Self-Help for the New Year, SMART Recovery for Alcohol&Drug Abuse

Dr. Micheal Edelstein has tons of great REBT information on his website Three Minute Therapy http://www.threeminutetherapy.com/index.html

His page on SMART Recovery from addiction to substances or behaviors is especially good. SMART is a great resource for anyone who would like a rational approach to changing lifestyle habits that have become self-defeating. You can find SMART's website here: http://www.smartrecovery.org/

From Dr. Edelsteins' page:

I've written a number of books about addictions and emotions. Many of my clients belonged to AA or other 12 Step Groups. Surprisingly, REBT and AA work well together, even with the AA material about a Higher Power. REBT's unconditional other acceptance makes it easy to work with clients who have strong spiritual or religious beliefs, even when I have none of my own. REBT is one of the most flexible therapies around.

Whatever method a person decides to use to recover from addictive life problems, REBT can help.

While reading the 10 points regarding SR the though crossed my mind that the bottom line is that addiction kills and does it really matter how we get clean and sober? I don't believe either the 12 step movement or SR have all the answers. I'm an alcoholic in recovery. An alcoholic who uses both the 12 steps and REBT to maintain that recovery and find that one compliments the other. I also found some of the statements erroneous in regards the 12 step movement.

AA's roots actually go back to the Washingtonians founded in 1840 and which at the height of it's popularity had 600,00 members and which foundered because they became involved in issues other than alcoholism. Thus the 12 Step movements singleness of purpose.

AA was also influenced by Carl Jung. Jung in his book Memories Dreams and Reflections speaks in 1909/1942 as alcoholism being a manifestation of a neurosis (he was actually treating a friend of Rowland Hazzards-Medill Mc Cormick (later a senator)who was related to Felicia Gizycka-Stars Don't Fall in 3rd edition of the Big Book of Alcoholics Anonymous) and by 1926 when he treated Rowland he had come to believe it a disease. It was Rowland Hazzard who carried the news that there was a solution to Ebby Thatchel and thus to Bill W, one of the founders of AA. Rowland H and Ebby T were both members of the Oxford Group and thus Bill W also joined and the Alcoholic Squad was formed which later broke from the Oxford Group. Drunks were not really welcome by the group as a whole-lowered the tone doncha know.

The Big Book of AA does not mention organised sponsorship. It speaks about individuals carrying the message that there is a solution to the still suffering alcoholic. It talks about finding "a closed mouthed, understanding friend" to share the inventory step with but nowhere does it say "thou shalt get a sponsor and do everything this person orders you to do".

Speaking personally, regarding cross talk, somehow I don't believe I'd have appreciated being shot down in early recovery. Each member of a 12 step group is entitled to their opinion and is entitled to voice it however off the wall it may be. There's plenty of advice available and it's delivered in a non-confrontational way. Again speaking personally one of the biggest problems anyone suffering from addiction has is their ego and we're all well able to spew plenty of BS and are mighty fond of listening to how the world ought run according to us. What we find harder to do is listen. Listening is an art that each and everyone of us has to develop along with empathy and compassion and they're very difficult to find in a confrontational setting with ego's flying all over the place.

There's certainly no home work assignments in the 12 step programme but one generally finds that if they don't do a written 4th step as laid out in the Big Book and share it with another person that they find no lasting peace or sobriety. A 4th step is something that can be repeated as one progresses and grows in sobriety and becomes more aware.

The BB states that the AA fellowship is only "one element in the powerful cement which binds us" (p.17) and also states the purpose of meetings is "to provide a time and place where new people might bring their problems"(p.160). A lot of the slogans bantered around such as "90 in 90" came from treatment centres and have absolutely nothing to do with the 12 step programme.

Alcoholism is a disease and is recognised as such by the AMA and is defined as such-"Alcoholism is a chronic, progressive, incurable disease characterized by loss of control over alcohol and other sedatives." Why minimise it by referring it to it as a mistake? If alcoholism is merely a distorted form of thinking how does one explain the physical aspects of the disease? e.g. alcoholics do not produce the same quantities of enzymes in their liver and pancreas as normal drinkers do.

