Step 3: Become a “Self Expert”
Now that you have done the hard work of taking an honest look at the problems that your drug or alcohol use has caused, strengthening your motivation to change, and creating your change plan, it is important for you to learn to truly know your addicted self. What does that mean? you might ask. Think back to when we talked about your “addicted brain” and how it drives you to act in destructive ways that support your addiction. Step 3 is the first major step you will take to strengthen your “rational brain” and put it into the driver’s seat.
To do this, you need to know your addicted self inside and out. That means knowing exactly how, when, and why your addicted brain is most likely to get triggered and start competing with your rational, recovering brain for control. Once you have that figured out, you will be a “self expert.” In this chapter, you will begin to learn how to use cognitive and behavioral therapy skills to understand your own unique patterns of thinking and feeling as they relate to your addiction.
The purpose of this chapter is to teach you three strategies that can help you to identify the situations and ways of thinking that fuel your addictive behavior: (1) identifying your unique triggers for alcohol or drug use, (2) recognizing distorted thinking, and (3) using self-monitoring skills. The more frequently you are able to recognize and anticipate when your addicted brain is taking hold and causing you to think and act in irrational, self-destructive ways, the better you will get at intentionally using your rational brain to make healthier choices for yourself. Each time your rational brain wins control over your behavior, your recovery gets a little bit stronger and your addicted brain loses a little bit of power over your behavior. In the long term, your rational brain can take over completely, so that making healthy choices is no longer a fight; it is a way of life. In this chapter, and the next, you will learn how to use cognitive and behavioral therapy skills to become a “self expert” and reclaim that control.
Becoming a “self expert” is a process of understanding how your addiction controls you, so that, with time and practice, you can turn the tables on it. That means getting a handle on the wide range of situations, places, people, and experiences that activate your addicted brain. These are called triggers. Typically, when you encounter a trigger, this causes a sequence of experiences that leads to drug or alcohol use when your addicted brain is in control. Here’s how it unfolds:
TRIGGER THOUGHT CRAVING DRUG OR ALCOHOL USE
Does this sequence look familiar? If it does, that’s great! If it doesn’t, that is perfectly okay; for many people with addictions, this process happens so quickly that it takes time and practice just to notice it. This practice is a very important part of the cognitive behavioral approach. As you progress through the exercises in this chapter, you will learn to notice when you are triggered, and what exactly that feels like for you. For instance, when you are triggered, you may or may not be aware of the thoughts that are going through your head. You may or may not have noticed exactly what the trigger was. Maybe you are simply aware of an urge or craving to drink or use drugs, and if so, that is a great start.
As you will learn, there are many components of cravings and people experience them differently. Some people feel cravings physically in their bodies, while for others the craving is more of a thought process, like I need it or I can’t handle these feelings without it. When you learn to self-monitor, you will be able to look at the diagram above and know exactly what happened during the sequence of TRIGGER THOUGHT CRAVING—physically, emotionally, and cognitively (which refers to the thoughts you were having). Once you are aware of what happened, you can begin an inner dialogue with yourself about it, and you can use this inner dialogue to cope with the thoughts, feelings, and cravings without drinking or using drugs.
Another key component of becoming a “self expert” is developing an awareness of the kinds of things your addicted brain will tell you to get you to drink or use drugs. In CBT, these distorted or irrational thoughts are called red flag thoughts. In this chapter, you will learn about some red flag thoughts that a lot of people with addictions experience when they are feeling triggered. In reviewing these thoughts, you can identify the ones that you’ve had, or even come up with your own. This will prepare you for the next chapter, where you will learn how to “talk back” to the thoughts using your rational, recovering brain.
At one time or another, most everyone in recovery experiences urges to drink or use drugs. In fact, cravings are one of the symptoms that define the disease of addiction (American Psychiatric Association 2013). That’s no surprise, of course; there are both biological and psychological explanations for why you would feel a desire to drink or use drugs after your last drink or dose has left your body. Physically, when you are addicted to something, your body becomes dependent on having a steady, consistent dose of it in your system. When that steady dose is diminished, or taken away abruptly, your addicted brain will communicate urges to you to get you to replenish it. This is because, as your body is adjusting to receiving less of the substance, you can experience uncomfortable physical and mental withdrawal symptoms. The conditioned, addicted part of your brain will tell you that you need to drink or use to get back to feeling normal. That’s the cycle of withdrawal.
