Relapse Prevention - February 2018

[Music] [Music] thank you first off I just want to thank Jess and all the volunteers that make this possible year after year they do such an amazing job can we like maybe give them a little round of applause because it it really makes the job of just kind of showing up and talking so much easier knowing that like all this stuff is kind of handled backstage so I have a lot of gratitude for you Jess and so this is I think my fifth year presenting on relapse prevention and I'm really kind of I don't know it's really bit of an honor to kind of come back year after year to talk about this because it's such a important topic for me both kind of professionally and personally because you know as many of us in the audience know that anyone with the disease of addiction is susceptible to relapse right and those those relapses can be devastating and more and more we're seeing that those relapses can be fatal however it is preventable and that's what gives me a lot of hope and that's why I show up year after year and so I understand that you know at the ED series we we get a lot of different kinds of right so I try to kind of tailor the talk tonight so there'll be something for people that are in recovery themselves there'll be something for maybe the helping professionals in the audience and then something for maybe like loved ones or family members or recovering people right around this topic of relapse and relapse prevention so I'm hoping by the no and a little bit of a caveat right so what I'm gonna focus on tonight is just one part I think of a larger kind of discussion around recovery maintenance right and because my focus tends my professional focus tends to be more clinical it's gonna be a lot more like what the individual can do but I think that in another I'd series talks and in other parts there's other discussions kind of going down the road in the country like on how we kind of talk about relapse prevention and on kind of larger scales right also like within our agencies within our schools within our communities and within our cities but tonight my focus is primarily gonna be with the individual so what the individual can do to prevent relapse right so I'm hoping by the end tonight we'll start to get some knowledge of relapse as a process and understand what that means when we say relapse is a process and be able to identify some of the stages that that are involved in that process before returning to alcohol or drug use after that we're going to talk a little bit about willpower what the research says around willpower identify some of the strengths and weaknesses of willpower as a resource for maintaining recovery over the long term after that we're gonna talk a little bit about habits how habits are formed and I think more importantly how we can work with habits work around changing habits and what hope that gives us for kind of long-term behavior change and then finally and this is really my favorite part I'm gonna present a model or framework for looking at the different kind of sources that influence that act upon recovery and relapse all the time and we're going to focus on the personal social and kind of environmental factors and how can we kind of set the stage so we can overwhelmingly pushed towards recovery and away from relapse but before we get there I'm gonna talk a little bit about the problem so these are short-term relapse rates and by short-term I mean about a year so this data comes primarily from addiction treatment centers outcome studies so treatment centers will check in with their clients or their patients and then that data is kind of sent back to NIDA which is the National Institute on Drug Abuse and it's compiled by them so in any given year forty to sixty percent of people who receive treatment for alcohol or drug use will return to use within that first year of treatment and sixty percent of those people are going to have multiple episodes of abstinence and use within that first year and so when we when we try to look at it over a little bit longer term right when we try to widen our scope a little bit there's a bit of paucity of data however we I did find this one study which is pathways to long-term abstinence which was funded by the Center for substance abuse treatment and I want to share a couple of the conclusions that was found in this study so in this study they found that 50 percent of the participants had sobriety periods of a year or longer before relapse and 29 percent so almost 30 percent relapsed after three years or longer and I don't put this up here as kind of a scare tactic but what this data kind of tells me is just how important it is to acquire and change our recovery maintenance skills over the course of our lifetime right and not just in the first 30 60 90 days six months one year if we're looking at 30% of people relapsing over three years we need to kind of broaden our scope and kind of change the way we're thinking about it and so I want to start off with that with a definition of addiction and I'm sure that there's a lot of audience members that kind of have their own definition of addiction and that's wonderful but I took this one from the American Society of addiction medicine and they say addiction is a primary chronic disease of brain reward motivation memory and related circuitry and like other chronic diseases addiction often involves cycles of relapse and remission and without treatment or engagement and recovery activities addiction is progressive and can result in disability or premature death right and so the part that we're really going to kind of zoom in on tonight is this is this bolded part so like other chronic diseases addiction often involves cycles of relapse and remission so when we're talking about chronic diseases we're talking about diseases like epilepsy HIV asthma MS diabetes Parkinson's schizophrenia addiction kind of falls in that category of chronic diseases and just like those diseases without treatment or recovery activities you know relapse is kind of a feature of the disease so let's compare two chronic diseases so over here on the Left we have hypertension treatment or hypertension and over here we have addiction when you look at these graphs they look identical right so what we're kind of measuring across the the y-axis is the severity of the condition and then across the x-axis what we're measuring is where it kind of falls in the stages of treatment and so what we see about hypertension and addiction is before we treat it the severity of the disease is generally pretty strong people have a lot of symptoms right and then we do something and then for a lot of people it gets a lot better right but then if we stop doing if we stop treating it we see this really significant rebound effect and I'm gonna suggest that the main difference between hypertension addiction is not in the course of the disease but in how we perceive it right so for a lot of people what makes a whole lot of sense that like yeah okay so it's really bad high blood pressure is really bad before we treat it we treat it and if we stop treating it it makes a lot of sense that it gets bad again right that perception still hasn't really kind of sunk in in the same way around addiction right still way too often we kind of see that it's really bad we treat it and then just expect it to stay the same and this is really where the line chair of tonight's is going to be over it is going to be about is like how do we kind of have these long-term maintenance strategies so we don't see the significant rebound effect right so where the disease doesn't have to kind of crop up again and before we kind of talk about that I want to talk about the way what we mean when we talk about relapse like what do we what are we actually talking about and so I'm going to present a couple different models of relapse and this is really the event based view of relapse and this model was really put forth and by more of a medical definition and it kind of stuck around for a long time and it really seems relapse is an event right so like you're over here an absent at land as soon as you use alcohol or other drugs you're over here in relapse and this this model is has this kind of common-sense appeal to it it's really kind of simple the main problem with it is that it just doesn't tend to follow the data that we have right which is actually a good thing because the event based view of relapse doesn't