The nature of addiction can be pernicious. Once we have overcome one problematic behavior, another can seemingly sprout up and take its place. In the addiction field, this is often referred to as cross addiction. It has often been stated in various programs and literature that just about everyone has some form of addiction that if not obliged causes irritability, unease and crankiness, to a host of more intense withdrawal symptoms.
Cross addiction is something that is helpful to be aware of early in recovery, as well as for those who have years of experience with recovery. It can often develop very subtly and outside of our conscious awareness, until we realize we have fallen prey to another form of problematic addiction. One of the main reasons cross addiction can be very subtle and innocent in the beginning is because when someone is overcoming an addiction to alcohol, opiates, gambling, or sex addiction, other “lesser” addictions are easily minimized in their capacity to cause harm and disaster. We may be so close to the consequences of our recent addiction that it is hard to imagine anything else causing such pain, especially if there have never been problems with the behavior.
Common cross addictions for people early in recovery are nicotine, pornography, sweets and processed foods, shopping, and sex. While cross addiction can come in many seemingly bad forms, it can also cloak itself in good behaviors, which can turn problematic. Exercise is often encouraged and since it is viewed as healthy some can use exercise in a problematic way early in recovery in an attempt to re-write the wrongs of our past substance use. Exercise addiction can cause physical harm through overuse of muscles, reproductive harm in females through intense exercise and dieting which can halt or interfere with menstruation and exacerbate other mental health disorders such as body image and restrictive dieting.
Mindfulness and awareness of what we are replacing our addictions with is key to notice if and when cross addiction is happening. All of us will at times develop some habits and behaviors which are compulsive and create discomfort when they are not engaged in, and for most, these are not life changing, nor require professional help. If you feel you have conquered one addiction, just to be pulled into the vortex by another behavior, give Realize Recovery a call and one of our addiction professionals will be able to provide guidance and insight on what might be helpful.
DeTUR™ (Desensitization of Triggers and Urge Reprocessing) is an empirically supported method developed and refined by AJ Popky, Ph.D. DeTur integrates elements of cognitive-behavioral therapy (CBT), and the Alternative Information Processing (AIP) model of Eye Movement Desensitization Reprocessing Therapy (EMDR). Cognitive therapy (inter-weaves) are utilized during the bi-lateral stimulation of EMDR Therapy to rapidly process the desensitization of relapse triggers and accelerate the recovery and healing process. Unlike Standard EMDR where the focus is more on the clients past DeTUR is focused more on the present and future.
Successful results have been reported across the spectrum of addictions and dysfunctional behaviors: chemical substances (nicotine, marijuana, alcohol, methamphetamine, cocaine, crack, heroin/methadone, and others), eating disorders such as compulsive overeating, anorexia and bulimia, along with other behaviors such as sex, gambling, shoplifting, anger outbursts, and impulsive control disorders (such as trichotillomania and intermittent explosive disorder).
The key elements of DeTUR are described by Popsky in his 2020 paper: AAIP DeTUR (Desensitization of Triggers and Urge Reprocessing) Accelerated Adaptive Information Model based on the EMDR Protocol.
Client’s attention is directed towards a positive, attractive, achievable, compelling goal of coping and functioning, NOT, away from a negative behavior. While most therapy sessions start with the therapist asking the client “What’s your problem?” DeTUR begins by asking clients to recall a time when they experienced feelings of being resourceful, powerful and in-control and direct them to those to notice the powerful feelings, and then install and strengthen these powerful feelings with the bi-lateral stimulation of EMDR Therapy .
Abstinence, though highly recommended, is not required in the definition of the treatment goal; coping and functioning in a positive manner as described by the client is the treatment goal.
Relapse is reframed from failure to new targets of opportunity to be addressed in following sessions.
Chemical withdrawal and anxiety appear to be addressed since the process seems to take place out of the client’s conscious level of awareness, not requiring constant attention on the part of the client. Clients often report surprise that at the end of the day they had not engaged in the negative behavior, had–but not as often, or had noticed urges to engage and could put them aside.
Targeting the individual triggers for desensitization allows this model to be used with clients early in recovery. DeTUR™ targets the triggers that bring up the uncomfortable feelings leading to the urges and reprocesses the triggers linking a positive state to the triggering urge. Similar to the stimulus-response mechanism, this is replacing the using response with the positive response that has been anchored and set into the individual’s physiology. Whenever the stimulus is activated the response of a positive state of being comes up that is aligned to their values, helping individuals in functioning more successfully in life.
Perry Passaro, Ph.D. a Realize Recovery Staff member is extensively trained in CBT, EMDR and DeTUR. He can be reached at PerryPassaro@Icloud.com or 714-488-8814.
