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Seven Self-Care Tools with Proven Benefits

What follows are some of the self-care suggestions that came up most often in my interviews with the experts cited in this book. To varying degrees, there is well-documented science to back up these “tools” for use in treatment, continuing recovery, and personal transformation.

When I use the self-care term “tools” to describe these approaches, I don’t mean in any way to minimize the seriousness of the compulsions being addressed. These compulsions destroy lives. They are serious business. If you have a chronic dependence problem and you’ve been chronic for a number of years, you’re probably going to need more treatment resources than what these seven tools have to offer, and that means seeking professional help and guidance.

For those of you who have the most severe forms of addiction and dependence, I strongly urge you to get good professional help. You have to be careful because there are people out there who don’t know what they’re doing. The people I refer to in this book do.

You will probably notice that medication isn’t one of the tools. That’s because medication isn’t necessarily beneficial or applicable to all of the Seven Toxic Compulsions. But depending on your compulsion and the severity of it, and your co-occurring underlying disorders, such as depression, you may need an assessment from a doctor as to whether you should be medicated at any stage of your treatment process.

Medication can be a number of things, and there are three different types. The first is substitution therapy. If you’ve got a heroin or another opiate problem, you may benefit from a substitution or maintenance therapy with buprenorphine or methadone, or go through detoxification and then work a long-term recovery program. The second medication type is drug therapy for cravings and drug effects. Naltrexone is commonly prescribed as a blocking agent for the craving and the “high” of alcohol or opiates. Finally, the third type is a kind of “Band-Aid” medicine, such as antidepressants, that treats the associated symptoms caused by the childhood or later trauma that you’ve never dealt with.

The seven tools can be used both in treatment and as continuing practices to assist in recovery, which for most of us means use over a lifetime. There is a synergy between all of those tools if you put them into practice together.

Everything presented here, to whatever extent possible, is evidence-based; however, it’s important to keep in mind that not all useful strategies and practices can feasibly be subjected to the gold standard determination typically used to assess the effectiveness of medications: the randomized clinical trial. Other research strategies are accepted and used when randomized clinical trials aren’t feasible.

Cognitive behavioral therapy can be effective to varying degrees for all seven compulsions. 12-Step programs work for all seven compulsions, though the evidence is currently lacking for hoarding compulsion. Meditation and mindfulness can be useful for all of the compulsions, and potentially so can acupuncture. Nutrition and exercise were also described as important by most of the experts.

Many experts and much of the research I’ve seen advocate a holistic approach to treating all of the Seven Toxic Compulsions. That means simultaneously using as many combinations of tools as you possibly can. Psychotherapist Dr. Ronald Alexander of Santa Monica, California, puts it this way: “The treatment for any addiction certainly needs to be holistic. That would include cognitive behavioral therapy, group therapy, a 12-Step program, meditation, mindfulness, exercise, yoga, changes in diet and nutrition, even acupuncture and vitamin supplements for some people who have been really deep in the rabbit hole of addiction. It’s a model you see practiced at Cottonwood, Sierra Tucson, and a few other treatment centers. You have to remember that treating addiction is like psychological boot camp. You need at least 90 days to go through all of the withdrawal and psychological reconstituting that needs to go on. So you need all of these tools for treatment and a successful long-term recovery.”

Another expert, Dr. Charles O’Brien, professor, Department of Psychiatry, the Charles O’Brien Center for Addiction Treatment, University of Pennsylvania, elaborated on how to use the holistic treatment model: “We’ve actually shown that if you tailor the treatment to the patient, you get a much better outcome than treating everybody the same way. There is no one thing that cures addiction. But you can use medications and behavioral therapies, 12-Step programs, group therapy, individual family therapy, motivational counseling, mindfulness, exercise, and cognitive behavioral therapy. All of these things can be tailored to the individual. There are even some excellent programs that are available now for cognitive behavioral therapy that can be done by computer. It is directed at their mood disorder and it really does work and it’s efficient and cost effective.”

Anchoring yourself in recovery can be expensive. If you lack the resources to enter a treatment facility or to hire a therapist, these tools may be a lifeline. I’ve tried to identify useful and effective resources that are available to everyone at little or no cost.

These tools have been likened to arrows in a quiver. All are basically arrows pointing and directing you to create a new life and a new relationship to life. There are things that you can rely on at different times in your early recovery. And then later in your recovery, their use will give you benefits for the rest of your life.

Compulsions and dependency survive in the dark. All of these tools, especially those designed to change behaviors, will shine a light on the bogeyman. Addiction thrives in isolation. The more you look at it, the brighter that light becomes, and the less hold these compulsions will have over your mind and your life.

Tool 1—Cognitive Behavioral Therapy

Over the years, I’ve done a lot of different kinds of therapy. I was with a very good therapist for many years before I ever got sober. Once I asked him, “Hey, Ed, what good did all that therapy do for me, because I never got sober? But I know it probably built you a new tennis court?” He’s a very good, smart guy and he said, “I don’t know, Chris. Maybe it kept you alive.”

Talk therapy can be a powerful gateway tool. It may not get you where you want to go right away, but it keeps a door open. It provides at least one person in your life with whom you’re trying to be truthful, somebody who’s more or less unbiased so you can be honest and hear things you might not be able to hear from many of the people close to you.

If you have a compulsion, no matter what the level of severity, you need to find somebody you can trust and confide in. If a therapeutic relationship is too costly, you need to confide in a family member or a trusted friend. This could also be done in a 12-Step program after you’ve found a sponsor. The important thing is to start the process of revealing yourself to another human being. It’s a relational tool and absolutely crucial to recovery.

People with severe compulsions who have never been in a therapeutic relationship have difficulty revealing personal things. It takes a long time to do that. It takes trust, and it takes time to build that trust. Therapy can work—it does work—but it takes commitment.

There are many different forms of therapy. Cognitive behavioral therapy (CBT) is just one of them; but it just happens to be the one recommended most often by the experts I surveyed.

They didn’t call it CBT when I was doing it. I’ve done behavioral therapy, which basically identifies why you do certain things and shows you ways to change those behaviors. That is some of the most effective kind of therapy for people like us, because this is all about changing behaviors and the thoughts that animate our behaviors.

The biggest problem addicts have is that they believe the way they feel. They believe that if they feel bad, they need to do this one thing to feel better. And the critical thing is to get enough space between the feeling and the behavior so you can actually change the behavior. A therapist can help you identify which behaviors result from which feelings. It’s a process. It doesn’t happen overnight.

Somebody once said to me, “When you do something different, when you behave differently, even if it’s the right (normal) behavior, it feels wrong to an addict, because we equate good feeling with good (normal) behavior even though we know it’s not.” That connection is so strong because we’re such slaves to the way we feel. Addicts don’t have great tolerance for things that don’t feel good because they are addicted to immediate gratification and the immediacy of the feeling.

That’s why CBT and mindfulness and meditation all work, but you’ve got to convince people that they have to take the time to let it work. That’s the biggest challenge. You drink alcohol, you smoke a cigarette or stick a needle in your arm, you go to the Internet for some porn, or go to a casino—it’s immediate. You get it right away. You get the jolt, and you get the thing right into your brain. These tools don’t work right away. It’s a whole new skill set people have to learn, yet this CBT technique definitely works.

CBT is based on the idea that your thoughts can both obstruct your ability to heal from physical or mental injury and can enhance your capacity to heal, depending on whether you are able to identify the negative or irrational beliefs that hold you back, and then are able to reframe those toxic thoughts. When toxic thoughts or reactions emerge and threaten to trigger cravings, CBT enables you to develop coping strategies based on healthier thoughts.

Psychotherapist, professor, eating disorder expert, and national vice president of the Center for Mindful Eating Donald Altman of Portland, Oregon, uses CBT with his eating-disorder patients and has had positive results, even surpassing the 50 percent reduction in compulsive eating behaviors that has been obtained in published studies on CBT. He explained how CBT offers anyone with one of the Seven Toxic Compulsions these skill sets:

1. It challenges distorted thoughts and beliefs. It can alter your beliefs about whatever compulsions hold you hostage.
2. It works to regulate emotions by having patients challenge the basis for their emotional distress—and the underlying behaviors. It helps the patients identify their thinking errors or cognitive distortions. Then, the individual can more easily look for evidence that disproves or discredits these thoughts. In this way, one is able to challenge the thoughts that are the basis for the emotional distress.
3. It increases understanding of the primary emotions and secondary emotions triggered by beliefs that increase distress. It increases an understanding of those underlying core beliefs—such as “I’m worthless” or “I’m unlovable”—that produce distorted thoughts.
4. It supports a person learning how to embrace the adaptive expression of emotion into something more positive. It supports a person learning how to take a broader perspective on any situation. In addition, it promotes the practice of being more realistic about any given situation.
5. It utilizes a psycho-educational component that helps people make the link between triggering events and the thoughts, emotions, and behavior that follow. In other words, you learn to trace the cause and effect pattern in your mind that contributes to compulsive thoughts and behaviors

Studies examining the impact of CBT on drug and alcohol relapse, along with binge-eating disorders, have been uniformly promising. Here are a couple of examples.

Researchers writing in a 2005 issue of The American Journal of Psychiatry reviewed results from dozens of studies on the development of behavioral therapies for drug and alcohol dependency. They had this to say about CBT: “Several studies have demonstrated that cognitive behavioral therapy’s effects are durable and that continuing improvement may occur even after the end of treatment.” One study found CBT to be “more effective than standard treatment” for methamphetamine-dependent individuals. Another study of 450 marijuana-dependent persons “demonstrated that a nine-session individual approach that integrated CBT and motivational interviewing was more effective than a two-session motivational interviewing approach, which was in turn more effective than a delayed-treatment control condition.” (Source: “Behavioral therapies for drug abuse.” Carroll KM and Onken LS. Am J Psychiatry. 2005 Aug;162(8):1452–60.)

