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Addiction

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Substance Use Disorders

Substance Use Disorders

By Peggy L. Ferguson, Ph.D.

Substance use disorders involve complex mental and physical health issues that can devastate individuals and their families.  Individuals with substance abuse problems experience an impairment of control, defenses that keep them from realizing they have lost control, obstacles to achieving abstinence, and ongoing challenges to maintaining recovery.

Loss of Control
In substance abuse, loss of control does not have to be a "complete loss of control." Those who cannot consistently control or predict what will happen when they take the first drink/drug have lost control.  Defenses seduce the afflicted person to believe they still have control, supplying "reasonable" explanations for failed attempts to control use.   Despite conspicuous examples of loss of control, the inability to identify and accept the loss of control contributes to the perpetuation of ongoing substance use, ultimately leading to destructive behaviors and further complications.   When an individual's substance use becomes compulsive and persistent, they have lost control of their use.  Substance use becomes a priority, and their behavior and lifestyle choices begin to revolve around the substance.  As the addiction progresses, people with substance use disorder experience more frequent loss of control, leading to potentially dangerous and destructive behaviors.

Early Recovery
Early recovery from substance abuse and addiction can be difficult, involving intense cravings bolstered by defense mechanisms.  Individuals in early recovery must learn to identify and address their cues, triggers, and cravings, to manage them to remain sober.  They must then learn to develop new living skills, such as dealing with feelings and learning other new recovery skills.

Cravings and Defense Mechanisms
Cravings, bolstered by justifications for using, are common in early recovery.  Cravings are the intense urge to use drugs or alcohol and can be challenging to resist.  Defenses are the justifications and cognitive distortions that people use to allow themselves to give in and take that first drink/drug after a decision to quit.  Cravings can occur at any recovery point but are usually the strongest and longest-lasting in the transition to recovery.  Recognizing and addressing cravings and the defenses that empower them is crucial in early recovery to interrupt the momentum of addiction.  

Detox
Detox is the process of removing all mind-altering substances from the body.  It can be difficult, with the discomfort or fear of pain derailing the person's attempt to get sober.  Detox can involve a variety of physical and psychological symptoms and may require medical supervision.

Dealing with Myths
Many individuals with substance use disorders may be unsure how to escape their addiction.  When contemplating what to do about one's drinking or using, myths and stereotypes confuse the situation with the seductive story that since they haven't lost everything, only drink beer, or don't drink every day, they don't have a problem.  They may believe that they must hit bottom and lose everything to get sober or are "too far gone" and that recovery is impossible.  Dealing with myths and stereotypes may be the first obstacle to healing. 

Dealing with Feelings
Many people find that when they stop numbing their feelings with chemicals, they return with a vengeance in early recovery.  Feelings of guilt, shame, and anger are common when first getting sober.  Other issues, such as depression and anxiety, are also present but have been masked by the chemical.  It is essential to be mindful of these feelings and other issues to learn how to cope with them healthily.  Support and encouragement for recovery and self-care are crucial.  Many people find they can relate to at least one of the many recovery support groups available.  There is much more to recovery than not drinking/using drugs.   Most people must learn new living skills, starting with coping with feelings of anxiety, depression, and guilt associated with their addiction.

Preventing Relapse
Relapse is a common but preventable occurrence in recovery.  To prevent relapse, individuals must understand their cues, triggers, and thought processes that make it ok to use.  Cognitive therapy helps challenge the rationale for breaking your abstinence to avoid relapse.  Predictable by your loved ones and support system, feedback about impending relapse can empower you to avert it and get back on track if it does happen.

Substance use and addiction are complex issues that require a multifaceted approach.   There is much to learn about substance use and addiction.  There seems to be a huge  learning curve in applying the knowledge to oneself.  Concepts such as the nature of addiction, loss of control, early recovery, detox, dealing with myths, cravings, defense mechanisms, the importance of a recovery support system, and the need for specific recovery skills are essential to overcoming addiction and preventing relapse.  With the right help and support, individuals can find recovery and live a healthy, substance-free life.

