Step 6: Rediscover Rewards
By now, you have learned a lot about how to cope with triggers and cravings. You know all about the kinds of situations, places, people, and things that make you vulnerable to relapsing, and you can plan ahead for how you are going to deal with them. But there is a big gap that still needs to be addressed to make your recovery plan complete. Now that you are not going to be drinking or using, what will you do to fill the void that the absence of alcohol and drugs will leave in your life?
Let’s face it: you are working your way through this book because you know that drinking or using has become destructive in your life. But knowing that doesn’t mean that giving it up is easy. It doesn’t mean that you don’t miss the escape or the positive feelings that you used to get from alcohol or drugs. And you might find that, when you are early in the process of recovery, your mood is up and down, and you don’t enjoy many things that you used to. Not everybody feels that way, but a large majority of people who are in recovery feel that way at first. So, if you’re wondering what you’re going to get those pleasurable feelings from, if not from drinking or using, you are not alone. In this chapter, you will discover and rediscover rewarding activities for your recovering brain and body, and learn how to overcome some of the barriers that stand in the way of experiencing joy.
The Role of Rewards in Addiction and Recovery
Rewards are a central part of all of our lives; they are the reason we are motivated to get up in the morning, take care of our responsibilities (whether those involve work, household, or other duties), and maintain a social life, family relationships, and hobbies. All of these things that we spend our time doing, we do because we anticipate that they will bring us rewards: emotional, financial, physical, and other types of rewards that provide joy and pleasure in life.
Working, for example, can bring about all kinds of rewards: There is, of course, the financial reward when you get paid for the work that you do. If colleagues or bosses at work tell you that you are doing a good job, then that brings emotional rewards, such as feelings of confidence and pride in your work, and a sense that you are liked and appreciated by others. All of those experiences will, of course, enhance your self-esteem and feelings of self-worth, which are even greater psychological rewards. Whether you have a job in an office, go to school, or carry out your primary responsibilities at home, the rewards you get from those responsibilities are at the core of your motivation to keep on fulfilling them.
What does this have to do with addiction recovery? you might ask. Think back to before you started drinking or using. What were the rewarding things in your life? Did they have to do with the pleasure you experienced from your important relationships with family, children, a partner, or friends? Were they connected to your hobbies? Your work? Now think about how your involvement in those rewarding activities changed as you started to drink or use more and more. When people become addicted to drugs or alcohol, pursuing the “natural” sources of rewards in life becomes less and less a part of the way that they spend their time. This is because of the increasing amount of time that becomes devoted to seeking drugs or alcohol, using them, and recovering from their effects (as in hangovers, crashing, depression, and the other uncomfortable withdrawal effects that come after the use).
Does this sound familiar? To relate this to your personal experience with addiction, think about the things you started to do less of as your use of alcohol or drugs increased, and write them down in the space provided.
Things I used to enjoy that I did less of as my drinking or drug use got out of control, for example: spending time with friends or family, exercising, or pursuing hobbies:
In recovery, it is not uncommon to feel like your sources of pleasure are limited without alcohol or drugs among your options. How will you spend your free time now? What can replace the role that drinking or using had in your life, and will it feel anywhere near as good? These are very normal and important questions that you might be wondering about, and it may take you some time and trial-and-error to figure out the answers. So be patient with yourself. The exercises you complete in this chapter will help you to find new ways to experience joy and pleasure in recovery.
Studies show not only that rewards relate to the development of addiction, but also that they’re very important in determining how successful people are at making changes to their alcohol or drug use once they enter recovery. According to what is known as behavioral economics theory, when people in addiction recovery have access to a range of sources of pleasure, joy, and satisfaction, they are more likely to quit drinking or using drugs successfully (Green and Kagel 1996; Higgins, Alessi, and Dantona 2002). This theory has a lot of scientific evidence behind it. For example, in one study that compared two different types of behavioral treatments for addiction, the people with the most success in staying sober were those who got involved in a range of pleasurable activities and did them frequently. It didn’t matter what type of treatment they received—the single most important thing that determined whether people were able to stay sober was their consistent involvement in a wide range of enjoyable activities. These activities replaced the time and energy they had been spending on addictive behaviors, enabling them to experience pleasure without having to face the devastating consequences of alcohol or drug use (Farabee, Rawson, and McCann 2002).
Behavioral Activation in Addiction Recovery
As studies have continued to prove how important it is for addicts in recovery to find healthy ways of experiencing joy and fulfillment, a treatment approach that has been used to help people with depression to do this very thing has recently been applied to the treatment of addiction as well. This approach, called behavioral activation therapy, is focused on motivating people to get involved in pleasant activities on a regular basis (Daughters et al. 2008; Magidson et al. 2011).
