Some Thoughts on Wine After 5 Years Without It

I get a rush when I see a woman lift a glass of red wine, part her lips, tilt her glass and head at just the right angle, and let the liquid pour into her mouth. Not because I like to watch, but because, vicariously, I’m drinking it myself.

I find these experiences tedious. The predictable swell of emotion, the anguish of longing and not having, then weepy stability regained, similar to the shaky relief after a bout of stomach flu. Since I now understand the instinctual automaticity created by the neurobiology of addiction, I note these episodes without judging myself or others. Still, I try to put myself through this as rarely as possible. When people say, “Come on over! Just don’t drink!”, I think, “Right. Be around air, but not breathe, except in little gasps? No, thanks.”

Kittens Ted and Ken

This Medscape article has been updated, but the line I read several years ago is still the same: “Patients who have been sober for 5 years are likely to remain sober, but they are still at risk for relapse.” I thought if I could just hold out for 5 years, I’d be done with this.

I’ve been asked, “How do you abstain?” Since the primary symptom of addiction is an inability to abstain, I don’t. I can’t directly command myself to abstain. Instead, I help myself not drink. I do hundreds of things every day, choosing from among the myriad ways research suggests help people not drink or use.

When people congratulate me for five years of abstinence from alcohol, I’m not appropriately or humbly grateful. Since addiction is a medical condition, not a moral one, abstinence is not a moral achievement. While some people recover from addiction on their own, a whole lot don’t because being without is so very difficult. And knowing ethyl alcohol is a neurotoxin doesn’t help.  Reasons don’t change minds. I help myself the best I can, but I’ve mainly just been lucky with this illness.

I have wondered if, given a choice between opioid use disorder and alcohol use disorder, I should choose opioid use disorder. Although opioid addiction is much more rare than alcoholism – 2 million vs. 16 million – at least there’s medicine for it.

I get in trouble with people in recovery when I say I think my life would be better if I could drink wine again. I feel as much desire to have a bottle of wine tonight as I did five years ago. Personally, everything wine did for me would be done again. Socially, oh my gosh. My town, Blacksburg, Virginia, and its environs, were rated the drunkest locale in the state of Virginia by USA Today. Now, where I am to go, or with whom am I to be, in a town where beer and wine are served at the movies, even church? We have recovery support groups, but talking about not drinking often elicits the automaticity thing in me. Let’s have a drink while we’re talking about not drinking, shall we?

Alcoholism has stripped me of my life with others.  I get that a sense of social connection and possession of social capital – even the existence of love – are considered essential to human thriving, as well as to recovery from addiction. But they’ve been hard to come by in my town. Stigma certainly hasn’t been a pal, either. Inability to be around alcohol in a drinking town puts defeating constraints on prescriptions for happiness that I, or others, might derive.

I hear the “you-shoulds” starting. You should be happier, Anne. You should think differently, Anne. You should want more for yourself, Anne. You should do something about this, Anne. And for heaven’s sake, you should write an uplifting recovery story at 5 years sober, Anne!

It’s un-American to not try to manufacture good times, to not set things up to make better things happen, to not toil now for future reward.

My peak experiences were chemically created in a brain not built to be overwhelmed by chemicals. Nothing in life since – no sunrise, no kitten licking my nose, no lover’s touch, no work achievement – has done for me what wine did. Why would it?

How I have found a modicum of contentment is decidedly un-American. I don’t wish things were different. I practice extreme, intense, relentless, radical acceptance of reality. I laugh at the appalling absurdity of giving work-loving Anne something that work won’t fix.

Then I become available to take delight in what’s available.

The first person I ever saw do this was my father. He usually takes his coffee black but once, when I was a little girl  standing by his chair at the dinner table,  he poured cream into his coffee.

“Look at that swirl,” he said. He pointed for me to look. I peered into his mug. I can still see the star of white cream, black coffee, and caramel.

A few moments like that each day, day after day, make a sweet, little life. Not a grand, famous, or accomplished one.

When my thoughts turn to tragedies in the past or worries about the future, I become aware of this, and I just shift.

I have a friend who nearly daily cooks an astonishingly exotic meal for himself in a studio apartment’s tiny kitchen, plates it, and sends me a photo. The colors and textures are gorgeous, the imagined scents heavenly. I chortle over what he has wrought today.

A friend fosters cats who need special care before they can be adopted. She blocks off the entry way and hall to her house to make them a safe haven and invites friends over to help socialize them. We sit on pillows on the floor, and pat the cats. She describes every nuance of each cat’s morphology, gastroenterology, and kinesiology as if uttering lyric poems.