A Florida study of older military veterans with alcohol- or drug-use problems, many of whom were homeless, also showed CBT’s effectiveness. The University of South Florida research team put 49 of the veterans/patients through a 16-week CBT program emphasizing the teaching of coping skills. A follow-up after six months found that those who did the CBT program “demonstrated much higher rates of abstinence” compared to those who didn’t complete the program. (Source: “Cognitive-behavioral treatment of older veterans with substance abuse problems.” Lawrence Schonfeld et al. J Geriatr Psychiatry Neurol. 2000 Fall;13(3):124–9. doi: 10.1177.)

In another study, researchers at Canada’s University of Toronto Centre for Addiction and Mental Health put 38 people diagnosed with binge-eating disorder combined with a substance-use disorder through a 16-week mindfulness-based CBT program. “Participants significantly improved on measures of objective binge-eating episodes, disordered-eating attitudes, alcohol and drug addiction severity, and depression. CBT appears to hold promise in treating individuals with coexisting binge-eating disorder and substance-use disorders.” (Source: “Mindfulness-action based cognitive behavioral therapy for concurrent binge eating disorder and substance use disorders.” Christine M. Courbasson et al. Eat Disord. 2011 Jan;19(1):17–33.)

The latest innovation using CBT for compulsive disorders involves interactive online CBT programs that can be accessed from home. For more information, go to www.recover2live.com.

Several studies have assessed the value of online CBT. At the Yale University School of Medicine, Division of Substance Abuse, Prof. Kathleen Carroll and five other researchers conducted a randomized clinical trial in which 73 persons seeking outpatient treatment for substance dependence were placed in either a treatment-as-usual group or in eight weeks of biweekly access to computer-based CBT training. Participants were interviewed at 1-, 3-, and 6-month intervals after the termination of the two study treatments. Significant differences were found between the two groups. “Those assigned to treatment-as-usual increased their drug use across time, while those assigned to CBT tended to improve slightly … computerized CBT appears to have both short-term and enduring effects on drug use.” (Source: “Enduring effects of a computer-assisted training program for cognitive behavioral therapy: A 6-month follow-up of CBT4CBT.” Kathleen M. Carroll et al. Drug Alcohol Depend. 2009 Feb 1;100(1–2):178–81.)

Another potentially useful tool—voice dialogue

Though this process isn’t directly connected to CBT, it does involve a type of reprogramming of thoughts that could be useful in treatment and recovery. The principle behind the practice of voice dialogue is that we all have different voices within us attached to recurring thoughts. It’s not different personalities, but it is different aspects of self that are embodied in certain voices. For example, we have the voice of hope and the voice of inspiration, the voices of cynicism and doubt. We have our controller voice and multiple other voices we reactively obey or respond to.

For everyone there are certain dominant voices. Control freaks have the controller voice that dominates and influences decisions and perceptions, and this voice tries to censor what is thought or spoken. Or there might be a victim voice of someone who’s constantly in despair, or a sort of masochistic voice characterized by diminished self-esteem.

Part of the process of voice dialogue is to determine which are your predominant voices and then to work with those voices to either diminish or enhance them. It’s not hypnosis. It’s a one-on-one process of being asked a series of questions, doing a short meditation, and going into a place within yourself where you access the particular voice that needs to be worked with.

If you have a bad habit or a compulsion dependency, you try to determine what voices are connected to that. If you have a voice of cravings, for example, when you work with that particular voice, you might ask it a series of questions: “Why are you in control? What role do you serve? What feelings come up whenever this voice is dominant? What are the early warning signs of feelings or sensations you have when that voice is going to make an appearance?”

Sometimes the sessions are recorded, sometimes not, but the person who’s being asked the questions begins by feeling and embodying the voice in the moment. Everyone can learn to do this. You begin to sense exactly what is involved in the cravings, how to control the cravings based on the early warning signals, and what counterbalancing voices you need to summon in the moment—counterbalancing voices you can shift into to diminish a voice of neediness or a voice of craving.

No peer-reviewed science studies, at least as far as I know, have been conducted on the voice dialogue technique. I have included it here as a potentially useful tool for recovery in the hope that studies might happen one day. For more information, read Embracing Ourselves: The Voice Dialogue Manual, by Hal Stone, Sidra Stone, and Shakti Gawain.

Tool 2—12-Step Programs (and Other Groups)

Each of the various 12-Step programs for the Seven Toxic Compulsions are based on Alcoholics Anonymous, so they’re all branches of the same tree, which is about eight decades old. In a very real sense, 12-Step programs are the way of personal transformation.

All of the experts I spoke with say these group programs can be helpful. For some people, being involved in 12-Step meetings can be the difference between life and death. That doesn’t necessarily mean if you go to a 12-Step program you’re going to like it or that it’s going to work quickly for you. But it should be tried. If you don’t like it, there are other things to consider, such as group therapy. Having a group dynamic involved in your support system, whatever form that takes, is a critical piece of recovery.

If you’re a person who has a bad habit rather than dependency, a 12-Step program most likely isn’t for you. That doesn’t mean it wouldn’t be worth going, but you may benefit more from moderation management meetings or a group with a therapist to talk about your underlying issues.

Some treatment experts urge caution about relying entirely on a 12-Step program during recovery. Dr. Morteza Khaleghi and Dr. Karen Khaleghi, addictions specialists and founders of Creative Care in Southern California, explain in their book The Anatomy of Addiction how 12-Step programs “are rarely the answer in and of themselves for most addicts. The problem is—and this problem is made stunningly clear in the indisputably dismal relapse rates—that the examination of a client’s emotional history prescribed in the 12 steps does not go deep enough. And, all too frequently, it doesn’t even touch upon underlying physiological or psychological issues that, left untreated, will sabotage sobriety as surely as night follows day.”

What distinguishes 12-Step programs from group psychotherapy?

Jeffrey Roth, addiction psychiatrist, author, editor of Journal of Groups in Addiction Recovery, and medical director, Working Sobriety Chicago, leads group psychotherapy sessions. He describes what separates his process from the 12-Step program structure: “You go to a 12-Step meeting and the boundaries of that meeting are that there’s no professional approach in there. And that’s according to their traditions. There’s no crosstalk. And there’s a reason that there’s no crosstalk, because that fits the structure of the meeting.

“Group psychotherapy is exactly the opposite. Group psychotherapy is all crosstalk. The 12-Step meeting is an opportunity to share experience, strength, and hope. The group psychotherapy is an opportunity to share your insanity. The more insanity you let go of in the group, the more you can see it, and the more you can accept the help of the group as a higher power in doing your personal inventory.”

Scientific studies support 12-Step’s effectiveness

Probably no one alive has studied 12-Step programs longer or more intensively than Dr. Scott Tonigan, research professor, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico. By his count, he has sat through at least 1,000 different 12-Step meetings, taking notes, interviewing participants, and later conducting studies to determine what factors make the program effective for the recovery of some people but not others.

“The evidence is clear that 12-Step attendance is beneficial for many, but not all, problem drinkers and polysubstance abusers,” Dr. Tonigan explained. “Those who continue to attend and work the steps and have a sponsor derive great benefits, including increased abstinence. Meeting attendance and having a sponsor are very important. Other things are less clear, like spiritual growth. We are seeing a number of recent studies that point to the scientific possibility that increased spirituality does predict improvement. Six or seven studies now indicate that changes in spiritual practices partially explain the benefits of 12-Step programs, though the studies also find that atheists or people with social phobias generally don’t engage well in these programs.

“The role that spirituality may serve in 12-Step programs is a broad terrain, but what we are seeing is that the practice of prayer and meditation helps explain the success of the program. Mindfulness and meditation do inhibit a drinking response when drinking cues are present, and they put a safety on those triggers. I have no doubt that also occurs (along with consequent brain changes) as a result of 12-Step program social interactions.”

Because there is so much variance in how 12-Step programs and the various meetings are practiced and conducted, because there is so much migration between groups—someone attending Narcotics Anonymous one week and Alcoholics Anonymous the next—trying to measure the overall effects of these groups and their various practices on long-term sobriety becomes a unique challenge for researchers like Dr. Tonigan. But he and his colleagues have found that across the various 12-Step programs, the processes involved are much more similar than different. It’s usually just a difference based on emphasis, although that emphasis will help to determine whether a person feels like he or she can fit into and feel comfortable sharing with a particular meeting and group.

There is also a research question around whether the principle of “harm reduction,” an emphasis on reducing substance use rather than complete abstinence, has any place in the 12-Step program’s structure, where abstinence has been one of the guiding mantras for decades. In results that surprised him, Dr. Tonigan found that harm reduction is already being widely practiced, but in virtual secrecy. “Up until recently,” noted Dr. Tonigan, “I would have said the harm reduction approach has no place in 12-Step programs because of the programs’ emphasis on abstinence. But our research shows that about 20 percent of people we studied in AA who reported complete alcohol abstinence also reported the use of illicit drugs, such as low marijuana use. That made us reevaluate what abstinence really means and what sobriety really means in 12-Step programs and the role of harm reduction.”

Here is a summary of 12-Step study findings produced by Dr. Tonigan and other scientists over the past few years:

In a 2010 study of 1,726 people with an alcohol-use disorder, the team of Dr. Tonigan and four other researchers found that “attending AA was associated with increases in spiritual practices, especially for those initially low on this measure at treatment intake” and that “AA leads to better alcohol-use outcomes, in part, by enhancing individuals’ spiritual practices.” (Source: “Spirituality in recovery: A lagged mediational analysis of alcoholics anonymous’ principal theoretical mechanism of behavior change.” John F. Kelly et al. Alcohol Clin Exp Res. 2011 Mar;35(3):454–63. doi: 10.1111/j.1530-0277.2010.01362.x. Epub 2010 Dec 16.)