The psychological urge or craving can feel just as potent—and sometimes even stronger. You may recall that in chapter 2, you learned about how your use of alcohol or drugs can become a conditioned, automatic response to certain cues, much like a habit. When drinking or using drugs becomes associated, or “linked,” with certain situations, emotions, people, or things, then those become triggers. Because that psychological link between triggers and using substances can be very powerful, being in the presence of these triggers can become quite uncomfortable without alcohol or drugs. You’ll experience this discomfort as a craving.
Studies have shown that triggers fall into several categories (Marlatt and Gordon 1985; Larimer, Palmer, and Marlatt 1999). As you become a self expert, think about which of these categories apply to you, so that you can learn to become more self-aware when you enter triggering situations:
Exercise 5.1: Identifying Triggers
Below you will find a list of triggers that can initiate the sequence of thoughts, cravings, and behaviors (like drinking or using drugs) that we have been reviewing. Place a check mark beside the triggers that you have experienced, and place a star next to the ones that you feel come up repeatedly for you. You’ll notice that we’ve separated internal from external triggers, so that you can start to learn to distinguish between them. Remember that internal triggers are just what they sound like; they are emotions inside of you. External triggers, on the other hand, are cues that are external to you—such as places, people, or situations that you have come to associate with drinking or using.
Internal Triggers
Depression
Loneliness
Happiness
Excitement
Feeling stressed
Feeling irritable
Feeling overwhelmed
Feeling jealous
Anxiety
Boredom
Anger
Feeling rejected
Frustration
Guilt or shame
Needing an energy boost
Other internal triggers:
External Triggers
In this exercise, we focus on four types of external triggers: people, places, situations or activities, and things. Under each category, place a check mark beside the triggers that apply to you, and place a star next to those that come up repeatedly for you.
People
Friends
Spouse or significant other
Family members
Coworkers or bosses
List of people who trigger me:
Places
Bars or clubs
Friends’ houses (name those friends here):
Concerts
School or work
Neighborhoods or freeway exits
Other places that are triggers for me:
Situations or Activities
Parties (or other gatherings at which you meet new people)
Holidays or other special occasions
When home alone
When dining out
Before or during a date
Waking up in the morning
After work or school
Other situations or activities that are triggers for me:
Things
Stashes of alcohol or drugs in the house
Paraphernalia associated with drinking or using (favorite shot glasses or wine glasses, bongs, rolling paper, pipes, or other objects used as part of rituals when getting high)
Other things that are triggers for me:
The Role of Thoughts in Relapse
Now that you have learned what your triggers are, you are ready for the next step: uncovering the thoughts that lead you to drink or use. Remember, the usual sequence that can end in a relapse is: TRIGGER THOUGHT CRAVING DRUG OR ALCOHOL USE. In the exercises that follow, you will start connecting your personal triggers with specific thoughts.
In everyday life, our thoughts are directly connected to our emotions and our actions. We all have some thoughts that are rational and some that are irrational. As someone with an addiction, your irrational thoughts around drinking or using mostly come from your addicted brain. Thoughts are very important to notice and understand, because when we encounter a trigger—or any stressful or unexpected situation—the way we think about it dictates the way that we cope with it (Marlatt and Gordon 1985). Let’s look at an example.
Scott Gets Triggered
Scott is a software engineer with alcoholism. He has been abstinent from alcohol for two months and is doing well in his recovery. One day, he goes to work and his boss asks to meet with him. Scott’s boss says that one of the clients he has been working with is complaining that he has been too slow to resolve problems with his new software, and that he was not very polite in his email when this issue was raised. Scott’s boss is writing him up, and warns him that he needs to improve his efficiency and customer service to meet performance standards.
So, there it is: a triggering interpersonal situation. Scott feels devalued by his boss, leading him to feel inadequate both personally and professionally. Ideally, Scott would respond to this with some positive coping skills, like finding a healthy outlet for the emotions that this feedback from his boss brought on. He might try to resolve things with the client who is upset, and find a way to communicate with his boss constructively to improve his standing at work. But Scott’s ability to take these actions depends on the way that he is thinking about the situation, and himself. Let’s take a look at some of the thoughts that go through Scott’s head after his talk with his boss.