My former owner of my house and I share joint custody of her garden, and she and our gardener coach me on the wonders in our yard. Who knew breathing in the scent of lavender could bring such a sense of tenderness?

I have adopted two of my friend’s foster kittens. I have named them Ken and Ted for the boy dolls my sister and I had as little girls. My elder cat and I rub chins when we meet, but she would bolt when she smelled wine on my breath. She hasn’t run from that odor in five years, my middle cat has never needed to, and maybe these kittens never will, either. I can’t say one way or the other. Protecting them is neither an incentive nor a disincentive. Addiction persists despite the fear of negative consequences or the promise of positive ones.

Substance use disorders occur on a spectrum, and so does recovery from them. Some people claim gratitude for having developed addiction because of new gains. I do not. I had a quarter century as a respected teacher, and a lovely new marriage, when alcoholism delivered its sucker punch when I was 50. Alcoholism cost me everything I valued. I am okay with this good-enough, workaround life. But, gee.

To my friends, family members, and to anyone who thinks they might even have the hint of a problem with alcohol, maybe wine like I did, perhaps my tale can serve as a cautionary one. Limit yourself while you can. Once you can’t? You do not want this.

Ah, wine, my lost love. I miss you so.

Shift.

Looky! The markings on Ken’s and Ted’s fur swirl like cream newly poured into black coffee.

Another Way of Looking at Anger

The feeling of anger simply lets a person know something is wrong. When individuals can become aware they feel angry, they can then pause to figure out what’s wrong, think about options, and choose what to say or do next that would be helpful or useful.

Some people find themselves:

Pause to become aware of intense feelings

  • spiking quickly to intense anger,
  • reacting with immediate anger to words, actions or situations that may or may not be a problem,
  • feeling flooded with anger and unable to think,
  • staying extremely angry for longer than desired,
  • having trouble easing themselves back to a steady state,
  • having trouble choosing their behavior when they are angry,
  • finding themselves speaking and acting automatically, and harming themselves or others,
  • and finding this happening more often than desired.

Since anger lets a person know something doesn’t seem right, attempting to “control anger” or to learn “anger management” may actually work against a person’s normal survival instinct. Instead, research on the brain and anger suggests gaining a nearly instantaneous awareness of the presence of anger may be more useful.

Awareness engages the “thinking” function of the brain, adding it to the “feeling” function of the brain. This awareness balances and stabilizes one’s inner experience. Then, the best of one’s “feeling” and “thinking” can inform one’s inner wisdom, termed “Wise Mind” in dialectical behavior therapy. An individual’s Wise Mind can determine the magnitude of what’s happening, then decide what next steps would be most helpful and useful for themselves and others.

Having the ability to immediately become aware of anger in the heat of the moment requires prior practice and training.

1. Become aware, and stay aware, of what’s going on within you all the time. Become curious about, and interested in your feelings, thoughts, physical sensations, and what captures your attention. As you observe them, practice naming them to yourself. Examples: “I am aware I am feeling angry.” “I am aware I am thinking that I don’t like that guy.” “I am aware that I feel a trickle of sweat on the back of my neck.” “I am aware I am giving my attention to buzz of the air conditioner.”

2. Suspend judgment. Feelings, thoughts, physical sensations, and the subjects of one’s attention are neither good nor bad, neither right nor wrong. They are simply information to consider.

3. About feelings, imagine an inner volume control, then ask, “What adjustments, if any, do I need to make on my inner volume to keep myself in a range that helps me stay aware and stable?”

4. About thoughts, ask, “Do facts support this thought?” and “Is this thought helpful or unhelpful?” Use your answers to guide you. Ask, “Have I thought this thought before?” If so, consider this thought: “I have given this thought due time and I will now shift my attention to something else.”

5. About physical sensations, ask, “What adjustments, if any, can I make to increase to make myself more comfortable?”

6. Practice engaging one’s attention with an object, then disengaging, shifting, and engaging one’s attention with another object, preferably one that engages a sense.

7. Return your attention to the present. If you are reminded of past events or concerned about future ones, say to yourself, “That is not happening now. I am here and this is what’s happening right now.”

8. Anticipate anger. Having practiced the above skills, be ready to become aware of anger, thus adding your “thinking mind” to your “feeling mind.” Watch in wonder as your inner wisdom – your Wise Mind – skillfully handles the situation in ways you never thought possible.

