There are many types of addictions including addiction to alcohol, cigarettes or certain other drugs. People can also be addicted to certain behaviours such as gambling and particular sexual behaviours including accessing Internet pornography. Sometimes addictions occur in the context of other mental health problems such as depression and anxiety disorders. For example, individuals suffering from psychological trauma reactions are approximately four times more likely to abuse alcohol and other substances. It can be especially helpful to talk to your general medical practitioner or other mental health professional when addictive behaviours are accompanied by other mental health problems.
Characteristic signs of addictions include compulsively seeking out the addictive drug or activity despite clearly negative consequences such as financial loss, health problems, legal problems, increased conflict in relationships and/or increasingly risky behaviour. The addictive behaviour may interfere with work performance, relationships and other roles such as parenting. People when addicted generally spend more time on the activity than intended and develop an increased tolerance for the addictive substance (seeking more of it for a similar effect). The addicted person would likely experience signs of withdrawal, such as cravings and feelings of anxiety, when unable to access the substance or activity. Those addicted may commonly tend to minimise or downplay the difficulties associated with their addiction.
It is increasingly being understood that addictions are commonly accompanied by changes in the brain including changed brain cell connections and changed brain chemistry. By repeatedly practising the addictive behaviour in stages of excitement the addictive behaviour becomes paired with the activation of pleasure centres in the brain. This applies not only to the use of addictive substances, but also behaviour such as gambling and repeatedly accessing Internet pornography. These changes in the brain help account for why it can be so difficult to curb addictive behaviours. When people are aware of starting to develop a pattern of addictive behaviour there are great advantages in curbing the behaviour at an early stage. However, by learning to deal with high risk settings in ways other than engaging in the addictive behaviour, and by instead pursuing other healthy and rewarding behaviours which enhance pleasure, this can help reverse some of the changes described above.
Readiness for Change
In order to help oneself or others to deal with an addiction it is especially useful to consider the person’s readiness for change. Therapists commonly consider the following stages of change:
- Pre-contemplation: when the person has no intention to make changes and appears to avoid talking or thinking about the addictive behaviour and may deny or minimize the behaviour.
- Contemplation: the person is considering some advantages or disadvantages of change, but seems ambivalent and not yet ready to take clear action.
- Preparation: the person intends to take action in the near future and has perhaps bought a self-help book or made an appointment with a GP or other health professional.
- Action: this involves some actual change in behaviour such as switching from heavy beer to light beer, avoiding a particular poker machine venue or discontinuing smoking cigarettes in particular settings. The person can then continue to build on their constructive actions, potentially to the point of overcoming the addiction.
- Maintenance: this involves maintaining the changes that have been made, in part by being vigilant about relapse. This may involve anticipating challenges and developing new strategies to manage with such challenging situations. It is helpful to remind yourself of the changes you have already made.
- Relapse: when this occurs, it involves slipping back to the point of a recurrence of the earlier pattern of addictive behaviour. There can be a sense of going back to the start even though the person may have learnt valuable skills and strategies in the previous action stage. Most relapses occur within the first four months, so it is especially encouraging when people have discontinued or markedly reduced an addictive substance or behaviour for four months or more. Following relapse a person may revert to one of the earlier stages, such as pre-contemplation, or may have renewed efforts to take action.
Lapse vs. Relapse
One of the most helpful strategies in dealing with addictions is to recognize the difference between a lapse, which is a brief or more minor slip, and a relapse. Lapses or occasional slip-ups are not uncommon when acting to change any persistent behaviour. It is important that people don’t become overly disappointed or harsh on themselves after a lapse. Otherwise they may think that now they have slipped up, they might as well give up because they have now “blown it”, or clearly failed in their attempts. This is commonly called the “abstinence violation effect”. In the long run lapses can serve some purpose in reminding people why it is important for them to change their behaviour. People can learn what particular circumstances have triggered the lapse and can use this understanding to redouble their efforts in such situations in future. People can then “use a lapse as a lever” for further change. The most important thing is not whether people have lapses, but how they respond to them. Most people who successfully overcome addictions have had lapses along the way.
Specific Psychological Strategies for Change
Some of these strategies aim to increase your awareness of the impact of the addiction on your life, and therefore the importance of addressing it. Other strategies are geared towards increasing your sense of “self-efficacy”, or confidence in managing with addictive urges. As you experience some success in managing with addictive urges using strategies such as these, your sense of at least partial control and self-efficacy will grow.