give us much place to intervene right so if the only place we can do it is at an event and that's it's a really small window that we have to work with so it turns out that relapse looks a lot more like a process and I want to kind of talk about what that means so two of the people that really helped usher in this idea that relapse is a process rather than an event are Terry Gorski and Alan Marlatt both of them did some really groundbreaking work starting in the the 1980s around that this around working with hundreds and hundreds of alcoholics and addicts and they say just like I mentioned that we let the fact that relapse a process is actually a really good thing because it gives the recovering individual the helping professional the family members someplace to do something before we actually end up at alcohol or drug use right and both of them say that the relapse process really ends with the alcohol or drug use at which point we kind of enter a using episode right and everything that comes before it it's all a part of the relapse process so I want to take a look at both of their models so we can kind of get a sense of of what that means exactly cuz I remember when I first heard that relapse was a process I was like okay and what does that mean right so we're gonna start off with Terry gorski's I'm not oh because it's called the early warning sign approach and before I I can't go into that I just want to kind of point out that both of them kind of have relapse is the sixth and final stage in the process right so Terry gorski's model is probably gonna feel a bit more intuitive to members of the audience that are familiar with 12-step recovery because his model is kind of in line with both the philosophy and principles of Alcoholics Anonymous so for Terry Gorski he says the relapse process really gets started with stress right and he says it's really interesting so when the stress starts occurring a lot of times it's outside of our awareness right we're not even aware that it's kind of going on and so that's kind of this denial piece right and because we have the stress and we're not able to kind of address it we end up with internal dysfunction an internal dysfunction is just kind of a fancy way of saying that we were having a hard time regulating what's kind of going on inside of us right we're hard time regulating maybe some emotions hey has a kind of a term for this what's called being restless irritable discontented right and he says as a result when when we're not able to kind of address what's kind of going on inside of us in a in a skillful way it starts affecting things outside of us right and that's what external dysfunction is that's this idea that they start spilling over into other areas of our lives right start spilling over into our relationships starts playing over into our work it maybe starts to filling over into our school as well and as a result of the stress denial internal dysfunction external dysfunction we end up down here at option reduction which is just basically saying that for the recovering person because they've maybe kind of these relationships they've had maybe they're kind of either stepped away from them or maybe damn into them that they don't have a lot of room to reach out and ask for help at this point right they've made their recovery program so small that really the only kind of salient response for kind of dealing with all of this is to return to alcohol or drug use right Allen Marla's model is a little bit different right he's more of a social learning psychologist and more of a cognitive behavioral therapist but kind of key to understanding his model is this idea of high-risk situations so for Alan marlott high-risk situations can be either external or internal meaning they can be people or places or they can kind of be emotional states right so and when we're kind of working within his model what you're trying to do is to identify what are all my Huayra situations either internal or external at the same time identifying what are effective coping skills for dealing with all these high-risk situations and at the same kind developing this belief that hey if I use these coping skills in these high-risk situations then I should be okay and when that kind of falls apart we kind of slide down this slope all the way down here to relapse and so when we look at what are the high-risk situations Alan Marla did quite a bit of research and gathered quite a bit of data around it we see what really tops off the list regardless a drug of choice is negative emotional states so negative emotional states can be accounted our kind of be told to be responsible between 28 and 43 percent of relapses also kind of key determinants are interpersonal conflict or so problems in our relationships and social pressure and what we know about negative emotional states and problems in our relationships is they tend to put a lot of strain on the brain and the body of the recovering person right they cause a lot of stress and so stress seems to be this kind of key key player in in relapse and tends to happen pretty early on right so stress is a major player and I know actually everybody however we don't all face the same severity of stress we don't all face the same pattern or stress in our lives we don't all have the same functioning coping mechanisms to be able to deal with the stress and I think most importantly we don't all come to the table with the same brain because I think that acknowledging the fact that there are social structural psychological as well as very much biological differences in the way that we address stress helps us open up a very real and a needed dialogue around what I think one of the biggest and most destructive myths around relapses and that's at its root is kind of this lack of willpower and that willpower is this kind of fix character trait that you either have or you don't have because if we choose to believe that if we choose to kind of accept that kind of common cultural myth the natural conclusion we're gonna arrive at is that just some people are doomed to fail so I want to spend a few minutes talking about willpower what I've learned about willpower what the research has told us and and what it might mean for recovery and relapse so I'm gonna start off with the willpower trap now this is a term that was coined by um Carey Patterson and I'm gonna kind of adapt it to addiction and recovery so if you spend enough time around newcomers to treatment or newcomers to AAA you're bound to hear versions of the following I thought I should be I thought I should be able to do this on my own I just need to be strong I won't let it happen right and I think these sentiments they really come from a good place like their intention is really positive but I think they also reflect these larger kind of social and cultural norms to tribute our successes to kind of our determination our strength of character our great our Moxie right and we attribute most of our failures to our lack of willpower to kind of put this to into a little bit of context just whether you're in the recovering person or not think about how many times you blame your lack of willpower for the reason that you cheat on your diet or maybe don't exercise or what binge watch that extra episode of Netflix right we tell ourselves we don't want it enough that we're not kind of working hard enough right and this idea that we're just not digging deep enough I think tends to be a little simplistic right and this simplistic view is not only wrong but I'm gonna argue that it's tragically wrong and it's wrong because it's incomplete and it's tragic because it gives us nowhere to go when we fail to change ourselves when a recovering person believes that their ability to change themselves comes from nothing more than willpower and that willpower is something that they either have or don't have well eventually they're just gonna stop trying altogether and that's the willpower trap right this idea that it kind of starts off with this really heroic commitment to change that's followed by this kind of a [ __ ] motivation and eventually kind of terminated in relapse and then when the pain of addiction gets so bad we muster up another really heroic but ultimately doomed attempt at change right and so there's an analogy that really helped kind of cement this in my mind so I wanted to share it with you tonight it says the willpower trap feels like we're ascending a summit it