9. Practice radical acceptance. Acknowledge that people say and do stupid and cruel things, that we say and do them, too, and so do our loved ones. Accept that anger and other emotions don’t prevent or change that. Affirm that it’s what we say and do about what’s happened that determines the quality of our lives and our relationships.

. . . . .

A printable worksheet accompanies this post: Becoming Aware of Anger (.pdf opens in new tab).

. . . . .

This post is part of a series on evidence-informed, self-care for addiction.

The table of contents is here and posts are published in the category entitled Guide.

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

I Strong-Arm My Attention to Help Myself Not Use

In the moment when a longing to use a problematic substance arises, or the opportunity to use it appears, if I can become aware of my longing, strong-arm my attention away from my longing and toward my preferences, I can increase my chances of not using.

If I have substance use disorder, why a longing arises has complex origins. In the moment, I don’t have time to figure any of that out. I can endanger myself and others with a return to use. I need something to work for me right now.

Scent of rosemary can draw attentionThe ability to use one’s attention with gentle but intentional force may be a fundamental skill for preventing a return to use. I draw that conclusion from my relentless review of the research on addiction, my professional training, my observation of the experience of others, and my personal experience.

To set myself up to be able to use my attention with intentional force:

  1. I need to gain awareness, in the moment, of my longing to use.
  2. Prior to the moment of the longing to use, I need to have already collected the data described below, practiced the skills, and trained with that data.
  3. In the moment, I need to skillfully use the process described below to give my best attempt to help myself not use.
  4. Repeat.

“Indeed, lack of awareness of substance craving has been shown to be predictive of future relapse.”
Garland, et al., 2013

Awareness

I practice on-going awareness of what’s going on with me so I can instantly become aware – in the midst of the wonder and complexity of being me in this astonishing world – of a longing to use. To do this, I focus on my feelings, thoughts, physical sensations, and actions.

I ask myself:

  • “What am I feeling?”
  • “What am I thinking?”
  • “What am I sensing?”
  • “What am I doing?”

Further help with practicing awareness:

Data

List 1: Real-Time Sensory Experiences

I need to be able to shift my attention from substances and using to something else. Any old thing will not do. Our preferences make us gloriously ourselves and have the power to draw our attention. The brain is particularly called by sensory experiences. I need to discover and know my preferences, starting with sensory preferences.

What do I prefer to see, hear, taste, touch, and smell? What motion do I prefer to observe?

Worksheet: Discovering My Sensory Preferences. Printable .pdf opens in a new tab. More handouts are here.

One easy way to get started with answering these questions is to take “sensory tours.” I’ve taken sensory tours of my kitchen, living space, yard, a department store, and my town. I become aware of several things I prefer within each sensory category. Then I rank order my options. What would I most prefer for that sense? What would be my second choice? I try to keep at least one of these top-ranked, preferred sensory items with me.

List 2: Imaginary Sensory Experiences

In the moment of longing, I may not have my preferred sensory items at hand. I may not be able to get them. So, the additional data I need to collect is an imagined set of sensory preferences.

If time, space, and money were of no concern, what image would I love to see? What sound would I love to hear? What would I love to taste? What texture would I love to feel? What scent would I love to smell? What would I love to see in motion? I keep a mental list of these sensory experiences.

List 3: What’s at Hand

I may feel flooded with longing, feel alarmed by its intensity, and be unable to remember my sensory items. I look around at my surroundings. I ask myself, “What is my preferred sensory item here?” I engage my attention with it.

List 4: The Breath in My Nostrils

If I’ve got nothing at hand, or I’m in a particularly threatening situation, I may need to shift my attention to the ever-present sensory experience that I own: the sensation of air in my nostrils as I breathe. Taking deep breaths can trigger panic and offer a “tell” about my distress to those I don’t trust. I can engage my attention with the sensation of the air in my nostrils with even the tiniest breaths.

Skills

Here’s the sequence for how to gain muscular control of attention:

  1. Become aware of my attention on that.
  2. Disengage my attention from that.
  3. Shift my attention to my preference.
  4. Engage my attention with this preference.

Become aware > Disengage > Shift > Engage

To have this happen automatically, I need to practice the sequence and train my attention.

I collect some of my preferred sensory items. I put them on a table or on the floor in front of me. I become aware of my attention on one item. I imagine having my hand lightly on the top of the item. I give it my full attention for a moment. Then I disengage my attention from the item by imagining opening my hand. I shift my attention by imagining my hand and arm moving in mid-air from that item to another item. I engage my attention with this item by imagining placing my hand on top of it. I give it my full attention for a moment. Then I disengage, shift, and engage, continuing to practice the sequence, moving from object to object.