Scott is stuck in a cycle of negative and irrational thinking. You might notice as you look at each of his thoughts that he is not stepping back from the situation to try and evaluate whether there is anything constructive about the feedback his boss gave him, or whether there is a way to get some resolution to the problem. Instead, his irrational thoughts take hold; he is quick to interpret many aspects of the situation as reflections of his own personal inadequacy. It’s as though he is overly sensitive to any aspects of the situation that could reflect rejection and negativity. Looking at life from this irrational perspective, it is not surprising that he feels like a failure—an unlikable and unsuccessful person—and that he predicts that he will be fired.
Scott is not alone; a lot of people (both addicts and non-addicts) can get easily swept into this irrational way of interpreting and reacting to an upsetting experience. The key is to recognize what is happening and prevent yourself from “falling for it.” It is, after all, irrational! If you fall for it, your actions will be irrational too. If you catch those thoughts when they happen, you can switch gears, engage your rational brain, and use some positive coping strategies that will lead you away from a relapse. Let’s break it down further so that you can figure out your own patterns of distorted thinking.
Distorted Thoughts—Learn to Catch Them!
There are certain types of distorted or irrational thoughts that make you more vulnerable to relapse. Like Scott’s distorted thoughts, some are directly related to drinking or using, while others are not. It’s important for you to know that even the thoughts that are not directly related to drinking or using can lead you to a relapse. In Scott’s situation, some of the negative, irrational thoughts he has about himself (such as Nobody likes me) trigger negative emotions, which he experiences as feelings of worthlessness. These negative emotions lead him to have thoughts about drinking.
Have you ever had thoughts about drinking or using after something upsetting happened to you? If so, it was not just the upsetting event or situation that created the desire to drink or use; it was the thoughts and emotions that you experienced during or after the event. Picture the most recent upsetting event that got you thinking about drinking or using. Can you pinpoint the thoughts you had in that situation, just before you started thinking about drinking or using? If so, that is terrific! If not, don’t worry, you’ll get plenty of practice with this.
For some, the hardest part of overcoming irrational thinking is recognizing when it is happening. That is because most of our irrational thought patterns have repeated themselves so often over time that they have become automatic. When our thoughts are automatic, we tend not to notice them. As a “self expert in training,” you are going to learn to “catch” your thoughts as they happen. Let’s take a look at some of the most common types of irrational thoughts so that you can start to identify the ones that you’ll need to work on.
Because they are directly related to drinking or using, red flag thoughts may be easier for you to “catch” than other thoughts that can lead you to relapse. A red flag thought is something that you tell yourself about drinking or using that increases the likelihood that you will relapse. In CBT, sometimes these are referred to as “relapse justifying” thoughts or a process of “relapse justification.” In the example above, Scott’s red flag thought is, If I could just have one drink, it would calm me down. These types of thoughts, that “make it okay” for you to drink or use when you are in recovery, are coming from your addicted brain. When you find yourself having these thoughts that give you “permission” to drink or use, that’s when you have to work harder to kick your rational brain into gear and use your new coping skills, which you will learn in steps 4 through 7. Your job right now is just to notice the thoughts as they happen.
Exercise 5.2: Identifying Red Flag Thoughts
The following is a list of some common red flag thoughts (Brown et al. 2006). Check all that you’ve had at one time or another and add any that you don’t see listed.
I have to… (I have to have a drink.)
Nobody has to know.
It really doesn’t matter if… (It really doesn’t matter if I use.)
I can control it.
I’m only going to have one.
I’m having a bad day; I might as well use.
I deserve to… (I deserve to have a drink.)
It’s a special occasion! I can always start over tomorrow.
Other red flag thoughts I’ve had:
Now that you have a better handle on your red flag thoughts, it’s time to take a look at other common mistakes in thinking. Take a look at the six common types of irrational thoughts that follow, noticing the ones that you relate to the most. Keep in mind that not everyone experiences every type of irrational thought; if you notice that there are some types of irrational thoughts you are unfamiliar with, then you don’t need to come up with a personal example for those.