To examine the relationship between relapse and volunteer work in AA, which usually involves serving as a sponsor helping other alcoholics, Dr. Tonigan and three other researchers did an intensive examination in 2004 of AA participants and concluded: “These findings provide compelling evidence that recovering alcoholics who help other alcoholics maintain long-term sobriety following formal treatment are themselves better able to maintain their own sobriety.” This finding reinforced the sentiment often heard in AA meetings that “You can’t keep it unless you give it away.” (Source:“Helping other alcoholics in Alcoholics Anonymous and drinking outcomes: Findings from project MATCH.” Maria E. Pagano et al. J Stud Alcohol. 2004 Nov;65(6):766–73.)

At four Kaiser Permanente hospital programs in Northern California, researchers monitored 357 adolescents with drug and alcohol disorders to determine the effect that their participation in 12-Step meetings had on long-term recovery. The study concluded: “12-Step attendance at 3 years was associated with both alcohol and drug abstinence at 3 years. Similarly, 12-Step activity involvement was associated significantly with 30-day alcohol and drug abstinence … the findings suggest the importance of 12-Step affiliation in maintaining long-term recovery.” (Source: “12-Step affiliation and 3-year substance use outcomes among adolescents: Social support and religious service attendance as potential mediators.” Felicia W. Chi et al. Addiction. 2009 Jun;104(6):927–39.)

An expert’s story of recovery using 12-Step meetings

From Dr. Robert DuPont, President of the Institute for Behavior and Health Inc, first director of the National Institute on Drug Abuse, second White House Drug Chief, and clinical professor of psychiatry at Georgetown Medical School: When my daughter Caroline was a freshman at Georgetown, she called me the day after Halloween to say that she had a problem and needed help. One of the young men in her dormitory, whom I will call David, the night before had thought Caroline—dressed for Halloween as a black cat—was the devil. He thought he had to kick her. He was obviously psychotic. Their friends had to subdue David before they learned that his disturbed mental state was caused by his use of marijuana and hallucinogens.

On her call the next day, I asked Caroline to tell a bit more about David. She told me that he was a minority student from another city. On a full scholarship, David was the first person in his family to go to college. She emphasized that David was the most popular student in the dormitory. Everyone thought he was the smartest kid in their class. They really wanted to save him.

I suggested that Caroline take David to a meeting of Narcotics Anonymous. She responded, “I don’t know where to find a meeting.” We talked through how to do that. I suggested that there was sure to be an NA meeting near Georgetown at noon. Caroline took David by the hand and walked him to that meeting. For the next week, each day, Caroline went to the noon meeting with David. She held his hand and sat right next to him. For the rest of that year David went to NA meetings every day and he didn’t use drugs. But when he went to his home that summer he relapsed. In distress, he called Caroline asking, “What do I do now?” She responded, “One of the nice things about AA and NA is that there are meetings everywhere you go, including right now in your town. Get a new sponsor and work the program.” David did. He never relapsed again.

When they graduated, my wife and I had an informal dinner for Caroline and her friends at a nearby restaurant. David sat next to me. He told me that Caroline had saved his life. “If she had not gone to the meetings with me for a week and sat there holding my hand, I would not have been able to go to the meetings.” David told me that his father had been a jazz musician who died at 25 of a heroin overdose. David continued, “If there had been a Caroline in his life, I would have known my father.”

Four years later this young man graduated from medical school. Now married with a young daughter, he is practicing medicine. David continues to go to a lot of AA and NA meetings. He tells people how he got into that fellowship and what a difference it made in his life. David’s story made a big impression not only on Caroline and David, but on their whole dormitory—and on me.

The commune that became a treatment community

Communal living is another model for a group recovery setting. For example, a place in Italy called San Patrignano, which has no therapists, is a community where thousands of people have overcome heroin addiction just by coming together and working together in a community.

Monica Luppi, international outreach and relations officer at San Patrignano, described how this program works: “It wasn’t started with the idea of being a treatment center for drug addicts. It was founded by a local entrepreneur in the 1970s to help some heroin addicts who were living on the street have a place to stay. The idea was you could come if you were someone who probably needs love, or a good kick in the ass, anything a real good parent would give you. It began as a kind of a hippie commune. It was built by the people who were the first addicts to come here. The founder had no training in treatment. He just had a big heart.

“Now, more than 30 years later, about 1,600 people live here. It’s become like a small town, or a very well-oiled machine. It feels like one big family. If you’re looking around, you can’t tell who has arrived yesterday and who’s been here 20 years. There’s no hierarchy. It’s not like the guy in the white lab coat saying, ‘Okay, you’re admitted or you’re in phase one or whatever.’ It’s very natural. It’s not at all like treatment. We don’t even talk about drugs. I went through the program starting in 2000, so I’ve been here 11 years.

“The treatment here is everyday life. When someone first arrives, they are assigned to a person who will be like a big brother, sister, or sponsor who teaches them the rules. The treatment is you’re in a group of people who become like your little kind of related family. You learn your job. It’s not busy work; it’s always something productive, and it’s good training. We take orders and make stuff that’s sold all over the world. So the treatment is interaction with people.

“There’s no talk of groups and there’s no talk of being a patient or being cured or anything like that. I’ve barely ever heard people talking about drugs. Once you’re here it’s not an issue anymore because there are no drugs here, so it’s about you. The philosophy behind San Patrignano is that drugs are just the last little kind of symptom of what’s gnawing at you. So we try to make sure that people come here after they have been thoroughly prepared mentally and are ready and motivated and know what they’re up against.

“The program is individual for everyone, but usually it lasts three-and-a-half to four years. The decision to leave, again, is very individualized. It’s been built up over relationships all those years where you have very strong ties with the people around you. They know you and you’ve talked about it, and when the time is getting close and you know you’ve done certain things inside of yourself, there are conversations you have. It’s not like an evaluation process or you decide when you’re ready. You know the person so well that you can say, ‘Maybe you should go and see what that outside world is like for a week or 10 days and realize what you’re going to be up against.’

“We have about 50 volunteer associations in 50 different cities around Italy made up of former San Patrignano residents and parents of residents who wanted to volunteer. These groups hold meetings where people who want to go to San Patrignano can show up and ask for help. These groups prepare the person, which means helping them to detox and to understand what will be expected of them. These associations also become points of reference when people leave San Patrignano, especially if the person doesn’t have good family relationships. At the same time, these associations are places for the parents to go while you’re in the community, so the family does a parallel path, because obviously you can’t just fix just a piece of a car that’s broken. The whole car is usually broken, so the parents work on themselves in the association.

“We used to have people coming in who were in their 40s. That was the norm 10 years ago. Now we see many young kids, 17 and 18 years old, coming in. So we focus a lot more now on providing education for people. We’ve built a huge center for people for formal education. People finish their education, high school, whatever, and we get them to be as independent as possible.

“We don’t have state funding. Half of our 23 million euros budget every year comes through our work, our own services, and the other half comes from donations, a couple of patrons, and grants from foundations. That works out to about 35 euros a day for each person at San Patrignano. Our success rate is also quite high. In 2007 two universities did a study sampling of 517 of our former residents and found that 72 percent were drug-free two to three years after leaving.

“The energy of this place pushes people to be good. In my 11 years here I have never seen more than four or five shoving matches. It never goes beyond that. About 30,000 people have come through here. They were all considered the worst addicts, the ones that nothing could be done for, the ones who had been in prison or gone through 20 rehabs. They screwed up everything they could screw up, until they got here.”

“Harm reduction” groups and programs

SMART (Self-Management And Recovery Training) Recovery is an alternative to 12-Step programs and covers all types of toxic compulsions, although most members are dealing with drug and alcohol issues. It’s a worldwide nonprofit organization of free support groups with an emphasis on self-empowerment and developing self-control.

This approach can involve controlled use, or reduced use, as opposed to an emphasis on enforcing immediate abstinence. It’s known as the “harm reduction” model of treatment and gives users various tools, including instructions on behavioral self-control techniques. The SMART Recovery mission statement reads, in part: “To support individuals who have chosen to abstain, or are considering abstinence from any type of addictive behaviors (substances or activities), by teaching how to change self-defeating thinking, emotions, and actions; and to work toward long-term satisfactions and quality of life.”

Dr. Thomas Horvath, psychologist, president of SMART Recovery, and president of Pyrysys Psychology Group, Inc. drew several distinctions between SMART and the structure of 12-Step programs: “SMART Recovery meetings are an active discussion with a facilitator, as opposed to the monologues you hear in 12-Step meetings. The majority of SMART Recovery people do believe in God, according to our member surveys, but we don’t include the Higher Power angle as the 12-Step programs do. We are available to people at all levels of problems and work with them toward both abstinence and harm reduction. We use eight or so tools in our program. These will look familiar to any cognitive behavioral therapist.”

Dr. Horvath’s workbook for overcoming addictions, based on SMART Recovery principles, is titled Sex, Drugs, Gambling & Chocolate. For more information about the differences between SMART Recovery support meetings and 12-Step approaches to recovery, visit www.smartrecovery.org/

A second group that uses a harm reduction model for problem drinking is the Moderation Management Network Inc. (www.moderation.org). Dr. Thomas Horvath is on its board of directors, along with Dr. Reid Hester and, at one time, the late Dr. Alan Marlatt, all of whom were interviewed for this book.

Moderation Management describes itself on its Web site as “a behavioral change program and national support group network for people concerned about their drinking and who desire to make positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own path, whether moderation or abstinence. MM promotes early self-recognition of risky drinking behavior, when moderate drinking is a more easily achievable goal.”