feels like we're climbing a mountain when in fact we're simply walking on a treadmill that's the willpower trot lots and lots of effort no progress thanks I didn't make it up I wish I could take credit for it not me so to explain why Baumeister or to explain my willpower often fails Roy Baumeister and Jonathan Tierney wrote this book called willpower and I want to spend a few minutes kind of talking about what the research has told us around it so when people were asked to list their personal strengths self-control came dead last when people were asked to list which virtues gave they wish they had more of self-control was at the top the list right so here we see that willpower is this very kind of valued ability that most people in our culture don't think we have enough of and so if we take this thought just a little bit further one conclusion I draw from this is that when it comes to maintaining change willpower might be the only thing we can see right it's the only kind of skill we can identify and the fact that most people feel that willpower is this ability they don't have enough of makes me think that we might be overestimating its importance in sustaining any kind of change in our lives far too many of us are relying on relatively old and ineffective strategies of just kind of pushing through sucking it up and soldiering on so to explain this Baumeister and tyranny say we there we use willpower when we engage in any one of four broad categories of activities so I want to kind of walk through it so we all have an understanding of it so they say we use willpower anytime we're trying to control our thoughts so we're trying to think about nothing or ignore something we're using willpower we also use willpower anytime we're trying to control our emotions anytime we're trying to escape a bad mood or even not so how we feel right so let's say I'm feeling a lot of fear on the inside which I am and I'm trying to present kind of confidence on the outside which I am I'm using willpower right so we also use willpower anytime we're trying to control our impulses so every one of you that was out in the lobby looked at just as cookies and didn't eat one that used willpower right and finally we use willpower anytime we trying to control our performance so anytime we're monitoring our effort our speed or our accuracy we're using low power so just let's pause just for a moment and think about how many activities in your life where you're using one or two or three or even all of these at this same time right and then let's think about someone in early recovery right someone who's trying to actively not think about drinking or taking a drug someone who's actively trying not to feel the anxiety or depression that they're feeling someone who's trying to not give in to that deep sense of craving that they're experiencing all while trying to get done whatever work they have to do in front of them it seems like a superhuman amount of willpower and that's just a normal day for someone in early recovery right that's just it's just like today and maybe that wouldn't be such a huge deal it's except Baumeister and tyranny have kind of discovered that willpower is finite and it becomes depleted when we use it they call this phenomenon eco depletion and and I think just as important we have we used the same supply of willpower for absolutely everything meaning we don't have a separate supplier willpower for our thoughts another supply for our emotions another one for our impulses and another one for performance right we have like basically one bucket of it willpower inside of us and if we use it up earlier in the day it just won't be available to us later when we may need it so to kind of demonstrate that we only have kind of one bucket of willpower there's been a bunch of studies last time I searched I found over 80 that say that we have a kind of a finite amount of willpower but the classic one has to do with cookies and radishes so I'm gonna kind of walk us through it so a group of psychologists asked a bunch of hungry college students to come in for an experiment right and then they drove these college students up into two groups so group one was led into a room that smelled of delicious chocolate chip cookies there was chocolate chip cookies sitting out and they said go ahead eat the cookies the other half of the group they brought into the room that also smelled like delicious chocolate chip cookies there was cookies setting out and they said you know what don't eat these cookies instead you can snack on those bull or a dishes and then they left the room they watch their one-way glass and they thought what happened what happened was kind of interesting so kind of despite looking at the cookies really longingly those college students didn't eat them right so that's willpower at work right they they were able to resist that impulse right so then they they dismissed them all and they asked him to all come back three hours later for what they were told was an unrelated study but what the researchers are actually looking at was hey what was the effect of using willpower earlier in the day on an unrelated task so they were brought back in and they were all given these math puzzles to work on and they said hey just work on these math puzzles as long as you can and when you're done turn them in what the students didn't know was that all the math puzzles were essentially unsolvable right yeah psychologists like to mess around with college kids it's kind of very good thing but the results were telling so the cookie group spent on average 19 minutes making 34 attempts on these unsolvable problems right so this is a good have to use willpower earlier in the day the group that did have to use willpower earlier in the day spend on average eight minutes and making only 19 attempts on the unsolvable problems right they were only able to work about half as long I can showing their performance as a result of having to control their impulses earlier in the day and you know like I said there's been study after study that has shown that these results are pretty reproducible they're pretty valid they're pretty strong they're pretty reliable so let's go back to our friend an early recovery and just think about how much time is spent resisting temptation concealing feelings feeling stressed and making difficult choices this would lead to almost a constant state of willpower depletion and when our willpower is depleted we give up too easily on tasks and given to easily temptation so I'm hoping by now you can start to see why relying on willpower alone it's kind of doomed to fail as kind of a long-term strategy all right so all that stuff I was talking about was like the bad news the stuff that kind of takes willpower away the good news is Baumeister and tyranny discovered that willpower tends to function like a muscle meaning you can exhaust it but you can also make it stronger but what's interesting is the the type of things that were linked with actually either increasing our capacity for willpower or being able to replenish our willpower wins depleted so really little things like having an open and erect posture was related to being able to replenish your willpower exercise were strongly correlated with both increasing your capacity for willpower and replenishing it focusing on one task at a time this idea of mindfulness was also linked with increasing Outworld power there's also a lot of things that a a both provides and reinforces that was linked with with increasing our willpower things like meditation and prayer faith in something larger than oneself and social support so before we kind of leave this discussion on willpower for right now I want to kind of leave with one final willpower fact that I found really interesting so remember earlier when I said that making choices deplete your willpower well it turns out this only holds true when you're making choices for yourself when you're making choices for someone else you don't see that same kind of depletion over your willpower and the reason why this kind of struck me is that it's kind of really common practice in in 12-step recovery to go to a sponsor or go to a support when you have kind of an important decision to make so when you go to your sponsor or you when you go to your support with that decision not only are you saving your own willpower for later when you might need it you're also not depleting your sponsor supports kind of