Process

Here’s the inner dialogue for the process I use to bring together awareness, data, and skills, and practice when a longing arises or an opportunity to use appears.

  1. I have become aware of a longing to use.
  2. I acknowledge this reality with courage, self-kindness, and without judgment.
  3. I will now strong-arm my attention.
  4. I disengage my attention from longing, substances, and using
  5. I become aware of my preferences, either present or imaginary.
  6. I shift my attention to them, and I engage my attention with my preferences.
  7. When my attention is drawn back to longing, substances and using, I strong-arm my attention back to my preferences.
  8. I continue to strong-arm my attention until the longing passes, until I can get help from someone, or I can leave the situation.

In the moment, this straightforward, mechanical process, distilled from neuroscience findings on addiction and attention, might protect me from a return to use. Sometimes, strong arming my attention doesn’t work. That’s when research suggests I need to interrupt my neurobiology by splashing cold water on my face. If that’s not available, I can press something cool to my face, even if it’s my own cold fingers or the side of a pen. Then I can attempt to engage my attention sequence again.

To manage my longing for substances by managing my attention, the only self-analysis required is awareness of what’s going on within me in the moment. It requires no assessment of my past, my motivations, or my morals. The only inventory it requires is discovering what delights my senses, then making lists of my preferences. Practice and training can happen anywhere, anytime. The only equipment needed is imagination.

While some addiction treatment protocols recommend using distraction to interfere with craving, distraction is a symptom of substance use disorder.  Longing to return distracts me from my plans for my life. Distraction has too much power in my life already and tries to make me do what it wants. With the power of attention, I may be able to counterbalance this symptom and choose to do what I want. I can certainly rest my mind by watching TV, listening to music, or playing a video game, but I want my action to be a conscious choice resulting from me having given it my full attention.

When a longing arises and it’s showtime – on-demand, never scheduled – part of my performance will be limited by the changes my brain has undergone through addiction. I get that. I also get that my brain’s ability to exert will has been compromised by addiction. That’s going to hurt my efforts. Still.

If I can use gentle but intentional force on my attention, practice, train often and intensely enough to gain enough endurance to shift my attention over and over again, I might just be able to help myself not use.

. . . . .

This post is part of a series on evidence-informed self-care for addiction. Self-care is NOT an evidence-based treatment for addiction. However, when treatment is scarce or denied, people with addiction must take treatment matters into their own hands. The introduction and table of contents are here and posts are published in the category entitled Guide.

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Addiction Recovery: Define Terms and End Conflation

People with addiction are at risk of premature death. Defining terms and making sure we know what we’re talking about is an imperative.

Illogic and misinformation can kill people with addiction.

Do no harm. 

Discussion of addiction is plagued with conflation, i.e. thinking things are the same when they are different. Discussion is also compromised by confusing correlation with causation, i.e. assuming that if things happen at the same time, one caused the other.

Definition of conflationFollowing is a list of terms and basic definitions used in this guide. Terms are in narrative order, not in alphabetical order. Terms explicitly not used are listed at the foot of this post.

Addiction is the generally-used, non-clinical term for substance use disorder.

A substance use disorder is a medical condition involving the organ of the brain. The primary symptom of the disorder is persistence in behavior despite negative consequences. (For brevity and the general audience intended for this guide, “addiction” is the term used most often, but interchangeably with “substance use disorder.”)

Dependence is conflated with addiction. The difference between addiction and dependence can mean life or death. Dependence exists when a substance is needed to function and physical withdrawal symptoms will result without the substance. Humans are dependent upon the substances of water and air to function and experience physical symptoms without them. People who cease taking antidepressants can experience withdrawal symptoms. People who cease taking blood pressure medication can experience withdrawal symptoms. People who do not persist in negative consequences, but experience withdrawal symptoms when ceasing substances, are not addicted to those substances.

Similarly, babies born to mothers dependent on substances – whether opioids, antidepressants, nicotine or others – may experience withdrawal symptoms, but are not born addicted to those substances. Babies are developmentally incapable of persisting in behavior despite harmful consequences.

Making it through withdrawal from substance dependence is not a treatment nor a cure for addiction.

The neuroscience of addiction suggests that through compromising the brain’s basal ganglia, extended amygdala, and prefrontal cortex, addiction under-sensitizes people to pleasure, over-sensitizes them to pain, automates use of the substance to feel, not necessarily good, but normal, weakens decision-making abilities, magnifies emotional highs and lows and incapacitates the ability to regulate them, interferes with recognizing cause-and-effect relationships, and confounds the ability to make a plan and follow through with it.