MM also provides a “supportive mutual-help environment that encourages people who are concerned about their drinking to take action to cut back or quit drinking before drinking problems become severe. A nine-step professionally reviewed program provides information about alcohol, moderate drinking guidelines and limits, drink monitoring exercises, goal setting techniques, and self-management strategies. As a major part of the program, members also use the nine steps to find balance and moderation in many other areas of their lives, one small step at a time.”

Other noteworthy groups

Women For Sobriety (www.womenforsobriety.org). Here is how the group defines itself: “Women for Sobriety (WFS) is an organization whose purpose is to help all women find their individual path to recovery through discovery of self, gained by sharing experiences, hopes, and encouragement with other women in similar circumstances. We are an abstinence-based self-help program for women facing issues of alcohol or drug addiction. Our ‘New Life’ program acknowledges the very special needs women have in recovery—the need to nurture feelings of self-value and self-worth and the desire to discard feelings of guilt, shame, and humiliation. WFS is unique in that it is an organization of women for women. We are not affiliated with any other recovery organization and stand on our own principles and philosophies. We recognize each woman’s necessity for self-discovery. WFS offers a variety of recovery tools to guide a woman in developing coping skills which focus on emotional growth, spiritual growth, self-esteem, and a healthy lifestyle. Our vision is to encourage all women in developing personal growth and continued abstinence through the ‘New Life’ program.”

LifeRing Secular Recovery (www.lifering.org). Established in 2001, this nonprofit abstinence-based support group is operated on the principle that “You can get clean and sober regardless of your belief or disbelief in a ‘higher power.’ We welcome people regardless of their ‘drug of choice.’ We encourage crosstalk in meetings. We each build Personal Recovery Programs tailored to our individual makeup.”

Nonsecular, faith-based resources include organizations Celebrate Recovery (www.celebraterecovery.com/), Calix Society (www.calixso-ciety.org/), JACS (Jewish Alcoholics, Chemically Dependent Persons and Significant Others, www.jacsweb.org/), Millati Islami (www.mil-latiislami.org/), Buddhist Recovery Network (www.buddhistrecovery.org/), and many more. Find additional possibilities in Appendix Two of this book.

Tool 3—Mindfulness

When skeptical people hear the term mindfulness they may automatically think it’s New Age gibberish or Eastern religious dogma. People need to know there is science behind the technique and that the practice of mindfulness has an effect on the brain, on the way the brain actually changes itself.

Mindfulness is a wonderful tool when you’re dealing with cravings or the triggers or the impulses; it can help you become less reactive. I remember a doctor saying to me many years ago, “When you want to use drugs, you should just go sit at the beach and watch the ocean.” I guess what he was trying to tell me was that watching the waves coming in and going out is just a way to focus your mind so you don’t give in to the cravings. Now with mindfulness we have an actual practice with protocols and a basis in science—you can actually train your mind to lessen its reactivity.

Addiction is all about reactivity. “I feel bad, I have to take this or do that.” Addicts are reactionary and undisciplined in their thoughts. Mindfulness teaches mind discipline and creates a structure so we are no longer slaves to our triggers and cravings and desires. We learn to create some distance between the impulse, the craving, and the behavior. If you do that, you have a chance of changing the behavior. It’s what spiritual people call “witness consciousness,” where you can actually create space between your thoughts.

Mindfulness is understanding that you don’t have to be attached to your thoughts. Mindfulness is proactive. It’s actually about doing something. You’re maintaining a space between your thoughts and you’re mindful about your behavior. You’re mindful about what’s happening and what you’re going to do (or not do) about it.

“Mindfulness helps individuals move beyond addiction by actually resetting the brain’s neuro networks to produce positive mental states of optimism, encouragement, openness, and positive thinking (as opposed to negativity, rumination, and reactivity),” observed Donald Altman, a psychotherapist, professor, and eating disorder expert in Portland, Oregon, who is national vice president of the Center for Mindful Eating.

Altman and other therapists associated with the center practice the following principles of mindfulness:

• Mindfulness is deliberately paying attention, nonjudgmentally.
• Mindfulness encompasses both internal processes and external environments.
• Mindfulness is being aware of what is present for you mentally, emotionally, and physically in each moment.
• With practice, mindfulness cultivates the possibility of freeing yourself of reactive, habitual patterns of thinking, feeling, and acting.
• Mindfulness promotes balance, choice, wisdom, and acceptance of what is.

Be mindful of your deceptive brain messages

One reason you may not be able to stop unhealthy behaviors and compulsions is that “You have bought into your deceptive brain messages and assimilated them into your sense of who you are,” wrote Dr. Jeffrey Schwartz and Dr. Rebecca Gladding in their book You Are Not Your Brain: The 4-Step Solution for Changing Bad Habits, Ending Unhealthy Thinking, and Taking Control of Your Life.

Deceptive thoughts come in multiple ways. You may have bought into the brain message that someone doesn’t love you, not because this is reality but because you are feeling your own damaged self-esteem. You might buy into the deceptive brain message that your family approves of your toxic compulsion simply because they remain silent about it, when in reality they are too passive, afraid, or enabling to challenge the damage you are inflicting on yourself and on your relationships.

To counteract these sorts of self-deceptions, the UCLA-based mindfulness experts Schwartz and Gladding developed a four-step approach to evaluating the toxic thoughts that surface, particularly when you’re in the throes of a compulsion. Here are the steps:

1. Re-label the thought or uncomfortable sensation. If you’re having a recurring “what-if” worry-thought about something, for example, label it for yourself as “Here I am playing the what-if game again.” That helps break the thought recurrence cycle.
2. Re-frame the brain message. Ask yourself why the thoughts and urges keep bothering you. Repeat to yourself: “This isn’t really me; this is just my brain spewing out these false messages.”
3. Re-focus your attention. When the false and deceptive thoughts and urges arise, practice shifting your attention toward healthy and productive thoughts and personal goals. Practice until this becomes second nature.
4. Re-value the thoughts and urges. Put them into perspective for what they are—just sensations that flow from deceptive brain messages. They have little or no value and deserve to be dismissed, not dwelled on.

These four steps are designed to help you “wire new, healthy routines into your repertoire and into your brain.” This is particularly important to practice when you’re feeling stressed because “stress causes your brain to recruit its old, hardwired routines to go into overdrive.”

Two mindfulness coping skills

A month before he died in early 2011, Dr. Alan Marlatt, director of the Addictive Behavior Research Center at the University of Washington, described for me the following two mindfulness skills that he and his colleagues taught people battling compulsions:

Urge surfing: “I learned this from a guy who was trying to quit smoking,” said Marlatt. “He said to me, ‘As soon as I have an urge to smoke, it just gets higher and higher and if I don’t have a cigarette, I think I’m going to go crazy.’ I explained to him how urges are like conditioned responses. If you don’t give in to the response, it will go down. And the guy said, ‘Oh, so it’s like an ocean wave.’ It turned out he was a surfer from San Diego. So he got this idea that if he could ride the wave—that urge—and surf it, using his breath as a kind of surfboard, he could get through it and go down the other side. And it worked. After about two weeks, he was able to quit smoking by just doing this coping skill that resembles surfing.”

SOBER space: “This is an acronym to use when you’re on the verge of losing your willpower and giving in to an urge. Stop what you’re doing, just pause. Observe how you’re feeling and what you’re thinking in the moment. Breathe. Focus your breath and get it centered. Expand your awareness, observe things beyond the urge. Respond mindfully. You have a choice. You can exercise that choice.”

Scientific studies support mindfulness benefits

It makes positive changes in your brain. Harvard Medical School researchers did brain magnetic resonance imaging on 16 participants before and after they did an eight-week program of mindfulness-based stress reduction (MBSR). On average, each participant spent 27 minutes each day practicing the mindfulness exercise. The research team measured the brain’s plasticity and concluded, “The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.” An additional benefit was a decrease in gray matter density in the amygdala, that part of the brain involved in heightened anxiety and stress. (Source: “Mindfulness practice leads to increases in regional brain gray matter density.” Britta K. Hölzel et al. Psychiatry Res. 2011 Jan 30;191(1):36–43.)

It can treat co-occurring disorders. Yale University School of Medicine researchers examined mindfulness study results on both depression and substance-use disorders, which are often co-occurring. They observed: “Mindfulness training has been shown recently to benefit both depression and substance-use disorders, suggesting that this approach may target common behavioral and neurobiological processes.” (Source: “Mindfulness-based treatments for co-occurring depression and substance use disorders: What can we learn from the brain?” Judson A. Brewer et al. Addiction. 2010 Oct;105(10):1698–706.)

It can be effective for relapse prevention. Mindfulness-based cognitive therapy (MBCT) studies involving 593 participants were analyzed to determine the effectiveness in reducing relapse or recurrence of major depressive disorder. Though the focus was on depression, these results also have application to any relapse from compulsions, particularly substance abuse. The study authors concluded that MBCT reduced the risk of relapse/recurrence by 34 percent compared to treatment-as-usual approaches. In two studies, MBCT was just as effective as the use of antidepressant medications. (Source: “The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis.” Piet J. Hougaard E. Clin Psychol Rev. 2011 Aug;31(6):1032–40.)

Relapse prevention for substance use. University of Washington researchers put 168 adults with substance-use disorders through an eight-week outpatient mindfulness-based relapse prevention (MBRP) program. They were assessed at two- and four-month intervals after the intervention. Those in the MBRP program, as opposed to those who had treatment as usual, showed “significantly lower rates of substance use over the four-month post-intervention period. Additionally, MBRP participants demonstrated greater decreases in craving, and increases in acceptance and acting with awareness.” (Source: “Mindfulness-based relapse prevention for substance use disorders: A pilot efficacy trial.” Sarah Bowen et al. Subst Abus. 2009 Oct–Dec;30(4):295–305.)