reservoir of willpower and I always find it terribly fascinating when this kind of wisdom from the 30s and 40s and 50s is backed up by the the social science and neuroscience of today and so Bill Wilson had it right when he wrote in the 12 and 12 that our whole trouble has been just our misuse of willpower all right so willpower alone obviously isn't enough to kind of help us sustain change where does that leave us what I want to talk about next is habits and how understanding analyzing and reworking some of our habits can give us some chance for creating sustaining change right so habits scientists say exists because the brain is constantly looking for ways to save effort right our brain is essentially lazy and left to its own devices the brain will try to make almost any routine into a habit and Charles Duhigg who wrote this wonderful book called the power of habit says that the process of habit in our brains is a three-step loop and so I kind of want to walk through it so we all have an understanding it says first there's a queue and the queue is basically a trigger that tells our brain to go into automatic mode and which habit to use then there's a routine and the routine is basically an action it can be a physical action but it can also be a mental or a kind of emotional action as well can be external or internal and then reward and the reward is there to let our brain didn't know is this loop worth remembering right so over time this loop of cue routine reward cue routine reward becomes more and more automatic until there's a powerful sense of neurobiological craving that emerges right so that's when our when we experience the cue and our brain starts craving the reward that's when the habit really gets locked in so habits are not destiny but they are very powerful and habits can be changed ignored and replaced but the reason that the discovery of the habit loop was so important is that it reveals this basic and fundamental truth that when habit emerges the brain stops fully participating in decision-making it stops working so hard and diverts focus to something else so unless we deliberately fight a habit unless we find new routines habits will kind of emerge automatically and almost without our consent and there's a reason for that so when we were talking about willpower when we were really talking about our prefrontal cortex in our frontal cortex right this is where executive decision this is where choice lies for some of us argue this is where kind of the seat of consciousness lies right this is where the the thinking deciding rationalizing part of the brain is this is not where habits live habits live in our basal ganglia which is way down here which is a much more primitive much faster part of the brain and what's really interesting is that once a habit once that cravings start existing a habit right once it gets locked in there it gets stored in here permanently you cannot delete a habit once it's in there it's in there so you can't just be like I'm gonna stop that habit because it can remain in there literally for years and years and years even if the cue and the reward hasn't been present they did this really kind of weird study but where they essentially put these receptors in the brains of alcoholics that prevented preventing them from receiving any kind of pleasure from alcohol and they said you know what this is gonna cure alcoholism right turned out didn't work right so because and and I think part of that reason why is this right so we still have queues to drink and our brain will still go into automatic mode and be like well when this happens I drink right and so it doesn't really get at that yeah and so in order to kind of rework a habit scientist psychologists social scientists have come and come at it a bunch of different ways throughout the years and they found that there's really only one way that works we have to keep the same queue provide the same reward and the only thing we can really mess around is a routine this is called the golden rule of habit change and I know this feels a little bit abstract so I want to kind of put it in context of addiction and recovery so we can get a sense of how this might work so here's a here's a habit loop that most people are probably pretty familiar with right so here's our friend right here we're gonna say the queue is a kind of an internal queue and it's a feeling of maybe feeling anxious the routine is he has a few drinks or gets drunk and the reward is that he feels momentary relieves right and so over time this becomes more and more automatic until as soon as he starts feeling anxious he starts craving that relief and that's when this habit loop really gets locked in so let's apply the golden rule of habit change to this loop to see what it might look like alright so queues and rewards have to stay the same the only place we can mess around with it is the routine so our friend over here is feeling anxious this time he goes and let's say talks to a sponsor about that anxiety and then feels relief so it can take a little bit of time and a little bit of work to insert these new routines but over time they can become more and more automatic so I want to talk a little bit about how we can go about finding new routine so Charles Duhigg wrote this book if you if you do have a chance to read it I really can't recommend it enough it's really great he's also a huge kind of supporter of AAA and 12-step recovery and he says that when we're trying to find new teens first we have to identify our cues right what are the what are our triggers for drinking he says step work can help out a lot with that specifically our four step right which is our fearless and searching moral inventory he says specifically going to our fears and resentments right so for a lot of us fears and resentments are our cues and triggers to drink okay so if you've done the four-step that youyou kind of have some of this work done already and then he says think about what you felt immediately after the routine was completed and by immediately after I mean the moment after you did it not three hours not the next day but immediately after and that's the reward right so now we have the cue we have the reward all we have to do is find a new routine that provides that same reward and that can be the tricky part right but luckily 12-step recovery provides all sorts of routines that don't involve alcohol or drug use right a there a provides social support there's meetings there's being a service to other people there's can't think of other stuff but there's a lot of other stuff that happens that you can use as routines there's all sorts of routines that are there so play around with new routines and I encourage people when they're doing this kind of work to kind of come at it with a sense of curiosity right because the likelihood of kind of like hitting the nail on the head the first time isn't really that high because you're gonna have to find a routine that that provides the same reward so you might have to play around with that routine a little bit until you figure it out so I want to talk a bit about what makes a habit change stick right so the theory that AAA worked solely on reprogramming as participants habits like the crack started appearing that about 15 years ago when researchers started discovering something so they said okay so how do replacement works pretty well most of the time until something big happens in someone's life right something like finding out a loved one has a chronic disease or you have a chronic disease yourself or we're losing a relationship or experiencing a death they're experiencing a loss of a job at which point a certain number of recovering people would fall off the wagon and they want to figure out why did this happen why some people could kind of go through those experiences with their sobriety intact and other people couldn't and it didn't seem to be about what habits they'd replace right so they started doing some research and and the recovering people said yeah identifying cues and inserting new routines is important but without this other ingredient the habits never really took hold in the secret ingredients and so initially the research was really kind of hated this idea because like God and spirituality weren't really kind of testable hypotheses but then in 2005 a group of researchers out in California wanted to look at this so they started talking to recovering people about all sorts