Craving (18 page)

Another scientifically validated method of addressing substance use disorders is called network therapy (NT). NT was developed by Marc Galanter at New York University and is a technique in substance abuse rehabilitation in which select family members and friends are enlisted to provide ongoing support and to promote attitude and behavior change.
¹⁰⁶
In this method of treatment, the people in the addict’s network are serving as an extension of the therapist and can be thought of as a team that is focused on helping the person get and stay well. Network therapy is highly compatible with other methods, and many participants also engage in Twelve Step programs while undergoing the therapy. I’m a very strong believer in network therapy in the treatment of addiction, and I’ve seen many people achieve recovery using these principles. The evidence to support this type of therapy is extremely strong, and the entire program is based on the fundamental observation that the network can do what the individual cannot.

What to Look for in a Group

The group can be either the most positive influence in helping you manage your own cravings or the most destructive force you can encounter. What characteristics are most helpful in finding a group or team to help you with your cravings? What should you look for as you attempt to find or create a group to help you deal with your cravings?

I believe in the value of “going to any lengths to get well.” But the reality is that if your group isn’t convenient, it will be much easier for you to find an excuse not to go. Of course, sometimes the support group that is closest to your work or your home is not the one that works best for you; maybe you identify better with people at a group that is farther away or one that meets at an inconvenient time. The most important thing is that you go, but the more convenient you can make it, the better. I usually recommend putting meetings in your calendar, rearranging commitments to ensure you have the time to get to the group, and having an accountability partner to whom you can commit to attendance. Sometimes it’s as simple as committing to your best friend that you are going to go to the quit-smoking group at the local church every Wednesday for the next six weeks. Look at the dates, times, and locations of groups and begin by selecting groups that are the easiest for you to commit to. Do everything in your power to make it easier to go.

Also, look for groups that are welcoming. Do they greet you at the door? Do they say hello? Are members available to speak with you before and after the group? Are there printed materials for you to review between visits? Is there a phone or email list of members who are willing to help you? Can the members of this group suggest other groups that might be helpful? Which ones seem the best to them? Word of mouth is often the best way to find the groups that are most welcoming and focused on helping members get and stay well.

As I noted above, no group is perfect because no person is perfect. You are not likely to find a group that fits all of your criteria. You may, at times, find that your objections and excuses for not attending a particular group may start to pile up. That’s usually when it’s important to stick it out and go anyway. In most cases, going to a mediocre group is still better than trying to handle cravings on your own.

Once you find a group, how do you use it most effectively? Although it may feel socially awkward, I recommend arriving early and leaving late. Unlike a social cocktail party, where it may be appropriate or even helpful to arrive late, it may be very hard to connect adequately with group members if you do that. Much of the helpful discussion may be occurring before the group even starts; plus, it’s an opportunity to discuss any questions, concerns, or even reservations you may have about the group on a one-on-one basis with another member or, if the group is professionally led, with the instructor. For example, if it’s your first time to a spin class at the gym, going early can give the instructor or another member a chance to make sure your bike adjustments are a good fit for you.

I also recommend that you “be a joiner.” It is extremely tempting to sit by yourself, leave as soon as the meeting ends, not talk to people, and generally keep to yourself. If you do that, you may be discarding many of the effective components of groups. Consider striking up a conversation, asking questions, or even just going up to a group of people chatting to listen in or participate in their conversation. Although difficult at first, the results can be very rewarding. Most successful group participants are people who really
joined,
rather than simply attended.

If the self-help or support group norms permit it, stay in touch with members between groups. In some settings this may not be appropriate. You’ll generally know it’s okay if the self-help or support group keeps a phone list or membership list. If it’s a professional group (therapy group, for example), you can ask the group leader what’s appropriate. Try to extend the power of the group beyond its sixty minutes (or whatever duration it is). Do that by staying connected with members between meetings, if it’s the group norm to do so.

Finally, follow suggestions, especially from people who have been successful in overcoming a problem that is similar to yours. If someone suggests you call two people on the phone list, do it. If someone suggests you join the group for dinner at the diner afterward, do it. If someone suggests you obtain a sponsor (as is common in Twelve Step meetings) or read a particular book, do it. If someone suggests another meeting, attend it. If you go to an Overeaters Anonymous meeting and they suggest you go grocery shopping on a full stomach and take a friend with whom you can be accountable, then do that. That said, use your judgment and don’t do anything that feels unsafe or inappropriate, but in general you want to harvest the successes of others so you can make them your own. One important way of doing that is to ask them how they succeeded and then follow those recommendations.

Groups are extraordinarily effective in helping people deal with their cravings, and in most cases, participating in a group that is focused on your particular craving is much more effective than trying to address your craving by yourself or just with a counselor. Find groups, join them, and use them.

…

8

The Naïve Perception of Immunity

“Where ignorance is our master, there is no possibility of real peace.”

— DALAI LAMA

An unfortunately common but sad situation familiar to anyone who has ever worked in an addiction treatment center is when someone leaves treatment prematurely, believing they are cured and will never drink or use drugs again. One of the best examples of this was a man I treated several years ago whom I’ll call “Jim.” Jim, who was a sixty-something physician, arrived in residential addiction treatment for alcoholism as a result of pressure from his two adult children and his grandchildren. Jim was not the sort of person who bowed to pressure from anyone, but when his granddaughter read him a letter describing the impact his drinking had on their relationship, he knew he needed help. Although Jim was initially reluctant to get help, once he arrived in treatment he described the choice to get treatment as one he had been thinking about for a long time and that he just needed the right excuse to find the time. It was so important to his brain to experience a sense of control that his recollection became distorted and created the story that entering treatment was his idea all along. This is very common and is an example of the hindsight bias we discussed in
chapter 3
.