I have yet to hear our disease was caused by our nutty families or anyone else. I have heard it said that it's caused by our having an allergic reaction coupled with a mental obsession but while many do look unkindly on the mother in law initially, they usually come to see that she was innocent. The 12 steps are not something one does once and forget about. To maintain physical and emotional sobriety they're practised everyday and dysfunctional thinking and rationalisations are challenged.

The first step to change is identifying and admitting something is wrong and through admitting powerlessness over addiction we actually get on the path to recovering our power through changing our thinking and actions. The 12 step movement talks about a spiritual experience or awakening and defines it "as a change of thinking sufficient to recover". Nothing magical or miraculous just down to earth "get over yerself".

To me there's a commonality in our journey and I'd prefer to see the focus on this rather than on nit picking differences which cost lives.

Common 12-Step phrases are geared to change thinking, behaviors.(Alcoholics Anonymous-cognitive behavioral therapy)


Discussing a client with symptoms of social anxiety, our medical director said, "If only this client could force himself to go to the supermarket. If he could just make himself get going, he might get energized."

Someone replied, "In AA they say, 'Bring the body and the mind will follow.'" Over time, we found ourselves frequently drawing upon the language of Alcoholics Anonymous to underscore a point made from a cognitive or behavioral perspective.

We quickly realized that the halls of AA are full of cognitive and behavioral interventions, packaged comfortably as mere suggestions. So we created a list of such phrases commonly heard at meetings. It is certainly not complete, and it is shaped by AA and NA meetings in the Northeast region of the country. But these observations may be useful to the clinician who is not entrenched in the language of 12-Step recovery. Of course, we do not pretend to speak for AA here.

For the purpose of this article, cognitive therapy means changing how one thinks. Behavioral therapy means changing what one does. The word "sober" here refers to abstinence from one's substance of choice. It might be alcohol, or it could be cocaine, heroin, etc.

Cognitive restructuring

Let's begin with some of the cognitive restructuring that occurs every day among people staying sober in AA. As we learned from Albert Ellis, Aaron Beck, and others, we can change how we feel by changing how we think. For many clients, this concept seems unreal, academic, or simply semantic hocus-pocus. But it works--and clients are better able to embrace the idea when we point to the ever-popular "one day at a time" adage from the AA tradition.

We humans don't instinctively think in terms of "one day at a time." We learn to focus on today--giving less energy to yesterday and tomorrow. "One day at a time" offers a good example of cognitive restructuring. It is a learned skill and something that gets easier over time.

"This too shall pass" constitutes another example of changing how we think. It moves us away from "catastrophizing" and toward acceptance--the foundation of AA's serenity prayer.

Mind-set adjustments such as these require neither a high IQ nor complex training. All that is required is a willingness to choose consciously to think in a new way. Going to AA meetings reminds the alcoholic to embrace new ways of thinking.

Table 1 lists some phrases commonly heard in AA meetings. Notice that they encourage the participant to challenge his/her worldview--the old way of dealing with life. Some of these phrases also belong in the behavioral category, but they are good examples of the cognitive restructuring that goes on in the minds of recovering people.

Behavior modification

Simply put, classical conditioning (Pavlov) and operant learning (Skinner) are the foundations for how we help people to change their behaviors. Focusing on the cravings caused by certain triggers (classical conditioning) and on the rewards or consequences associated with using or not using (operant learning), clients are able to create behavioral options for themselves.

But if cognitive restructuring sounds like hocus-pocus to the average client, the concept of "Fake it 'til you make it" can be even more foreign. Substance abusers, particularly those in early recovery, are too wrapped up in emotional chaos to make wise choices.

It is for this reason that AA's "Just keep coming" mantra is so important. It says to the newcomer, "You don't have to understand why; you just have to show up." Other important messages to the newcomer include: "Knowing how to stay sober won't keep you sober. It's not what you know--it's what you do." Table 2 lists some of the phrases commonly heard at AA and NA meetings that reinforce the importance of changing one's behaviors.

But what about the client still in the precontemplation stage, not ready to admit that change is needed? Clinicians using Motivational Interviewing techniques, for example, help clients find the willingness to change from within. Similarly, 12-Step recovery programs rely on attraction, not promotion. AA is not for people who need it--it's for people who want it. If a client maintains even a marginally open mind and attends enough AA meetings, he might come to want the serenity that many AA members seem to possess. He might become willing to change his way of thinking and/or his way of behaving. He might admit that, for some reason, people in the group seem to be doing what they were unable to do on their own.