of religious and spiritual topics and what they found was really really interesting they what they found was that the recovering people that believed that some power great in themselves has entered their lives were more likely to make it through a large stressful event with their sobriety intact right and what the researchers found it was it wasn't necessarily God that mattered it was belief belief was kind of the key ingredient that made the habit loop into a permanent behavior right believing in something being able to believe in something again and so you know putting people in meetings in a a meetings where belief is a given right well belief is kind of this integral part of us that 12 steps allowed people to start practicing to believe in something again right and that skill started spilling over into other parts in their lives right so like maybe I might doubt my own ability to stay sober but you know I look at Mike and I'm like well believe it works for him right so I can middle to practice a little bit of belief right there right and then I'm able to start believing that maybe it'll work for me and I can start believing in the program so this became this this this ability to believe in things was what really made the reworked habit loops into a permanent behavior and so I'm gonna kind of let habit sit for a moment and we're gonna talk about what I think one of the most dangerous myths about relapses you know and in my time at Don Farm I heard probably nine million different versions of the same thing is that I'm gonna be able to see this relapse coming and I'm gonna be able to kind of stop it before it before I get too far off the path right like you know I understand that I'm kind of relaxing on my recovery right now but if it gets too bad I'll self correct and it won't it won't get too bad and most of the time it ends with pretty disastrous results so I want to think about you know because when you talk to someone normally after a relapse and this isn't always the case but often times you don't hear about someone planning a relapse for months or weeks and then finally just kind of giving in right often time they kind of describe it as is kind of a shock or a surprise like you know I was kind of angry and shopping at Meijer and the next thing I knew I was drunk in my car like stories like that come up a lot right and so why does this happen and what can we do about it so when recovering people describe a relapse as a shock or a flash like a lightning bolt hit them and all of a sudden they were using one explanation for this is that they were unable to see all the different forces out there that were acting on them all the time they were essentially blind to the external and internal forces at play in recovery and relapse and it's all too easy at this point in time once we relapse to fall into that willpower trap and blame it on the inability to tough it out or we didn't want it enough or the one I hear probably the most frequently is I haven't hit my bottom yet right and while that may be the case in in some circumstances I'm gonna say that's the exception and not the rule because when we relapse our problem isn't that were weak it's that we're blind and when it comes to long standing habits we can rarely see what's actually controlling us we might also be outnumbered right so the forces working against our recovery might be numerous and working in tandem right so if when we can begin to start to see all these different sources that are working against our recovery and being able to kind of stack the math and favor recovery rather than relapse we can really set ourselves up for success over the long term and to that end I want to present this model which is a model created by Carrie Patterson and his uh and his colleagues I first came across that when I was reading the book change anything but it also shows up in a number of their other books Crucial Conversations and influencer and the reason why I like this model is that it's both simple and comprehensive right it's basically you know three rows and two columns so we're gonna be looking at the personal the social and the environmental and how it relates to motivation and ability so I'm gonna kind of start off with a high-level look at look at this model so source one is personal motivation so what we're really looking at here is do we want to make this change in our lives and if we don't how do we increase personal motivation so we do want to make this change in our lives source to is personal ability and so that's saying you know now that we have this motivation now this motivation is here do we have the actual skills that are necessary in order to be able to do this like do I know how to do this and if I don't how do i acquire those skills source three is social motivation and that's whether the people around us are encouraging the right behaviors and if they're not how do we get them to encourage the right behaviors or how do we get people around us that will encourage the right behaviors source for is social ability and that's do we have people around us that are providing us with tangible health information and resources source five is environmental motivation and is that is the physical and digital world around us kind of encouraging the behaviors and source six is environmental ability and that's why the environment kind of supports our right decisions and so again this might feel a little abstract right now but we're gonna kind of step through each one of these and I'm gonna provide some very kind of specific interventions or tactics for each one of these six sources of influence so we're gonna start off with personal motivation right that's source one so when it comes to changing ourselves here is one of the biggest problems the things that we should do are often boring or uncomfortable or even painful so we don't want to do one well it's not entirely true we want to do them in the abstract just not in reality right we want to do them tomorrow just not today right so none of you trying to think so here's a common example that comes up right like you know I really want to do 90 medians 90 day but today I'm just really tired of busy or whatever I'll start tomorrow right so none of this tomorrow talk would be necessary if we could learn to enjoy doing the right behaviors today right if we can learn to start to love what we hate because let's face it everybody in this room is probably really good at doing things that you enjoy right like you don't have to like build up your motivation in order to do that and it turns out there are ways that we can begin to love what we hate so let's go back to an example the person that said you know I'm going to start 90 meetings in 90 days tomorrow so kind of like looking at that process in finding what are the parts of the process even if they're very small that you do enjoy or that you may enjoy right maybe it's just a free coffee maybe it's the one or two regulars that you get to visit before or after the meeting maybe it's the meditation component in the meeting right so focusing on the parts of the process that you do enjoy or that you may in because everyone that's alive today had ancestors that have a negativity bias right meaning that we're really good at picking out things that we don't like it's an evolutionary thing that's why I like you know we're alive and the people that were happy all the time or didn't make it here right and so in order to seriously so in order to kind of work against that we have to be very kind of conscious around it and so there's there's there's research that's coming out more recently saying that these parts right so when we focus on those small parts of the process that we do enjoy or may enjoy we have to do it for about twenty or thirty seconds so like really calling up what is it about this process that I might enjoy or do enjoy and giving ourselves like twenty or thirty Seconds to install that because anything less than that it's kind of fleeting and most of our brains will go right back to that negativity bias without alright so the next tactic for increasing our personal motivation is to tell the whole vid story why we want to stay sober right so telling our story reminds us why we're doing it it gets support from other people it helped us identify with other people this is a huge part of recovery and in a a telling our story at meetings telling our whole story to sponsors and then telling our story to