Friday, June 26, 2009

Staying Sober: Tips to stay on the wagon

Dear Dr. Weston I noticed on your bio that you work at Pride Institute so I thought you might have some ideas to help me. I've been in and out of recovery for the last 6 years and just haven't been able to stay clean. I've been sober for about 9 months now, I go to my meetings, but I'm getting way too close to relapsing again. Got any help?

Although your dilemma is bigger than what I can tackle in a simple online article I believe there are two immediate things you can do that may begin to help you.

  • First, you need to identify the "payoffs" of using drugs.
  • Second, identify ways to get these "payoffs" in healthy ways.

Pay attention to the payoffs of your continued using. Counselors do a good job identifying the "consequences" of use. I'm sure you can identify your laundry list of horror stories about what has happened as a result of your use. All behavior is goal focused, including drug use, so I think it is important to focus on the payoffs of using as well. Someone who is using has a belief that a real or perceived payoff will result from the drug use. As you can probably recognize, the payoff is usually temporary.

I think about payoffs on three levels.
The primary level of payoff is the result of the actual drug use. For example, I'm bored and have nothing to do. Getting "high" is something fun to do, at least for a while.

A secondary payoff refers to an outcome that also happens. It might be a helpful consequence of the use. Many meth users experience significant weight loss as an outcome. For individuals struggling with body image, when they start to get sober they struggle with the weight gain.

The third type of payoff is difficult to recognize. It's also important to think strategically. The following example might be helpful. This level of payoff doesn't make sense to those watching on the outside, but on the inside, the payoff is that ongoing use gives the person the illusion that they are in charge of how messed up their life is. "I know drugs are bad, and that's why my life is so messed up." The outcome is that "I'm to blame." What makes this type of thinking so dangerous is the use of the fact that when a person's life is out of control, it is justification for additional drug use.

Finding healthy ways to get the payoffs

Primary Healthy Payoff
Looking first at the primary level payoff, we need to talk about filling your time with healthy friends, sober fun and other personally meaningful activities. You have to develop plans and social networks where you can have healthy fun without using. Additional Healthy Payoffs

If, for example, body weight becomes a problem, developing a healthy body image is also part of the treatment plan. If you are self-sabotaging your recovery because of low self-esteem, it's important to address the belief that you have no control in your life. A person needs to get a sense of an internal source of power. In my opinion, these three payoffs require a lot of work and effort. This is why therapy may be helpful.

If you find that you continually relapse, professional help might be necessary.

The question I'd like to hear about is "What healthy ways have you developed to get your needs met?"

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