We wouldn't be so naive to suggest that AA negates the need for individual or group therapy. For a million reasons, it doesn't. But AA and other similar programs employ some compelling cognitive and behavioral interventions. So let's not compare AA with CBT. AA is CBT.

Brian Duffy, LMHC, is a mental health counselor at SMOC Behavioral Health Services, a division of a Framingham, Massachusetts, agency promoting social change and economic independence for disadvantaged individuals and families. To send comments to the author and editors, e-mail duffy0506@addictionpro.com.

Resources

Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York: The Guilford Press; 2002.

Prochaska J, Velicer W, Rossi J, et al. Stages of change and decisional balance for 12 problem behaviors. Health Psychol 1994;13:39-46.

by Brian Duffy, LMHC


Table 1. Changing how we think--common phrases at AA meetings

* Identify, don't compare (with the speakers)
* This too shall pass
* It's the first drink that gets you drunk
* Keep it simple
* Learn to listen--listen to learn
* One day at a time
* We can do what I couldn't
* Don't try to figure it out (neither the disease nor the process of
recovery)
* Live and let live
* Let go, let God
* I can't, He can, I think I'll let Him (the basic elements of the first
three steps)
* Surrender to win (powerlessness)
* When the fun stopped, I couldn't
* Remember when
* Easy does it
* Think through the drink
* Groups don't drink, individuals do
* It's OK to want to drink
* Believe that we believe
* It doesn't get any better out there
* Meeting makers make it
* Progress, not perfection
* I'm responsible for my side of the street
* Don't compare your "insides" with everyone else's outside
* Regarding a higher power, all I have to know is that I'm not It
* Think of the fellowship as your new family
* I'm a drink away from a drunk
* My best thinking got me here

Table 2. Changing our behaviors--common phrases at AA meetings

* Bring the body and the mind will follow
* Just keep coming (to meetings)
* Fake it 'til you make it
* Right action leads to right thinking
* You are what you do; the rest is just talk
* It's not what you know--it's what you do
* Join a group
* Get a sponsor
* Get active with your home group
* Go on commitments with your group
* Talk to another alcoholic each day
* Ask for help
* Help another drunk--do service work
* Do the steps of recovery
* It works if you work it
* People who don't go to meetings don't get to hear what happens to
people who don't go to meetings
* Don't drink, no matter what (even if my ass is on fire)--this is
cognitive and behavioral
* Listen to the message, not the messenger
* Do the next right thing
* Let us love you back to health
* Pray for people who've offended you, even if you don't mean it
* If you want what we have, do what we do

Funen, thank you for sharing important information about A.A. It has always been my experience that A.A. and REBT can work well together. The important thing is to avoid a dogmatic approach to how things SHOULD be. That gets in the way of improvement.

The idea of A.A.'s reliance on a Higher Power doesn't go over so well with some folks. Some can't relate and others feel downright offended. An equal number of people are put off by REBT's humanistic and secular approach to solving life problems.

Bottom line: There are enough alcoholics and addicts to go around for both approaches. Let's make sure that folks know about the resources available to them.

Would this be good thread to discuss issues related to addiction?

Addiction/alcoholism is not one of my personal problems, but I have written six books on the subject and worked as an addictions therapist. I am considered an expert in this field, although my approach is considered somewhat old-fashioned, seeing that I don't recommend medication as the first line of treatment, unless a person is going through withdrawal. Medication helps then. People used to go through gruesome withdrawal and DTs. We now know that can be medically prevented.

People ask how can you do that kind of work if you're not an alcoholic/addict yourself? I guess the same way you can treat any illness without having experienced it yourself -- diabetes, heart disease, cancer, schizophenia and so on.

I view addiction/alcoholism as primary disorders. It's popular these days to say that abuse of alcohol and drugs is merely self-medication for some other primary disorder such as bi-polar, anxiety or depression. That's rooted in Freudian theory. The idea is that if you treat/cure the anxiety, depression, mania or whatever, the person will somehow magically stop drinking/drugging abusively.