After some time getting familiar with his peers, his counselor, and me, he started to develop some trust in us and revealed that, in fact, he had made numerous efforts to decrease or stop his drinking. These attempts would usually last a few days or weeks before he invariably started drinking again. He described strategies such as promising himself he wouldn’t drink, staying at work later into the evenings to avoid going to the liquor store, switching to nonalcoholic beer, even taking self-prescribed Antabuse, a drug that makes you sick if you drink while taking it. (The adage “physician, heal thyself” is usually
not
a good idea, especially when it comes to self-prescribing.) He admitted to me that, truth be told, he knew he couldn’t stop. My staff believed he was beginning to make some progress and look at how he might reduce his risk of relapse when, all of a sudden, Jim announced to the group that he now understood alcoholism and would “never drink again.” He described a sense of profound insight into his alcohol use and the reasons why he drank. He was certain that he had changed substantially, ensuring he would remain sober. He dismissed the experience of his peers in rehab who explained that they, too, had believed at times that acquiring some insight and making different plans would be sufficient to avert relapse.

Jim planned to leave treatment immediately. All attempts to convince him otherwise were unsuccessful. His family made arrangements for his continued stay, with pet care and coverage at his office, but he was very insistent, calling a cab to take him home. He wouldn’t even stay for one more day to reflect on what everyone explained to him was an impulsive decision. Not surprisingly, his family was very upset about this, and when he returned home he started drinking again within a week. When he finally returned to treatment two weeks later, he told me, “I’m not sure what happened, but this time I’m
really
not ever going to drink again.” Within a week, he had left treatment again. You can guess the outcome.

Similarly, I have worked with countless people who have allowed themselves to be exposed to situations that undermine their goals and lead them back to their cravings and unwanted behaviors. In so many cases, people who suffer from cravings simply don’t believe they will be affected; they believe they have the willpower to withstand the environmental threats (“triggers” in the addiction treatment-speak).
They think they are immune.
Whether it’s the committed dieter who thinks a walk through the mall is safe on an empty stomach (it’s the food court that got him), or the compulsive gambler who takes a trip to Vegas “just to see the shows,” people who mean well often fail and don’t know why.

The three examples I’ve given above are situations that are obviously risky, and you might be surprised that anyone could be so easily fooled. But the truth of the matter is that
everyone
who experiences the kinds of cravings we are talking about has been fooled, even if it’s been in more subtle ways. The brain tricks us into believing we’re immune—that we’ll be okay, this time will be different, we’ve finally figured it out, we just needed to be more committed, and this time we really are going to put our minds to it. Our brains work very hard to find some singular defect in our prior strategies, and then we focus only on those defects to the exclusion of all else. It’s like buying a used car and finding out too late that the transmission is shot and then
only inspecting the transmission
while shopping for the next used car. The focus is on addressing historical problems and defects, while completely dismissing the risk associated with potential or future threats to recovery. Sadly, often what happens when people experience limited success is that they stop trying; they do just enough, which turns out later to be not nearly enough. And who could blame them? Making this type of change is hard work and often uncomfortable. Most people want to experience such discomfort as little as possible.

As if that weren’t enough, people usually don’t know what they need to do in order to break free of the vicious cycle of cravings. Instead of using the types of suggestions found in this book—such as asking others for help, finding people you can trust and sharing your secrets, joining and participating in groups, connecting with spirituality, practicing helpfulness and altruism, and all the other suggestions you are finding here—they will often direct their energy and efforts toward actions that will do little to alter the course of their cravings and subsequent behavior. There are many examples of this. I’ve seen countless people struggling with cravings for food who stocked their cabinets with low-calorie snacks only to find themselves eating dozens of the packages at a time. I’ve worked with many people who believed that the latest fitness gadget they saw on TV would finally motivate them to exercise. I’ve met hundreds of people who wanted to stop smoking and discarded their cigarettes, but not their lighters and ashtrays. I’ve helped hundreds of alcoholics who didn’t want to give up the investment in their wine cellars. In these cases, and many more, an unwillingness to change perspective has led to heartbreaking results: a relapse and return to the very behaviors that they’ve been trying so desperately to avoid.

The Johari Window

We can be blind in numerous ways to the things that really matter with cravings and thus begin to believe, erroneously, that we are immune. To help you understand this important idea, we’re going to review a concept called the Johari window. The Johari window is a tool developed by two psychologists in the mid-1950s and describes a way of looking at ourselves based on what we know, what we hide, what we can’t see, and what nobody can see. As you look at the diagram, think of everything that is true about you. Think of all of your traits, interests, hobbies, personality characteristics, struggles, strengths, and weaknesses. Now, among all of those things that you know about yourself, the things that others know about you belong in the first or “open” quadrant. While not all of your friends know these things about you, the things in this quadrant are known to you and to some of the people you know. It could be that they are people who are close to you, or maybe friends or loved ones whom you trust. I sometimes call this first quadrant the transparent quadrant, because it tends to include facts about you that are more easily known by others.