The Difference Between a Debate and a Decision
One of the most important tasks of the many items that recovering addicts have to achieve is to finally DECIDE that they will no longer use drugs or alcohol NO MATTER WHAT. This is probably impossible to do in the early stages of recovery, but the goal must be clearly delineated.
I have to credit this idea to Preston Fordstrom, the founder of the San Francisco Recovery School (www.sfrecoveryschool.com), who introduced me to the concept when I interviewed him for my radio show, A New Prescription for Health (www.gracermedicalgroup.com/node/112). When he talked about the fact that most recovering addicts have not absolutely decided to finally be done with drugs and that they had a continual debate with each craving, it started me thinking about what it takes to get to the place where there is no debate.
Those in early recovery do not want to use, they just have problems with the confidence that they can succeed. The most common confidence factor is fear of cravings. It’s “one day at a time”. This is normal and expected. In fact, the best way to support a person in early recovery is to find out how they really feel and then use that as a starting point for treatment, rather than imposing a set of ideals that they “should” or “have to” embrace as their own from the outset. This confrontational approach is all too common in chemical dependency treatment and is one of the “flaws” in a treatment system that can only claim to be successful about 20% of the time. The method that uses empathy is called “Motivational Interviewing”, which will be the subject of another paper.
What is The Debate?
Many times every day each of us makes many decisions from what to wear in the morning to what to eat for dinner. Most of these are obvious and require little or no deliberation. Other times we have to choose between several alternatives, such as what movie to see, when to go to bed, or what to drink with dinner. Some decisions are more difficult and require a long thought process, such as what college should I attend or should I accept a marriage proposal. The decision to use drugs is more complex than any of the above because it is controlled not solely by the cerebral cortex, which is where we think and reason, but also by the mid brain where basic drives such as for sex and food, as well as emotions and pleasure are centered. There is always a tension between these two areas. David Gildea, the director of our adult IOP program, calls this the fight between the front of the brain and the rear of the brain, an easy way to understand this.
When an addict is confronted with a stressful situation or finds herself in a familiar place where she commonly used in the past, she will find it easy to slip back into old habits. This urge is the basis for cravings. Cravings are both physical as well as psychological. Psychological cravings often affect the mid brain and can cause physical symptoms similar to drug withdrawal, sometimes months and even years after recovery.
Since the recovering addict does not want to use, they must deal with these cravings and not give in to them. This is where the debate begins. Think of the cartoon that shows a person with a little man on each shoulder. One is the “angel” and reasons with logic; the other is a “devil” that lives in the mid brain. The tension between them is the debate. Most of the time logic wins for all the reasons that an addict has decided to stop in the first place. But what happens when the situation is very bad, the person is tired, angry, and depressed? They may “lose” the debate and go back to using, either short or long term with all of the problems that this choice causes.
The Menu
When we encounter a situation where there are choices to make, a virtual “menu” drops down and we choose one of the items on it, much like the menus we use everyday on our computers or when we go to a restaurant. Think of a vegetarian at a steak house. While the menu may be large and comprehensive, for them there is very little to choose from. Another way to look at this is to think of what the file menu on a computer that does not have a printer connected looks like. The “print” choice is gray. No matter how many times you click on it, nothing happens.
For most of us, using drugs is simply NOT ON THE MENU. No matter what may happen that choice never even comes to mind. There are things that are not on almost anyone’s menu, such as committing suicide or physically abusing a spouse. The goal for a recovering addict is to remove using drugs from the menu or at least graying out the choice to use if (or more likely, when) the menu drops down.
How to Make “The Decision”
The process to get to the decision comes slowly. It involves setting longer-term goals that become more important than the immediate gratification that drives drug addiction. It can only come after the brain disease causes by drug use and any mood disorders, such as depression or bipolar disease are treated. It comes after experiencing and successfully coping with cravings.
At first we only ask that the recovering addict commit to a length of time that they can deal with: maybe only one day. We ask them to write this down and put it on the refrigerator. They also need to write down the reasons why they are doing this. The time interval gets longer and longer until they reach the point when they KNOW that they have made a final DECISION to not use.
Once this point is reached, there is no longer a debate that can be lost.
As I stated at the top of this paper making a decision is a goal that needs to be clearly discussed early in recovery. Getting there is a long and valuable process.