Alcohol relapse prevention. In this University of Wisconsin School of Medicine study of alcohol-dependent adults, 15 of them were enrolled in an eight-week mindfulness meditation relapse prevention course. After the course, “Their severity of depression, anxiety, stress and craving, and documented relapse triggers decreased, and the degree of mindfulness increased. Participants rated the meditation course as ‘very important’ and a ‘useful relapse prevention tool.’” (Source: “Mindfulness meditation for alcohol relapse prevention: A feasibility pilot study.” Aleksandra Zgierska et al. J Addict Med. 2008 Sept;2(3):165–73.)

Tool 4—Meditation

In 12-Step programs they talk about the 11th-step being prayer and meditation to increase your conscious contact with God, as you understand God. So whatever that means to you, there are two aspects to prayer and meditation. Prayer is talking to God, meditation is listening to God.

Meditation can radically change your life. Anybody who has done it will tell you that. If you meditate at the same time every day and in the same place every day, meditation becomes like an energy that builds up. The more you do it, the more energy you create in that place, and that energy facilitates the act of quieting your mind, of stilling the craziness that’s usually going on in the head of an addict.

There are many different traditions of meditation. You don’t have to walk into an ashram with yogis and do this in front of a group of strangers. You can do it on your own, when and where you choose.

What do all of the various meditation traditions have in common? In her book The Blissful Brain author Shanida Nataraja proposed these four criteria to assess whether a practice amounts to meditation:

1. The specific technique is clearly defined and can be taught.
2. It has to involve the progressive relaxation of muscles.
3. It must involve reducing brain activity, what is known as logical processing functions of the brain.
4. It must be self-induced by the practitioner.

The late Prof. Alan Marlatt, former director of the Addictive Behavior Research Center at the University of Washington, noted how meditation “may serve as a useful alternative to alcohol use and may result in some of the same positive consequences, including tension reduction and relaxation.” Not only that, but Marlatt noticed in his patients how “meditation may also provide a useful antidote to the experience of craving, which is often characteristic of addictive behavior and is strongly related to relapse following a period of abstinence. The heightened state of present-focused awareness that is encouraged by meditation may directly counteract the conditioned automatic response to use alcohol in response to cravings and urges.”

Marlatt and other treatment experts began utilizing two techniques in particular—transcendental meditation (TM) and Vipassana meditation (VM)—to help people reduce alcohol-related cravings and problems. TM involves the meditator using a mantra (which is a word or phrase that is repeated silently), as you sit with eyes closed, during two 20-minute periods every day. Vipassana meditation doesn’t involve a mantra. Instead, the meditator focuses awareness on the breathing process while sitting silently with eyes closed.

At the Chopra Center in Southern California, founded by Dr. Deepak Chopra, meditation is the centerpiece of a treatment regimen for compulsions around alcohol, drugs, smoking, overeating, and gambling. “In our decades of experience working with people attempting to free themselves from addictions, we have found meditation to be the most powerful tool to change negative patterns,” wrote Chopra and Dr. David Simon, medical director of the Chopra Center, in their book Freedom from Addiction. “In fact we have never witnessed a person relapse when they are meditating regularly.”

That makes perfect sense to me. Compulsions create turbulent thoughts and stress in the body. Meditation helps to quiet the mind and relax the body. If you’re meditating every day, you have less free attention for generating or responding to compulsive cravings. As an example, a Danish study did brain scans on meditators and discovered a significant increase in the release of dopamine during the act of meditating, which means the brain’s pleasure circuit is activated, the same part of the brain that gets activated by compulsive cravings. (Source: “Increased dopamine tone during meditation-induced change of consciousness.” Troels W. Kjaer et al. Cogn Brain Res. 2002 Apr;13(2):255–9.)

Dr. Ronald Alexander, a psychotherapist and executive director of OpenMind Training Institute, uses a variety of meditation techniques in working with his clients. “Mindfulness practice helps us to develop the capacity to see clearly what we’re attached to so we can let go of it and end our suffering,” he explained. “There is a great meditation that you use when treating addicts that’s called the ‘death meditation.’ You actually take somebody through their own death and then take them to the body decay process. You also take them to the kind of death they would have if they were to continue drinking or using drugs. It’s heavy stuff. I learned it in Sri Lanka. And they use it in Thailand at some of the monasteries where they send people to cure addiction. They make the person do the death meditation every day. And sometimes two or three times a day, so they see their body system shutting down, what it’s like to have liver failure and cirrhosis. What it’s like to experience their heart stop, or not being able to eat solid food anymore. The meditation is motivating. I don’t think you have to have a soft approach when you’re dealing with addicts and addiction. This is a meditation that motivates people to really live in the moment.”

A high percentage of prison inmates enter prison facilities with a substance-abuse problem and once released, many relapse, resulting in more criminal behavior and more prison time. To test whether Vipassana meditation might be useful in lowering the relapse rate, Prof. Alan Marlatt and a team of nine researchers from the University of Washington put a group of inmates through a meditation course. “Results indicate that after release from jail, participants in the VM course, as compared with those in a treatment-as-usual control condition, showed significant reductions in alcohol, marijuana, and crack-cocaine use. VM participants showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes.” (Source: “Mindfulness meditation and substance use in an incarcerated population.” Sarah W. Bowen et al. Psychol Addict Behav. 2006 Sep;20(3):343–7.)

A second study of inmates a year later yielded similar results for Vipassana meditation, showing that the emphasis of Vipassana on acceptance rather than suppression of unwanted thoughts (cravings) helped to reduce substance abuse. In this experiment, 173 inmates at a Seattle jail were divided into two groups—a treatment-as-usual control group and a group who completed a meditation course over 10 days of intensive training. Participants ranged in age from 19 to 58 years, and 79 percent were male. From the study findings: “Individuals who participated in the 10-day Vipassana meditation course reported greater decreases in their attempts to avoid unwanted thoughts than individuals who did not take the course. Change in levels of avoidance partially mediated the relationship between Vipassana course participation and alcohol use and consequences three months following release from jail. These results provide support for the hypothesis that avoidance of unwanted thoughts may be an important component in the relationship between meditation and alcohol use.” (Source: “The role of thought suppression in the relation between mindfulness meditation and alcohol use.” Sarah W. Bowen et al. Addict Behav. 2007 Oct;32(10):2324–28. doi: 10.1016. Epub 2007 January 23.)

For more information on how mindfulness meditation has been shown to dramatically change criminal and addictive behaviors in various prisons, visit Vipassana (Insight) Meditation Prison Trust at www.prison.dhamma.org.

Tool 5—Nutrition and Exercise

Let’s start with nutrition, because without having proper levels of nutrients in your body, you won’t be able to summon the energy to exercise at an optimal level, and you certainly can’t remain physically or mentally healthy in the long term. There is even a case to be made that eating the “wrong” foods and not enough of the “good” foods can trigger or worsen many of the Seven Toxic Compulsions.

During the 1980s one of the pioneer investigators into the role that nutrients play in behaviors and the mind was Stephen J. Schoenthaler, a professor of criminal justice and sociology at California State University. He and a team of colleagues examined the interaction between nutrient intake and crime, antisocial behaviors, and educational performance of schoolchildren. Since four out of every five prison inmates have a problem with alcohol or illegal drug use at the time they are incarcerated, according to research from the National Center on Addiction and Substance Abuse, the effect of nutrition on the brain could offer a cost-effective treatment approach.

Kathleen DesMaisons, PhD, conducted a nutrition-based program to treat alcoholics in San Mateo County, California, for three and a half years, through 1997. DesMaisons focused on diet and nutrition to reduce the sugar cravings that prompted DUI offenders with flawed carbohydrate metabolisms to crave the sugar in alcohol. A control group that didn’t receive the nutrition education re-offended with alcohol-related crimes at four times the rate of those who were in the nutrition program.

More clinical evidence for the key role that brain neurotransmitter deficiencies play in drug, alcohol, and toxic foods abuse came from studies by pharmacogeneticist Kenneth Blum at the University of Texas at San Antonio. His research with both animal and human test subjects during the 1990s confirmed that malnourished brains seek comfort from the abuse of substances.

Dr. Charles Gant successfully used a nutrition-based medicine approach to treating substance abuse when he served as medical director of Tully Hill Hospital, a rehabilitation facility in Syracuse, New York. His emphasis then and since has been on the use of nutritional supplements to treat biochemical imbalances in the brain that contribute to substance abuse and subsequent relapses from that abuse.

In his book End Your Addiction Now, Dr. Gant made a case that compulsive substance use usually results from biochemical imbalances caused by one or more of four risk factors:

1. Poor nutrition
2. Exposure to toxins, including chemicals in the foods we eat
3. Stress
4. Genetic vulnerabilities

Based on questionnaire results from patients and readers of the book, Gant recommends nutritional supplements that include amino acids, vitamins, and minerals to boost neurotransmitter production to help “reduce or eliminate your substance urges, mood swings, irritability, difficulty in concentrating, sleep problems, and other symptoms.”

For example, if you complete the serotonin deficiency questionnaire and discover that you have a deficit in this critical neurotransmitter, which could be a cause of your substance urges, Gant proposes taking a nutrient regimen of 5HTP (up to 300 mg three times a day), L-glutamine (up to 1,000 mg four times a day), B-complex vitamin (one capsule three times a day), vitamin C (at least 500 mg three times daily), and a multimineral supplement of calcium, magnesium, potassium, iron, zinc, manganese, chromium, selenium, and molybdenum.

(For more information on Gant’s nutritional approach to compulsions, go to Connected Pathways LLC’s Web site: www.connectedpathways.com.)