Detoxifying the Body, Calming the Mind by Managing Cravings

By Peggy L. Ferguson, Ph.D.

Detox, is the process of removing toxic substances from the body, typically under medical supervision, to manage withdrawal symptoms safely. Cravings, on the other hand, are intense desires or urges to use substances, which can persist even after detoxification.


During detox, the body undergoes physical and psychological adjustments as it eliminates the substance of abuse. Withdrawal symptoms can vary depending on the type of substance used, the duration and severity of use, and individual factors such as metabolism and overall health. These symptoms may include physical discomfort (such as nausea, sweating, and tremors), psychological distress (such as anxiety, depression, and irritability), and intense cravings for the substance.


While detox addresses the physical dependence on substances by eliminating toxins from the body, it does not necessarily eliminate cravings or address the underlying psychological aspects of addiction. Cravings can persist beyond the detoxification process and may continue throughout the recovery journey, fluctuating in intensity over time.


Cravings during detox can be particularly challenging for individuals in recovery. They may experience strong urges to use substances as their bodies adjust to the absence of the drug. Cravings can be triggered by various factors, including environmental cues, stress, emotional triggers, social situations, and conditioned responses linked to past substance use.

Managing cravings effectively is a critical aspect of addiction treatment and recovery. Strategies for coping with cravings may include:


Medication-Assisted Treatment (MAT):

Certain medications, such as methadone, buprenorphine, or naltrexone, may help reduce cravings and withdrawal symptoms during detox and throughout the recovery process.


Therapy, Counseling and InPatient Treatment:

Cognitive-behavioral therapy (CBT), Mindfulness-based Cognitive Therapy, Dialectic Behavior Therapy, motivational interviewing, and other therapeutic approaches can help individuals develop craving management and coping skills, and learn healthier ways of managing stress and regulating emotions.  A specific cravings management plan focuses on a specific set of recovery skills. A more general recovery plan developed in outpatient therapy, counseling, or in-patient treatment serves as an inspiration and a roadmap for a recovering person’s efforts.  


Support Groups:

Participation in support groups like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), SMART Recovery and other non-12-step programs can provide peer support, encouragement, and strategies for dealing with cravings in a supportive environment. Find more information on the Getting Help Page.


Healthy Lifestyle Changes:

Engaging in regular exercise, reading recovery and inspirational materials, creative endeavors, practicing mindfulness and relaxation techniques, maintaining a balanced diet, and getting adequate sleep can help reduce stress and improve overall well-being, which may help manage cravings.  Having a recovery mindset helps keep the importance of recovery supportive activities in the foreground.


Managing Cues and Triggers: It is very important to be able to identify and manage cues and triggers when they occur before they become cravings.  You may be able to avoid some cues and triggers by identifying specific places, people, or situations associated with past substance use.  Avoidance is very important to help reduce the likelihood of experiencing intense cravings.  This is especially true in early recovery when cravings are the most frequent and the most powerful.  Since avoidance is not always possible, other skills and techniques are needed.  


Overall, while detoxification addresses the physical aspect of addiction by managing withdrawal symptoms, managing cravings requires ongoing support, coping strategies, and commitment to the recovery process to achieve long-term sobriety and wellness.

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Essential Ingredients for Successful Addiction Recovery

By Peggy L. Ferguson, Ph.D.

Addiction recovery is never easy, but the right components can make the journey more manageable. While commitment to abstinence is essential, more than this single ingredient is required. The recovery process involves developing a range of skills and coping mechanisms to help the individual navigate the challenges of recovery and life. Here are some essential ingredients for relapse prevention in early recovery that are crucial for long-term success.

Commitment to Abstinence:


The commitment to abstinence, the foundation of addiction recovery, requires an individual's unwavering determination to abstain from alcohol or other substances of choice. This commitment acknowledges a problem and recognizes that the way forward is to become abstinent.  This commitment is managed on a one day at a time basis.