There's no evidence to support that. In the area where I live, methamphetamine addicts are regularly diagnosed as bi-polar because when they're high on meth they're manic and then they use downer drugs such as alcohol or tranqs to smooth themselves out. They look bi-polar when they're on a run, but they're really suffering from drug effects. Meth addicts also tend to fry their brains, ending up with seizure disorders if they abuse heavily. Seizure disorders are best treated by neurologists. And, of course, getting clean and sober is vital.

These views make me a dinosaur in the A&D field. Oh, well. So it goes. If folks don't mind talking to this dinosaurishly thinking and behaving person, I don't mind disagreement with my point of view.

As odd as it may seem, I also view REBT and AA as fitting well together. The 12-Steps tell people what to do and REBT tells people how to do it.

There have been some pretty big arguments between advocates of SMART and Rational Recovery and AA. My view is this: There are enough addicts and alcoholics to go around to fill up every kind of program. My interest is in helping people accomplish the difficult task of living healthier, happier and more productive lives sans the drama and trauma of addictive behaviors. Maybe something I have to say will help, maybe not. All views are welcome.

If people want to talk about that, this would be the right thread for it.

Gayle

I'm an alcoholic in recovery through the 12 steps. I'm also a qualified counsellor in the Recovery Dynamics programme which is basically recovery through the 12 steps and I facilliate an aftercare group. It's in the aftercare group where I use REBT mostly, to help people challenge their thinking.
Stopping drinking is one step of the process and indeed when one is in the throes of active addiction the main part of the process, because until the using stops no purposeful work can begin. I'd be a promoter of abstince therapy as opposed to substitution therapy, as Gayle is. Stopping drinking is the first and main step and then the living has to begin and that's where I found REBT kicked in-to challenge and change the thinking which propelled me to seeing alcohol as an answer to anything.
I have no doubt that alcoholism is a primary disease, it's not as a result of any anxieties or depression or mania. It's a physical disease. How do I know? Well I'll put it this way, at 27 years of age I went from being an non drinker to a full blown alcoholic who couldn't stop drinking for 12 years in the space of 2 weeks. Yip two weeks. Now if that is not proof that there is a genetic component to alcoholism I don't know what is. All it takes is for enough alcohol to be put into the system and the physical aspect of the disease kicks in.
This is the difference between someone with a problem with drink and someone with full blown addiction. The person with the problem can stop when they find sufficient reason to stop, the alcoholic can't until they are literally looking at death and even then some cannot stop.

When it comes to dealing with the thinking, an alcoholic's thinking is no different from any other neurotic. Yip, neurotic. That's the mental aspect of alcoholism. being willing to go to any lengths to drink our thinking is ever so slightly distorted :-) I don't believe that alcoholics think any differently from normal people. What we have done is used distorted thinking for so long that our minds have become warped and through the 12 steps and REBT we iron out the kinks again.
I'll be hung for saying this in many quarters as many people promote the idea that the poor old misunderstood alkie thinks differently-we don't. We've just got good at believing our own bullshit.

F

Funen and Gail, Thanks for your extensive contributions here. I wrote on the other website as I tried to get to this one and got tired of waiting and then got it later. My problem is after copying what is written here and the other websites haven't visited may take me days to think about. I do find what both of you have written most interesting and now I can only wish that others with some comments would contribute as how else are we going to get many, many people to take advantage of what you and others say and could say in the future< Again thanks and as it is already 11:30 I am going to bed.

I just had an interesting discussion with a well-known REBTer, who told me several times that the worst possible scenario for people with serious problems is to put them in a treatment program with a "12-step approach and psychodynamic supervisors."

I agreed with the last half of that statement, but not the first. A psychodynamic approach usually teaches that alcohol and drug abuse represent efforts to self-medicate some kind of severe emotional pain or trauma. The emotional problem is viewed as primary and the A&D abuse is viewed as a symptom.

According to psychodynamic theory, if you treat the trauma and emotional pain, the patient will no longer "need" to self-medicate and they will become social drinkers and/or responsible drug users. The preferred treatment is heavy dosing with pharmaceuticals. Anti-depressants, anti-anxiety agents, mood brighteners, anti-psychotics, sleep inducers, narcotic painkillers and ADD drugs.

This view has taken over in the area where I live. If I was looking for work, and I'm not, I probably could not get a job in any of the local treatment programs or mental health programs. That's because I view A&D abuse to be primary disorders, not symptoms of some underlying emotional problem.