Another nutritional medicine expert, Dr. Hyla Cass, a professor at the UCLA School of Medicine, coauthored a book with the British nutritionist Patrick Holford titled Natural Highs, in which they provided a nutritional and exercise-centered program for counteracting substance addiction caused by brain-chemical imbalances. “Since neurotransmitters are literally made from nutrients—amino acids, vitamins, and minerals,” they wrote, “we can formulate the perfect ‘brain food’ to improve how we feel and think.”

(For more information see: www.cassmd.com or www.naturalhighs-book.com)

Substance treatment specialist Dr. Kenneth W. Thompson, medical director of Caron, cautions: “There is currently insufficient science to support the use of nutritional supplements for the treatment of addiction. There are many gimmicks and pseudoscience surrounding justification of various supplements. Chemicals and supplements advertised as precursors to vital brain neurotransmitters required to feel good do not necessarily result in improvement in the brain’s chemistry when taken orally. But I’m a big believer in regular exercise, healthy diets with good nutrition, watching your intake of concentrated sweets and white flour, etcetera.”

So be careful about what you choose to try, but also be willing to experiment a little to see what works for you. Consider getting a checkup first, and consult with a physician to determine whether any of these supplements may interact with any prescribed medications.

As Dr. Frank Lawlis and Dr. Maggie Greenwood-Robinson pointed out in their book The Brain Power Cookbook, “Food is an unsung hero when it comes to addictions,” and while “eating healthy foods won’t necessarily break the hold of an addiction, it will help rebuild a body nutritionally depleted by substance abuse. What you may not realize is that alcohol, nicotine, and illicit drugs destroy nutrients, prevent their absorption, and flush them from the body. Cocaine and heroin addictions, in particular, reduce the intake of nutritious foods and cause serious malnutrition, whereas marijuana creates an abnormally large appetite for sweets and snacks, leading to unhealthy weight gain … I find malnutrition in every addict I see.”

If you’re being treated for an addiction or recovering from one, Lawlis and coauthor Greenwood-Robinson recommend that you enhance your recovery by adhering to a diet with five key components:

1. Make sure that protein comprises up to 25 percent of your total daily calorie intake; this ranges from fish to low-fat dairy and legumes.
2. Try to consume foods containing vitamin A in abundance; these range from fish to carrots and sweet potatoes.
3. Include foods that are high in B vitamins; these include whole grains, vegetables, and legumes.
4. Vitamin C foods should be heavily consumed; that means citrus fruits, green and red peppers, collard greens, broccoli, brussels sprouts, cabbage, spinach, artichoke, strawberries, etc.
5. Eat raw fruits and vegetables as much as possible, especially the dark-green leafy veggies like broccoli, kale, and spinach; also try juicing them, which is a fast and effective way to infuse your body with nutrients.

Here are a few representative studies showing a link between nutrition, mind health, behavior, substance abuse, and impulse control:

“Findings support the position that nutrition education is an essential component of substance-abuse treatment programs and can enhance substance-abuse treatment outcomes. Dietitians should promote and encourage the inclusion of nutrition education into substance-abuse treatment programs.” (Source: “Nutrition education is positively associated with substance abuse treatment program outcomes.” Louise P. Grant et al. J Am Diet Assoc. 2004 Apr;104(4):604–10.)

“Poor nutritional habits in children that lead to low concentrations of water-soluble vitamins in blood impair brain function and subsequently cause violence and other serious antisocial behavior. Correction of nutrient intakes, either through a well-balanced diet or low-dose vitamin-mineral supplementation, corrects the low concentrations of vitamins in blood, improves brain function, and subsequently lowers institutional violence and antisocial behavior by almost half.” (Source: “The effect of vitamin-mineral supplementation on juvenile delinquency among American schoolchildren: A randomized, double-blind placebo-controlled trial.” Schoenthaler SJ and Bier ID. J Altern Complement Med. 2000 Feb;6(1):7–17.)

“Driving under the influence (DUI) offenders with either alcohol-or cocaine-related problems were studied. The neuronutrients SAAVE and Tropamine significantly reduced relapse rates and enhanced recovery in these DUI outpatient offenders over a 10-week period. Follow-up on both the SAAVE and Tropamine groups after 10 months revealed a 73 percent and 53 percent overall recovery rate, respectively.” (Source: “Neurodynamics of relapse prevention: A neuronutrient approach to outpatient DUI offenders.” Brown RJ., Blum K., and Tachtenberg, and MC. J Psychoactive Drugs. 1990 Apr–Jun; 22(2):173–87.)

N-acetyl-cysteine (NAC) is an amino acid critical to brain health because it is needed to produce the neurotransmitter glutamate in the reward center of the brain, which is often altered by substance abuse and other compulsions. Several studies have found NAC supplementation can help in the treatment of cocaine and heroin dependence, and even in treating pathological gambling.

Previous studies had found NAC administration inhibits the desire for cocaine in addicts and in animals. A 2008 follow-up study at the University of South Carolina using lab animals found that “Daily NAC inhibits heroin-induced reinstatement and produces an enduring reduction in cue- and heroin-induced drug seeking for over one month after the last injection of NAC.” (Source: “N-acetylcysteine reduces extinction responding and induces enduring reductions in cue- and heroin-induced drug-seeking.” Zhou W and Kalivas PW. Biol Psychiatry. 2008 Feb 1;63(3):338–40. doi: 10.1016. Epub 2007 August 24.)

Cocaine impairs the brain’s ability to develop adaptive behaviors using brain plasticity. In this 2009 study, NAC treatments induced “metaplasticity that inhibits further induction of synaptic plasticity, and this impairment can be reversed by NAC, a drug that also prevents relapse.” (Source: “N-Acetylcysteine reverses cocaine-induced metaplasticity.” Khaled Moussawi et al. Nat Neurosci. 2009 Feb;12(2):182–9.)

At the University of Minnesota School of Medicine, researchers put 27 pathological gamblers through an eight-week trial of NAC supplementation. Compared to the placebo group, those in the NAC group greatly reduced their scores on an obsessive-compulsive scale. “The efficacy of NAC lends support to the hypothesis that pharmacological manipulation of the glutamate system might target core symptoms of reward-seeking addictive behaviors such as gambling.” (Source: “N-acetyl cysteine, a glutamate-modulating agent, in the treatment of pathological gambling: a pilot study.” Jon E. Grant et al. Biol Psychiatry. 2007 Sep 15;62(6):652–7.)

Exercise is also about strengthening your brain

Today I do Bikram yoga instead of pounding my knees in the gym. I decided to do something that’s more benign, but I’m still going to do it every day. It takes an hour and a half a day. It keeps me healthy and helps me deal with the constant chatter that is always present in the recovering addict’s brain.

If you can begin an exercise regimen sooner in your recovery—it could be running, walking, going to the gym, or doing yoga—it will absolutely help you get through the difficult times because of what exercise does for us in terms of the endorphins making us feel good, helping us sleep, all of those kinds of things.

Yoga has been a huge part of my recovery from day one. I’ve morphed from somebody who ran every single day, five or six miles, to someone, as I’ve gotten older, who does yoga. Going to yoga every day, no matter whether I felt like it or not, helped me with all of the physical and mental aspects of recovery because it changes the levels of dopamine and serotonin in your brain to minimize any tendency you have toward depression.

Yoga actively reduces stress. That’s now a well-established fact of medical science. A July 2011 study in the Journal of Pain Research showed how women who engaged in the Hatha form of yoga experienced a level of relaxation that decreased activity of the sympathetic nervous system, which lowers heart rate and increases breath volume. That in turn regulates levels of cortisol, the hormone produced by the body in response to stress. Since stress is one of the primary triggers for cravings associated with toxic compulsions, anything that naturally reduces stress levels also helps to alleviate dependency and relapse.

“Exercise can activate the pleasure circuit” of your brain, wrote Johns Hopkins University School of Medicine neuroscience professor and editor-in-chief of The Journal of Neurophysiology David Linden in his book The Compass of Pleasure. Aside from the well-documented positive effects of sustained exercise on physical health, exercise is also associated “with long-term improvements in mental function and is the single best thing one can do to slow the cognitive decline that accompanies normal aging. Exercise has a dramatic antidepressive effect. It blunts the brain’s response to physical and emotional stress. A regular exercise program produces a large number of changes in the brain, including the new growth and branching of small blood vessels, and increases in the geometric complexity of some neuronal dendrites.”

More study support for this idea came in the Journal of Applied Physiology (April 28, 2011), with the finding that “aerobic and resistance training are important for maintaining cognitive and brain health in old age.” This is also true for children. Research has found that “3 months of aerobic exercise training improved prefrontally mediated executive function abilities in 7- to 11-year-old overweight children.”

University of Florida psychiatrist Mark Gold further noted that exercise can actually reverse certain types of brain damage caused by substance abuse. “If you look at the changes in the brain caused by drugs, challenging the survival of some of the neurons and connections, exercise is the best neurogenic treatment we have. It changes brain structure and prompts the growth of new nerve cells and blood vessels.”

Studies on exercise for alcohol, drugs, gambling, and smoking

One of the early studies showing the benefits of exercise in diminishing a compulsion—in this case, heavy alcohol use—occurred in 1986 when 60 male students between the ages of 21 and 30, all classified as heavy social drinkers, were randomly assigned to either an exercise group or a control group. The exercise group engaged in a regular running routine. Their alcohol consumption was assessed over a 16-week period. “The results showed that subjects in the exercise condition significantly reduced their alcohol consumption compared to the no-treatment control condition,” the study authors concluded. (Source: “Lifestyle modification with heavy alcohol drinkers: Effects of aerobic exercise and meditation.” Timothy J. Murphy et al. Addict Behav. 1986;11(2):175–86.)