newcomers we really understand everything in life by developing and creating stories to explain it and these stories have a lot of power right they really help shape our identity they when we create a story of our change it stops being just something we're doing and it becomes a part of who we are there's a neuroscientist by the name of Paul Zak who's who does work around stories and he says when we hear or tell a story that has a beginning a middle and an end and for my a people you know what I was like what happened what I'm like now something happens in our brain it starts releasing cortisol and oxytocin in this kind of particular combination that facilitates our ability connect empathize and make meaning right so to steal his line like a story is literally in our DNA and I've always loved this quote by Bernie Brown who says that owning our story can be hard but not nearly as difficult spending our lives running from it embracing our vulnerabilities risky but not nearly as dangerous as giving up on love and belonging and joy the experience that make us most vulnerable only when we're brave enough to explore the darkness will you scope the infinite power of our light because I think it really gets at just how transformative the power of the power of story can be in our lives so the next tactic I want to talk about for increasing personal motivation is to visit our default future and this can really take a couple of different forms the first form is kind of like in a a what we say like kind of play the tape all the way through right just kind of imagining what does my life look like if I continue to use alcohol or other drugs okay and then like wiring that into our present decision-making right there's a second option and when it's possible and I'm an argue that's mostly possible I suggest you try this so if you know you've notice your motivation waning literally take a field trip into your default future right go to spera sit down with somebody and talk to someone who's an hour or two away from their last drink or a day or two from their last drink right and and not only do you get the kind of be of service to other people you can also be like oh yeah that's what it looks like feels like and smells like if I go back out and use again right like but seriously and I think that you know in 12-step recovery the idea of the newcomer being the most important person in the room like there's a part of it that's about being a service absolutely but there's also a part of it that's about this kind of default future right like what does it look like right this is this is what it looks like for me if I go back out there so using their present you know as like your future to help kind of both their motivation when that's falling the next tactic I want to talk about for increasing your personal motivation is used to value words so we in the helping profession you've known for a long time that the words we use to describe our experience profoundly affects our experience of it ultimately right and using value words so using those things that are kind of sacred to us to explain what we're going through can profoundly affect it right so one way that I would do this with with clients a lot is I'd give them a deck of value cards right and they would kind of sort through these eighty some I value cards and they put them into piles of like most important not important kind of important and then we take those most important ones those those kind of five or ten kind of core values and asked them to explain the choices they're making right now in terms of those values right have them kind of describe the maybe the discomfort that they're going through right now in terms of those values and this idea it always brings up this really kind of beautiful quote by Nietzsche that says that he with a why to live can bear almost any how and I think that's really the power of using value or it's around motivation so we're going to leave personal motivation for right now and we're going to step over into source two which is personal ability saying now that we have this motivation what we're really highlighting is a skill now we have the available skill to to make this change and really a great place to start off is a skill scan which is just simply kind of going back to your list of triggers to your list of cues and saying do I have the necessary skills in order to be able to survive and thrive in these situations and if the answer is no then find a treatment group find a therapist find a book find a friend who can teach you those skills right which leads directly into the next tactic which is employing deliberate practice so you know a lot of these skills take practice like taking inventory takes practice brain takes practice meditation takes practice asking for help takes practice telling on yourself prick takes practice for some of us picking up the phone takes practice learning to be real takes practice and stop pretending everything's okay when it's not takes practice for me gratitude takes a lot of practice and most of us think about talk about and think about what we need to do but we never get around to actually practicing it and this is a huge mistake because we all need practice again going back to your cues and triggers and ask yourself you know what is it need to be able to do find somebody and practice it and if the skill seems really daunting break it up into small chunks practice the chunks right so let's say meditation is something that you've identified as a skill that you need to learn if it's your first time doing it probably don't sign up for a week-long silent meditation retreat right but like do it do a 5 or 10 minute guided meditation and do it today so the next tactic for increasing our personal ability is developing well power and again I know I spent a long time talking on willpower I just feel the need to like bring it up again because a lot of times when I would work with people around this they'd say like yeah I got this Eric I'm gonna go put myself in a situation where I'm running alcohol or other drugs and when I don't use I'm gonna feel real good about myself and that will help out my willpower and I'll be like man I do not doubt that you're gonna feel good about yourself but you are not increasing your willpower when you're doing that because remember any time showing our impulses or our emotions or our thoughts were actually depleting our willpower so doing those things that are linked with increasing hair well power right meditation exercise posture prayer social support those types of things right so we're gonna leave we're kind of leaving the personal from for right now and we're gonna talk about the social and for the purpose of this talk I've kind of combined social motivation and social ability into one kind of category and so you don't have to be a social scientist to know that people around us influences for good and for ill right and you hardly have to scratch the surface of the field of social psychology to find just a ton of studies where people fall kind of prey to social pressure right the kind of classic example is in the 1950s there was a psychologist named Solomon Asch who could give have people give embarrassingly wrong answers to questions by having a half dozen or so people first give that wrong answer right so given the choice between like giving like a really embarrassing answer or deviating from the social norm two thirds of people would rather give a knowingly wrong answer rather than deviate all right so what I'm talking about today though is okay that's a really kind of powerful pressure inside of us how do we cultivate it for good right so we know that we can make us do really stupid things but how can we get it to kind of help us in our recovery and so the first tactic I want to talk about is identifying who's a friend and who's an accomplice so when it comes to recovery there's basically two kinds of people around you right friends and accomplices friends keep help keep you on the road to health we're accomplices essentially do the apps that they aid and abet your addiction and so one mistake that kind of happens a lot around this is you might mistakenly call some of your accomplices friends because you like being around them and however if they're kind of if they enable or encourage you to behave an unwise or unskillful ways lower your aspirations you know encourage you to take a dream skip a meeting then they're acting as