Cognitive Behavioural Therapy (Brilliant Business) 1st Ed.

11. Breaking the cycle: using CBT to overcome addictions and destructive habits

There are few of us who can’t identify with the truth of the old Chinese proverb: ‘Habits are cobwebs first; cables at last.’ Whether our destructive habits range from trivial but annoying things like procrastination or biting your nails, to more serious problems with drugs or alcohol, we can all find ourselves locked into undesirable patterns of repeating behaviour that can undermine our quality of life. Addictive behaviour is becoming an increasing problem for our society. Between 2009 and 2010 there were over a million alcohol-related admissions to hospital and figures from 2007 suggested that 10% of men and 4% of women were showing some signs of alcohol dependence. Drug dependency figures are also on the increase, not to mention the increasing numbers of us reporting having fallen prey to modern addictions like obsessive use of internet pornography and social networking sites.

Finding yourself so out of control – however you may rationalise it to yourself – is a miserable experience. Fortunately, whatever form your personal compulsions may take, the evidence is that CBT offers one of the most effective approaches to understanding and managing such difficulties, even if you have reached the point at which your habits or addictions very definitely feel more like cables than cobwebs.

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Source: www.CartoonStock.com

Understanding the ties that bind – what is addictive behaviour?

You may have turned to this chapter looking for help in dealing with a very minor annoying habit or an incredibly common problem like smoking or overeating that affects huge numbers of us. If this is the case (and even if you use recreational drugs and smoke a little more cannabis than you suspect is good for you) being invited to lump yourself together with someone struggling with a full-scale opiate addiction or who meets the diagnostic criteria for alcoholism may seem ludicrous, possibly insulting. But please bear with me. Although there are clearly some significant differences between the major addictions and the more trivial, common or garden habits most of us fall into at one time or other, many of the mechanisms underlying these problems, big or small, are remarkably similar. I will be taking several examples from cases of more significant addictions, because the extreme nature of them helpfully illustrates some of the principles involved. But just remember: there is very little advice pertinent to them that does not also apply to the tackling of the minor stuff that, as you probably already know, can still prove remarkably hard to shift.

What’s the payoff?

The cognitive behavioural view of addictions and habits regards them all as forms of learned behaviour, reinforced by the rewards they provide for us. It’s important to acknowledge that addictions and habits persist because at some level they work for us. They can be genuinely pleasurable and may successfully (if only temporarily) relieve states of pain, tension, boredom or distress. This is why they become such powerfully conditioned responses. Addictions are dysfunctional coping strategies that help us get our needs met: it’s just that the way they meet those needs oftens comes at a heavy price. When we have an addiction or indulge a bad habit we want the immediate results; we turn a blind eye to the long-term consequences. Nicotine, caffeine, alcohol, heroin, procrastination, obsessively playing Angry Birds into the small hours every night: whatever form our habit takes, it will almost certainly make us feel good or, stop us feeling bad, for at least a while.

Addictions and habits usually take place within specific contexts and they are developed and are kept going with the aid of characteristic thought patterns. Habits and addictions are actually very similar to each other in terms of their underlying mechanisms, varying only with regard to their degree of severity and the level of disruption they cause to your daily life. Some addictions are purely psychological but, when mood-altering substances like cocaine, nicotine, and alcohol are involved, they may create elements of physical dependency as well: the body gets used to the poisons you are putting in and reacts strongly if they are withdrawn.

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Is there such a thing as an addictive personality?

The jury is still out on this question. It does appear that the way the dopamine receptors are distributed in some people’s brains may give them poor impulse control and make them vulnerable to abusing stimulants. However, rather than looking for answers in our genes or a specific personality ‘type’, we would do better to be aware of the character traits and moods that can put us at risk: if we are particularly anxious, impulsive, sensitive or someone who just craves different kinds of altered states, then we need to be on our guard. Invoking the concept of an ‘addictive personality’ is generally unhelpful, because it can become an excuse. It creates the impression that if we fit the type, we stand little chance of controlling our behaviour, which of course then may become a self-fulfilling prophecy.

Introducing the cognitive model of addiction

The following model illustrates some of the main features of the cognitive model of addiction. These features explain how addictions and habits are established, and why they then become so hard to break.