- Consider your reasons for change: it helps to clearly recognize why discontinuing or reducing the addictive behaviour is important to you. It is worthwhile to write down the advantages and disadvantages of discontinuing or markedly reducing an addictive behaviour. It is important that your reasons are personally relevant and meaningful for you (but you can of course take into account the feelings of those closest to you).
- Consider high-risk situations: It helps to recognize the circumstances in which you are most likely to lapse including negative emotional states, such as anxiety, depression or boredom; social pressure; interpersonal conflict; positive emotional states, such as when in a mood to celebrate and situations involving ready access to the addictive behaviour, such as meeting friends in a bar or at a casino as compared to somewhere else.
- Monitoring: this is always a helpful strategy for changing any persistent unwanted behaviour. When you have made a decision to take action, simply recording the number of standard drinks you consume per day, the number of cigarettes smoked or the amount spent on gambling can be enough to help you start to enact significant change.
- Urge surfing: this is probably the single most important strategy for overcoming addictions. Any addictive behaviour will be accompanied by urges. The key point is, if you do not give in to an urge (using whatever means possible) it will not continue at the same strength. It will reduce. It may well return, and may return often, but it will not continue at the same peak level indefinitely. Each individual urge will reduce from its peak. The urge will tend to first increase, then level off, then decrease (like a rising and falling wave). Riding out the urge is called “urge surfing”. This may take place over an hour or two and may be very uncomfortable. It may help to distract from the urge by engaging in other behaviour. By persistently and repeatedly resisting individual urges, in time they willreduce in intensity and become fewer and further between. By breaking the connection between a particular situation and subsequent addictive behaviour, the addictive urges will reduce in that setting, even if this takes weeks and months. For example, people who used to smoke cigarettes in settings where it has long been banned (such as on public transport or in meeting rooms at work), may recognize a generally lesser urge to smoke whilst in such settings than they used to have when smoking there was allowed. If not completely resisting an urge until it passes, at least delaying acting on an urge can increase your sense of partial control over addictive urges.
- Coping self-statements: This involves using a helpful mantra, a word or phrase, to help bear with the urge and get beyond it. This could include, “The urge will pass”, “Breathe”, “It’s not worth it”, or “Hold On” (a phrase referred to in the colourful novel about severe drug addiction by James Frey, “A Million Little Pieces”). Such coping self-talk helps counter negative inner dialogue, perhaps in the form of self-sabotaging thoughts or a persistent and harshly self-critical “voice”.
- Stimulus control: this involves limiting its use for the addictive substance or behaviour or access to it, such as having no alcohol in the house or driving a different way home to avoid the club with poker machines. It can also involve changing the settings in which you use the substance such as only smoking whilst outdoors.
- Social supports: let someone know that you’re interested in addressing an addictive behaviour. It can help to have someone to whom to report your changes in behaviour, whether it be a health professional or supportive friends. You might elicit support from a partner to, for example, avoid high-risk situations for a while.
How Others Can Help
Partners and concerned family members can help in a number of ways, for example, by encouraging the addicted person to talk to a health professional about their addictive behaviour, by pointing out relevant information if the person seems open to it and by encouraging the person in any active efforts they are making. It helps not to get caught up in a pattern of nagging or acting in ways that one’s partner might view as overly controlling as they are then more likely to resist one’s efforts to help them change their behaviour. Partners of those with serious addictions might seek out support for themselves.
In summary, people are more likely to overcome problems related to addiction when they recognize that changing their addictive behaviour is very important to them and when they are ready to take action. To increase one’s confidence it can be very helpful to pick one way of taking action – preferably using your own idea of how to do this – then monitoring your change and giving yourself credit when you have acted differently. By making a constructive change in any way at all you have created some success to build on. Then some additional change may help to add further positive momentum. It is important to not be overly discouraged about lapses. Lapses are normal. You can learn from them. By putting positive energy into changes that you have decided upon, and by persisting in the long term despite occasional lapses, and by learning from the lapses without being too hard on yourself, you are increasingly stacking the odds of beating an addiction in your own favour. It can also help to seek professional assistance to explore barriers to change and to help stay on track with reaching your goals.
For those interested in relevant practical strategies for dealing with alcohol addiction in particular, see www.acar.net.au, the website of the Australian Centre for Addiction Research, a very useful resource for those contemplating or ready to take further action.