambivalent. We like it in some resepcts, and we don't like it in some other respects. So part of the difficulty with getting motivated is accepting that ambivalence we have about the activity. It's fun to look at pornography or it's fun to gamble, and you're going to deprive yourself of those fun things? You're going to take that lollipop and purposely give it away? So motivation is very hard to generate within yourself. But the place I would encourage people to start is accepting their ambivalence. Ideally they would make a chart with a four by four square, and put the pros of stopping their addiction, the cons of stopping the addiction, the pros of not stopping the addiction, the cons of not stopping the addiction, and get some sort of reading on all the language you use to stay on the fence about this sort of topic. Beyond that, motivating yourself is leveraging yourself where it's not comfortable. You've got to be somewhat off the edge, you've got to be willing to do something, but let's say you went and told a lot of people about your behavioral addiction and asked, maybe not for their help, but let them know that you're struggling with it. Well, you're locking yourself in there. You're closing the back door on your behavior, at least with these people. That's a way you can motivate yourself. Other ways of motivating yourself include stopping for a while and seeing if there are any benefits, such as increased energy or optimism, self-esteem rises, things like that, and trying to capitalize on the outcome of that.
What changes positively influence a behavioral addict?
There are many environments available to positively influence your ability to stop your addictive behavior. Primarily, it lies within understanding the environment that you're living in. Do you live alone, do you live with someone who engages in that same behavior are typical questions. It might be smart to look at a sort of a recovery home or living with someone else or living in an enviroment that does not support or endorse those sorts of behaviors.
Will I ever be cured of my behavioral addiction?
Cure is a very funny word. Cure also comes out of the disease model. Cure sort of says "Well I was healthy prior and then I've gotten sick and now I'm going to return to health." In many respects, there are no real cures to addiction. Unfortunately as an addiction evolves, especially a behavioural addiction, you're learning things. You were not born with a preoccupation to gambling but you learned over the course of time that playing the slots or going to card games made you feel better and it wasn't sort of something you learn. What is learning? Actually, neurological pathways began to develop as a function of this learning, just like you learned how to ride a bicycle. You didn't know how to ride a bicycle when you were born, but practicing and practicing actually changed your brain and actually there's new wiring in there. Will you ever forget how to ride a bicycle? Not completely. Will you ever forget how to engage in your destruction behaviour? Not really. You can learn to develop a new way from getting from point A to point B. Not using the old way, not using what I'm going to call a freeway; the way you used to engage in your addictive behaviour. To make yourself feel good, you're now learning how to go out and play games, sports, or something like that rather than engaging in your addictive behaviour. We do not provide, we do not offer, neurosurgery that can go in there and clip neurologically generated synapses that were once there.
Is cognitive or harm reduction therapy appropriate for all behavioral addictions?
I believe that the harm reduction model could be applied to everyone that comes through the door with an addiction. However, there are people who find small gains and then relapse or who occasionally find getting involved in their destructive behaviour to be so dramatic that it's better to leap the entire way; to go to abstinence the first time and try to stay there. So, yes, there are limitations; there are people that probably shouldn't try a harm reduction model, rather they should try to limit the amount of involvement in their addiction behaviour as quickly as possible, because there's often massive loss of control and great danger if they engage in even small portions of their addictive behaviour.
Is harm reduction effective for addicts who a feel their behavior is out of control?
The issue here is which is better. Is it seventy percent of something better than one hundered percent of nothing? If you are not willing to take the big leap and obstain from the destructive behavior, then it's an obvious choice to try a harm reduction model. Determining if it's the correct model for you sometimes takes time. Sometimes it takes a few relapses such as falling off the wagon, falling back, to determine whether small steps are ideal for you or larger steps, meaning complete abstinence or something short of that.
What are the main criticisms of 12-step programs?
The reason why there is so much criticism of the 12-step approach is because it is the dominate paradigm. It has been around for 50 plus years. It has not really changed; there is not a new addition, no a new attempt to reintegrate new knowledge. It is based on theories and models of personality and sociology of the 1930s. It is an easy target, to be frank; that's where most of the criticism comes from. The success rate, also, is dubious. It is someplace between 5 and 15, depending on the research you check. The problem is that it's being applied as a 'one-size-fits-all for all things', and it was never designed as such. Therefore it's easy to criticise its shortcomings in particular domains or things such as that. It is just not, like any treatment, a fix for everything that ails you. Yet traditionally, the people who have recovered through a 12-step programme are quite enthusiastic about their own success, and try to convert others into that model.
How do I prepare for my recovery from behavioral addiction?