Many clients seeking services for addiction are often ambivalent about whether or not they have to completely quit, forever, or if they will ever be able to use moderately. This is a frequent conundrum for those in early recovery, and something that we at Realize Recovery often explore with clients uncertain in which direction they want to go. Pressures from loved ones, work, the legal system and societal beliefs from a predominantly 12-Step philosophy often play a role in the push for complete abstinence.
Uncertainty about which direction to choose is normal at the early stages of recovery and can remain for years to come. If you are considering which path may be best for you, it can be helpful to first identify what your main goals are with your substance for the near future. It is often recommended for those with their minds set on moderation to experience a period of complete abstinence in order to have something to compare abstinence with. If one has been using some form of mind altering substance for years on end, it will be hard to gauge if moderation or abstinence is right, when abstinence has not been experienced since childhood, or years in the past. Taking a break from all substances for at least 30 days (if possible) gives one the opportunity to compare how they feel being sober, versus having a mood altering substance affecting their perception. I have often worked with people set on moderating, only to go a month or two abstinent and then report that they have never felt better and have no desire to return to using their substance of choice.
Moderation can be helpful for those that are unwilling to abstain and are fearful of a life without their substance. Considering moderation may still be a scary decision for the person who has been using heavily for a long period of time and would be considered a harm reduction approach. Harm reduction seeks to reduce the harm in a person’s life caused by the substance. If one is used to drinking 12 beers a day and now drinks 6, that would be reducing the harm in the individual’s life and a step in the direction towards moderation. This can open the door to change for someone who is resistant to stopping their addiction, while helping them gain momentum in a value driven direction.
Moderation can also work for a lot of people who do not see any consequences from their substance use and therefore have little desire or internal motivation to change. For those with comorbid disorders, or dual-diagnosis,moderation may work once the individual has worked on their mental health and feel they are in a good place as substances are often used to self-medicate. Individuals who are dual-diagnosis may have used their substance as their primary coping mechanism and in some cases may be able to drink moderately upon receiving the mental health they need.
For behavioral addictions such as shopping, eating and in some cases sex, moderation is a necessity and therefore points to the ability for individuals to be able to learn how to have a different relationship with their addiction.
For those struggling with a severe addiction, the easiest and safest way to avoid negative consequences is to abstain. It can be much easier for many people to set their mind to complete abstinence instead of dealing with all the decisions on when it is okay to use, how much, under what circumstances etc. Research has shown that the number aspect for those maintaining long-term sobriety is a commitment to complete abstinence. This makes a lot of sense as it takes out the guesswork and allows the mind to simply focus on one thing–abstinence under all circumstances.
Certain substances can also be deadly and pose dangers legally and professionally, and one may find it easier to abstain instead of risking severe long term consequences for short, fleeting euphoria, with no long term payment comparable to the degree of possible long term consequences.
Is there a Right Way?
There are no absolutes in the world of relativity, and therefore there are no right or wrong answers to this question. Each individual is free to decide which path they choose, as each individual gets to experience the positive or negative consequences of their choices. Thinking back to past experiences with both approaches and getting honest with oneself is often the first step to take. Regardless of what has happened in the past, know that those patterns do not have to carry on moving forward.
Realize Recovery works with all clients regardless of which approach they prefer and can help you or your loved one sift through the pros and cons of each approach based on their unique experiences. There are interventions and methodologies that can be implemented to test and experiment with moderation if one so chooses to take that route. We are not here to tell anyone what to believe or how to live their life, rather we work within your values and help each individual to come to the best conclusions for themselves.
Establishing long term sobriety is hard, and how one manages returns to old behaviors can either enhance this process or greatly jeopardize long term gains. Gaining some sober time in the sum of weeks or months can feel invigorating and motivating; at times it is easier than it looked, while at others it is a downright battle. Embarking on the journey of sobriety will bring ups and downs and lapses or relapses can dismantle even the purest of intentions, creating interpersonal conflict, legal/ work issues, and diminish self-worth.
Progress is not a linear path and will require one to endure the oscillating effects of pleasure and pain. It is a rarity for someone to determine to make a change in their lives and stick with this change without any reversals. While this is true with any behavioral change, it is especially so with chemical dependency. Receiving ultimatums from spouses, parents and bosses and the high consequential costs of relapses adds to the pressures felt to be perfect and to never use again under any circumstances. It is true that these boundaries can influence abstinence and add in reminding us of the consequences of using, and they also can add to the guilt and shame felt if any deviance from abstinence occurs.
