Two Cool Addiction Web Resources to Add to Your Favorites Folder

A couple weeks back I was perusing the news on the internet when I came across an interesting story and really cool idea in addictions research. Researchers at the Virginia Tech Carilion Research Institute in Roanoke, Virginia have created a National Quit & Recovery Registry. To better understand how people quit using drugs and alcohol, as well as how people remain in recovery from drug and alcohol problems, researchers at the institute created an online database where people share what helped them quit and what helps them in recovery. The researchers are asking people who have at least 1 year in recovery from an addiction (including overeating, nicotine, or “other harmful behavior”) to describe their personal strategies for quitting and staying in recovery. People who share their stories can do it anonymously or confidentially and will be offered the opportunity to participate in various research studies aimed at better understanding addiction and recovery. Based on the registry’s website, it looks fairly easy to contribute your “success story.” If you are a person who is in recovery from addiction this seems like a great way to share your own personal strategies for successfully quitting an addiction and also contribute to science.

Why The Registry is Awesome (in My Personal Opinion)

Many of you who follow the blog know that my colleagues and I really value science and the research process. One reason why I’m excited about this registry is that it will likely yield a wealth of research studies that will improve our understanding of addiction and ultimately lead to better addiction treatment. Although mental health researchers and professionals have done a wonderful job in creating effective therapies for addiction, we know that these treatments do not help everyone and that relapses are common. I am excited about the possibility that we can improve addiction treatment and help reduce the suffering of people with addiction, their families, and their loved ones.

A second reason why I’m excited about the registry is that comes from a person-centered perspective. What do I mean by this? Person-centered refers to a focus on the individual, including the unique factors that are related to a person’s personality and mental health. Prior to my work here at Portland Psychotherapy, I worked with individuals experiencing serious mental illness (e.g., schizophrenia). At the clinic where I worked there was a strong emphasis on putting the person first, not their mental illness. As result of my experiences working in a place that heavily emphasized person-centered care, I continue to value this perspective in mental health and addiction treatment. I think it can be easy to fall into the trap of only seeing the addiction and forgetting about the person with the addiction. I believe there is great value in gaining from perspectives of people who have quit using and who continue in their recovery from drugs and alcohol. I really like the blending of science with a person-centered perspective.

A Second Cool Addiction Website

Another interesting internet resource I came across recently is Dirk Hanson’s blog “Addiction Inbox.” Dirk Hanson is a science reporter who has done a fair amount of writing on addiction and recently had a book on the science of addiction published. His blog is a treasure trove of posts about addiction. Although I disagree with some of Mr. Hanson’s points, I find his blog to be informative and accessible to a wide audience. I particularly like his posts about new research studies on addiction, as well as his posts about emerging substances that may be potentially addictive, but not yet recognized by the government as such (e.g. “Spice”). I appreciate Mr. Hanson’s ability to take complex research and to simplify it to its most interesting (and possibly most useful) points.

With so many addiction websites and blogs available, it can be difficult to find ones that are easy to understand and science-based. I believe the two websites offered in this post are accessible to a wide range of people and give people the opportunity to look behind the veil of scientific research on addiction. I hope you will find these websites as useful as I have.

Riding the Wave: Using Mindfulness to Help Cope with Urges

Changing a habit is hard. Anyone who has tried to change their eating habits, quit smoking, start an exercise program, or stop drinking or using drugs can tell you how difficult it can be at times to change old habits. In my last post I discussed how slipping (i.e., falling back into an old habit) can sometimes set us up for a relapse (i.e., continuing a habit beyond the initial slip) due to a phenomenon known as the Abstinence Violation Effect. In this post, I’d like to talk about a technique that can help you before you slip, a technique called “urge surfing.”

What is Urge Surfing?

Urge surfing is a technique attributed to the late psychologist Alan Marlatt, Ph.D., a pioneer in the field of addictions treatment. We can think of an urge as an impulse to engage in an old habit, such as drinking or using, and they are often experienced as physical sensations in the body. Urges are like waves in that they rise in intensity, peak, and eventually crash.