Aerobic exercise as an adjunctive treatment for drug dependence was the focus of a 2010 study of 16 drug-dependent people who participated in a 12-week moderate-intensity aerobic exercise program. Those who attended 75 percent of the exercise sessions “had significantly better substance-use outcomes than those who did not.” Exercise participants in general demonstrated a “significant increase” in days abstinent from both alcohol and drug use at the end of treatment. (Source: “Pilot study of aerobic exercise as an adjunctive treatment for drug dependence.” Richard A. Brown et al. Ment Health Phys Act. 2010 Jun 1;3(1):27–34.)

In 2009 Brazilian researchers put a group of pathological gamblers through a four-week exercise program that involved 45-minute sessions of stretching and running. This followed their participation in 12 to 15 cognitive behavioral therapy group sessions. The exercise group was evaluated using a 10-item gambling scale both at the beginning of the exercise program and at the end. All patients showed an improvement in their gambling behavior scores to within the range of complete remission after completing the exercise program. (Source: “Physical exercise for pathological gamblers.” Daniela L. Angelo et al. Rev Bras Psiquiatr. 2009 Mar;31(1):76.)

Reducing the cravings associated with a smoking cessation program was the goal of a 2011 study at Brown University that used moderately intense aerobic exercise. Sixty previously low-active but healthy female smokers went through an eight-week program that included three sessions a week of exercises, along with smoking cessation counseling and the nicotine patch. Cigarette cravings were assessed throughout the program. “Results suggest that aerobic exercise has potential as a smoking cessation treatment, but that it must be engaged in frequently and consistently over time in order to derive benefits.” (Source: “Acute effects of moderate intensity aerobic exercise on affective withdrawal symptoms and cravings among women smokers.” David M. Williams et al. Addict Behav. 2011 Aug;36(8):894–7.)

(Note: As with nutrition, you should consider consulting a medical professional first, as various forms of exercise may be risky for individuals with certain medical conditions.)

Tool 6—Body Work

Years ago I did Reichian therapy. It’s based on the belief that your emotional history is stored in your body. You talk about things, about your childhood, and when something comes up, the therapist pushes his fingers into different parts of your muscles. You may scream or hit a pillow or something, and that’s how you release the pain of the memory.

If you can afford to do that kind of work, it goes a long way toward dealing with the underlying causes and conditions of one’s addiction. You can really fast track by doing this kind of psychological work. It’s like a depth charge. It can bring clarity and movement to deep emotional issues that otherwise might take years to understand. The therapy moves you dramatically right away, but then, of course, the rubber band of habituation pulls back over time, only it never pulls you back to where you were before.

As the name implies, “body work” concerns ways to manipulate your body to help relieve the cravings and other symptoms associated with a toxic compulsion. If you’ve ever had therapeutic massage, you can relate. You know it relieves stress, and if you simply allow yourself to experience the ensuing relaxation, your mind is no longer dwelling on any compulsive thoughts.

You probably have heard of acupuncture, but not somatics, which I describe below. Though some people might say that acupuncture isn’t body work, it certainly looks that way to me. It simply involves a manipulation of the body using needles rather than hands. There have been a lot of scientific studies examining what acupuncture can and can’t do for you. Not so with somatics, which is a relatively new player in the toxic compulsions treatment field.

Some needles may help you recover

Chinese medicine texts describe acupuncture as the stimulation with tiny needles of an energy called qi (pronounced “chee”) into areas of the human body known as meridians, vein-like pathways under the skin’s surface connected to different body organs.

All of this may sound a bit strange to many Westerners; however, acupuncture has been shown to treat arthritis, nausea, and chronic pain, apparently by releasing the body’s beta-endorphins. After a 1989 study published in the British journal The Lancet showed acupuncture to be effective in treating alcoholism and its relapses, treatment specialists and drug and alcohol treatment centers in the United States and Europe began to take notice of its potential to treat all types of chemical dependency.

Dr. Kenneth Carter is both a psychiatrist and an acupuncturist at the University of North Carolina–Chapel Hill Medical School Psychiatry Emergency Services, as well as immediate past president of the National Acupuncture Detoxification Association, who specializes in treating symptoms associated with substance abuse; he also teaches medical personnel how to use acupuncture. He described some of its benefits:

“The beautiful part about acupuncture is that it can be used across the spectrum from acute distress, acute illness, to a wellness soul. I use it as an adjunct therapy, not as a replacement therapy. You can do it in your own home.

“Home use of acupuncture to treat drug abuse originated in the Bronx, New York (The Lincoln Recovery Center was an outgrowth), at a time when many people could hardly afford to pay a doctor and there were long waiting lists for drug treatment. It was started by community people concerned about heroin. They brought it into existence in spite of opposition from the mainstream medical system.

“It’s so simple and easy. Your grandmother should be able do it for little Johnny who started smoking weed or drinking and is too embarrassed to go see a psychiatrist. It only involves doing five acupuncture points in the ear. A pack of acupuncture needles might cost a dollar for 10 needles.

“First thing I would suggest is to visit our Web site, www.extra-detox.com. There is a lot of very easy-to-read material to guide you. We have a list of registered trainers. We have a training resource manual. And when someone has been a practitioner for up to two years, they’re qualified to become a trainer.

“How does such a simple tool work across so many different substances, from drugs to alcohol? It seems to have a general balancing effect on the body. The ears are the only place on the body to access cranial nerves without surgery. The lower half of the ear connects to the vagus nerve. Acupuncture really works to reduce cravings. I don’t know of a tool that is more useful across the whole spectrum from acute to long-term recovery.”

Lincoln Recovery Center has become a worldwide pilot program in auricular acupuncture for the detoxification and treatment of drug-addicted persons. It has used acupuncture as the primary method of treatment for drug addicted persons and its acupuncture model is used by at least 1,000 programs worldwide. It has trained more than 3,500 alcohol- and substance-abuse counselors in the New York City area in the use of acupuncture.

Here’s how the clinic describes its use of the procedure to relieve substance cravings and withdrawal symptoms: “Auricular acupuncture patients receive five thin needles (0.25-mm dia., 15mm long) that are inserted into the appropriate area of the ear cartilage ridge, located next to the outer rim of both ears. Ear points used for detoxification are labeled ‘Shen men,’ ‘Kidney,’ ‘Liver,’ ‘Sympathetic,’ and ‘Lung’ in acupuncture texts. The patient is instructed to relax for 45 minutes with needles in place. The needles are then removed. Only sterile needles are used since strict antisepsis is necessary to avoid infections. Before needle insertion, the auricular points are cleaned with 75 percent alcohol.” For more information, go to http://sad-lincoln.org.

Mixed study results on acupuncture’s effects

A review of medical science studies examining whether acupuncture is effective to help quit smoking, drugs, and alcohol, reveals a variety of results and starkly contrasting opinions about its usefulness.

Let’s start with several of the negative result studies:

“The results are consistent with the findings of other studies that failed to find any effect of acupuncture in the treatment of drug dependence. The failure to find any clinical gains from the adjunctive use of auricular acupuncture during detoxification from opiates raises concerns about the widespread acceptance of this intervention.” (Source: “Auricular acupuncture as an adjunct to opiate detoxification treatment: Effects on withdrawal symptoms.” Jennifer Bearn et al. J Subst Abuse Treat. 2009 Apr;36(3):345–9.)

“The results of the included studies were equivocal, and the poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence.” (Source: “Acupuncture for alcohol dependence: a systematic review.” Cho SH and Whang WW. Alcohol Clin Exp Res. 2009 Aug;33(8):1305–13.)

“The NADA (National Acupuncture Detoxification Association) protocol was not more effective than sham or treatment-setting control in reducing anxiety. The widespread acceptance of auricular acupuncture in the treatment of addiction remains controversial.” (Source: “Determining the efficacy of auricular acupuncture for reducing anxiety in patients withdrawing from psychoactive drugs.” Shaun Black et al. J Subst Abuse Treat. 2011 Oct;41(3):279–87.)

Positive result studies are more numerous. Here are a few:

“Acupuncture can lessen heroin cue-induced activation degree of the brain areas involving psychological craving, suggesting that acupuncture is able to suppress the heroin addiction patients’ drug abuse craving.” (Source: “Effect of acupuncture on heroin cue-induced functional magnetic resonance images in heroin-addicted human subjects.” Xiao-ge Song et al. Acupunct Res. 2011 Apr;36(2):121–7. www.ncbi.nlm.nih.gov/pubmed/21717780.)

“The authors think that acupuncture application provides the patients with deterioration in the taste of smoking, decrease in desire of smoking, and the obstruction of psychological symptoms that appear as a result of smoking cessation. Because of these effects it is presumed that acupuncture may be used as an important method for smoking cessation treatment.” (Source: “Smoking cessation after acupuncture treatment.” Cabioglu MT, Ergene N, and Tan U. Int J Neurosci. 2007 May;117(5):571–8.)

“These results provide evidence that acupuncture may be effective for inhibiting the behavioral effects of cocaine by possible modulation of the central dopaminergic system.” (Source: “Acupuncture attenuates cocaine-induced expression of behavioral sensitization in rats: Possible involvement of the dopaminergic system in the ventral tegmental area.” Lee B, Han SM, and Shim I. Neurosci Lett. 2009 Jan 9;449(2):128–32.)

“Over the last three decades there has been an increasing interest in acupuncture treatment of substance abuse around the world. The recent advance in this field was made by Dr. Han of the Peking University, Beijing, who characterized a protocol (2005) using electrical stimulation of identified frequencies on body points to ameliorate heroin withdrawal signs and prevent relapse of heroin use.” (Source: “Acupuncture for the treatment of drug addiction.” Cai-Lian Cui et al. Neurochem Res. 2008 Oct;33(10):2013–22.)

“We determined that acupuncture detoxification programs are a useful component of a substance abuse treatment system.” (Source: “The value of acupuncture detoxification programs in a substance abuse treatment system.” Michael Shwartz et al. J Subst Abuse Treat. 1999 Dec;17(4):305–12.)