an accomplice and this might sound harsh but let's be clear people around us don't have to have an agenda to be accomplices what makes him an accomplice is not having bad intentions but exerting bad influence so if you hate if you hope to change the tough habits in your life when the most important steps you'll need to be able to do is identify who's acting as a friend and who's acting as an accomplice and so that leads directly into this neck tactic for social motivation and social ability which is redefining normal so a lot of times and probably did it myself but a lot of times and when I would sit down with people when they were kind of newer to treatment they would say something along the lines of like yeah no I don't use any different than anyone else around me right like everyone I know gets wasted all the time or everyone in my family gets drunk all the time or everyone in my neighborhood gets high all the time you know is that really so or do we tend to just notice people that use like us and this idea demonstrates a cognitive error known as confirmation bias which basically just says that once we form an opinion were more likely to notice the information that kind of confirms that opinion and even if it happens kind of outside of awareness we're more likely to kind of discount any of the information that doesn't confirm that opinion so I encourage you not to be fooled by people who rally around the words everybody or normal as a means of justifying their own unhealthy behavior instead call it unhealthy call it unwise even call it dangerous just not normal and perhaps the best response to this shifting sense of normality is to quit making external comparisons to begin with right rise above what is kind of a shared sense of common or acceptable and to do so you can start by just pausing and asking yourself you know how do I want to live and feel and who do I want to be the next tactic for increasing our social motivation and sociability is to tell people about what you're doing tell them about your covery tell them why it's important to you and if you can ask them for their help right and we need to keep telling people and having this conversation over and over as a recovery progresses especially around new relationships particularly romantic ones and this can be a big hang-up for a lot of people because these new relationships might have some really good you know intentions behind them but if we were if we're unable to kind of tell them the whole vivid story and recruit them to be like a friend for our recovery they run the risk of kind of being an accomplice and setting us up for unhealthy behavior even relapse right so if we want to have this conversation with people it can be helpful to start the conversation by asking others for help right don't blame others but do let them know that the role that there may be unintentionally playing in your unhealthy behavior and by focusing on effect rather than blaming them for bad intent you decrease the chance that they're gonna feel defensive and then ask them for a new and healthier relationship remember we want them to be kind of friends and finally explain to them exactly what they can do to help you for example if you notice me being quiet and saying everything's ok feel free to encourage the to ask me what's really going on so giving people permission to kind of hold you accountable and help you out when you're feeling kind of strong is a huge part of this so the next tactic for increasing social motivation and social ability is adding friends and anyone in a or 12-step recovery is gonna have kind of have a huge leg up on this so one thing that researchers especially as social researchers are looking at a lot lately is something called social contagion and social contagion is like an easy way of kind of understanding it is that like people who have obese friends are more likely to be obese right people who have friends that exercise are more likely to exercise people who have friends who go to a lot of meetings and have sponsors are more likely to go to a lot of meetings and have sponsors right and the final tactic I'm going to talk about when it comes to social motivation and social ability is distinct ourselves from the unwilling and this can be a tough one for a lot of people and early recovery especially if you're involves family and so not everyone that we associate with is going to be willing to kind of transition from accomplice the friends and in some instances we might have to put some distance between those relationships and oftentimes this distance kind of can occur kind of naturally and painlessly but when it doesn't you know there's a you know a a has a lot of wisdom for how to kind of manage some of those relationships such as like meeting at a restaurant driving yourself taking a friend and always planning and out for yourself and so before I kind of leave social motivation and social ability today I really just want to highlight how important this is by kind of talking about a study so gosh a member here's maybe like six years ago now there was a study of 3400 people so a pretty big study people that were trying to change any of everything from addiction to exercise habits and so the kind of criteria for success in the study was they were able to maintain that for a period of three years or longer right so we're talking about a relatively decent amount of time and so in this study they found that people that had accomplices around them were drugged down pretty easily and there's not a huge surprise there however people that had six or more active friends playing the role of a lie cheerleader coach or mentor were 40% more likely to be able to stain a change of a period or three years than people with six or less active friends in their lives so this is you know more than any one single component I think this is one of the largest determinants and and being able to sustain change over a long period of time so I'm gonna shift now from social down to environmental and what we're talking about here is the entire physical world out there and how it affects our recovery in ways that we rarely see you know 12-step recovery has this idea of like what places that kind of gets at their idea of being able to avoid places where addiction is the norm and using is kind of a part of the landscape but I want to really kind of focus on tonight is how can we make our environment work for us right how can the physical and digital terrain actually help our recovery and prevent relapse because when we can transform our environment from foe to friend we can make changes that felt nearly impossible in the past practically inevitable now and the first tactic I'm going to talk about for transforming our environment is to build fences right so fences essentially just keep good things in and they keep bad things out so some really kind of simple example offenses that people can put into their lives is never having alcohol no home never going into bars you know not touching a cigarette you know residential treatment is a type of fence right like that it kind of keeps you know keeps us kind of protected from our triggers for addiction there's also our kind of growing support around chemical fences right so things like vivitrol which is a once monthly shot actually blocks opioid receptors in the brain or Rivia for alcohol or an abuse one word of kind of caution about fences though like fences are a great single tactic but some people feel such comfort in fences that they will kind of rely on these exclusively and kind of forget about everything else that I'm talking about and that's a huge mistake because as soon as the fences come down if it's the only thing that you have kind of going for you you can expect kind of a pretty disastrous result right and like I had the you know I don't know with the the right adjective is because it so I've worked with a lot of people who have relied on maybe chemical senses exclusively and and and not much else and then when they kind of discontinued that chemical fence like more often not they relapse right so use the fence right to build up some of this other stuff that I'm talking about in the personal and the social and environmental but don't rely on it kind of exclusively the second tactic I'm going to talk about for getting your environment to work for us as to manage distance right so keeping good things closing convenient and bad things dissing difficult right so don't