Here’s a brief exercise you can do to explore this technique: Stop for a moment and think about an urge that you recently experienced. As you think about this urge, see if you can notice all the sensations that come up as you think about it; see if you notice how these sensations shift across time. Use your breath to help you ride out the waves (i.e., the urge); like a surfboard, you can simply observe your breath as you ride out each wave that arises. Congratulations! You just successfully surfed your first urge!

Urges usually peak between 20 – 30 minutes, if we let them. What I mean by this last phrase is this:  if we adopt an open and curious attitude about the urge and watch it without doing battle with it, then the urge will subside. However, if we go to battle with our urges (e.g., “I can’t stand this urge! I have to get rid of it right now!”), they will subside more slowly. Worse, by giving into urges we can actually strengthen them and we can lose confidence in our abilities to change our old habits.

How to Surf an Urge

There are slight variations of the urge surfing technique, but most include the following steps:

  1. Take a few moments to notice where you experience urges in your body. You can do this by taking some time to sit in a quiet place, and if you are comfortable doing so, closing your eyes, and just allowing your attention to go to the place(s) in your body where you tend to feel urges. For some people they notice that urges are most connected to sensations in their abdomens; for others, they notice urges in their mouth (e.g., their mouths water when experiencing an urge to drink). There is no right or wrong place for an urge to be located. What is most important is that you notice where in your body you most notice urges when they show up. If you are having trouble noticing urges, think back to a time when you experienced an urge to engage in an old habit. If you are concerned that thinking about a particular instance when you had an urge will lead to doing the habit, pick a situation where the urge was less strong or you successfully prevented yourself from acting on the urge. Picture the situation as clearly as you can in your imagination. Once the situation is clear in your mind notice where in your body you are experiencing the urge.
  2. Once you have noticed what part of your body is most connected to the urge, focus your attention on it (if you notice that more than 1 area of your body is connected to an urge, start with the place that you most intensely notice the urge). Take note of the sensations you are having in this body part. What do the sensations feel like? Does it feel like pressure, tingling, warmth, or coolness? How much space do these sensations take up in this place in your body? Try to draw an outline around the place where the sensations are felt. See if the sensations have any movement. Some people tend to associate sensations with colors or temperatures. Check to see if you notice any colors or temperature associated with these sensations. For some people it can be helpful to silently describe the sensations in an objective and non-judgmental manner (e.g., I notice warmth and tingling in my belly). If more than one part of your body is associated with an urge, go through this exercise with each body part.
  3. Bring your attention to your breath. You do not need to change your breathing at all. Notice your breath for the next 1-2 minutes. Some people find it helpful to bring their attention to a particular place in their body where they notice their breath (e.g., the abdomen); some find it helpful to say phrases like “breathe in,” “breathe out” as they inhale and exhale.
  4. Gently shift your attention back to the part(s) of your body where you notice the urge. Allow yourself to notice whatever sensations come up in these places. If it becomes overwhelming to notice the sensations, gently return your attention back to breath for a few moments and then go back to noticing the sensations connected to the urge. You may find it helpful to imagine sending your breath to the parts of your body that are associated with the urge (e.g., you can breathe into your shoulders and let your breath fill up that part of your body). Notice if and how the sensations change as you watch them. Be sure to practice this step for at least 1 minute, but longer is probably better.
  5. This next step is optional, but I have found it to be helpful in my own life and in working with people with addictions. Imagine that the sensations connected with your urge are a wave. Watch the wave rise and fall over and over again as the intensity of your sensations peak and subside. Your job is to use your breath as a surfboard to ride these waves. No matter how big the wave gets, no matter how much you feel as if the wave will consume you, you are a skilled surfer and you will use your breath to ride each wave as it comes. Practice this for at least 1 minute, but again, longer is probably better, particularly the first few times you practice this.
  6. As you’re riding the wave (or just noticing the sensations), you may find it helpful to silently describe the sensations in an objective and non-judgmental way (e.g., I notice warmth in my belly that is increasing…the warmth in my belly is decreasing and my belly feels cooler).
  7. When you are done surfing the urge, take a moment to thank yourself for taking the time and being willing to do something different with your urges. You can also use this time to set your intention for the next few minutes, hour, or day.