What are we to make of these conflicting study results? A common sense observation is that acupuncture has different effects on different people. Whether it’s partially a placebo effect or entirely a manipulation of “energy” centers of the body thereby easing substance withdrawal, it’s a technique that may benefit you, particularly if alcohol, drugs, or cigarettes are involved. Just don’t have high expectations, and don’t be disappointed if the results fail to meet your needs.

Other forms of body work

Somatics is a type of body manipulation and deep massage that’s designed to release trauma, especially childhood traumas. The Reichian therapy treatment I mentioned earlier might fall under this category.

Somatic Experiencing was developed by Dr. Peter A. Levine, a stress and trauma expert who wrote Waking the Tiger: Healing Trauma, which provides many useful exercises based on his medical practice—exercises that have been designed to help resolve shock trauma (the experience of life-threatening events, such as in war) and developmental trauma (experiencing cruelty and neglect in childhood.)

“I believe that people, in community with family and friends, have a remarkable ability to bring about their own healing,” wrote Dr. Levine. “Body sensation, rather than intense emotion, is the key to healing trauma …. Of all the maladies that attack the human organism, trauma may ultimately be one that is recognized as beneficial. I say this because in the healing of trauma, a transformation takes place—one that can improve the quality of life.”

Self-medicating with substance abuse is one of the means that Levine first identified two decades ago “by which traumatized people attempt to stabilize or suppress symptoms” associated with the trauma they experienced. Find out more about Somatic Experiencing, including lists of practitioners of this technique in your area, by going to www.traumahealing.com.

A second pioneer in the field of body-based therapies is somatic psychologist Pat Ogden, PhD, founder and director of the Sensorimotor Psychotherapy Institute and coauthor of Trauma and the Body. Written primarily for clinicians and psychotherapists, this scholarly book explains how using body sensation and movement can help heal the wounds of trauma, and though she doesn’t specifically address the relationship of trauma to toxic compulsions, her work makes clear that trauma treatment should involve both the body and mind.

Christine Caldwell, PhD, founder and chairperson of the Somatic Counseling Psychology Department at Naropa University in Boulder, Colorado, has developed innovations in the field of body-centered psychotherapy. She calls her work the Moving Cycle. This system goes beyond the limitations of therapy and emphasizes lifelong personal and social evolution through trusting and following body states. She has authored two books: Getting Our Bodies Back and Getting in Touch. She offers trainings in somatic psychotherapy (Moving Cycle) with a specialization in addictions. For more information, visit www.themov-ingcycle.com.

Try a “vision quest” using sensory deprivation

From Frank Lawlis, PhD, director of Psychological Services, Origins Recovery Center, South Padre Island, Texas, and author of Retraining Your Brain: As the individual begins to detoxify, his or her brain starts to heal itself. It usually takes two years for the addict’s brain to heal enough to make responsible decisions; however, that is longer than we have in most rehab situations. Also, there is usually some need or fear that propels us to go for drugs, and that has not gone away. In the grown-up world there are distractions, many distractions, that take us away from what we need to be focusing on. This is why we have a place to go with no distractions so you can begin to hear your voice inside, the one that looks out for you and gives you wise counsel.

At Origins Recovery Center in South Padre Island, Texas, we have built such a place. It is called an SDC, which stands for Sensory Deprivation Chamber, built with the express purpose of keeping the world out, including light, smell, sound, and touch. This will be a major vehicle for knowing yourself and especially forgiving yourself as you begin to separate your true self from the ghosts that have haunted you since you were born, giving you the opportunity to confront them in a totally safe environment. Here is where you can find and understand your power. This is the place for you to go and release the monkey on your back, see it, label it, and control it.

We are all born and raised with one part of our self looking in to understand what we need and who we are, while another part of our self is looking out, listening to what the outer world thinks of us, what the expectations are, and how to survive. Too often we forget the first part and try to make our inner world fit our outer world. This is the reason for the Sensory Deprivation Chamber.

An SDC is simply a device designed to eliminate all the external sensory perception of a person in order that they may look within. It is lightproof, soundproof and free of distracting touch. The intention of the SDC is to help you look within yourself and get to know who you are, what thoughts are prevalent, and possibly learn to free yourself of unwanted stressors in the mind through deep relaxation.

By eliminating the outer world for an hour, you can have the opportunity to feel your inner self. You may feel yourself expand beyond your skin boundaries because your energies are very big. You may feel your inner self speak to you internally. Or you may hear your outer self trying to get your attention. The sounds of a busy mind will eventually subside and you will begin to discriminate as to what is your real voice and what are only memories of the outer world demands, such as family names or labels.

So as you enter the SDC, relax with your breath. Let go of all your fears. You will not be locked in, so if you start getting panicked, merely push the door open. You can also be heard through an embedded microphone where medical professionals will be monitoring and listening. Remember, the SDC is only empty darkness and that this may be the first time you have experienced the freedom to get to know yourself and the genuine sense of connection with who you have become. This is not problem-solving time, just an opportunity to observe how you think and seek your internal truth.

Tool 7—Journaling

It may not seem relevant at first, or even logical, but regularly writing down your thoughts and feelings can play a significant, positive role in early recovery. I’ve looked at my journals again and they do validate what you experience on the road to recovery.

Journaling keeps an addict’s mind focused on what’s real. That’s a huge benefit for those of us prone to getting stuck in magical or delusional thinking.

During the process of releasing something from your mind through computer keys or a pen on paper, you get to read it and see your improvement, or your temporary insanity. Sometimes you read it and go, “What am I thinking?!” It gives you a different perspective—a more therapeutic perspective—on what you’re thinking and what you’re experiencing.

Writing it down can be enormously helpful in working through things. It can be enormously helpful if you have resentment against somebody. Instead of yelling or screaming or getting into a fight, which could put you in such disarray that you run back to whatever behavior you need to stay away from, you can journal it and release the anger that way—a useful technique to circumvent triggers that could cause a relapse to self-destructive behaviors.

You can journal about anything. It could be cravings, what you’re feeling, your fears—anything. You write down anything you want; there’s no right or wrong here. It’s about getting what’s in your head out of your head and relieving the pressure these stagnant thoughts can generate. It makes the thoughts more manageable, not as overwhelming.

Journaling also enables you to visualize what you want your life to be like. The pros and cons of everything in terms of relationships become clearer. For example, if you’re thinking “I’ve got to get out of this marriage,” and this thought is occurring just 35 days into some kind of recovery, you can journal to see if what you’re thinking is real or just a fear that will resolve itself over time.

The thing to keep in mind is that people enslaved by their compulsions believe their feelings. They feel them so strongly. Journaling provides a counterbalance in black and white, whether it’s a negative feeling or a positive feeling. Writing is cathartic. Your feelings become concrete. It’s hard to write down something that’s insane—and a lot of times we addicts can be insane in our thoughts. But in the act of translating our thoughts into the written word, something transformative happens; something that is reality-based occurs. With journaling, you don’t just hear a bunch of internal voices screaming and yelling all the crazy shit that enslaves you. Journaling is like calling a committee into session that you can objectively listen to. You realize that you aren’t your thoughts.

You can write down your questions. What do you want in your life? What does this behavior mean to you? Does it mean freedom or slavery? Does it mean happiness? Does it mean a new Ferrari? What does recovery really mean to you? The act of just putting it down and getting it out diminishes the negativity of the thoughts, and re-reading what you wrote later can give you a different sense of your reality.

Think of journaling as a really cool tool with two edges. One is the active edge of writing what you’re feeling in the moment; the second is the passive edge of reading what you had previously written in the moment. Each serves a beneficial function.

Journaling provides a safety check and reality check on your thoughts, especially the toxic ones. Otherwise, your thoughts will convince you of anything to get back to what the cravings tell you to do. The disease of addiction is cunning, baffling, and powerful. It will use whatever it can to get you to do whatever it wants, and your thoughts are its greatest weapon.

Quite a few of the treatment specialists I interviewed for this book mentioned the benefits of journaling. Prof. Howard Shaffer, for one, said: “People need journals so that they can keep track every day of both their emotional states and their behavioral states. This enables people in recovery to chart and see their improvement.”

Scientific data begins to support journaling benefits

Regularly writing down your thoughts and feelings, journaling, is labeled by scientific researchers as “written emotional expression,” a technique that has been shown in countless studies to be of use in soothing chronic pain, lowering blood pressure, reducing stress and anxiety, lifting depression, healing post-traumatic stress disorders, and boosting the immune system.

Somehow, written emotional expression seems to unknot and release the chronic cramp of negative emotions that can cause and complicate disease, including the disease of compulsive behaviors. Though few studies have looked at the benefits of journaling on toxic compulsions, the evidence thus far is quite promising.

What may have been the first study examination of the effects of written emotional expression on recovery from drug dependence—in this case, cocaine—came in 2010 from researchers at the Department of Veterans Affairs Medical Center in Kansas City, Missouri. Subjects in this controlled trial experiment were receiving intensive treatment for cocaine dependence in a residential-unit setting. The findings were remarkable: “Treatment [with written emotional expression] produced changes in blood pressure and mood during writing sessions, possibly because of its ability to stimulate active coping behavior. At an initial follow-up visit, patients that had received written emotional expression reported lower values for craving intensity and were less likely to self-report use of cocaine. These results may indicate a therapeutic effect of written emotional expression during recovery from cocaine dependence.” (Source: “The value of acupuncture detoxification programs in a substance abuse treatment system.” Michael Shwartz et al. J Subst Abuse Treat. 1999 Dec;17(4):305–12.)

(Important note to readers: If you want to expand and deepen the integration of the Seven Self-Care Tools into your recovery life and become empowered to take more effective action, then go beyond just reading about the tools in this section of the book and access the extensive support resources for these tools, assembled at www.recover2live.com.)