A Support System:


A support system is essential to the recovery process. It should be composed of people who know and understand the individual's challenges in addiction recovery, along with family and friends who support recovery. Every significant person in the newly sober person's life can be a support person and an accountability partner if there is a willingness to maintain openness and honesty. Having a support system offers a safe environment for recovering people to share their struggles, successes, and challenges. Support people often provide a first line of defense against relapse when they tell the person in early recovery that they see old thinking, feelings, and behavior. This feedback is essential to those who are still well-defended in early recovery.  

Abstinence Skills:


Abstinence skills are developed over time as an individual progresses through recovery. These skills include recognizing and managing cues and triggers to avoid cravings and potential high-risk situations. Early abstinence skills also involve applying techniques to withstand the siren's song of cravings. Applying abstinence skills increases the probability of avoiding relapse. These skills improve with practice over time.

Awareness of the Role of Chemicals in Life:


One early recovery task is identifying and understanding substances' roles. It's essential to take stock of the roles the chemical has served. Those roles often appear to be the "reason" for drinking or using other drugs. It is vital to gain insight into the differences between the anticipated benefit of the chemical and the actual outcome. An example could include using alcohol to sleep and interfering with your sleep. Another example could be using alcohol to feel less stressed about not being able to pay a bill, then still not being able to pay the bill after spending your money on alcohol. A recovering person should be able to connect the dots between the desired performance of a drug and its actual performance and impact on one's life.  

A Plan for Replacing The Chemical:


The aim is to replace the roles and functions filled by the substance with healthy alternatives. Replacing the chemical with new healthy living skills involves identifying and acquiring the skills necessary to replace those roles, including stress management, feelings identification, communication, social, and coping skills.

Structure:


Early recovery requires numerous tools for relapse prevention. Structure provides another level of safety, security, and predictability. Having enough of your time and attention structured can keep someone's attention, energy, and activities occupied enough to prevent boredom, rumination, and drifting back to euphoric recall. Time management helps improve productivity and restore self-worth and self-efficacy. Believing in yourself aids in recovery.

Self Care:


Self-care is crucial in improving physical and mental health. Many people find that they experience anxiety and depression in early recovery. Self-care activities such as exercise, nutrition, rest, regular checkups with doctors and dentists, and finding ways to manage both physical and emotional pain are good for reducing or mitigating those symptoms. Self-care is also a core living skill.

Identifying Destructive Defense Mechanisms:


Addictions have a psychological component that fuels compulsive substance use and prevents or delays people with addiction from seeking help. Conscious awareness of the defense mechanisms that enable distorted reality and persistence of continued use despite the consequences is crucial.

Accepting responsibility:


Although people find their way into recovery due to many different kinds of external motives, ultimately, recovery depends on the person's acceptance of responsibility for their recovery. The connection between one's behavior and its consequences is not so straightforward, thanks to defense mechanisms. Identifying the effects of one's substance use disorder, recognizing the damage caused by addiction over different life domains, and owning your addiction's contribution to your loved ones' pain is a painful but necessary component of not returning to the old behavior. Some recovery tasks involve cleaning up the destruction caused by addiction --financially, emotionally, psychologically, socially, spiritually, and physically. Making amends with those hurt by addiction is an example of taking responsibility.

Healing Old Wounds:


Old, festering wounds can serve as a reservoir of excuses for relapse in addiction recovery. Often, many recovering people must do much work to let go of resentments, eliminate repetitive dysfunctional relationship dynamics, and resolve trauma.

Persevering through addiction recovery requires a mix of these ingredients to establish and maintain a healthy, sober lifestyle. While daunting, leaning on a support system, developing coping mechanisms, and dedicating oneself to working through roadblocks and unresolved issues in recovery, individuals can emerge healthier, happier, and stronger than ever.

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"The continued drinking creates a snowball effect, creating multiple areas of disarray in a person's life, destroying their happiness, self-esteem, relationships, and livelihood."