While 12-Steppers and Rationalists fought battle after battle over what to call somone who has a history of abusing alcohol, the armies of psychodynamic theory quietly won the war. To me, this is one of the most discouraging trends in therapy that's happened in my lifetime.

What I would strongly prefer to see is REBT as the main therapy, with pharmeceuticals reserved for only the most severe symptoms. 12-Step programs can make a great adjunct to therapy. I would really love to see REBTers extend unconditional acceptance to AAers. And I'd love to see AAers say "Live and Let Live" to the REBTers. And then, in my strongly preferred state, we'd all join forces in routing psychodynamic theory.

Call it a pipe dream. It's what I'd strongly prefer.

Gail your information is appreciated. I am wondering if the Veterans Hospital use the REBT approach to assisting people very much. I still don't like the idea of over generalizing and calling anyone an Alcoholic as they are so much more and of course that goes for hundreds of other nouns to identify someone. I prefer to think of someone who seems to get into difficulties just someone with a drinking problem who hopefully would start to realize the problems it causing themselves and there fore they would seriously start to change. Of course I think the best way to change is to learn more of what Albert Ellis has written over the years. I'm going to Wenatchee to assist on putting on a new roof so I may not be on line for a few days. Maybe it is time to print up a few thousand slips of paper with this web site on them.

Dennis, let us know when you return.

In regard to your question about the VA, I've worked closely with veterans experiencing PTSD and A&D problems. There is a large VA hosptial with a 5 state catchment aree in my town. At this particular hospital, most of the treatment has a psychodynamic and/or transpersonal orientation. Some hospital programs around the nation use CBT. If they use REBT it is likely because therapists and supervisors in key programs are already REBTers.

The problem, especially here on the West Coast, is a shortage of people trained in REBT. Most (not all) training in REBT took place in NYC and in Tampa Florida. Mental health and A&D programs will often pay for their staff to receive training in different therapeutic techniques, but it's not common for programs on the West Coast to pay for their staff to travel to the East Coast. It costs too much and it's one of those things that gets highly criticized if the program is publicly funded.

The shortage of REBT therapists will get worse. AEI is moving away from REBT and toward CBT. And I'm told by people in NYC that the training sessions have fewer and fewer enrollees. The downturn started when Al was aced out by members of the board. They did not realize that people would be willing to foot the expense of traveling to NYC for training if they had the opportunity to interact with the great Albert Ellis. Not many people are willing to do the same to interact with the likes of Ray D. or Windy D.

Another problem is that REBT therapy requires engagement, involvement and hard work on the part of the therapist. Much harder work than psychodynamic therapy.

When I was the clinical supervisor of an alcohol treatment program, we trained our therapists in structured therapy based on REBT. Some of the therapists took to it because they saw people getting better and they enjoyed the humor and interaction with clients. Other therapists actively resisted because what they prefered to do as therapy was basically sitting around, sipping coffee or tea and smoking cigarettes with folks all day, chatting in a gentle and indirect fashion. That's much less work for the therapist.

Many clients prefer that psychodynamic approach, too. It allows them to go through the motions of therapy and to have someone pay attention and show kindness and interest in what they have to say -- something they may seldom or never experience in their work and personal lives. It also allows them to avoid the major issues in their own thinking and behavior that keeps them living and working in situations that anyone can recognize as self-defeating and oppressive.

On the Albert Ellis Blogspot, Steve made an interesting comparison between the Dalai Lama in exile and REBTers in exile. The Dalai Lama has kept the idea of Tibet alive although he is exiled from his home. REBTers can take an important message from this.

The Albert Ellis Institute in NYC is a building of brick and mortar. The Legacy of Albert Ellis can live anywhere. In exile, but vibrant and alive.

I spent the last week advising someone where to go to get help with a gambling problem. Choice mind you was limited, 12 step based treatment programme, 12 step meeting or a cognitive therapy. REBT based therapy wasn't an option simply because there are no practicioners listed. Perhaps some of the CBT folk listed do practise it but not publically.
Even though I use a 12 step programme I'd have had no hesitation about sending this particular client to a REBT oriented programme but when there's nothing available it limits one's options somewhat.