As it is often said in the recovery field, relapse is a part of the recovery process and can be used as a learning experience. A relapse refers to a prolonged return to a pattern of use that one is trying to control or quit, and a lapse represents a momentary slip, typically a one-time occurrence. There are major differences between a lapse and a relapse in terms of how one might want to move forward and adjust their recovery process. A lapse may entail increasing mutual support meetings or counseling sessions, whereas a relapse may require additional lifestyle changes and safeguards. The tendency for the individual to beat themselves up over their deviation from recovery is counterproductive and often propels one to use more of their substance as a means of avoidance and emotional support.
Turning a relapse or lapse into a learning experience and an opportunity to remember the pain and challenges that lifestyle brings can help enhance future recovery and reinvigorate present resolve. These experiences provide an opportunity to identify both internal and external triggers that may have gone unnoticed before and prompt us to seek additional support we may have been avoiding. A relapse is not a sign of failure, but a sign to turn a different direction and seek additional approaches. It can also assist in one deciding whether moderation or abstinence is the right choice for them based on their previous attempts and resultant consequences. Ambivalence is often tested on the cold hard battlefield of daily experiences and can be overcome through occurrences that cause friction and pressure in our lives as the result of their natural consequences. The guilt and shame felt do not have to be overly indulged and used as further justifications to get faded. Instead, those feelings can be used as reminders of why we wanted to make changes in the first place and what we do not want to experience as a result of choosing to drink or use. If we can objectively look at our behaviors and how they affect those around us, and remember the feelings felt post re-engagement with our substance of choice after determining to make changes, then we can use a relapse or lapse as a catalyst to continue moving in a value driven direction.
The holidays can be a treacherous time for those wanting to avoid alcohol and other mind-altering substances. This time can be triggering for several reasons, attending work parties, family gatherings, increased stress, financial strains, and the list goes on and on. The American Psychological Association has found that the holidays increase stress levels in 41% of women and 31% of men, increasing the risk of unhealthy coping strategies during this time. While the holidays can be a time of happiness and joy for many, others find it stirs up memories of painful pasts and a time for increased isolation. Here are some suggestions to assist in navigating this time while maintaining sobriety.
Planning ahead is the best strategy you can implement. If attending work or family gatherings it is important to think through how you will manage these events.
Have an entry and exit plan. Arrive early, leave early or arrive late and leave early
Bring your own drinks and have a drink in hand as often as possible. This helps alleviate the uncomfortable “may I get you a drink” question.
Plan how to refuse a drink offer and practice this beforehand. Know that you are under no obligation to drink or use. When offered, look the individual in the eye (this shows you are serious), say no, and then change the subject.
Arrange alternative transportation if necessary. Take an extra vehicle if you need to escape the situation, have Uber, Lyft or a taxi service readily available on your phone.
Bring a supportive friend or family member who knows your situation to help with accountability. If that is not possible, you can have periodic checks ins with someone via text or a phone call every so often.
Know that you can you leave the gathering at any time an urge becomes too unbearable. If you need to, step away outside, to an empty bedroom or the bathroom to regroup, take some deep breaths and let the urge pass.
Remember that most people are not as concerned about whether you are drinking or using and are more focused about themselves as opposed to watching what you are doing.
Set up your own plans with friends or loved ones in environments of your choosing and at times of day that drinking or using may be most unlikely to occur.
While this list is not exhaustive, it offers some suggestions on navigating high risk situations and can hopefully assist you in thinking about the various ways one can manage holiday events and environments. Staying connected with sober support, making sure to eat well, get rest, exercise and practice stress reducing coping skills will also assist in building overall stress tolerance. If you need assistance in tailoring a plan more specific to your situation or find the holidays to be particularly difficult to manage drinking or using, give us call, we are here to help.
For many who have been using alcohol or drugs problematically, the advice given from loved ones and many mental health professionals is they must remain abstinent from all mind-altering substances and any deviation from complete abstinence is a cause for major concern. This approach to substance abuse follows an all-or-nothing model that does not consider all the gray areas between severe problematic addiction and complete abstinence, and can often have devastating consequences when a slip, or a lapse, occurs.
Harm reduction is about reducing the harms associated with substance abuse. It can be applied to any circumstance where there is less harm, or the potential occurrence of harm, due to specific interventions or actions to reduce, substitute, or replace the use of a harmful substance. In the case of alcohol, if someone were drinking a fifth of vodka a day, and is now drinking a bottle of wine, the harm would be reduced because a bottle of wine has much less alcohol content. If someone has been using heroin and now strictly uses cannabis, they will have reduced the harm of a potential lethal overdose.