Loss of Control of the Drinking

By Peggy L. Ferguson, Ph.D.

When people begin drinking, it's usually for fun or to feel good. At this time, drinking is not the main focus of their lives, even though they enjoy its effects on them. At the beginning of alcohol use, there is usually an ordinary or reasonable level of importance placed on the drinking. The drinker likes what alcohol does for him. Alcohol can lower inhibitions, offer a sense of camaraderie, and aid in fitting in, but alcohol does not take center stage in his life.
 

Alcohol use can change for those susceptible to substance use disorder. Relief drinking begins relatively quickly, where alcohol serves
psychological or emotional purposes. Purposeful drinking eventually leads to the individual relying on alcohol to solve their problems; consequently, they drink more and build up a tolerance. As alcohol becomes more central in their life, changes begin happening in daily behavior and also in their brain.


As someone with substance abuse disorder begins to apply alcohol as a "problem solver" to more areas of his life, he not only drinks more, he comes to rely on alcohol as a "problem solver." Increased use and increased tolerance happen. "Tolerance" is where the alcoholic needs more alcohol to achieve the same results.


An essential component in a definition or diagnosis of substance use disorder is the loss of control. Eventually, loss of control is noted by observant people in the person's life. One of the reasons that family members do not catch on more quickly is that they usually believe there must be a complete loss of control every time they drink. Everyone assumes that loss of control is an all-or-nothing occurrence. However, for those in the early stages of substance use disorder, occasional loss of control can occur without noticeable changes.

 

Defense mechanisms color the explanation for drinking events. The drinking loved one will sometimes come home after two beers at the bar, keeping their promise, or close down the bar at 2:00 a.m. The family explains this disparate drinking behavior as one of willful disregard for family members' feelings. The observation that their loved one can sometimes drink only two or go for six months without drinking feeds the denial that there is a problem. Everyone in the family can point to the times when the family member with a drinking problem drinks two beers and behaves normally as evidence that there is no problem. These "pieces of evidence" of continuing control distort the overall picture of what is happening in the alcoholic's life.

Loss of control can have different faces, depending on the progression of the illness. After the first drink, the person with an alcohol use disorder cannot reliably predict how many drinks they will have or what will happen while drinking. Eventually, loss of control can involve an inability to withstand urges to drink (cravings) despite a desire to do so or a failure to stop drinking or to maintain abstinence despite one's best efforts.

 

People with a mild level of severity of alcohol use disorder may obviously 'lose control" infrequently. But the illness worsens over time. Remember that loss of control doesn't always mean a consistent loss of control. It can manifest as unpredictable, erratic drinking behavior. The negative consequences of drinking are a part of the illness that subtly affects most areas of a person's life. The continued drinking creates a snowball effect, creating multiple areas of disarray in a person's life, destroying their happiness, self-esteem, relationships, and livelihood.

What About Pot?

By Peggy L. Ferguson, Ph.D.

Marijuana, commonly referred to as pot, weed, or cannabis, is a substance that has sparked considerable debate and controversy over the years. With shifting legal landscapes and evolving societal perceptions, it is more important than ever to have a clear understanding of its effects, risks, and the challenges it presents, especially for those in recovery from substance use disorders.

As marijuana becomes increasingly accessible, many individuals find themselves questioning its role in their lives and its impact on their health and well-being. Even for people without other substance use disorders, marijuana use can spiral into dependence and create a need for abstinence and recovery. For others who are trying to abstain from other mood-altering drugs, it can pose significant challenges to sobriety and complicate recovery. 

In our article "Quitting Pot – Establishing Abstinence in Early Recovery: 16 Tips to Help You Quit and Stay Quit," we explore strategies to achieve and maintain a cannabis-free lifestyle, emphasizing the importance of setting a solid foundation for long-term sobriety. Another essential read, "Quitting Pot: Why You Have to Quit Hanging Out With People Who Use Marijuana," discusses the critical role of a supportive environment in recovery and offers practical advice on how to cultivate healthy, drug-free relationships. The Getting Help Articles and The Links pages may be able to point you in the right direction for finding the help and support you need for your recovery. 