When you see things in black and white, it means that they are either completely good or completely bad. Scott was caught up in a lot of black-or-white thinking just before he started entertaining the idea of drinking. When his boss gave him critical feedback, he started to view himself as completely worthless on the job and a failure—with thoughts such as Nothing I do is ever good enough, and I never succeed at anything. When your thoughts contain words like nothing and never, then you’re definitely in the thick of some black-or-white thinking. If you’re a perfectionist type, you’re more vulnerable to this; like Scott, making a mistake causes you to view everything you’ve done as useless. Let’s look at an example of how black-or-white thinking can lead to a red flag thought.
| Black-or-White Thought | Red Flag Thought |
| I messed up everything at work. | I might as well go and drink. |
Now, try writing down one or more examples of your black-or-white thoughts and the red flag thoughts they can lead to.
Examples of black-or-while thoughts I’ve had:
Red flag thought:
Picture yourself wearing a pair of glasses with a screen in place of the lens. You filter your interpretations of experiences, situations, and the ways that people interact with you through this screen. The screen keeps all of the positive thoughts about your experiences on the outside, letting only the negative thoughts come through. This is the case even when good things happen. For example, if Scott’s boss gives him a compliment on something he did well at work, and he’s “discounting the positive,” he might have a thought like, He didn’t mean that. He just feels sorry for me because I keep on screwing up. He said that out of pity. By discounting the positive, Scott is casting aside all of the ways that this compliment might be reassuring. Below is an example of how discounting the positive can lead to a red flag thought.
| Discounting the Positive | Red Flag Thought |
|
My boss only said something nice to me out of pity. | I’m pathetic. I have nothing to lose by drinking. |
Now, try writing down one or more examples of thoughts you’ve had that discount the positive. Then, write down the red flag thoughts they can lead to.
Thoughts that discount the positive:
Red flag thoughts:
If you tend to jump to conclusions, you are doing one of two things: You are either mind reading or fortune telling. If you are a mind reader, then you assume that other people’s behavior toward you reflects something negative about how they feel about you. You make these interpretations with very little or no factual information. For example, if you are with a friend who is not being especially talkative, rather than assuming that your friend might be having a bad day, or might have something on her mind, you think, She’s not talking to me because she doesn’t like me. That is one form of jumping to conclusions.
If you fall into a habit of fortune telling, then you predict that things will turn out badly for you. The way you see things, there is doom and gloom waiting for you around the corner; that is your ultimate fate. Scott did some fortune telling after his boss gave him the negative feedback; he predicted that he would get fired, even though his boss did not say that he was on the road to losing his job. Although getting written up at work obviously isn’t a positive, it is also not a sure path to getting fired. When you are fortune telling, you go straight to the worst-case scenario without considering the other possible outcomes.
Let’s look at a couple of examples of how jumping to conclusions can bring on red flag thoughts. You’ll notice that in the first example below, the red flag thought is one that is triggered by interpersonal conflict; sometimes you may feel like retaliating against someone who has upset you, by drinking or using. Make a mental note of it or write down an example in the exercise below if this is a pattern of thinking you have experienced before. In steps 4 through 7, you will learn how to cope with interpersonal conflict in a healthier way.
Now, try writing down one or more examples of ways that you have engaged in jumping to conclusions, and the red flag thoughts that are connected.
My ways of jumping to conclusions (mind reading or fortune telling):
Red flag thoughts:
TAKING YOUR FEELINGS TOO SERIOUSLY
When you take your feelings too seriously, it means that you think of your feelings as reality. Even though your feelings are real, they can lead you to some unrealistic conclusions if you take them too seriously. For example, if you feel depressed you may draw the conclusion that you can’t enjoy anything. Although your depressed feeling is real, if you were to get out and try to do something enjoyable, chances are it would help you get out of that mood.
Here’s another example: Scott felt worthless at work after his boss spoke with him about his need for improvement. Just because he felt worthless, it doesn’t mean that he is worthless. It is hard to separate an intense feeling from reality during the moment, but the fact is that just because you feel a certain way, it doesn’t mean that you are that way. Let’s look at an example of how taking your feelings too seriously can lead to a red flag thought.
Now, try writing down one or more examples of your experience with taking your feelings too seriously, and the red flag thoughts that this can lead to.
