Addictions: Alcohol and Substance Abuse

An Alternative to Powerlessness

William Dubin, Ph.D.

The Problem of Immediate Gratification [The PIG] is a defining feature of Incentive Use Disorders. So, naturally, those suffering the negative consequences of their excessive appetites want immediate gratification of the desire to be free of their problem. Overeaters want quick weight loss, but weight loss is not a cure for obesity! The vast majority of the participants of diets and weight loss programs will weigh more a year later than they did when they began their program. One- and two-year outcome research for substance abuse, gambling, and other addictive disorders shows similar patterns of short-term behavior change (while the individual is under the influence of the program) followed by an increasing likelihood of relapse with time from program completion, typically reaching around 80% within the first year after treatment.

woman standing outsideThere is no external salvation from dependence on an external agent. To the extent an external agent-a treatment provider, program, support group-was responsible for the behavioral control, relapse is likely when the salience of the external source of control diminishes with time.

The Nature of Your Challenge

An alternative to admitting powerlessness over a disease and turning responsibility for outcome over to an external agent is to admit you have freewill and accept the responsibility to develop the faculties required to act as you intend despite the influence of local conditions.

Volition is a controversial topic and many people believe that willpower is a destructive illusion. Most everyone with an excessive appetite has tried what they call willpower-"white knuckling it"-without success. [The "brute force" method may, perversely, provoke counter-regulatory motivation.] However, if willpower is defined as acting as intended despite the influence of local conditions, then the term describes a faculty worth developing. Simply stated, you have a two-phase challenge: First, you must decide how you intend to act when you encounter high-risk situations. Second, you must get yourself to act in accord with that decision, despite the influence of the local stressors and temptations.

You learn to exercise will1 during your encounters with a wide range of high-risk situations. At these critical moments, you have the opportunity to observe the cause-and-effect principles that govern your actions when exposed to stress and temptation. An important component of exercising will is to shift from an emotional trance to a dispassionate trance. This shift in perspective can enable you to become aware of your core motivation and act accordingly.

Addictive traps are easy to fall into and hard to escape. No escape plan works for everyone, because each trap is unique. An external source, such as a book or generic program, cannot show you the way to good long-term outcome, or even tell you what good long-term outcome means in your particular case. To act in accord with your interests and principles, you have to first define what they are. No external agent can do this for you; the path to self-determination is for your steps alone. Experiential invitations designed to encourage contemplation will enable you to focus your cognitive resources on how you want to use the remainder of your lease on life-your core motivation.

Appreciating what you want and doing what it takes to get it are different challenges. Acting as intended despite the influence of local conditions that would motivate you to lapse defines the "exercise of will." This kit has the ambitious goal of enhancing your power to intentionally influence the course of events.

An Efficacy Enhancing Treatment Strategy

The strategy of this kit is strikingly different from that used by programs based on the 12-Step model of Alcoholics Anonymous. According to the latter view, incentive use disorders are diseases. Treatment emphasizes getting the patient to admit powerlessness over the illness and to comply with the plan developed by a treatment provider. Rather than encourage you to accept powerlessness, or recommend that you turn your problem over to a higher power or treatment provider, here are tools and methods to enhance the power of your will.

Preventing relapse requires that you are able to make good choices in real time, which turns out to be much more difficult than it sounds. In your fantasy, you will respond heroically during your future encounters with stress and temptation. When you are in the midst of a crisis, performing mindfully will not be as easy as it now seems. To follow your path of greatest advantage rather than yield in the direction of least resistance requires the exercise of will.

The challenge ahead is among the most important and the most demanding of your life. It takes more than wanting it to achieve the benefits of good long-term outcome. Preventing relapse demands that you act as intended during the critical moments of crisis when your energies and cognitive resources are depleted or otherwise occupied.

Exercising will is a heroic undertaking. The text and other media contained in this kit provide conceptual models, concrete tools, and experiential invitations that will strengthen your ability to act in accord with your interests and principles, rather than yield in the direction of least resistance.

A major advantage of a self-directed approach is that it encourages the development of the faculties required to exercise will.

 

Consider Mr. Hasslebring who has been clean and sober during his stay at a 30-day rehab program. Sadly, the content discussed in the psycho-educational groups was of little value during the critical moments of the actual crisis he encountered in his home environment, and the program staff and structure were not available to help him.

The vast majority of the graduates of inpatient and intensive outpatient chemical dependence and weight loss programs relapse soon after the influence of the external agent disappears. Evidently, their treatment left them insufficiently prepared to cope with the high-risk situations they actually encountered. Good long-term outcome is the byproduct of good performance during high-risk situations.

 

Question: Why is it that the thing you are trying to find is always in the very last place you look for it?
Answer: Because once you have found it, you can stop looking.

 

Usually, people do not seek my services until they have tried many other approaches to solving their problem. These range from no plan-usually labeled "willpower" or "white-knuckling it"-to highly intrusive plans such as inpatient treatment. The fact that they are seeking my help means that everything they tried has failed. They and I hope that our collaboration will finally enable them to break free of the recurring pattern of good intentions decaying into relapse.

Footnote

1 - Will is defined here as the capability to act as intended in real time, despite the influence of local stressors and temptations that would motivate a lapse.

 




Clinic Locations

 

Erath County

906 Lingleville Highway

Stephenville, TX 76401

(254) 968-4181

 

Hood & Somervell Counties
104 Pirate Drive

Granbury, TX 76048

(817) 573-2662

 

Johnson County

1601 North Anglin Street

Cleburne, TX 76031

(817) 558-1121

 

Palo Pinto County

214 SW 26th Ave, Suite A

Mineral Wells, TX 76068

(940) 325-9541

 

Parker County

1715 Santa Fe Drive

Weatherford, TX 76086

(817) 599-7634

 

Administration Office 

2101 West Pearl Street

Granbury, TX 76048

(817) 579-4400

 

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