Straight Thinking is the name of the Kolmac Integrated Behavioral Health Centers approach to the treatment of alcohol and drug problems. Its focus is on thought processes and behavior, which are usually easier to work with than are feelings.
As you are on your road to recovery, there are terms we may use that are very familiar and important to us, and soon they will be to you, too.
Abstinence from alcohol and drug use is a cornerstone of the Kolmac Integrated Behavioral Health Centers treatment approach. Initial abstinence is the prerequisite for starting treatment and permanent abstinence is the goal. Many people seek treatment hoping that they will be taught how to return to a non-problem level of use, which they may have experienced previously and may still be able to achieve intermittently. Another hope is to be able to maintain use of secondary substances that, unlike their primary substance, have not yet clearly created problems. These hopes can be powerful and persistent, but such a goal is incompatible with the Kolmac treatment program.
Relapse Sequence Diagram
When a person develops a problem with alcohol or other drugs, one of the consequences is that his or her thinking about these substances becomes distorted in a way that perpetuates the problem. Even after the person acknowledges that a problem exists and understands that stopping alcohol and drugs is necessary, a return to alcohol and drug use is nevertheless common. This is referred to as a “relapse” and consists of a predictable sequence of events in which distortions in the person’s thinking dominate decision-making and behavior. We call these distortions addiction thinking. In AA, it is known as stinking thinking. It consists of partial truths and rationalizations that cause inaccurate assessments of important aspects of life and lead to self-deception. Consequently, people behave in ways that generate results that were not expected or wanted. This process is illustrated in the Relapse Sequence diagram.
First, set up rationalizations lead the person into unnecessarily exposing him or herself to risky situations (“I’ll just stop by the liquor store to buy a pack of cigarettes.”). Once there, environmental and internal cues can trigger cravings and automatic thoughts about the benefits of using (“A drink would sure taste good right now.”). These, in turn, activate more deeply rooted beliefs that alcohol and drugs are necessary in order to live life in a satisfactory manner (“The only way I can really relax and enjoy this party is with a drink.”). As the process builds momentum and cravings intensify, relatively superficial rationalizations give permission to use (“I’ll only have one drink.”). The last step is actual use, which on any given occasion may be limited or quickly get out of control.
Trigger: A trigger is anything that has been repeatedly associated with the use of alcohol and drugs, thereby becoming a conditioned stimulus. Although it was initially psychologically neutral, exposure to it now will stimulate a thought about or craving for the substance. A trigger can be external (people, places, and things) or internal (emotional or physical states). The strength of a trigger varies from mild to intense. The presence of one very strong trigger or a combination of mild to moderate ones creates a high-risk situation with an increased danger of relapse.
Craving: A craving is a complex combination of physiological and psychological reactions that are experienced as a desire to use alcohol or drugs. The strength varies from mild to severe.
Automatic Thoughts: Automatic thoughts are spontaneous thoughts that normally stream through our minds without our active effort or participation. They occur as a monologue in our minds, serving as ongoing internal commentary about what is going on in our lives. For the most part, we are not directly aware of their presence. They do reflect our mood, however, and significantly affect the way in which we feel and potentially the way in which we behave.
Automatic thoughts relating to drinking and drugging occur in response to triggers or cravings. These negative thoughts heighten relapse dangers by setting off cravings or reinforcing cravings that have already been triggered, as well as by activating addiction beliefs. To the extent that the thoughts remain outside of awareness, they are regarded as being true, which therefore increases their effect. Disarming these automatic thoughts becomes an important part of the recovery strategy.
Addiction Beliefs: Aaron Beck defines beliefs as “relatively rigid, enduring cognitive structures that are not easily modified by experience.” They are self-reinforcing, in that experience that supports them tends to be remembered while contradictory ones tend to be disregarded. Our lives are founded on beliefs, which are too numerous and basic to be re-examined continuously.
Addiction beliefs are distortions in thinking relating to the effect of alcohol and drugs on an individual as well as their role in one’s life. They may be partial truths but are inaccurate because of significant omissions. They represent a form of self-deception, and are sometimes subtle because they can include accurate assessments as far as they go. Following are examples:
- Set up rationalizations: “I’m only going to see my drug dealer to pay him what I owe.”
- Permission giving rationalizations: “I’ll only have one drink this time.”
- Stress-relieving beliefs: “I can’t stand feeling this angry unless I use.”
- Pleasure-enhancing beliefs: “I can enjoy this party more if I smoke pot.”
Recovery Beliefs: Recovery beliefs are the whole truth. They correct the distortion by starting with the partial truths of addiction beliefs, but include the rest of the story. In early recovery, they are reactive in that they are corrective responses to addiction beliefs.
“I have to pay my drug dealer what I owe him but I better go there with a non-using friend, because otherwise I will end up buying more drugs.”
“I would like to have only one drink, but my past experience is that once I have one I won’t stop at that, so I’d better not even start.”
“I don’t like feeling this angry, but if I drink to make myself more comfortable I will probably end up behaving in ways that make the situation worse.”
“If I drink at this party, I’ll enjoy myself more at first, but I’ll probably end up drinking more than I planned and ruin my fun or someone else’s.”
In the later stages of recovery they become proactive and are not responses to addiction beliefs.
“I haven’t had a craving in a long time, but it’s important to remind myself regularly that I’m only one drink away from serious trouble.”
Addiction beliefs are, by definition, relatively unaffected by experience. They are also not going to be readily changed just because of authoritative assertions by a clinician. The goal in the early stages of recovery is more limited: to encourage the re-examination of one’s beliefs on the basis of current experience. When this is done in a supportive environment while one is not under the influence of the substance itself, the chances are improved that one’s higher intellectual functions will be brought to bear.
The expectation is that when one is clearheaded and less defensive, one will be more aware of distortions in addictive beliefs, and will be more open to exchanging the addiction beliefs for recovery beliefs.
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