Aaron Beck proposed that early experiences and key life events create mindsets that dispose some people towards addictive behaviours. For example, if your father was always in the habit of pouring himself a large whiskey after getting in from work, you might have absorbed the belief that ‘regularly drinking alcohol is normal and good way to relax’. On the other hand, if you have had the misfortune to suffer trauma or abuse in childhood, the common knowledge that people sometimes use drugs to numb emotional pain or calm themselves down can be all the encouragement you need to start considering using them yourself. Or perhaps social learning mechanisms mean that you have simply copied the bad habits you observed in others?

A cognitive behavioural model of addiction

A cognitive behavioural model of addiction

The way we learn to see ourselves can also promote addictive habits. If you are prone to outbursts of rage, or your impulsive behaviour keeps getting you into trouble, you may develop unhelpful core beliefs like, ‘I don’t have much self-control’ or ‘My will power is pretty weak’. Put yourself in a setting where someone offers you a cigarette (even though you are trying to give up) and your self-image can end up weakening your resistance to temptation. Repeatedly failed attempts to conquer addictions or overcome habits can also strengthen negative automatic thoughts that such acts of self-control are beyond us.

For most people with addiction issues, exposure to the relevant triggers is usually what brings their good intentions crashing down. These triggers can be internal such as unpleasant moods (or euphoric ones for that matter) or external, such as the company of particular people or settings that facilitate our habit. These triggers and cues activate your beliefs about whatever it is you are addicted to and cascade negative automatic thoughts that generate powerful cravings: ‘Those pub crawls with the lads were just the best’; ‘How I’d love to be cashing in a big pile of chips at the end of the evening’; ‘Those online girls are just unbelievably hot…’; ‘I’m going to feel brilliant if I can just get to the next level…’

The human brain is a pattern-making device. It creates connections between things that occur together. Because we learn to associate addictive behaviours and their payoffs with the settings, actions, moods and people that accompany them, just being around those things lowers our resistance and makes us much more likely to fall back into addictive patterns. The smell of cigarette smoke makes us want one, the bright lights, euphoria and pumping rhythms of the club music turn our thoughts to the ecstasy tab we are used to having as part of that experience. This is why lifestyle changes that reduce exposure and access to these triggers are such a crucial aspect of conquering more serious and destructive negative habits.

A key component of the cognitive model is that cravings also prime any number of facilitating beliefs. These are the things addicts tell themselves that make it more likely they will yield to temptation. They might include:

·        positive expectations of the outcome of using or indulging, usually maintained by screening out or dismissing any potential negative consequences (e.g. ‘If I take one of these I will be the life and soul of the party …’; ‘One hit and all my troubles will be gone for a while …’)

·        rationalisations of the addictive behaviour or habit (‘A second slice of that cake will taste amazing and will keep me full until lunch time so I won’t have to keep on snacking …’)

·        permissive beliefs: thoughts and attitudes that justify using or indulging (‘It’s been a tough day: I deserve to relax…’; ‘Life’s too short not to have fun!’)

·        self-efficacy beliefs that encourage you to see yourself as incapable of resisting (‘I have a physical dependency that makes me keep using…’; ‘I am just a weak person who can’t say “no”…’).

These beliefs lower resistance to the cravings yet further and commonly precede a lapse. As you can see from the model, this then serves to strengthen the original learned behaviour, reinforces the associated automatic thoughts and beliefs, and makes people more responsive than ever to the relevant cues and triggers in future. ‘Bad habits,’ someone once said, ‘are like a comfortable bed … easy to get into but hard to get out of …’. Any behaviour that we repeat often enough becomes a learned response that is ever more likely to just keep replicating itself in the future.

In for a penny…

It’s not just habit that drives this pattern, it’s also what we tell ourselves afterwards. The old saying ‘in for a penny, in for a pound’ reflects the ethos of what psychologists have called the abstinence violation effect. In a nutshell, this means that once we feel we have slipped up, we tend to resign ourselves to further transgressions without putting up much of a fight. We have effectively ‘proved’ to ourselves that we can’t avoid our habit or keep ourselves clean, so we revise our beliefs about our self-efficacy. Seeing ourselves as helpless then increases our chances of acting in a helpless way in future. Also, because we have ‘blown it’ and the difficulty of resisting is no longer offset by the potential gains of abstinence, part of us feels that we might as well enjoy the pay-off of the addictive behaviour. One slip then becomes the prelude to a massive binge.

