August 27th, 2018

More Choices Translate into More Recovery Opportunities

Alcohol Problems DiseaseErich Fromm observed that a prophet does not see the future, but instead sees the present without blinders (or un-blindered). That idea can be applied to understand how people in active addiction regularly get into difficulty by inaccurately predicting the consequences of using addictive substances. What the recovery support community calls “stinking thinking” is a central focus in alcohol and drug treatment programs. Addiction clinicians have used different theoretical models to try to understand and address this problem. Historically, the psychoanalytic concept of “denial” has been invoked by clinicians who attempt to “break through” what they see as a psychological defense mechanism. More recently, the concept of “cognitive distortions,” developed for the treatment of anxiety and depression, has been expanded to the treatment of addictions by cognitive-behavioral clinicians who work to correct these distortions.

In my work with patients, I prefer to use the idea of “wishful thinking” to understand the process by which people abandon their usually good judgment and convince themselves that – despite extensive experience to the contrary – on this occasion, they will be able to return to the problem-free enjoyment of an addictive substance. The wishful thinking approach combines understanding of what motivates a person in this direction, with a more surface-level focus on the methods used to mislead oneself. It incorporates the evidence from neuroimaging that the heavy use of substances strengthens the more primitive areas of thinking in the limbic system and weakens the more sophisticated ones in the cortex. Also included in becoming un-blindered is the awareness that psychological processes can be influenced by interpersonal interactions and social norms.

Recovery occurs when the addict gradually relinquishes this type of thinking and applies his or her otherwise clear thinking to the issue of substance use. Insight develops not in the psychoanalytic sense of the unconscious becoming conscious, but rather that one’s psychological field of vision becomes broader as the “blinders” of wishful thinking become less restrictive. Just as there are many paths to recovery, there are many roadmaps for clinicians and patients to use to navigate those paths. Thus being un-blindered means more choices, which translate into more recovery opportunities.

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