The music must change! Obsesssion, compulsion, shame an guilt in addiction

Guest co-author: Jeff Brandler from Changeispossible.org

The nature of addiction is one of obsession and compulsion. Regardless of the substance, behavior, or process, the addicted person will continue to obsess (countless and endless thoughts) and have compulsions (repetitive actions). They will repeat this obsession-compulsion ritual over and over.

music-sheetImagine a radio station that plays the same song over and over. Imagine that song being a steady diet of thoughts, and feelings of guilt, shame, remorse and self-loathing (GSRSL). Imagine an endless supply of obsessive thinking and compulsive replays of the thing(s) that the addict did to start the song playing.

People get involved in all kinds of self-defeating/self destructive behaviors. There are numerous reasons for this. The top ones that I see are: addictive disorders, mood disorders, self-sabotaging behavioral and personality traits. The GSRSL is a constant loop. It never stops. The problem with it never stopping is that it creates more GSRSL. The more GSRSL, the greater the need for the behavior. The more behavior that happens, the more GSRSL that you need and so on and so on. Does your head feel like it wants to explode?

Obsession and Compulsion – An example

Let’s say I had a fight with my spouse. I decide to smoke a joint in order to relax, escape, or unwind. Afterwards, I feel a lot of GSRSL. I have guilty thoughts, feel embarrassed and shameful. I have remorse for what I did, and beat myself up unmercifully. So what do I do in order to stop this behavior? You got it, smoke another joint, or maybe have a drink, only to feel more GSRSL. In doing so I then have the trifecta GSRSL of before, during and after-The music must definitely change!!!!

Or, imagine an alcoholic who receive a 3rd DWI citation after finally getting his license back following a 2 year suspension for his previous offenses. That’s some serious GSRSL. I have the most recent driving incident plus the 2 years where I lost my license swirling around my head like a blender. Talk about a bad song!!!! Please change the music!!!!

How does a person change this music?

It’s easy to change a radio station, but something that is so ingrained, so obsessive & compulsive is going to be much harder to change. Part of stopping this music is recognizing: 1) this is going to be hard to do 2) that I have been doing this for a while, and 3) it’s going to take some time to stop it. The key word that describes this is permission – I have to give myself permission to take the time that it’s going to take to make this major change. I’m also going to need to use a variety of approaches to change these thoughts and feelings (i.e. thought stopping, disputing irrational beliefs, identifying affirmations, (and using them regularly), and finding gratitude despite the pain).

Using this total package will be a first step towards change. It begins a long process of turning down the GSRSL music . I may need to also speak to a therapist to examine why I do these behaviors and what they are “wired” to. If in fact there is something biologically based, there may be a need for medication to “tune” these thoughts/feelings into healthier ones. Yes the music can change– It can go from “Comfortably Numb” to “Peaceful Easy Feeling”. The process of change is possible, but it’s going to take time and hard work.

The business of addiction treatment and health care

Whether it’s you suffering with addiction or a loved one, it’s easy to forget that at least in this country, treating the sick is a cash-money-business. This is true for health-care as well as for addiction treatment, and as the polls right before the passage of the recent health-care reform suggest, enough Americans like it this way that it’s likely not going to change in my lifetime.

I attended a networking event for Los Angeles area investors (LAVA) that focused on health-care and technology, especially in the post Obama Care era. Though they didn’t specifically talk about addiction, I brought the topic up and spoke to a few of the panelists after. Based on everything I read until now and what I heard this morning, there’s big change a-comin’ in the addiction treatment industry. Here’s where I think we’re heading and why:

1. Obama Care will add millions of new health-insurance clients to the mix, most of whom are exactly part of the vulnerable populations (poor, disadvantaged, less-educated) that more commonly need addiction treatment.

2. The Mental Health Parity and Addiction Equity Act passed in Congress a few years ago and now in effect means that all health-insurance policies that offer mental health and addiction treatment coverage have to include it at levels equal to those of standard physical care. This means billions of dollars added to the pool of money for addiction treatment. As of right now, the details about coverage of therapy, outpatient substance abuse treatment, and residential programs is being worked out, but it’s likely that all three will  benefit.