Who are you kidding?

Have you ever found yourself ending up in trouble even though you thought you were doing your best to avoid it? This often happens to people with addictions too. While investigating the processes leading to relapse, psychologists Marlatt and Gordon found that addicts made a lot of ‘seemingly irrelevant decisions’ (SIDs). These amount to self-sabotaging choices that expose people to triggers and cues that can erode their conscious good intentions.

For example, Bill who is trying to give up smoking, ends up mysteriously taking a seat right near the smokers’ lounge in the airport, even though there are many others available to him. Jane leaves four bumper bags of crisps in the cupboard because now she’s on a diet she knows she will only eat them in moderation. Now sober for two months, Robert decides to take the bus rather than drive to Tara’s twenty-fifth birthday bash, even though he knows that previously the knowledge that he is going to have to drive home at the end of the evening has stopped him from drinking. After all, he’s not going to be drinking anyway, is he? These innocent, apparently inconsequential choices are not really innocent at all. They are an indirect means of placing yourself in temptation’s way, based on an unconscious recognition that when you do so, you are much more likely to fold.

Getting ready to change

Established habits are not easy to break: if they were, addiction wouldn’t be such a big social problem and new year’s resolutions might have some teeth. Deciding to free yourself from a habit or compulsion is a significant step, and it requires a bit of preparation and planning if it is to stand any realistic chance of working. Often attempts to break habits and addictions fail because people haven’t thought through what is likely to be involved, they haven’t properly understood the nature of their problem, or because they are not quite ready to change in the first place.

Psychologists James Prochaska and Carlo Di Clemente believe that effective change is not just a one-off decision but the result of a whole process, and one which may have to be repeated several times. In their model, throughout the various ‘stages of change’ the individual’s attitudes, priorities and thought pro-cesses evolve. They position themselves towards the prospect of change in new ways, and each stage of change brings with it different tasks and fresh priorities.

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Prochaska and Di Clemente’s stages of change model

Stage one: precontemplation

During the pre-contemplation stage, most people are not really prepared to admit to themselves they might have a problem. You may have a sense that something isn’t right, but are certainly not quite ready to do anything about it. At this point you will rely on a whole raft of strategies including denial, self-justification and cognitive biases to avoid the issue. So what if you still smoke 50 a day? A few decades ago everyone smoked … Some people might say that spending four hours in the gym everyday was too much but we all know exercise is good for you and anyway the pounds are just dropping off … The best thing you can do for yourself at this point is to become more aware of the distortions in your thinking and stop shutting off the negative consequences of your actions.

Stage two: contemplation

If the negative impact of the problem increases, this might move you into the contemplation stage. This is the stage at which you allow yourself to think about the problem or addictive behaviour in a more objective manner in order to reach a decision about the best way to proceed. You will be looking carefully at the pros and cons of the behaviour, considering the benefits and costs of the alternatives, and evaluating what resources you have at your disposal to make a lasting change. A number of techniques and strategies may be useful to you at this point:

1.     Keeping a diary in which you look at the frequency of the behaviour, its impact on your life and how it makes you feel throughout the day. There are a number of handy applications now available like Moodscope and Moodjournal that allow you to do this very easily (see Appendix 2).

2.     Performing a costs–benefit analysis that takes into account both the short- and long-term outcomes of the behaviour you are thinking about modifying. The table overleaf is an example of what this might look like. You need to be clear about your motivations. It’s going to be tough at times, so you need to convince yourself that change really is worthwhile.

3.     Making an inventory of the resources, qualities and experiences that indicate that you may be able to make the change you are thinking about. This might include recalling previous occasions when you have accomplished something difficult, looking at the conditions under which the habit or behaviour seemed to have less of a hold over you and thinking about the people and organisations that might be able to offer you support in your attempts to break the cycle.

4.     Collecting the information you need to start creating your personal formulation. This is a vital step as it will form the basis for your action plan, coming up next. Look back at the model of addiction on page 221 and start personalising it. You should be trying to identify the situations in which you are most vulnerable and the internal/external triggers that lower your resistance. You need to isolate any thoughts that make abstinence harder, and those that are likely to make things worse if you do slip up.