A life of recovery in a harm-me-at-you perspective is a continual sort of orientation to reducing the harm that the bad habit the substance the behavior has caused you. It often includes making room for occasional relapses, and most importantly, learning from your relapses rather than seeing your-self as a failure in some way. Life is rather ordinary, need not involve on going treatment though advised. It need not involve a support group, but advised. Need not have a lot of components but it's a it's a philosophy of self improvement. If if I can characterize it in in its totality. Just, I'm going to improve myself a little bit each day each week and it's about not feeling deprived but but seeing yourself as growing and maturing and getting more out of out of this experience we call life.
What skills do I need for a successful recovery from behavioral addiction?
The skill base for a successful recovery from behavioural addiction obviously depends on the skill base of the someone that came into the recovery room or came into the doctor's office. Many people come into the recovery room and they really have very few life management skills; very few skills of how to cope with feelings, how to date, or how to obtain a job. Then there are others who virtually have almost all the skills necessary for a life except a few, and those few are generally about how to cope with uncomfortable feeling states. If that were to be the only skill I would recommend everyone acquire, that would be it, and that's what I'm calling the development of emotional muscle. This skill is about "How do I learn to feel sad, depressed, lonely, or whatever, without reaching out to my magic elixir or magic behaviour to sort of self-medicate that feeling away?"
What does it mean for an addict to take life "one day at a time"?
The concept of "one day at a time" is a wonderful concept. It comes out of the 12-step approach. It is nothing more than being concerned with primarily what's happening today, not projecting to the future, tomorrow, the next day, what will happen when I go to that party next month, or something like that. It's about living life today, realizing, taking on today as the task, not taking on tomorrow or future events.
How can a recovering behavioral addict build resilience?
As a recovering behavioural addict, you build up your resilience by first of all having the mindset that this is not about doing it, it's not an event, it's not a single "I'm going to do it once" and it's going to be over. Resilience comes out of a model of, "I'm going to probably relapse, I'm probably not going to do it perfectly, and that's okay. I need to understand that when I fall; when I relapse, or when I lapse, I'm going to pick myself up, get on the horse, and do it again. I need to understand that it's a long-term process and the key issue is, of course, looking to gain as much as I can from a relapse; looking to see what I did wrong within the relapse that caused the relapse so I don't do it again." Of course, you need to keep a sense of optimism out of every relapse, rather than shaming yourself, blaming yourself, or saying, "I can't do it"; realize that is about this resilience, or springing back and trying again, and again, and again. Many recovery programmes could even be conceptualised as like the acquisition of an advanced sport, like tennis or golf or something. You can learn the rules of recovery in about a few minutes in the same way as you can learn the rules of golf in a few minutes, but it takes a lot of buckets of balls to really get good at it. If you conceptualise it as nothing more than an advanced skill like golf, tennis, or whatever it may be, you'll have the right mindset to acquire that resilience and understand that it's important to come back and do it again, and come back and do it again. It's never going to be a single event; it's going to be a process, and have fun with it even, to have the resilience that we would all hope for.
How can a recovering behavioral addict handle fears?
Fear is very central to every behavioural addiction, that is not emphasized enough. How do you handle fear? Well, technique 1 is to face your fears and go ahead anyway. If there is a central feature to addictions that postpone addicts from engaging in recovery, it is fear of the unknown. Fear of being unable to handle things and fear you're going to go crazy. Fear of not knowing how to live life without the involvement of your addiction. So, preparing for the fears is recognizing that it's normal, recognizing it's important that you face them, see the outcome, see that you don't fall apart, see that you don't make a fool of yourself and realizing it's a natural process (a necessary process) to continue to face your fears and go ahead with life anyway. There is no shortcut to facing your fears and there is no shortcut to recovery and diminishing the need to face your fears. The faster and more often you can face your fears and continue on anyway, the faster your recovery is going to be.
How can recovering behavioral addicts strengthen their recovery?
Regarding the actions in your recovery, first of all, we have to address the idea that there are fears involved in taking actions. Part of the addiction, we must understand, is the avoidance of the discomforts; the fears, so taking action, by definition, is facing fears and you're already beginning to take action when you're willing to do something that's uncomfortable, where normally you would avoid it. Once you've decided, "I'm going to face my fears," you need to decide and prepare for the fact that you need to evolve into a person that functions without the elixirs; without these behaviours. What does that involve? Does that involve being more social without them? Does that mean being involved in relationships or knowing how to relax at the end of the day without these elixirs? To prepare for them, it's a very individual effort that needs to be sort of considered by the individual. What things are you avoiding? What are you utilising these addictions to avoid, in some way? Then, you need to specify to yourself, a counsellor, or a support group, what it is you need to actively approach.