Co-occurring disorders are medical – including physical illnesses and substance use disorders – and mental illnesses, that may occur simultaneously in an individual. The medical condition of substance use disorder may co-occur with mental illnesses such as anxiety, mood, thought, and/or personality disorders, and/or physical illnesses.

Determining which symptoms go with which disorder, how to manage symptoms, and treat the conditions, is an on-going conundrum. Which are due to brain malfunctions, cognitive distortions, perhaps unregulated emotions?

Further, the definition of addiction is conflated with the symptoms of the illness. Although some people with substance use disorder may engage in behaviors that are perceived by society to be immoral, criminal, or illogical, behavior related to addiction results from brain functioning, not from moral functioning, and persists despite negative consequences. Ergo, moral or religious instruction would not be a treatment for a brain disorder. Counseling might help a person with substance use disorder manage symptoms of the illness, but would not directly treat the brain for a brain condition.

Evidence-based treatment is what research reports works for most people, most of the time, better than other treatments, and better than no treatment. Specifically, that means the treatment is supported by numerous, peer-reviewed scientific experiments with rigorous methods that include control groups, randomization of subjects to experimental conditions, and bias-free samples, with statistically significant results. Some treatments that are evidence-based to work for groups may not be helpful to a particular individual, however. It is imperative that individuals and their treatment teams continually co-monitor current condition and progress.

Anecdotal data is an individual’s personal experience. Research data – the evidence resulting from research experiments – is conflated with “anecdotal data.” Data from a sample size of one does not provide sufficient information from which a generalization can be made about a group or population. Principles believed to account for outcomes from inspirational individual stories, practitioner wisdom, or theories based on logic, cannot be safely applied to others without first subjecting those principles to rigorous research.

Medical care is the first line of treatment recommended by the medical professionals and researchers who authored Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health. Medications approved by the FDA for treating substance use disorder are listed here. Currently, no licensed treatments are available for stimulant use disorder.

As long as addiction is attributed to some aspect of the person – lack of motivation, un-readiness for change, lack of self-restraint while self-pleasuring, willful criminality – the myth of addiction as a moral problem within the person’s power to correct, rather than a medical problem in need of medical care, is perpetuated.

Terms not used in this guide:

Addict and alcoholic. The complexity of human identities defies the limits of definition by trait or condition. This guide, as does the new edition of the Associated Press style manual, uses the terms “person with addiction” and “person with alcoholism.”

Substance abuse. “Abuse” means to wrongly maltreat. “Self-abuse” is a pejorative term for masturbation. “Sexual abuse” and “child abuse” are heinous acts. Use of the term “substance abuse” conflates addiction with sexual acts and violation, misrepresents the medical illness of addiction, perpetuates stigma, and needs to be jettisoned from any reference to addiction.

Disease. Although carefully defined by NIDA, the term “disease” used to explain addiction can be unhelpfully misunderstood by laypeople. Scientists and researchers may eventually decide other terms may be more accurate. Terms used in this guide include “disorder,” “condition,” and “illness.”

Dopamine. The neurotransmitter dopamine is conflated with “pleasure.” But dopaminergic pathways involve reward-related cognitions that include incentive salience (desire or “wanting”), pleasure (“liking”), and positive reinforcement, i.e. a desired event occurs. Most laypeople are not qualified to discuss addiction at this level. Addiction is more complicated than simply stating, “It’s all about dopamine.”

Enablingcodependency, “hit bottom,” and “tough love.” People with medical illnesses that can result in premature death need care, support, and treatment, especially when their symptoms are severe and life-threatening. For further reading:

Trading one addiction for another. Use of substances, for any reason, prescribed or not, where behavior does not persist despite negative consequences is not addiction. Opioid replacement therapy does not replace one addiction with another.

. . . . .

