Addictions. Alcohol, food, smoking, shopping, gambling…..As human beings we have the capacity to become pathologically attached or addicted to just about anything. Addiction has been on my mind for the past two weeks, not just because several folks have verbalized wanting help with their addictions, but because a giant in the field of addictions, Alan Marlatt, has died. He died suddenly on March 14. I think Alan was the first to study the processes that caused people to relapse, and the first to develop treatment tools to prevent relapse. Stanton Peele (Love and Addiction) has written a tribute to Alan Marlatt which you can read here.
I had the pleasure of meeting Alan in 1989 during an interview for my clinical internship at the University of Washington. He gave a short presentation to us prospective interns which just blew me away. I was not especially interested in specializing in addictions treatment, but had I accepted the UW internship and studied with Alan, I very likely would have become an addictions specialist. His warmth and passion for his subject and his compassion for the people he dedicated his life’s work to simply radiated. It was hard not to be affected by him. Although I do not consider myself a specialist in treating people with severe addictions, my willingness to try with my clients who are struggling with addictions and my respect for them,I owe to Alan. My understanding of how we are all in some way addicted to things that can ultimately harm us as well as our environment, I owe to Buddhist philosophy.
Nowadays, I realize I rarely talk about addictions without summoning one of Alan’s ideas and contributions to the field. Relapse prevention is the main focus for anyone who is striving to break free of an addiction and the troubles that often go with it. My interest in mindfulness dovetails with the key components of relapse prevention. Most relapses or lapses occur in a state of “autopilot” when the addict is not paying attention to their mental, physical, or emotional state and when they are not connected with what is happening in their environment and not even aware of where they are. Lest you think this sounds strange, consider that the majority of people, yes, you and I, are in this state of autopilot most of the time!
Abstinence, total abstinence from the substance or behavior to which one is addicted has for many years been the accepted model of recovery and is common to most 12-step programs. The idea that people can recover from an addiction without total adherence to complete abstinence has been challenged and has placed Marlatt at the center of much controversy in the field. Nevertheless, his research has consistently supported a more moderate approach. Marlatt pioneered the concept of “harm reduction” in addictions treatment. Harm reduction involves taking a broader focus on the overall impact of a person’s addiction on their life and the lives of others, and supporting the behavior changes that reduce harm to self or others. While sustained abstinence, if it could be accomplished would certainly reduce harm, the fact remains that very few addicts achieve it, “and even that small group who do will take time to do so and may relapse periodically,” writes Stanton Peele in his article on harm reduction which you can read here: http://www.peele.net/lib/smart.html.
The “abstinence violation effect” is another of Marlatt’s contributions. The term refers to the guilt and perceived loss of control someone feels when they break a self-imposed rule such as not to smoke or drink or eat something ‘forbidden.’ We’ve all experienced the feeling of resignation that follows indulgence in something we only days or hours ago swore we would not do. Ever notice how much willpower you have at the bottom of a carton of Ben and Jerry’s ice-cream? Tons. Give it a few days. Just one scoop and there you have it, abstinence violation. Might as well eat the whole carton. Now imagine the emotional state that accompanies this behavior, especially if it is involving using a drug. Thoughts like “I don’t deserve to have a good (sober) life” rush through the mind. In a matter of moments, the addict is drinking or drugging “at” themselves with a total lack of self-compassion. Read the following article in Time magazine here about this. I think it applies to most of us.
I expect I’ll write more about these concepts as I read further. I’m going to explore Marlatt’s last book Mindfulness-Based Relapse Prevention for Addictive Behaviors.
As always, I encourage you to post your comments and ideas.