These articles and more provide valuable insights and tools for those looking to navigate their recovery journey. Whether you are just beginning to address your marijuana use or are seeking to strengthen your recovery, the informative resources on this site are designed to support you every step of the way. Understanding the complications of problematic marijuana use and its implications is crucial for preventing relapse and building a fulfilling, substance-free life.

Recovery's Battle: Overcoming Defense Mechanisms And

Illusions of Control

By Peggy L. Ferguson, Ph.D.

When facing substance use disorder, the realization that one has a problem with alcohol or drugs does not come quickly. The telltale signs may have been present for quite some time, but the disorder is camouflaged. To an outsider looking in, it can resemble many other ailments or problems, making it challenging to discern the true nature of the struggle. Someone with substance use disorder may attribute the signs to countless other factors or difficulties.

Defense mechanisms allow people to dismiss substance use disorder as the problem, even in the face of apparent destructive drinking patterns. Before even identifying an alcohol or drug problem, most people with substance use disorder make countless attempts, with a variety of different strategies and methods, to regain control. People with substance use disorder, despite those attempts, eventually realize the harsh truth: consistent control over their drinking or drug use eludes them, and their lives are unmanageable. At this pivotal juncture, they decide "to quit."

Ironically, the decision to quit is not always the catalyst for recovery. Many individuals believe that merely desiring to stop drinking or using drugs is sufficient to achieve abstinence. For a select few, this may be true, but for most people with a moderate or severe substance abuse disorder, the belief that "I can quit any time" is another example of a worn-out defense mechanism. Holding on to defenses that justify maintaining the status quo perpetuates behaviors that impede the transition to recovery. Take note of the following counter-productive behaviors:

Continuing to Socialize with Drinking and Drug-using Friends:

Those with substance use disorder may persist in keeping the company of their drinking and drug-using friends, convinced that they can be around mood-altering chemicals without succumbing to temptation. This situation presents grave risks to the success of initial efforts at abstinence.

Substituting One Substance for Another:

Some individuals convince themselves that their specific drug is the root of their problem. They believe that by switching to a different substance, they can circumvent the negative consequences. Switching drugs of choice leads to cross-addiction and more negative consequences.

Handicapping Professional Help:

They may attribute their struggles to depression or anxiety and seek counseling or psychiatry. Fearing judgment or not wanting to confront all their issues, they may conceal their drinking or drug use issue, leaving it unaddressed. They may seek a pharmacological solution to problems other than substance use disorder and believe it will quell their drinking or drug use. Not being honest with helping professionals undermines any help you might receive. Mixing mood-altering drugs, including prescription drugs and alcohol, can be dangerous.

Relocating to Start Anew:

Individuals grappling with substance use disorder may perceive their friends as the catalyst for their struggles. They may opt to relocate in pursuit of a clean slate free from drug-related associations. However, while distancing oneself from environments that facilitate continued substance use can be beneficial, relying solely on "geographical cures" is often ineffective. Regardless of location, cues and triggers persist, and the most significant trigger, oneself, inevitably accompanies the individual.

Surrendering Control to Others:

Some people get desperate enough to willingly hand over control of their drugs or money to someone else. The power and intensity of cravings lead them to a power struggle over that very control.

Establishing Short-Term Goals:

Setting goals to abstain from drinking or using for a week, a month, or even a year, they mistakenly conclude that achieving these milestones absolves them of any underlying addiction. Establishing short-term goals with the "reward" of returning to drinking or using is still chasing an illusion of control.  

Dismissing Supportive Resources:

Out of a desire to maintain autonomy, prevent stigma and feelings of shame, people with substance use disorder often reject the idea of seeking assistance from organizations such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) or refuse addiction-specific treatment, opting to persevere alone despite ongoing substance use.

