If you struggle with addiction, then I want to share with you the approach I use in clinical practice which may help you decide whether I am the right person to see.
There are many different therapeutic approaches that science has shown to be effective in treating addiction. This is good news! But it’s also a bit misleading, particularly if you have been to treatment before and continue to struggle. The reason is that there is not one specific approach that can effectively address all that needs to happen to successfully overcome addiction. In my early days as a counselor I became extremely frustrated seeing clients who had successfully completed treatment return weeks or months later due to relapse. It got me very interested in why treatment often failed clients, and what we can do about it.
Over the years I realized that treatment had not really failed. I was doing good work, and so were my colleagues. Nor had clients failed either, they had worked very hard in treatment. What we had all missed, was that for most who struggle with addiction, treatment needs to be a long term venture, delivered over years, and often a lifetime. Just like other chronic medical conditions (asthma, diabetes, hypertension), when the treatment is removed, problems return. This led to the realization that if treatment for those who struggle was to be delivered over many years, then the interventions needed to adapt and change as the client’s life changed. This meant developing a framework where many different treatment approaches could be utilized at different stages and times in therapy. The approaches that work best in the first few months of treatment are different than what works best a few years later. Thus the 5 Actions™ framework was born!
The 5 Actions™ represent the bare-bones necessary components to successfully overcome addiction. Within each action, there are numerous interventions that can contribute to good outcomes. It’s worth noting that interventions include both professional treatment and activities outside of expert help. While somewhat sequential, in truth the various actions get implemented more based on needs in the present moment. And there is no endpoint to any of them, because there is work to be done on each of them over the lifespan. Here is a brief summary of the 5 Actions™:
Action 1: Motivate
All behavior change (initial and sustained) requires motivation. It’s the fuel for getting from A to B, and is at the center of a number of the most influential theories on addiction (e.g., Motivational Interviewing, PRIME). It is the first action because motivation is the fuel necessary for following through with the other actions. Overcoming addiction can be incredibly challenging when the motivational tank is low, which often happens for those who have been to treatment multiple times and continue to relapse. It also gets low during times of stress, down moods, and when basic needs like enough sleep and a healthy diet are not met. So the 5 Actions™ approach begins by putting a strong emphasis on motivation, keeping the tank filled up, and utilizing both internal and external interventions, that include: rewards, positive relationships, goal-setting, and enhancing optimism for the future.
Action 2: Evaluate
One failure of our current addiction treatment system is the lack of a consistent use of a validated and reliable evaluation tool that both assesses addiction and co-occurring life challenges (i.e., mental health, physical, social). The most commonly used tool today, the Addiction Severity Index (ASI), assesses severity of substance abuse problems, but fails to evaluate behavioral addictions or diagnose mental health disorders (although it does screen for them). This action takes a different approach, a systems approach to evaluation. It not only assesses the most critical factors directly and indirectly contributing to addiction, but it also helps you identify powerful leverage points for intervention that most often are missed in traditional evaluations. It also helps you realize that not every factor needs to be treated. Why? Because if you intervene on one factor that is a leverage point in the system, the other factors will change as well, because they are all connected and influence each other.
Another key aspect of the 5 Actions™ evaluation is that not only are life challenges assessed, but strengths and natural talents are also identified, so it is a more balanced way of looking at your life. The output of the evaluation then falls into three buckets: 1) issues that require a solution, that need to be resolved, 2) issues that have no solution but require management over time, and 3) things that you need to create in your life that necessitate an entirely different energy and focus than problem-solving.
Action 3: Resolve
Interventions in the resolve bucket focus on problems and life challenges that have a solution. Foremost are crisis issues, such as being suicidal, homeless or hungry. It’s crazy to intervene on other issues before basic life needs are met. At this point you might be wondering whether addiction is a problem to resolve? It depends. For some who are quite early in their addiction history and have relatively few complicating issues, its possible that addiction can be resolved. For most, however, addiction more resembles other chronic illnesses like diabetes and hypertension, and therefore fits better in the manage bucket. But no matter which bucket you place addiction, there are many other issues in each bucket that must be addressed if you are to successfully overcome addiction.
Perhaps the two most critical issues to resolve are untreated trauma, and developmental deficits specific to initiating, developing and maintaining healthy relationships. Most who struggle with addiction have untreated trauma and often have no idea how it continues to fuel addiction, depression, and all sorts of other life challenges. Developmental deficits are one outcome of trauma, and include challenges reading non-verbal gestures, connecting with affects and feelings in the body, and translating them into appropriate words and actions. Fortunately, many good trauma therapies exist, as do a number of developmentally-based therapies as well – all of which fit into the 5 Actions™ approach.
Action 4: Manage
Interventions in the manage bucket address chronic, long term problems or challenges where no sustainable or identifiable solution exist, so the focus is on how best to manage these things over time. Examples include: stress, chronic medical issues, chronic mental health issues, sleep, diet, exercise, time and money. And yes, for most, addiction is a problem best managed over time. By managed I mean that the actions you take on a regular basis produce the outcomes you seek. If abstinence from drinking is the goal, then manage means that what you do each day allows you to go day after day without alcohol.
One benefit of grouping chronic issues in the manage bucket is that most evidence-based interventions work across the spectrum of issues. This is great news, because it means you can do certain things that benefit all of your chronic issues at the same time (think leverage points)! Such interventions include: setting goals and tracking behavior, preparing for and managing relapses, exercising, eating healthy, getting proper sleep, mindfulness practices, and many other things.
Action 5: Create
Treatment often fails because it neglects individual talents, strengths and virtues. Energy is expended on problem-solving interventions (Actions 3 and 4) at the expense of ignoring the incredible benefits that come from focusing energy on optimizing life. The field of positive psychology has helped us understand that often our most significant challenges in life can be addressed by not trying to address them at all, but instead focusing our efforts on what we want to bring into the world. The energy used to create cool stuff that makes the world a better place is a different kind of energy than that expended solving problems. So interventions in the create bucket indirectly help you overcome addiction because they provide an answer to “what am I going to do with my life energy if I am not engaging in my addiction(s)?”
Interventions in Action 5 enhance psychological wealth, and include proactive lifestyle design, ME/WE balance, spiritual practices, engaging in meaningful work, and recognizing that a good life is built on a network of quality relationships.