Examples of my thoughts when I’ve taken my feelings too seriously:
Red flag thoughts:
If you tend to be hard on yourself, and have an active self-critical voice inside of you, then you probably can relate to this mistake in thinking. You blame yourself for things that may not be in your control. Your addiction is a perfect example. Do you ever blame yourself for it? Remember, even if you have made bad choices during your fight with addiction, becoming an addict was not your choice; nor was it your fault. You developed a brain disease, and you are working very hard to overcome it and put your rational mind back in control. Let’s look at an example of how self-blame can lead to a red flag thought.
| Self-Blaming Thought | Red Flag Thought |
|
It’s all my fault that I drink too much. | I’ve ruined my life; I have nothing to lose by continuing to drink. |
Now, try writing down one or more examples of your self-blaming thinking and the red flag thoughts that it can lead to.
Self-blaming thoughts:
Red flag thoughts:
Labeling yourself is a close relative to taking your feelings too seriously. I feel ; therefore I must be . You label yourself for the ways that you feel, or for the mistakes that you’ve made. For example, if you are feeling down, you might think, I’m a depressing person; I’m such a downer for everybody. Instead of thinking of yourself as a person who happens to be in a depressed mood, you label yourself for it. Another example: if you make a mistake, you might label yourself as a “loser,” rather than a person who happened to make a mistake. Let’s look at an example of how labeling can lead to a red flag thought.
Now, try writing down one or more examples of your own experience with labeling and the red flag thoughts that it can lead to.
Labeling thoughts:
Red flag thoughts:
If you’re like most people who struggle with addictions, then you’ve probably made more than one attempt to cut back or stop drinking or using. Think about the last time that you tried, unsuccessfully, to stop drinking or using. Did you know that the first time you drank or used after days, weeks, or months of abstinence was not a relapse? That very first time that you drink or use after a period of going without is called a slip or a lapse. What you probably don’t know is that, when you lapse, the way that you talk to yourself about it can determine whether or not you will continue drinking or using. When you keep the lapse going, it turns into a relapse.
Research has shown that it is very common to think about lapses in ways that keep you on the path to relapse, rather than recovery (Marlatt and Gordon 1985). Although it’s true that a lapse places you at risk for a relapse, the relapse is not inevitable. You have more control than you might think over the outcome. To prevent a lapse from converting into a full-blown relapse, you need to avoid the mistake called the spiraling lapse. The spiraling lapse is when you interpret a lapse as being the result of one of two things:
Here are some of the thoughts that you might have had if you’ve experienced the spiraling lapse:
Can you think of any other thoughts you’ve had that are along these lines? The thoughts you’ll want to identify are the ones that you tell yourself that make it more likely that you’ll continue to drink or use after you’ve lapsed. If you can think of any that are not listed above, write them in the space provided:
Obviously, it would be best if you would get it perfectly the first time around, and never slip or lapse. But research demonstrates that relapse rates for people with addictions are similar to those for people with other chronic diseases, such as diabetes, hypertension, and asthma, occurring in 40 percent to 60 percent of those who receive treatment (McLellan 2000). What this really means is that a lapse or a relapse is not a sign that treatment has failed. In CBT, lapses or relapses are viewed as a sign that more treatment is needed, or that an adjustment to the treatment approach should be considered. Changes can include introducing different therapy techniques, introducing or adjusting a medication, or changing the therapy modality (such as shifting from weekly therapy to a more intensive type of program).
When it comes to the spiraling lapse, the adjustment you need may be as simple as changing your thinking about a lapse. Rather than interpreting it as a sign of failure, or the beginning of a downward spiral into relapse and loss of control, you can realize that, in the situation that triggered the lapse, you didn’t cope very well. If you think of it that way, you will see that the lapse is a learning opportunity. You don’t have to spiral into a full-blown relapse; it is not inevitable. If you talk about it with your counselor or therapist, and complete the exercises you’ll find in the next chapter (“Step 4: Respond to Cognitive Distortions”), you can learn from your mistakes and find healthier ways to cope with similar triggering situations in the future.
You are learning a lot about how the sequence from trigger to drug or alcohol use unfolds for you, now that you’ve come to understand your triggers and the thoughts they lead to. Next, we turn to the craving phase, which is the last experience in the sequence prior to making a decision about drinking or using. When you break the process down, and become aware of the triggers, thoughts, and cravings, then the final outcome of it (drinking or using—or not) does not have to be automatic. It becomes a decision that you can make with your rational brain.
