Outplaying the Game of Abstinence Solitaire

It would be easier to not use substances if wishing to use them would go away.

I think I’ve been on a personal, anti-wishing campaign since I began to abstain from alcohol nearly seven years ago. The neuroscience of addiction explains, however, that shutting down the brain structures and functions that long for alcohol would shut down the same networks that bond and attach to the ghost child I could never conceive and to my mother, gone seven years now. It is my humanity, not a pathology, that wishes for the substance that lifted me up and relieved me of my anguish, as if I were held in my mother’s arms.

Using the proverbial metaphor of life as a card game, wishing to return to use is a card I’ve been dealt. It’s a fact. What other cards are on the table? Medical care and medications are the first line of treatment for substance use issues. Let’s say I’ve got that. Given that each week holds 168 hours, even if I could schedule 40 hours of medical appointments, counseling sessions, and supportive meetings, that leaves 128 hours. We’re told we can’t recover alone, yet’s who’s going to staff my alone time? How can I help myself play what’s essentially a game of abstinence solitaire during all those hours I’m solo?

Based on my personal and professional experience, knowledge of counseling protocols, syntheses of literature reviews of research, and my desire to help people who want to or are mandated to abstain from substances, I’ve devised two “card decks.”

The first deck, entitled “Why Some People Return to Substance* Use After Abstinence: The Cards on the Table,” lists forces at play for many people with substance use concerns. For short, I call this the “fact deck.”

1. Many memories of positive experiences of substance use: experience of substance ≠ experience of consequences of substance use
2. Few memories of experiences of negative consequences of substance use: experience of substance ≠ experience of consequences of substance use
3. Abstinence anhedonia: Inability to feel pleasure during abstinence comparable to pleasure experienced using substances
4. Automaticity overpowers autonomy: Unskillful attention management; unskillful emotion regulation; unskillful thought-sorting; environmental cues
5. Experience of substances and substance use outcompetes experience of available life offerings (“Is this all there is?!”)
6. Experience of substances relieves inner experience better than other available options
7. Deprivation effect, up arrow: Abstinence may be experienced as deprivation, result in unremitting feelings of panic or rage, and cause bingeing to compensate.
8. Deprivation effect, down arrow: Abstinence may be experienced as deprivation, result in unremitting feelings of hopeless despair, and cause a sense of helpless return to use.
9. Mysterious brain changes inexactly defined despite the best efforts of the best minds and hearts among researchers, treatment providers, journalists, and those in remission.

The second deck is entitled, “How I Can Help Myself Abstain from Substances*: Outplaying the Hand I Have Been Dealt.” I call it the “action deck.” It provides corresponding counter-plays.

1. Many memories of the positive experience of substance use: Fact. Nothing to do but accept.
2. Few memories of the experience of negative consequences of substance use: Fact. Nothing to do but accept.
3. Abstinence anhedonia: Fact. BUT research suggests I can have a direct impact on anhedonia and apathy by deliberating discovering and “dosing” myself with multiple, small, anticipation-reward experiences.
4. Autonomy vs. automaticity: Use of awareness skills can effectively overpower automaticity: attention management; emotion regulation; thought-sorting; outmaneuvering or avoiding environmental cues
5. Experience of substances and substance use outcompetes life: I must honor my preferences and collect an adequate number of ways which, enough of the time, together, have more value than the value offered by substances. (synergy = whole greater than sum of parts)
6. Experience of substances outcompetes relief of inner experience: I must keep experimenting with other ways to experience relief and increase my ability to tolerate distress.
7. Deprivation effect, up arrow: Feelings of panic or rage: I must find what I can, and add what I can, to have enough experiences enough of the time to help my life feel enriched enough, not impoverished by scarcity.
8. Deprivation effect, down arrow: Feelings of hopeless despair: I have to find what I can, and add what I can, to have enough experiences enough of the time which help me feel reassured and encouraged enough.
9. Mysterious brain changes: Fact. Nothing to do but accept.

*”Substance” is defined as any substance with which use or overuse can cause negative health consequences. Problematic substances may include nicotine, caffeine, alcohol, marijuana, methamphetamine, opioids, other drugs, and food. One would not abstain from food, however.

I can envision these cards as screens in a mobile application.

(In another life, I was part of technology startups and this is what’s left of our attempts to create software applications for people in recovery. Potential referrers wanted clinical trials to prove efficacy and our attempts to gain funding failed. I cringe at the stigmatizing language I used in 2013 and am part of an initiative to change that.)

Because the magnitude of each factor might vary for each individual, the size of each card could be customized. Individuals could add or delete cards as well. The point is that I’ve created a simple, static version of a complex, dynamic system.

If you would like to try your hand at playing abstinence solitaire, here are .pdfs of the “fact deck” and the “action deck.” Once I printed the pages, I used scissors to snip the cards apart. I played the fact deck first, arranging the cards in the order of their impact on me.

Seven years ago, the deprivation effect cards would have been in the upper row. Today, an hour with a glass of wine might outcompete the many lonely, child-absent, partner-absent, elderly-parent-caregiving hours I’ve currently got going.

I have to outplay the hours that drain and demoralize me. Using the “action deck,” I play the synergy card. I work on creating enough small, meaningful experiences, enough of the time, to keep myself on the ground above a chasm of longing.

From using the fact and action decks, I’ve realized that many of my efforts to help myself with abstinence have been attempts to move cards glued to the table by reality. I’ve wasted time and energy on what I can’t do. I can shift my efforts to what I might be able to influence.

Some of the fact cards seem like wild cards, ones that might play me rather than me playing them. I have done everything that research and logic suggest to do, yet there they are.

Here’s how I see to play this. First, I acknowledge non-judgmentally and kindly that I really wish I didn’t have to play this game at all. However, given the current state of beliefs, policies, and laws about substance use, I simply may be required to abstain or risk losing what’s precious to me. So. Let me really look at the cards on the table. What’s really on the table? And the game is abstinence solitaire? Let me strategically and skillfully play the cards I’ve been dealt.

Fact Deck (.pdf)

Action Deck (.pdf)

Insider’s Guide to Early Abstinence may be helpful as well.

The abstinence solitaire card decks are supplements to the guide Sanjay Kishore, M.D. and I have co-authored, Help That Helps: A Kind, Research-Informed, Field-Tested Guide for People with Substance Use Concerns. A .pdf of 107 pages, Help that Helps is a self-guided program – tested and refined by real people with real substance use issues – for people with substance use challenges who need or want to abstain.  Caveat: Any self-help guide is to be used in tandem with medical care.

Last updated 10/25/19

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.