An example of a cost–benefit analysis grid

Target behaviour: spending all my free time on internet porn sites

 

Positive consequences (gains)

Negative consequences (losses)

Short-term

Exciting

Pleasurable

Allows me to ‘switch off’ from real life

Feeds and develops my fantasy life

Takes up more and more of my time

Stops me from doing other things (spending time with friends/playing sport)

Less and less rewarding the more I do

Makes me tired

I feel guilty afterwards

I find myself looking at more hard-core stuff that I don’t feel comfortable with

Makes me feel cheap, like I’m getting off at the expense of other people

Expensive – big credit card bills

Long-term

Helps me think of myself as a red-blooded guy – someone who isn’t prudish about sex

Supports an industry that exploits people

Will damage my relationship with Sam

Makes me feel ashamed of myself

May damage my chances of job promotion if it starts taking over any more of my time.

Stage three: action

This is the point at which your newfound resolution has to be translated into a practical and realistic plan that you stick to. There are a number of principles you should adhere to if you want to create effective change.

Set realistic goals

You must decide what the right targets are for you. For some people, aiming for total abstinence is the way to go since anything less exposes them to cues that increase their risk of relapse. For others, it makes sense to set more modest goals, particularly if you are in the process of tackling a physical dependency: going ‘cold turkey’ can be so assaulting to your body that many people quickly collapse under the pressure. Sometimes focusing on reducing the quantity of a substance used, or the frequency or duration of critical behaviours creates more sustainable goals that will produce better results in the long term. Crash dieting invariably ends up in subsequent binge eating and the pounds pile back on so you need to think carefully about what you can manage.

Draw up your plan of campaign

On the basis of your formulation you need to determine three things: firstly which negative or unhelpful thoughts or beliefs you are going to change and how to go about it, secondly how you are going to reduce your exposure to cues and triggers, and finally how you are going to deal with cravings and urges when they do arise.

Attack the thoughts that support your habit

From a cognitive behavioural perspective, working with the thoughts that drive addictive behaviour is no different from tackling other thoughts that are unhelpful. It is still a question of identifying the biases, distortions and unwarranted assumptions, and then mobilising evidence to help us replace our negative thinking with more balanced and productive alternatives. Try to notice which thoughts are the most toxic for you and target those if you can.

Use the techniques described in Chapter 4 to interrogate and revise your negative assumptions, as Francine has started to do below in a thought record that relates to her compulsive shopping habit.

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When tackling the thought patterns that drive addictive and habit-forming behaviour, it’s also a good idea to observe the following four principles:

1 Target the right beliefs

As with all CBT interventions, it’s important to be wise about selecting the beliefs that you are going to target. As you have constructed your formulation you will probably have become aware of certain beliefs that play a particularly important part in keeping the addiction or habit going, while others play more supporting roles. If you can effectively modify these key cognitions then it makes it much easier to bring the edifice of your addiction crashing down, although you can also start by chipping away at less central beliefs until the plausibility of the whole structure is weakened. For example, in the case of Paul, who has a gambling addiction, a critical belief might be, ‘If I can just win big one time, then it will make up for all the money I’ve lost over the years …’ whereas examples of less key (but still significant) cognitions might be: ‘I like the excitement that comes with knowing I might have a winning ticket in my pocket’ and ‘Being part of the Friday night poker game takes my mind off work and allows me to relax with my friends …’ It is probably a good idea to target at least one or two critical beliefs relatively early on because otherwise your resolution to get on top of your problem may wane over time.

2 Get specific

In tackling habits and addictions it is particularly important to make your negative automatic thoughts as concrete and specific as you can. Thoughts relating to addictive behaviours can be notoriously and even deliberately vague, which makes them hard to get a purchase on or counteract effectively.

For example, the belief ‘Drugs make my life bearable’ is hard to grapple with because it is so general. To get to the underlying NATs use techniques like the downward arrow technique (page 66) or interrogate the belief using relevant lines of questioning:

·        In what ways do I think my life would be unbearable if I didn’t use drugs?

·        In what ways do I believe my use of drugs helps me?