Four years ago some friends and I set up a day programme for alcoholism. We went and got ourselves the training we needed, we figured the costs, we rented a room and we set up a 20 day day care programme. We worked for fun and for free, just about covering the costs until last year and this year it's paying for itself. We trained ex attendees in how to deliver the programme and now they're out doing it for themselves.
Not everyone has health insurance, not everyone can afford treatment and our thinking was while it's fine to talk about the inequalities of this world it's much better to get off our asses and do something. Nothing grandiose mind you, no world wide movement, just a little local effort which has turned out to inspire more little local efforts.

F

That's an inspirational story, Funen! Regardless of the modality, Albert Ellis would have smiled upon the risk-taking involved and the fact that a group of people worked their asses off to accomplish their goal.

There is a big problem of not having certified REBT therapists available. I have no certificate from AEI. I never went to NYC. But REBT is one of the best self-help therapies and that means people can learn it, practice it, put it into action with the help of some of Al's books. "The New Guide to Rational Living" and "How To Not Make Yourself Miserable ..." are set up in a way that encourages self-learning.

Having worked in the field of addiction for so many years, I would strongly prefer that an REBT therapist had some hands on experience working directly with addictions, rather than going at it from theory. Lives can be at stake.

I hope your client with the gambling problem avails himself of the help that's there.

The course we did is recognised for 15 CE credits but that wasn't too important. What we felt was important was to be shown a structured programme which works and a method to deliver it. The guy who showed us how to do it, has worked in the field for many years and over the course of 2 weeks he turned us from the class into the tutors and after that it was practise, practise, practise until it became 2nd nature to us.

Our only asset was that we were all in recovery for years and knew what addiction was and knew how we got well. None of us were psychologists or psychiatrists, we came from all walks of life from the Salvation Army, to teachers, to administrators, to business people.

Is there anything standing in the way of the same being done for REBT? Train people how to use it and let them pass it on. REBT doesn't need a person to have a degree in rocket science to practise it, what is needed are people who know it to show others. How much does it cost to rent a room for a weekly meeting to practise as a group with someone leading who's living their life based on the principles of REBT? Indeed, as we do, get together in each others houses if you don't want the outlay.

There's an old gaelic word meithéal-which describes when people come together to work for the common good without thought of cost. Our trainers donated their services for free-we covered their travel expenses and accomodation. I took a 2 hour flight twice a week, to train and to work. Others took career breaks or took the risk and gave up their previous careers. When we didn't have the money to cover our expenses a very generous member of the group bailed us out without thought of recompense.

It took practise, it took time, it took risk and it took belief in what we were trying to do and I believe if enough people are willing to do as we did that you would have absolutely no problem spreading the gospel of St Al.

Okay don't all queue up together!

F

Funen and Gayle, both of you write such interesting and lengthly things that it is a damb shame there aren't more people to read it or at least reply here so I could realize that they do ead it. I do hope that those more knowledgable than I do the necessary things for REBT the Albert Ellis way to get started. My problem may be that sometimes in my pessamisstic moments I think if people are so damb stupid behaving let them suffer their consequences. Not the best UOA (Unconditional Other Acceptance) for those new viewers. Remember Rudolph Dreikurs use to say,"If it is to be, it is up to me". I am reading the book Prophecy by the author of Rich Dad, Poor Dad and find it a little depressing. I found this book one of the best I have ever read as it taught me about money , (along with 5-6 by the same author.

Thank you for your kind words, Dennis. If it's any consolation, I have received some nice emails from folks who know my email address, telling me how much they appreciate reading this posts. Not everyone likes to post, but many like to read.

Here's an interesting article I received from a friend and supporter of Albert Ellis.

I have heard of pills and hoped that someday I could loose weight easily now I guess it may be quite a few years. I was even hoping to grow a few good organs but I guess that will just have to wait too.I had prostate cancer when 53 and the exploratory surgery lead to the complete removal of the prostate. I just haven't been the same since then but it is nice to be in such good health and still alive. I use to always look forward to retiring and my future and when that happened I learned to live more for the moment as tomorrow might not come. Statistically I had a 10% chance of dieing during the operation but when I thought about it I realized if that happened I wouldn't know anything about it anyway. It did take 8 hours and 8 pints of blood. The nurses said I was the first one to ever really talk about it so much. I guess it was my counselor training. I finally noticed that at the bottom right of the page it says pages1,2,3. That does help me a lot.