Behavioral activation therapy has been found to be very helpful to people who struggle with depression, because depression can cause a loss of motivation to do enjoyable things (Cuijpers, Smit, and van Straten 2007; Mazzucchelli, Kane, and Rees 2009; Sturmey 2009). This becomes part of a vicious cycle: when people stop doing pleasurable things, their mood tends to get worse, which makes them more vulnerable to addictive behaviors; and as addictive behaviors take over, less and less time is devoted to doing enjoyable activities. Recent studies have shown that, when used to help people who struggle with both addiction and depression, Behavioral activation therapy helps them successfully quit their use of drugs and alcohol and improves symptoms of depression at the same time (Daughters et al. 2008; Magidson et al. 2011).
Bringing Pleasure into Recovery
As you begin to think about how you’d like to incorporate pleasant activities into your life, keep the following suggestions in mind. You’ll get to explore these suggestions in more depth when you complete the exercises in this chapter:
Pleasant Activities vs. Risky Situations
Now that you are getting used to living a lifestyle that supports your recovery, you are going to learn to be thoughtful in new and different ways about the activities you choose to do. As you start to plan how you will spend your time, you might try asking yourself, before you decide to do something (such as going to a movie or a concert, or hanging out with certain friends): Is this something that might trigger me to want to drink or use? Sometimes, without realizing it, we can be drawn to certain activities that used to be associated with drinking or using. Let’s consider an example:
Daniel Gets Triggered
Daniel has been abstinent from using marijuana for five weeks now. His friend Holden calls him up and invites him to go to a concert featuring an artist Daniel has seen several times before and would love to see again. This is great, Daniel thinks to himself. I didn’t know what I was going to do tonight, and now I have something to occupy my time. What Daniel doesn’t realize is that both Holden and this concert are risky for his recovery. He used to smoke pot with Holden all the time, and he has never been to see this particular artist in concert when he wasn’t high. When he gets to the concert, he finds himself with a craving he rates as an 8 in intensity on a scale from 1 to 10. Holden has some weed, so Daniel ends up smoking with him that night.
In this situation, Daniel was trying to find something pleasurable to do, but he didn’t make the link between the music he was going to listen to at the concert and his prior marijuana use. He also didn’t recognize how the cards were stacked against him with his friend Holden coming with him. While Daniel had quit five weeks ago and no longer had his own supply, Holden made it easy for him to access the marijuana.
Now, with the knowledge that he chose a risky situation when he intended to plan a pleasant activity, Daniel can think through how he might have planned to do things differently if he had asked himself the question, Could this concert trigger me to want to use? beforehand. If he had realized that Holden and the music itself could be triggers, there are a few ways he could have handled the situation differently:
Daniel’s example is included to give you a good sense of how to ask yourself the right questions about a planned activity so that you can learn to tell the difference between a healthy, pleasant activity and a risky situation. If you schedule your time in advance, and give thoughtful consideration to what you are planning, you can avoid placing yourself in a triggering situation.
Exercise 8.1: Activity Tracking
The first step in developing a healthy, rewarding life is to get an accurate sense of how you are spending your time, and how your current activities relate to your mood and use of alcohol or drugs. To do this, using the form below, you are going to record all of your daily activities, including the ones that may seem unimportant (like watching TV). You don’t need to change the way you are doing anything just yet; you will brainstorm about how to make positive changes a little bit later in this chapter. For now, the tracking will help you to get a sense of your current patterns of activities, moods, and behaviors.
Using the activity tracking form works best when you fill out the form twice per day—once in the afternoon, and once in the evening. When you use this form, you will rate how much you enjoyed each activity, from 0 to 10, with 0 meaning it was not at all enjoyable and 10 meaning it was extremely enjoyable. There is no “correct” rating for any activity; you are simply doing this to notice patterns. So, for example, if you spent the hour from 6:00 to 7:00 cooking dinner, and you really did not enjoy it, you would rate it a 0 or a 1.
A “pleasant” or “enjoyable” activity is anything that you rate a 6 or higher. At the end of the day, you will add up how many pleasant activities (rated 6 or higher) you did, and you will rate your overall mood on that day on a scale from 0 to 10, with 0 meaning your mood was as low as it can get, and 10 meaning that your mood couldn’t have been better. You’ll also rate your most intense craving of the day from 1 to 10, with 1 meaning it was very mild and 10 meaning that it was extremely strong. Finally, you’ll indicate whether or not you drank or used on that day. Complete this form on a daily basis for at least one week. You can download fresh copies of it at http://www.newharbinger.com/32783.