That’s it! With practice urge surfing gets easier and you may discover that you are an excellent surfer. You can practice this technique in two ways:

  1. You can start urge surfing whenever you notice yourself having an urge.  This can be a particularly useful technique when you notice urges to go back to old habit that you are trying to break.
  2. You can practice this on a regular basis by setting aside time to practice using the technique. Many people find that listening to an audio recording of the technique is useful at first.  Through this kind of formal practice, you can get better at urge surfing so that you’re better at it when you need it.

You’ll find that, with practice, urges will become easier to ride out. You may even start to feel a sense of pride or accomplishment as you successfully surf urges and act according to your values, instead of according to your urges.

If you would like to learn more about how to use techniques like urge surfing to cope with urges, the book below is a good option:

“I Already ate Half a Box of Cookies, I Might As Well Eat Them All”

If you’ve ever tried to change your diet, you’ve probably experienced a situation like the following:   You’re committed to pursuing a healthy lifestyle and as part of that commitment you’ve decided to reduce the amount of processed sugar you eat. It’s been tough, but over several weeks you’ve steadily decreased it. Then, you’re invited to a friend’s birthday party. At this party there are delicious, decadent cupcakes. Everyone’s enjoying themselves eating those lovely cupcakes. Your friend asks you if you want one and you say…”Yes.” You think, “One won’t hurt! It’s a celebration.” So, you eat a cupcake. If you stopped right there, after this initial slip, it wouldn’t be a big deal. You could just go back to your plan for eating healthy. But you don’t. Before you know it, you eat a second cupcake, drink 2 cups of sparkling orange juice, and eat a bunch of candy.

You are not alone in having this experience. Time and again I hear friends and associates talk about how they ate a whole loaf of bread (those who were on the Atkins diet), ate a whole box of cookies (those on just about any diet), or ordered the Grande size nachos when they were out at a happy hour (I, myself have been guilty of ordering a mountain of nachos even though I highly value a healthy lifestyle). An interesting phenomenon can occur after this initial slip into old habits (eating or other habits we’re trying to change). This occurs so frequently that researchers have studied it and clinicians have come up with strategies to combat it. The phenomenon I’m describing is called the Abstinence Violation Effect.

Abstinence what?

The Abstinence Violation Effect (abbreviated AVE) occurs when a person lapses, or slips, into an old pattern of behavior and then continues this pattern of behavior beyond the initial slip. Let’s come back to our cupcake example to more closely examine AVE. You experienced a lapse when you ate the first cupcake (you violated your commitment to a reduced sugar diet). You then ate a whole bunch of things loaded with sugar following your initial lapse. What just happened? When we violate a commitment we’ve made to change our behavior, an interesting combination of thoughts and feelings occurs. You might have thoughts like, “well, I already had one, might as well have another!” or “I just blew my diet so it’s ruined and it doesn’t matter what I eat now, because I already blew it.” We may also feel guilt, shame, or anxiety during or after our initial slip. This pattern of negative feelings, thoughts related to our initial slip (e.g., “I blew it, might as well forego the rest of my diet today”), and actions (e.g., eating another cupcake, drinking 2 cups of juice, and eating a bunch of candy) make up the Abstinence Violation Effect.

The Abstinence Violation Effect relates to any kind of habit change

This effect applies to anyone who is trying to break a habit. That habit could relate to patterns of eating, as in the example above, or it can relate to trying to exercise more, to stop biting your finger nails, or reducing drug or alcohol use. For people who are trying to stop or cut back on drug or alcohol use,  the abstinence violation effect can turn an initial slip (e.g., one drink after a period of sobriety), into a full-blown relapse (i.e., going back to old patterns of drinking or using). The consequences of AVE can be especially high for individuals with addictions and can lead to a cycle of multiple relapses or accidental overdose.