·        What did I experience and do during those periods when I used drugs less than at present?

·        What problems are drugs solving for me and how are they doing that?

3 Get your facts right

Ignorance may not be bliss but it certainly helps if you intend to keep on abusing drugs, alcohol or nicotine. In order to justify our addictions we often need to keep ourselves in a state of semi-ignorance about the reality of the consequences of our habits. We may even deliberately cultivate misconceptions that make us feel more comfortable about continuing as we are. For example, people who use drugs or rely on alcohol often deny the health risks involved or entertain false beliefs about the substances they use and how damaging they are.

If you are serious about overcoming your addiction you may need to equip yourself with accurate information about your habit. There are many unbiased and reliable sources of information available online (such as www.talktofrank.com for substance abusers). The facts you find on such sites can be invaluable in arming you to challenge false beliefs about your addiction.

4 Use experiments to test your addiction beliefs

Most addictions and habits take the form of behaviours, so the related thoughts often lend themselves to behavioural experiments that can be a powerful means of refuting them. The following are a few examples of the addiction-related beliefs that might be amenable to experimental investigation:

·        Beliefs about the perceived negative impact of reducing the habit/addiction. For example, Cal decides to explore her belief that ‘stimulants make me work better’ by comparing her productivity during a month in which she drinks her habitual eight cups of double-shot espresso and one in which she limits herself to two a day.

·        Beliefs about your inability to cope with your moods without the help of drugs, food or alcohol. For example, Nadine decides to test her conviction that ‘filling myself up with food is the only way I can manage to handle the pain that my loneliness causes me’ by sampling and rating her mood every 10 minutes for an hour after her customary binging cycle and then rating her mood if she spends the hour reading through a pile of magazines instead of overeating.

·        Beliefs about the importance of limiting exposure to triggers. For example, Darryl decides to keep a cravings diary to monitor the amount of cannabis he smokes over a period when he spends time with fellow ‘dope-head’ Nick and a period when he avoids Nick’s company to test out his belief that ‘being with Nick doesn’t necessarily mean I will smoke more weed’.

·        Beliefs about the rewards and performance benefits of addictive behaviour. For example, Geoff decides to examine his belief that ‘when I’ve had a drink beforehand, I am less tongue-tied and other people relate to me better’ by asking his friend Jamal to observe any difference in the reactions of party guests to him if he presents sober, compared with the reactions he gets at the next event when he arrives with a good few pints inside him.

Implement behavioural changes that weaken your habit

The main thrust of your work in this area is firstly to reduce your exposure to both internal and external cues that keep your habit or addiction going and secondly to put in place lifestyle changes that will help you feel better about yourself and support a habit-free existence.

Obviously if you have a physical dependency on a class A drug or a serous alcohol addiction, one of the first steps may be to undergo a process of physical de-toxification. If you fall into this category you are strongly recommended to seek professional help because some detox regimes are best conducted in in-patient settings, where you can also be given appropriate follow-up and support. Please don’t let embarrassment or any other factor prevent you from consulting your GP if you fall into this category and think you might benefit from this kind of help.

Develop new skills

Your action plan should incorporate the development of any new skills you might need to learn or that will reinforce healthier beliefs. For example, you might decide to take a yoga class to help you relax, so you have resources to help you cope with any stressful feelings.

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If your addiction is connected with your body in some way, doing regular exercise or even booking some sessions with a personal trainer at the gym can give you something else to focus on, get you out of the house on a regular basis and increase your sense of self-efficacy as you watch yourself achieving your fitness goals. For people who use substances of various kinds, doing something physical and actually taking care of their bodies can underline a really helpful message that their priorities have changed. Exercise also releases natural endorphins that make you feel much better and can counteract any physical effects of withdrawal.

Take practical steps to prepare for temptation

Planning what you can do physically when cravings take hold is also a helpful precaution. Perhaps you could identify a favourite walk you will take yourself on or make sure you get in a ready supply of DVDs to give you something else to focus on when the cravings get bad.

Keep yourself out of harm’s way

The most crucial aspect of behavioural change when tackling addictions is being very clear with yourself abut the behaviours and settings that make it harder for you to resist and developing a routine that keeps you well away from these fatal triggers. In the action phase you may have to take alternative routes getting from A to B in order to stay out of harm’s way. If your route to work happens to take you past your dealer’s house you are likely to end up in trouble. Find an alternative route.