Activity Tracking Form
Day/Date:
Total pleasant activities (rated 6 or higher):
Overall mood rating for today (0 to 10):
Peak craving rating for today (1 to 10):
Relapse: Yes No
The more frequently you track your activities, the better able you will be to recognize patterns that you might want to change. Using the previous form, you will start to see the connections between your moods and your activity level, both of which are related to your use of alcohol and drugs. People who do more pleasurable things tend to be happier, and the happiness makes them want to do more enjoyable things.
If you have a therapist or counselor, review your activity tracking form with him or her, and try to set some goals around the changes you’d like to make to it. If you don’t have a therapist or counselor, try to look for patterns: When you do more pleasant activities, are your mood ratings any different? What about your cravings? Maybe the activities help both, or maybe only one. Either way, understanding how your activities relate to your mood and cravings is part of strengthening your skill set as a self expert. You can then make adjustments to your activities according to what your needs are on any given day.
Balancing “Should Dos” with “Want Tos”
As you are reading this chapter, you might find yourself thinking, I’m a pretty active person. I do a lot of stuff. Do I really need to do more? The answer to that depends. Are the things you are spending your time doing things that you are obligated to do, or are they things that you find enjoyable? The key is to have a balance between the two. Often the scale is tipped in the direction of lots of “should dos,” or activities that are part of your responsibilities. This can feel very unfulfilling, and can lead to guilt, confusion, or dissatisfaction with life. On the other hand, when people are doing a lot of pleasurable activities and not working on any long-term goals, this can create a void, or a feeling of underachieving or not accomplishing enough. Let’s take a look at your personal balance of responsibility and fun, so that you can decide where you need to focus your efforts.
Exercise 8.2: “Should Dos” and “Want Tos”
For this exercise, you are simply going to make a list of the things that you do to fulfill responsibilities (your “should dos”) and the things that you do for fun (“want tos”), so that you can get a sense of how balanced they are.
Should Dos Want Tos
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.
8. 8.
9. 9.
10. 10.
What did you notice during this exercise? Was it hard for you to come up with things that you do for pleasure, or was it the other way around? Pay attention to where you see a gap in your activity balance, so that you can begin to brainstorm about ways to have satisfying numbers and types of activities in both categories.
Exercise 8.3: Pleasant Activities
Ideally, you should have one pleasant activity worked into each day. It doesn’t have to take up a lot of time; it just needs to be something you do with the intention of enjoying yourself. In this next exercise, take a look at the list of pleasant activities and see if there is anything that you’d like to start or continue doing. Circle each one.
Activities not listed in the Pleasant Events table that I would like to do:
1.
2.
3.
4.
5.
6.
Exercise 8.4: Activity Scheduling
Now that you have identified some new activities you’d like to do, the next step is to plan when to do them. Then, be sure to continue tracking your activities throughout the day, so that you can keep tabs on how you’re balancing Should Dos and Want Tos.
Activity I plan to do: Date I plan to do it, or start it:
Activity #1 ( ) Date:
Activity #2 ( ) Date:
Activity #3 ( ) Date:
Activity #4 ( ) Date:
Activity #5 ( ) Date:
Activity #6 ( ) Date:
Activity #8 ( ) Date:
Activity #9 ( ) Date:
Activity #10 ( ) Date:
Sometimes, things just get in the way of our doing things for fun. It could be a practical problem, like figuring out who will watch the kids or walk the dog, or how to free up your busy schedule. For this reason, scheduling activities in advance can be helpful, because it will lead you to plan for these kinds of obstacles. Looking at the list of pleasant activities that you planned in the previous exercise, take a few moments to think about potential barriers, or things that might prevent you from doing one or more of them despite your best intentions. Make a list of these obstacles below.
OBSTACLES TO PLEASANT ACTIVITIES:
1.
2.
3.
4.
Now, for each of the obstacles that you listed, there is a three-step process you can follow to find a realistic solution:
Let’s practice this now, with the first barrier that you identified.
Barrier #1:
Step 1: Here are all of the possible solutions I can think of for this problem:
1.
2.
3.
4.
5.
Step 2: These are the pros and cons of each of the possible solutions:
| Solution # | Pros | Cons |
|---|---|---|
| 1 | ||
| 2 | ||
| 3 | ||
| 4 | ||
| 5 |
Step 3: Pick the best two solutions:
1.
2.
Once you’ve tried one or both of these, evaluate how well they worked, so that you can decide which solution you’d like to use again in the future.