“A substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use.”
– Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 4-1

“Addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.”
– National Institute on Drug Abuse (NIDA), a division of the National Institutes of Health (NIH), 2014

“Research has shown that substance use disorders are similar in course, management, and outcome to other chronic illnesses, such as hypertension, diabetes, and asthma.”
– Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 1-18

“Remission of substance use and even full recovery can now be achieved if evidence based care is provided for adequate periods of time, by properly trained health care professionals, and augmented by supportive monitoring, RSS [recovery support services], and social services.”
– Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 1-19

“People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.”
Nora Volkow, M.D., Director of NIDA, 2015

“Be suspicious if someone is calling you a ‘client’ when seeking help. Addiction is a disease, best treated by a physician who treats ‘patients’ w/ medical & mental diagnoses or knows where to refer for evidence based care.”
Molly Rutherford, M.D., via Twitter, 12/28/17

“Unfortunately, despite decades of research, it cannot be concluded that general group counseling is reliably effective in reducing substance use or related problems.”
– Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 4-26

“Do not attempt to take away a person’s main means of trying to cope with pain and suffering until you have another effective coping strategy in place.”
– Alan Marlatt, Ph.D., 2004

“If you believe that something is essential to your survival, your priorities won’t make sense to others.”
Maia Szalavitz, 2016

“You have to think complexly about complex things.”
Robert M. Sapolsky, Ph.D., 2017

“People may not have caused their own problems but they have to solve them anyway.”
Marsha Linehan, Ph.D., 2014

“Love, evidence & respect.”
– Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”, 6/25/16

“It’s my life. Don’t you forget.”
– “Talk, Talk,” The Music Machine

This post is part of a series on evidence-informed self-care for addiction. Self-care is NOT an evidence-based treatment for addiction. However, when treatment is scarce or denied, people with addiction must take treatment matters into their own hands. The table of contents is here and posts are published in the category entitled Guide.

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Addiction Recovery: Realities and Possibilities

The goal of an evidence-based treatment plan for the medical illness of addiction would be to assist individuals in living healthy, functional lives, in connection with others, such that substance use does not result in negative consequences for themselves, others, or society.

A glass half fullHowever, society’s primary measure of recovery from addiction – and its measure of merit to receive continued treatment for addiction – is negative urine drug screens for illicit and non-prescribed substances. Secondarily, society measures addiction recovery progress in terms of reduced contact with 1) the criminal justice system, 2) emergency health care services, 3) child protective services, and 4) social services programs.

Achievement of legal negative urine drug screens requires abstaining from illicit and non-prescribed substances. (The illogic and injustice of citizens with a medical illness being required to prove they are asymptomatic of that illness to receive treatment for it is beyond the scope of this post.)

After medical care for the medical condition of addiction, this is what research suggests helps most people, most of the time, better than other ways, and better than nothing, to increase the likelihood of abstaining from substances:

Maintain a state of stability: physically, emotionally, cognitively, relationally, spatially, geographically, financially. Practice on-going awareness and, if any factors become unstable, adjust until they’re stable again.

Regulate emotions. Without judging feelings, adjust the “volume” on the intensity to a stable state while providing self-acceptance, self-reassurance, and self-soothing.

Sort thoughts, without judging them, into the categories of “helpful” and “unhelpful.” Focus on the “helpful” thoughts. Recognize and accept that opposing thoughts – for example, “I want to use” AND “I don’t want to use” – may both be true.

Consult your inner wisdom, your “Wise Mind.” Having given your attention to the truth of what you’re feeling, thinking, and sensing, what is your inner wisdom’s guidance?

Manage attention. Become aware and stay aware. Monitor your needs and wants. If you can become aware, in the moment, of what you are giving your attention to, what you are feeling, what you are thinking, and what physical sensations you are experiencing – and do so without judgment and without alarm – you can use this information to help yourself decide what would be most helpful for you to say or do next – or not say or not do.

Monitor environmental cues. Limit or eliminate exposure to items, individuals, locations, and situations that may produce a longing to return to use.

In addition:

Over time, identify the purpose and meaning of substances and substance use in your life.

Over time – acknowledging that no one source, perhaps even combinations of sources, might ever equal the complete experience substances offered – identify possible practices, activities, and conditions that might serve in place of substances.

Do research, consult with others, and discover evidence-based, therapeutic modalities recommended for any mental illness you might have. Help yourself with any trauma you may have experienced. Do self-paced therapeutic exercises, or receive counseling for that particular disorder. Examples: cognitive behavior therapy for depression; dialectical behavior therapy for bipolar disorder.

Attune to yourself, learn your preferences, and attach to yourself.

Attune to others to increase the possibility of connection, closeness, attachment, and bonding.

. . . . .

Here is a shortened version of this post as a printable handout. (.pdf opens in a new tab.)

This post is part of a series on evidence-informed self-care for addiction. Self-care is NOT an evidence-based treatment for addiction. However, when treatment is scarce or denied, people with addiction must take treatment matters into their own hands. The introduction and table of contents are here and posts are published in the category entitled Guide.

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, clients, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.