Noticing all of the sensations, thoughts, and emotions that you experience during cravings is a central part of becoming a self expert. Cravings are different for everyone. The first step to beating a craving is taking a look at each of the features of the craving and understanding how you experience it. In this next exercise, you will identify how you experience cravings in your mind and body.
Exercise 5.3: How Do You Experience Cravings?
Think about the last time you had an intense craving. Now, for this first part of the exercise, try and think about where you were feeling it in your body. Put a check next to the areas or sensations below that best describe your experience.
Chest (tightness or other sensation)
Stomach
Jaw
Neck
Shoulders
Heart (racing)
Nose (feeling like you could smell what you were craving)
Other areas or sensations:
Now, try and think about the emotions you experience during a craving. Check the emotions below that best describe your experience. Add any that are not listed in the space provided at the end.
Anxiety
Excitement
Anticipation
Restlessness
Irritability
The same emotions I experience when I am drinking or high
Other emotions:
Finally, let’s identify the cognitive (thoughts) part of your experience. Below are some common thoughts that accompany cravings. If thoughts are a noticeable part of your experience during a craving, then place a mark next to the ones that you’ve experienced.
I need it.
I have to have… (I have to have a drink).
If I don’t drink/use I’m going to go crazy.
I can’t handle… (I can’t handle getting sick / the withdrawals / feeling this way).
I can’t get it out of my head.
Other thoughts:
In the next chapter, you will learn a whole new set of skills for coping with cravings. Your job right now is simply to notice everything about them.
One important set of skills taught in CBT that is central to becoming a self expert is self-monitoring skills. Learning to self-monitor can help you to understand the psychology behind your addiction and begin to control it. By monitoring your experiences throughout each day, you become aware of your thoughts and emotions, and the behaviors that they are linked with, as they happen. Since most of us are not used to “thinking about thinking”—sometimes referred to as metacognitive skills (Dobson 2013)—it can be a little bit challenging at first, especially since our thoughts often go through our heads so rapidly that we don’t notice them right way. But with practice, you can learn to become more self-aware, and once you do, you can start building a repertoire of CBT and other skills that you can use to change your thinking and behavior patterns in ways that support your recovery.
Exercise 5.4 provides you with a craving self-monitoring form. Using this form, you will identify your triggers, thoughts, emotions, and the intensity of your cravings. In the first column, write down the date and time of day. Next, you’ll identify the situation you were in when you felt triggered. For example, did you experience an internal trigger (such as feeling depressed after an argument with your partner) or an external trigger (such as attending a party where other people were drinking or using in front of you)? Next, you will write down the thoughts that went through your mind when you were triggered and the feelings that came up for you in conjunction with your thoughts. Finally, you will rate the intensity of your craving on a scale from 0 to 10, with 0 being no cravings at all, 5 being an average number (meaning that you had some cravings but they were not constant or difficult to cope with) and 10 being severe, constant cravings.
Exercise 5.4: Craving Self-Monitoring Form
| Date/Time and Triggering Situation | Thought(s) | Feelings | Craving Rating (0 to 10) |
|---|---|---|---|
It would be helpful for you to make copies of the cravings rating form and complete it daily. (You can download the form at the website for this book, http://www.newharbinger.com/32783.) Try to fill it out in “real time” whenever you can, so that the details about your thoughts and the intensity of your cravings are as accurate as possible. By self-monitoring regularly, you may start to identify triggers and thought patterns that you weren’t previously aware of that lead to cravings. By raising your awareness of your psychological experience as it relates to your addiction, you are gaining the knowledge and self-understanding that you need to be a self expert.
Congratulations! You’ve made it through an intense set of exercises, and you are well on your way to changing your addictive behaviors. Now that you have intimate knowledge of your triggers, thoughts, and cravings, you are well positioned to learn to respond differently to the cues that used to lead you straight down a path to drinking or using. Remember to use the self-monitoring form regularly and complete all of the exercises in this chapter so that you can refer back to them as you begin practicing new coping skills. Beginning in the next chapter, you are going to develop a repertoire of skills to cope with your triggers, thoughts, and cravings without turning to alcohol or drugs.