Harm reduction can come in many forms and will be greatly needed during a time when addiction is expected to climb 100% over the next two years (CCAPP, 2020). For opioid use disorder, there are two main medications, Naltrexone and Buprenorphine, both of which can come in oral or subcutaneous once-monthly injections. Naltrexone can also be used for those who are wishing to stop drinking or reduce their alcohol intake as it helps with cravings and reduces the euphoric effects of alcohol. Often times, people may not want to use medications to help them cut back, taper or assist them in maintaining their abstinence, but harm reduction approaches have been shown to be highly effective when compared with total days sober, and not just total days abstinent (Peele, 2020).
When working with clients, my goal is to always help them find ways to reduce the harm, or the potential for harm, caused by their problematic use. Expecting or demanding complete abstinence, when that is not the goal or desire for someone only sets them up for guilt, shame, and a potential self-fulling prophecy if a slip occurs, giving them the opportunity to tell themselves, “See, I knew I would fail at this.” Following a harm reduction model for those who are seeking it or require it based on medical necessity helps individuals build the self-efficacy and belief that they have power to change their behaviors and live a balanced life, free from the grasp of addiction.
If you or a loved one have been told abstinence is the ONLY WAY, give Realize Recovery a call today and we can discuss options and provide education on the evidenced based treatments that have been proven to work.
Having a loved one who is struggling with addiction can feel overwhelming, create disharmony in the relationship and feel downright hopeless at times. The most well-known model used to help someone get into some form of treatment has been the Johnson Intervention method. Many have seen this model used on various television shows, filled with high drama, intense music and emotional reactions from both the loved ones and the individual struggling with addiction. This form of intervention typically involves hiring an interventionist who coaches the loved ones on how to effectively confront the addict and set expectations that they either go to treatment or face the reality of not being involved in their loved ones lives anymore, to greater or lesser degrees.
Research has shown that this approach is effective only 30% of the time and can often decrease the likelihood that treatment will be as effective for the individual who is “forced” to enter treatment (Myers, et.al, 2002). Those who are forced to attend treatment may not be ready to make a change in their behavior and this can cause resentment and resistance during the treatment process.
Another approach that has not yet hit the main stream world of addiction is called CRAFT, community reinforcement and family training. This approach was created by Robert Meyers and colleagues at the University of New Mexico and has been shown to have a roughly 65% success rate in getting a loved one into some form of treatment. CRAFT was developed to assist loved ones in learning new effective ways to interact with the substance user in a kind and loving fashion, with the intention of reducing or stopping their substance use or drinking, and encourage them to enter into some form of treatment.
Since friends and families lives often become completely consumed by their loved one’s addiction, CRAFT emphasizes learning coping skills on how to effectively care for themselves and take back control of their life. By practicing self-care regularly, LO are better able to handle stress, express their feelings in more tactful ways, and maintain a positive outlook on the situation which influences more helpful interactions that with the struggling individual and increases the chances they will choose to seek treatment.
While this approach may sound utopian and like all that is done is cater and be nice to the individual who is seemingly causing so much chaos and discord–there is a helpful way to approach the treatment conversations where someone is more likely to be open and receptive to the conversation. Nagging, pleading and threatening typically don’t work on us when someone wants to get us to engage in something so why would we think it would be helpful to do the same to a loved one?
Addressing conversations with a loved one, letting them know how you feel, and what you would like to see happen going forward is important. A few tips below that may be helpful in starting this process. If you would like further reading on this topic, I suggest reading How to Get Your Loved One Sober, by Robert Meyers and Brenda Wolf.
Do not have conversations with your loved one when they are under the influence. Remove yourself from the situation and let them know in a calm, matter-of-fact manner that they appear to be under the influence, how it makes you feel, and that you would like to have the conversation when they are sober. Remove yourself from the situation and do not reinforce their use by spending time with them or engaging in conversation. No argument or fighting, simply walk away and distance yourself.
Address your loved ones use at a time when they are most likely to be receptive, using the PIUS formula to address your wants, needs and feelings.
P: Positive communication that focuses on what you do like and want for the relationship, not what you don’t like and want them to stop. Instead of saying “you always ruin dinner by getting drunk”, try “I enjoy having meals with you so much when you are sober”.
I: use “I” statements to express how you are feeling. Using I statements lowers the defenses of the other person and allows them to be more receptive because the focus is on your feelings and not on their defects of character
U: show understanding to your loved one’s situation and express how hard it must be to change as an example. This too helps lower defenses and shows that you are empathizing with their feelings and difficulties.
S: Share responsibility to some extent for the current circumstances you all find yourselves in. How can you help and support your loved one during the change process and how has your mindset and behaviors potentially influenced the situation? While you are taking some responsibility for the problem, you are also taking some responsibility for developing a solution and path to a healthier, more loving relationship.
If you or a loved one is struggling with problematic substance use, we are here to help you find a solution. Even if we are not the best fit for you or your loved one, we can help you find someone who is.