Be careful of the company you keep

If you are serious about getting on top of an addiction, you must identify and stay away from people who encourage your habit. It’s hard to give up smoking if you hang out with smokers, or drinking if you allow yourself to spend every evening in the pub. The chances are today’s orange juice will become tomorrow’s rum and coke.

Extinguish opportunities for relapse

This is also where activity scheduling comes in. If you know from your diary that you are most vulnerable to your habit in the two hours when you come in from work before your evening meal, then fix up a regular meeting with a friend or take a class during that window to make sure you don’t end up on your own with time on your hands and opportunity to succumb.

Schedule in alternatives

However, it’s much easier to hold out if you have given yourself something else to do instead. Most serious addictions consume huge amount of people’s time and resources. Perhaps you can motivate yourself by investing some of the time and money you get back into doing something you’ve always wanted to achieve for yourself, or in finding alternative ways to enjoy yourself? However, unless you schedule it in, it may very well never happen.

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Habit-proof your environment

Rid your home of as many cues and triggers as you can. If looking in mirrors activates negative thoughts about how ugly and fat you look, then take them down and use a pocket mirror when you really need to. Don’t be tempted to test your willpower by leaving addiction or habit-related paraphernalia around the house. Perhaps you know that having loose cash at home is fatal for you because when you see it you thoughts turn immediately to spending it on drugs? Whenever possible try to addiction-proof your environment so it feels safe for you.

Dealing with cravings and urges

If you are considering changing any established pattern of behaviour it is very important not to be naïve. You are going to be tempted to slip back into your old ways, and remember, the habit established itself in the first place because you find it so seductive. You mustn’t underestimate this. Be aware, especially in the early stages before alternative healthier habits have had a chance to take root, that you will inevitably be confronted with cravings. Research suggests that people who plan ahead and who have decided beforehand what they will do when temptation strikes stand a much better chance of getting through their cravings.

However, the trick is to stay firm when your cravings are screaming at you. The following techniques may be of assistance.

Get out of there NOW!

Addictive behaviour occurs in particular contexts. Make a deal with yourself that if you find yourself weakening you will stop what you are doing and quickly remove yourself from the situation in which the craving has become acute. That might mean going for an impromptu walk or taking yourself to a public place where you won’t have the opportunity to pursue your habit. It might mean excusing yourself from a social gathering in which drugs or alcohol have started triggering unwanted thoughts.

Surf the urge

Like anxiety, cravings have a natural life cycle. They build to a peak and then, if you don’t gratify them, after a while they really will subside and leave you alone. The trick is to stay the course. Just acknowledging the wave-like trajectory of a craving, and learning how long they take to die down, can be really helpful. The mindfulness approach emphasises that if we do battle with our feelings they are likely to gain greater control, whereas if we step back, notice and accept them for what they are – just feelings that we don’t necessarily have to act upon – we can allow them to pass out of our minds much more easily.

Distract yourself

When you find yourself preoccupied with thoughts about your habit or addiction, try to fill your mind with something else. This might involve giving yourself a task that will absorb your resources like doing a puzzle or a crossword, or applying yourself to a hobby or pastime that you find interesting or enjoyable. It might mean taking a bath or going for a run – doing something that will generate alternative sensations in your body. Perhaps you need to phone a friend or direct your attention towards someone else.

Refocus your motivation

Remind yourself of the gains in both the short- and long-term quadrants of your costs–benefits analysis grid. Also mentally re-run the costs of not getting on top of your addiction. Cravings have a habit of shutting down our access to the future; they are all about immediate gratification in the here and now. Under their influence your head will be full of images of how great it would be if you allowed yourself a cigarette, a drink, a line of cocaine, a tub of ice cream. At this point you need to ‘unfreeze’ time and play the movie forward into the future when you have to pick up the pieces and deal with the consequences of your lapse.

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In case of emergency break glass!

Some people deliberately create an image of their very worst-case scenario - the lowest point to which their addiction could lead them - and then lock it away in a little red box in their head so that if they feel their resistance is about to collapse they can get it out, contemplate the full horror of it, and generate fresh resolve.