What can I do when I experience a slip? Practical tips for combating the AVE.

Being aware that the Abstinence Violation Effect (AVE) occurs is your first step in combating it. Armed with this knowledge you can develop strategies to help you avoid or reduce the impact of AVE. Some helpful strategies for AVE include :

  • Prepare yourself for high-risk situations (e.g., places where an initial slip may occur, such as birthday parties when you are on a diet) by making a plan to reduce or avoid triggers for your old behavior. For example, you can eat before you go to the party so you are too full to eat a cupcake. You can also reduce the amount of sugar you eat during the day of the party so you can have part or all of a cupcake without going over your allotted amount of daily sugar. You can speak with your partner or friend and enlist them to help you cope with temptation when at the party. Another idea is to tell your friend at the party about your commitment and how she can help support you (e.g., not offer you cake) before the cake comes out.
  • Remind yourself of your values related to why you are changing your behavior. For example, you might remind yourself of your values (why you are making the change in your life) on a daily basis by writing them down and placing them in strategic places (the fridge, your wallet, your pocket). You can set a reminder on your phone that helps you remember your values (e.g., a picture of your kids to remind you that you are committed to a healthy lifestyle so you can be around longer).
  • Encourage yourself if you do slip. Remind yourself that many people slip when making lifestyle changes; in fact, slipping is the norm! Congratulate yourself on the changes that you have made so far and tell yourself that one slip (or even many slips) does not mean that all the time and efforts you’ve made are worthless. Remind yourself that you can recover from a slip and that you are capable of recovering from it. Beating yourself up about slipping up is not.
  • Come up with a plan for how you will recover from your slip-up. Think of concrete steps you can take to get back on track following a lapse and write these down on a piece of paper. Put this paper in a place where you can easily access it.

A slip does not need to be the end of your pursuit of positive life changes, whether it is changing your diet or cutting back or stopping use of drugs or alcohol. By being aware of the Abstinence Violation Effect and developing strategies to combat it, you can remain on or quickly return to your path of valued living.

What do people think is the best treatment for anxiety?

Here at Portland Psychotherapy, we spend a lot of time researching the most effective treatments for problems in living. Too often, though, there’s a disconnect between what the research says works and what is often used in practice. Not only is it difficult to educate the public but even mental health professionals can have difficulty keeping up.

For these reasons, I read this CureTogether post (now associated with 23andme.com) with great interest. CureTogether is a website that collects ratings of treatments. It appears to have an ongoing survey of anxiety treatments. Anyone can log in and rate what worked and didn’t work for them. May 13, 2013, the website posted the results from over 10,900 people who had participated in their survey of anxiety treatments.

What do people think works?

I’ll confess: because there’s so much misinformation out there, I was a little worried about what I’d find. I honestly expected to find evidence-practice lagging behind pop psychology. When I saw the actual rankings, however, I thought to myself, “Not bad.”

Cognitive behavior therapy (CBT)—which arguably has the most impressive research base for addressing anxiety disorders—was number 6. Given that CBT is not as “sexy” as other treatments, I was pleasantly surprised to see it in the top 10. Even Acceptance and Commitment Therapy (ACT), the specific branch of CBT offered at Portland Psychotherapy, was number 11. (This is amazing, actually, as ACT is still new to many professionals.) Even exposure therapy, which has the greatest research support but is especially unsexy, was listed at number 14.

More informal treatments such as exercise (#1), yoga (#3), and meditation (#5) also have some research support for being helpful to people. Not everyone needs to see a therapist for anxiety.

What was more concerning—although not surprising—was the prominence of a class of drugs collectively known as benzodiazepines. These include Xanax (#2), Ativan (#8), and Clonazepam (#9). I say “not surprising” because these are commonly prescribed drugs that calm you down within 20-30 minutes. I say “concerning” because, although they make people feel better in the short-term, benzodiazepines can actually maintain anxiety in the long-term: they are a short-term solution, can be addictive, and can lead to withdrawal effects with prolonged use and rebound anxiety when people stop taking it. Xanax, which is faster acting, is particularly dangerous.