In addition to practical obstacles, our thoughts can sometimes run interference with doing pleasant activities. Often we think that we won’t enjoy something because we are too tired, or we’re not in a good mood, or we just don’t feel like doing anything. But sometimes we are wrong. Remember how we worked on recognizing cognitive distortions in chapter 5? We are going to revisit cognitive distortions, specifically as they relate to pleasant activities, here.
Negative moods can affect our expectations about how much we can enjoy things. That is, if your mood isn’t great, you probably don’t expect that going out for dinner or being with other people is going to be enjoyable, simply because you don’t feel like it. But the reality can be quite different from what you expected, because the activity itself can change your mood. Below are a few examples of thoughts that can get in the way of getting out and doing something fun:
Do any of these thoughts sound familiar? If not, then perhaps negative thoughts are not such a big barrier for you personally. If they are familiar, you should know that these are very common ways of thinking, and there is a way that you can change these thoughts, just as you’ve learned to change some of your irrational ways of thinking about drinking or using. Below you will be introduced to a technique that will help you learn how to challenge your thoughts about pleasant activities.
Exercise 8.5: Pleasure Predicting
As you are learning, our thoughts and feelings about activities can be very misleading at times. The idea behind pleasure predicting is that we can act like scientists, examining our negative thoughts and expectations about activities and gathering evidence to see whether or not they turn out to be accurate. According to this approach, just because you don’t feel like doing something doesn’t mean that it isn’t worth doing. You can choose to do something and then decide whether it was enjoyable, based on your observations about your thoughts and your mood during and after the activity. Here’s how to do it:
• First, when you’re planning to do an activity, before you do it, write down how much you expect to enjoy it, using a percentage from 0 to 100, with 0 meaning that you don’t expect to enjoy it all, 50 percent meaning that you think you will enjoy it moderately, and 100 percent meaning that you expect that you will enjoy it to the fullest extent possible. Pay attention to any other thoughts you are having about the activity and write them down.
• Then, do the activity, even if you rated it a 0. Without this step, you can’t do pleasure predicting!
• During the activity, pay attention to any thoughts you are having about it and jot them down.
• After you finish the activity, rate how much you actually enjoyed it, from 0 to 100 percent.
• Compare the enjoyment ratings from before and after you did the activity. These pleasure ratings might be different, or they might not be; either way, it’s okay. The idea is to be an objective observer of your experience and begin to identify patterns.
Exercise 8.6: Pleasure Predicting Form
| Pleasant Activity | Pleasure Prediction Rating Before (0 to 100%) | Pleasure Rating After (0 to 100%) | Thoughts Before and During the Activity |
|---|---|---|---|
What did you notice about your ratings before and after the activities? In some cases, you might find that while you approach certain activities with a sense of dread, or with low expectations about how much fun you will have, you get more enjoyment out of them than you expect. These are, of course, the types of activities that you’ll want to repeat, and you can remind yourself of how your predictions might have been more about your mood than about the activity itself. In other situations, you might find that the activity was just as you expected it to be.
Remember that in recovery, you are going to be redefining the way that you spend your time, and an important part of this will involve figuring out what kinds of things you can enjoy without feeling triggered to drink or use. The things you enjoy that are not risky for you now may not be the same things that were pleasurable and safe for you when you were actively drinking or using. If you look at pleasure predicting as a process of discovery, you can find ways to experience joy and fun in recovery, which will help you stay healthy and sober.
Exercise 8.7: Reward Yourself for Scheduling and Following Through
Now that you have some experience with pleasure predicting, you might have some activities in mind that you’d like to repeat, because you found that you enjoyed them. Scheduling activities helps to make it more likely that you’ll follow through, because you’ve already committed to it and worked your way through any barriers in terms of scheduling. To take it a step further, after you do an activity that you planned and committed to, you should reward yourself for following through, just as you did in chapter 4 when you worked on incorporating physical exercise into your routine. In this exercise, you will schedule your next few activities for the coming week, and plan how you will reward yourself afterward.
Week:
This week, I will do the following activities:
1. I will (activity) on (date),
and I will reward myself by .
2. I will (activity) on (date),
3. I will (activity) on (date),
and I will reward myself by .
In this chapter you learned about how you can reintroduce pleasurable activities into your life in a way that is compatible with your recovery. Finding balance between work and fun is a lifelong practice. Things aren’t always in perfect balance; there will be times when you find yourself doing more work and fulfilling responsibilities, with less time for fun, and other times when you have a little more free time on your hands. With continued awareness of your goal to keep things in balance as much as possible, you will get better and better at it, and this will serve your recovery well. The more joy and pleasure you come to derive from relationships, hobbies, and other activities, the less you will miss the presence of alcohol or drugs in your life.