pick a home group that's thirty miles away from home or work right because there's gonna be a day when future self doesn't want to get off the couch to go to it right I'm the digital front like keeping things on your phone that you can write so daily readings on your phone gratitude lists on your phone so they're close convenient there's no excuse not to do them adding cues that's the third tact that I'm going to talk about for getting our environment to work for us so like it or not our environment has a huge impact on what gets our attention right so signs shapes colors sounds anything that gets our attention can affect our emotions choices and opinions so an easy way to think about this is visual cues help set your mental edge for example right next to my desk I have a plaque that says what good shall I do this day and it's a sentiment that Benjamin Franklin started everyday with and it's a visual cue in my environment that reminds me to be a service when I'm feeling selfish or self-centered right so kind of like having something in my environment a good friend of mine wanted to floss every day and so she put a note on her bathroom mirror like remember to floss idiot it was actually what it said and so like that that visual cue in her environment like helped her triggered her her memory to engage in this habit so use that and you know again 12-step recovery makes use of these so a has sobriety coins which are our visual cue of like the progress that we're making in our recovery right and a has key tags right these are visual cues that remind us of the progress that we're making so the next tactic I wanted to talk about is engaging our autopilot so it actually turns out that you can make laziness a tool in your change arsenal so for decades social scientists have demonstrated that we humans have something called a default bias which is just a nice way of saying that once we have stuff kind of set up we're not likely to change it right so the kind of classic example is like we all have like a specific way we go to work right and even if they build a new road that makes it incredibly faster most of us will continue taking that same road to work well 12-step recovery is great for this right so even if you don't want to call your sponsor you'll have sponsors calling you you know the idea of making commitments for things so making a commitment to pick someone up every week for a meeting right so it takes choice out of the equation it just becomes something that you have to do right same is like making a commitment to make coffee or set up or break down like it helps remove choice out of it and the less we have to choose the better right because as soon as it starts like an earring our conscious like do I wanted to do this do I not want to do this we're kind of we're running a risk right if it's just something that we kind of have to do then we can kind of engage that out autopilot for good all right so the last tactic we're going to talk about tonight is the use of tools in our environment and as long as I've been doing this talk this probably gets the most feedback on the feedback sheets and I think the reason is that with kind of developing technology we're seeing kind of more innovative and sophisticated tools that can aid us in recovery and so I'm gonna talk about a couple of them that interest me this is not supposed to be exhaustive this is not like an endorsement I'm not paid by the manufacturers or in these tools but these are ones that I just think are interesting so the first one is called the spire breath right so it's an actual piece of wearable technology that you can either put in your belt or in your shirt and what it does is it measures your stress level and as soon as it notice your stress level rising you'll get a prompt on your phone that says hey Eric your stress levels rising do you want to do some activities that help lower your stress level and what I think is so cool about this is if you can remember you know back an hour when I started talking stress was really that first stage in the relapse process right like that's that was at the very top of the list and most of time were not aware that's happening so I think it's really cool that we can have a device that can maybe recognize our stress before we do right that that says okay you know your respiratory rates increasing or your heart rates increasing let's do some stuff to get that under control another piece of wearable technology that's kind of actually have this one it's called the LUMO lift and so it manages your posture right I am meant to bring it and I just didn't stop at home on the way here so it's basically a lapel pin and every time it knows you're kind of taking a closed-off posture it vibrates to remind you to kind of open up and stay erect and if you remember posture is linked with increasing your willpower right it's also kind of linked with other kind of positive attributes as far as like feeling like you have some control and agency in your life so this is just another type of wearable technology that might be useful sober grid isn't is basically a social networking app it's basically a social network for people that don't use drugs or alcohol it was good I got a lot of press a couple of years ago when it first came out in the New York Times another place there's a couple of features I think are particularly interesting in it one is that it uses geo-locating to kind of identify other sober people near you um there's also kind of a rideshare piece to it so you can if you need a ride to a meeting or you want to offer a ride to someone else in the meeting like you can find people near you that need or are willing to give a ride so it's kind of a yeah it's like you know Instagram for sober people hi the last kind of tool that I'm gonna talk about tonight is called a chess and this is actually in evidence evidence-based practice now that was developed at the University of Wisconsin and and kind of developed into a full feature platform for addiction treatment so inside of this app there's there's actually probably close to like 20 different tools so rather than me kind of talking about each one of them I'm going to show a really brief kind of a promo video about how it works so I think to do this I have to [Music] [Applause] [Music] [Music] [Music] the last two pages of your of your handout there's actually two worksheets that the myselfin clinical director of dhan foundation Schwartz kind of developed and the first one is a six source inventory right which is essentially looking at what are the pro addiction responses in each one of these pieces in the personal motivation personal ability social motivation social ability environmental motivation of our mental ability like what are the things that are moving me towards addiction and what are the responses that are currently in my life that are moving me towards recovery now this can be a really kind of useful inventory piece early in recovery but also any time a recovery is experiencing a significant shift right if we're changing jobs if we're changing if we're moving if we're experiencing a shift in our relationships it can be a nice way of kind of sensing okay where am I going to be experiencing some kind of rupture and how do I kind of put that piece back in place or a piece that can match it back in place and that second to let or that last handout is actually a six source plan which is like now that I have these Pro addiction Pro recovery responses what's the plan that I can put in around it so I encourage you to kind of you know try it out work it with a client or with yourself or with the with the sponsor even and it's something they can use kind of throughout the duration in recovery and I'm gonna kind of end this talk with what I hope one of the main takeaways are it's by American writer Susan Sontag theories that diseases are caused by mental states you can be cured by willpower are always in the index of how much is not understood about the physical terrain of disease so that's all I have for you tonight so I appreciate your kind of time and awareness [Applause] [Music]

Channel: Dawn Farm

Views: 4,395

Rating: 5 out of 5

Keywords: Dawn Farm, Dawn Farm Education Series, addiction, alcoholism, recovery, substance abuse, drug abuse, treatment, substance use disorder, chemical dependency, relapse prevention, Gorski, Marlat

Id: xuLf5K9v8G0

Length: 73min 58sec (4438 seconds)

Published: Tue Apr 24 2018