Employ positive self-talk

In 1972 psychologist Walter Mischel conducted a famous investigation into willpower with four to six year olds. He offered them the opportunity to eat one marshmallow straight away or, if they could just wait until the experimenter came back in the room, they could have two. The children who managed to hold out were more often than not those who talked themselves through the situation, reminding themselves of the reward that lay ahead and encouraging themselves to be strong. When faced with temptation it’s useful to keep telling yourself why you need to resist, and to rehearse positive self-statements that encourage you to believe that you can!

Use flashcards

Sometimes it’s hard to use or even remember the techniques described above. Some people find it really helpful to have a pack of cards with them which summarises really succinctly how they should respond and what they should be doing when temptation strikes. Restrict your messages to very brief instructions and exhortations.

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Imagine you are facing a craving right now. Write out a list of five positive self-statements that you think might help you stay strong in the face of temptation and commit them to memory. Now prepare a set of five flash cards, each containing one brief phrase that summarises what a good friend or counsellor would advise you to do in that situation.

Stage four: maintenance

Things are going well. You’ve followed the plan, done all the things you should and it seems to be working. You can feel your habit, addiction or compulsion starting to loosen its grip on you. You’re feeling good about yourself, more positive about life. This is surely the time you can relax and congratulate yourself for a job well done … Well, actually no. This is ironically precisely the time when you are most vulnerable to relapse, at the very point when you feel you have turned the corner. The problem is that people in the maintenance phase often get complacent.

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People doing well in recovery get lulled into a sense of false security. It is for this very reason that organisations like Alcoholics Anonymous don’t like their members to talk about being ‘cured’ and urge them to keep attending meetings at which speakers, however long sober, always introduce themselves with the phrase, ‘Hello my name is Martin and I’m an alcoholic …’ This is not to humiliate them but to keep them on their guard. Organisations like AA know how easy it is to relapse, even if you appear to be well in control of your habit or addiction.

It’s important and right to celebrate your victories and the pas-sing of significant milestones in your fight against addiction or the habits that have dogged you. We all need encouragement and such markers remind us that we can be strong. However, we also need to keep monitoring our progress, keep ourselves away from triggers, and use the respite from cravings to build up our resilience. This might be the opportunity, for example, to see a therapist about the childhood abuse that primed your gambling habit in the first place. You also need to keep an eye on yourself, checking you aren’t making any of those risk-laden ‘seemingly irrelevant decisions’ or sneakily replacing one addiction with another.

Stage five: relapse

Not a cheery note to end on, I appreciate, but the point is that Prochaska and Di Clemente’s cyclical model is a cycle. You may re-enter it at different points but the reality is that most of us will go round it more than once. Relapse, while not inevit-able, is very normal. The thing that does the damage is usually not so much the relapse itself, but what happens to people in the wake of it. We have already mentioned the ‘abstinence violation effect’, when people relinquish control completely after a slip. It is after you have found yourself giving in to your habit or addictive behaviour that you most need to gather your resources and determination to regroup, reset and resist the urge to throw the baby out with the bathwater.

Tell yourself that relapse is a normal part of recovery (because it is). Think of it like a military campaign. Losing one battle doesn’t normally mean losing the war; it’s the repeated loss of battles that causes you grief. If you fall off the wagon, simply pick yourself up and dust yourself down. Remind yourself it’s a long game and use thought records to challenge all the negative and unhelpful thoughts that will inevitably be crowding into your head. Revisit your goals and adjust them if necessary. Review your original motivation and remind yourself why it’s worth persisting. Think about the point at which it makes most sense to re-enter the Stages of Change wheel. If you do this properly there are many people out there who can testify to the fact that, however many times you relapse on the way there, you can still ultimately be victorious and get to the point where you control your addictions and habits rather than the other way round.

However, if you are battling significant addiction problems, please don’t try to go it alone. Whatever the nature of your addiction or compulsive habit, there are many dedicated groups and organisations out there very used to offering guidance to people struggling with the same issues you are facing. Cognitive behavioural techniques can be powerful, and many drug and alcohol services use them, but they are much more likely to work for you if you have some proper, experienced support behind you while you attempt to apply them.



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