Each person who eventually finds their way into recovery embarks on a personal odyssey, trying various approaches in their quest for sobriety. Many people grapple with addiction for decades, struggling to break free before they succeed.

Problematic use of alcohol and other drugs gets worse over time if not arrested. A series of crises, which gets more frequent and more serious, marks the progression of the illness. Eventually, these crises seize the attention of those struggling with substance use disorder or their concerned family and friends. In these moments of heightened awareness, the connection between their substance use and the crises becomes evident. At this juncture, the person afflicted with substance use problems may be motivated by the fear and pain of the latest crisis to seek a recovery solution. Family members may also recognize the problem and decide to intervene, which can create a crisis for the person struggling with substance use disorder. Fear, as a potent short-term motivator, can propel the afflicted to seek the help they desperately need to initiate their transition into recovery.

When someone finally admits to themselves and maybe to others that their best efforts to regain control have proven futile and are unlikely to work in the future, they begin to accept the need for abstinence and help to achieve it. It necessitates recognizing that others possess the knowledge and tools to achieve abstinence and being willing to embrace their guidance and suggestions.
Acceptance is not an act of weakness but rather an act of strength and self-awareness. It requires individuals to confront their vulnerabilities, acknowledge the limitations of their previous efforts, and open themselves up to the support and wisdom of those who have navigated similar journeys. In accepting recovery, individuals lay the foundation for a new chapter marked by healing, growth, and lasting recovery.

In conclusion, recognizing and addressing addiction is complex and arduous. The cunning disguises of substance use disorder often obscure its true nature, prolonging the denial and resistance to seeking help. However, when individuals can overcome their misconceptions, confront their vulnerabilities, and embrace the support of others, they pave the way for recovery. Acceptance becomes the catalyst for transformation, enabling those enslaved by substance use disorder to break free from the destructive patterns that once held them captive. There is strength, hope, and the promise of a brighter future in acceptance.

More Articles on Substance Use Disorder
By Peggy L. Ferguson, Ph.D.


To access these articles, click on the article title to open a PDF. You may save or print them. When sharing, please remember to provide proper attribution to both the author and this website. Editing or republishing is not allowed.


Table of Contents

Understanding the Relapse Process in Addiction

Cultivating Boredom: Managing Frustration and Restlessness in Addiction Recovery

The Transformative Power Of Forgiveness in Substance Use Disorder Recovery

Discover the Benefits of Having an AA Sponsor


 

Mindful Recovery: Preventing Relapse Amid Surgical Challenges


 

Recovery and Forgiveness: Breaking Free from Resentment

 



Recommended Readings for Substance Use Disorder

You Don't Have To Drink Everyday to Have An Alcohol Use Disorder

Emotional Mastery in Addiction Recovery

How to Gain Assertiveness to Empower Your Recovery

Standing At The Crossroads: Trying to Quit Using

Common Myths About Alcohol and Drug Addiction

Don't Let Grief Derail Your Transition Into Recovery

 

Regaining Your Credibility in Recovery

Addiction and Recovery: Don't Let Myths Keep You From Getting Sober

Addiction and Recovery Do You Really Have to Hit Bottom To Recover?

Quitting Pot: Why You Have to Quit Hanging Out with People Who Use Marijuana

Addiction and Recovery: Do You Need Detox After Relapse?


Top 10 Craving Management Tools That People With Addiction Should Use to Not Take The First One -

 

Cravings Don't Cause Relapse: Learn to Manage Your Cravings to Prevent Addiction Relapse

Addiction and Recovery: Act Now to Combat Drug Cravings

One More Tool For Early Recovery -- Structure

Drinking/Using Dreams as A Normal Part of Recovery

Addiction and Recovery: Preventing Relapse By Making Good Choices

Addiction and Recovery: Plan Your Vacation, Not Your Relapse

 

Complications of Co-occurring Disorders

 

The 'Cutting Back on Drinking' New Year's Resolution

 

SAMHSA's Working Definition of Recovery


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