What conclusions can we draw?

I should note that this isn’t an objective research study: it’s simply a summary of what people who filled out an online survey say they’ve tried and decided was helpful. That said, it’s an extremely useful snapshot of the real world treatment of anxiety.

Anxiety Treatment at Portland Psychotherapy

Help! My Loved One Won’t Stop Drinking!

If you’re reading this post then most likely you are a family member, partner, or friend of someone who’s drinking concerns you. You’ve most likely tried everything you can think of to help this person seek treatment:  nagging, pleading, threatening, leaving, staying, bargaining, contracting, and much more. Perhaps you’ve thought about signing up for the T.V. show “Intervention” on A&E, or staging your own intervention for your loved one. Maybe you have given up and no longer interact with your loved one; you have cut them out of your life completely. It may feel like you have used every tool at your disposal and yet, you are still fighting the same battle. Luckily, there is a new research-based approach to helping family members get their loved ones into treatment and to take back their lives from a loved one’s substance or alcohol use. This new approach is called Community Reinforcement and Family Training (CRAFT, for short) and it is starting to gain traction in addiction treatment.

The version of CRAFT that is practiced today originated at the University of New Mexico by Robert Meyers, Ph.D. and colleagues. Research on CRAFT shows that about 70% of families who go through the training are able to successfully engage their loved in treatment over the next year.  CRAFT also helps family members improve their own lives, whether their loved one ends up seeking treatment or not.

What is CRAFT?

CRAFT is an approach that works with family members, partners, friends, or employers of people using drugs or alcohol (in CRAFT, the term Concerned Significant Others, or CSOs, is used) to do the following:

  1. Help the CSO learn non-confrontational ways of breaking the person’s pattern of substance use;
  2. Empower the CSO to live a life not centered on the person’s use of or consequences related to the person’s addiction.

You are not to blame, but you can do something to help

  1.  You ARE NOT responsible for your loved one’s use of substances. You may be involved in situations related to your loved one’s use (e.g., getting into arguments with your partner) or the consequences related to his/her use (e.g., picking them up from the bar), but you did NOT make your loved one use substances. Your loved one is responsible for his/her behavior, just as you are responsible for your behavior. You CANNOT make a person drink or use drugs.
  2. At the same time, as a loved one of someone who uses drugs or alcohol, you have access to a wealth of knowledge about this person’s patterns of substance use. Also, you are a source of potential rewards for the person using substances. Your time, love, and attention are valuable resources that can help shift your loved one’s relationship with substances and with you.

CRAFT is non-confrontational

Unlike the interventions conducted on A&E’s show “Intervention,” family members in CRAFT do NOT use a confrontation to persuade their loved one to enter treatment. Instead, family members learn to recognize their loved one’s patterns of use and their own unintentional participation in these patterns. Family members learn how to stop their participation in these patterns in ways that keep them safe, set appropriate boundaries, and are consistent with the type of partner/daughter/parent/employer/etc. they want to be. For example, a mother will learn to stop arguing about her son’s drinking and instead, calmly express her desire that they not talk about this issue while he is drinking and then leave the situation to pursue a more rewarding activity (e.g., calling a friend, taking a bath). Additionally, CRAFT empowers family members by helping them engage in self-care and pursue their personal values and goals. For more information about CRAFT, stay tuned to this blog.

Resources on CRAFT:

To find a local CRAFT therapist for you or a loved one call 503-610-3370 or go to soberfamilies.com

Here’s  great self help book which summarizes the approach called: Get your loved one sober:  Alternatives to nagging, pleading, and threatening.

Center on Alcoholism, Substance Abuse, and Addictions (CASAA):  http://casaa.unm.edu/craftinfo.html

Website for Dr. Meyers with information about CRAFT:  http://www.robertjmeyersphd.com/craft.html