3. Health insurance companies want standardization of services, and for their money, they’re going to get it. Just like there’s a standard way to treat diabetes, addiction treatment is going to become standard among the larger providers that are going to begin doing serious billing with insurance companies. So while CBT, MI, and medications will see a lot of reimbursement there, we’ll have to see about mindfulness therapy, yoga, and other less conventional approaches. My guess is that the bigger 12-step centered providers will be part of the mix whether they offer residential or outpatient substance abuse treatment.

4. More people will get addiction treatment, especially now that the government is refocusing its efforts on the initial assessment for substance abuse problems being performed in primary-care physician offices. forget about 10% of 24 million addicts getting attention for their problem, I think we’re going to see something more like 25%-30% of 60 million people with substance abuse problem of varying degrees (not just full blown addicts) making use of the system.

5. Addiction treatment will focus more on outpatient substance abuse treatment than inpatient services. Not only do we not have the capacity to put everyone in residential treatment, but as we cast a wider net, a smaller percentage of individuals will need intense residential work. Hopefully this will mean that residential facilities will actually start adhering to NIDA recommendations and extend their average lengths of stay towards the 90 day minimum recommended.

That’s a lot of change, but I think it’s about time for all of this to happen. Addiction treatment has spent too much time as a small industry that doesn’t have much power behind it. We’re going to start seeing better results soon because people are going to want to get a piece of this pie, and in the U.S., that’s almost always the biggest motivator for change.

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Tips for consistent boundaries and better addiction outcomes

People close to addicts (mothers, wives, brothers, and such) often find themselves struggling when trying to decide how to treat the substance abuser. They feel betrayed when the addictive behavior is displayed, but are lost when it comes to what they can do. For example, a mother with an alcoholic husband may feel that it’s unfair to withhold a father’s love from her child, even if he did get drunk when he promised he would not. She doesn’t want to punish her boy for his father’s behavior.

Consistent boundaries are important for the substance abuser

When teaching people how to behave, one of the worse things to do is to provide inconsistent feedback. It’s true for babies, hell, it’s true for dogs, and it’s certainly true for addicts. The basic principles of learning research tell us that rewarding good behavior while not rewarding (or even punishing) bad behavior is the best method to affect change. Being inconsistent will make the substance abuser more likely to repeat their offensive behavior than rewarding them for it all the time! It’s called a random reinforcement schedule and is the best method to teach a simple behavior and the hardest one to unlearn. Even mice in an experiment are more likely to repeat an action if they know that they’ll get rewarded for it once in a while and can’t predict when that reward will come. Consistent boundaries let people know what to expect in return for their actions.

Tips for better addiction outcomes

So before you go any further, decide on what behaviors you want to reinforce and make them clear – Not going to happy hour with coworkers, not hanging out with that friend who always ends up mysteriously getting some coke, or any other such behavior that seems to keep creeping up in your particular situation. Then make sure that you have a little list of “rewards” – they can be as simple as quality time with the kid, a nice dinner, or spending money for your kid. By having the list ahead of time, it’ll be easier to stay consistent, knowing what to withhold and what to use as rewards (depending on the behavior).

Addicts should never be rewarded with things they want after failing to deliver on their promises of staying clean. No matter the manipulation, the rules must stand. I’m not necessarily a big supporter of punishment, since it can often put additional stress on a relationship, but rewarding bad behavior should not be an option. This way, the hope is that the substance abuser will change their behavior even if their own willingness to change isn’t quite there, out of their need for the rewards that are being withheld. Slowly, they should begin producing more of the desired sort of behaviors.

This isn’t exactly like tough love (which normally includes punishment), but it’s not far from it either. Obviously, this falls under the category of “easier said than done.” Still, as difficult as it may be, as in raising a child, changing the behavior of a substance abuser requires consistency and perseverance. If a good dose of basic training can help, I say why not give it a try, even if it feels a little bit like training your favorite pet.

Good luck!