How to Help Yourself Not Use or Drink: A Kind, Straightforward, Evidence-Informed,  Do-It-Yourself, Insider’s Guide to Early Recovery from Addiction
by Anne Giles, M.A., M.S.

Dedicated to my clients: You helped write this. For confidentiality reasons, I can’t use your names, but as you read along, you’ll recognize your own – and each other’s – wisdom. Thank you beyond words for sharing the extraordinary beauty of who you are with me.

This guide is intended for people who have already received medical care for the medical condition of addiction. This guide assumes you are medically stable, have detoxed through medical monitoring, and/or have been medically cleared as having successfully detoxed on your own, and/or are stable on medication treatment. You either have received, or have appointments to receive, medical care for the medical conditions that can accompany addiction.

“Use” refers to use of any substance that has caused problems for you, brought into the body in any way.

How to Help Yourself Not Use or Drink Right Now

1. If the substance is nearby, turn away from it.
2. Sort your thoughts into “helpful” and “unhelpful” categories. Focus your attention on the helpful thoughts.
3. Without judging your feelings, or trying to control or change them, simply turn down the “volume” on the intense feelings.
4. Do what you can to make yourself more physically comfortable.
5. When thoughts of using or feelings of craving arise – which they will – without judgment, simply shift your attention to a specific item that engages one of your senses. Become curious about your preferences, focusing on what sensory experiences might be helpful to you. Focus your attention on something you see, a sound you hear, the texture of an object you can touch, a scent in the room, a motion you can observe, or the taste of something available.
6. When a thought arises that begins with, “Yes, but…”, say, “I am trying to help myself not use,” and shift your attention to what is helpful to you.
7. When a memory from the past emerges, or a worried thought about the future occurs, say, “I am focusing on this right now,” and shift your attention to what is helpful to you.
8. If nothing else is working, splash cold water on your face. If cold water is not available, place a cool object safely and gently against your face.
9. Even if you have to do it 100 times a day, even 100 times a minute, kindly, gently, but determinedly return your attention over and over again to what you think would be helpful for you. Not to what someone else might think is “right” or “good.” To what would be helpful. For you.

How to Help Yourself Not Use or Drink Today

1. Do the items on the “Right Now” list.
2. Make two lists of all the people in your life under the headings “safe” and “unsafe.”
3. Find a way to physically be in the presence of the “safe” people.
4. Stay away from the people on the “unsafe” list. Do not have contact in person, by text, by messaging, or by any means of any kind. Do not listen to, or seek information about them by word-of-mouth, gossip, rumor, Crime Times, or any way of any kind.

How to Help Yourself Not Use or Drink This Week

1. Keep doing the “Right Now” items. Stay with safe people.
2. Make a list of all the problems present in your life that substance use solved.
3. Rank order the problems.
4. Make a list of everything that’s missing in your life that substances provided.
5. Rank order what’s missing.
6. Think strategically.
7. Ask yourself, “What is one small thing I could do today to help make a small improvement in my top ranked problem?”
8. Ask yourself, “What is one small thing I could do today to help provide a little bit of the top-ranked thing that’s missing from my life?
9. Do those small things.
10. Think about how you have handled the loss of beloved people and beings in the past. You can never be with them again. How have you handled longing and not having? How have you coped with the loss of your loves? The brain circuitry of love and addiction are interrelated. Answering these questions may provide important information about what might help you cope with the loss of substances.

How to Help Yourself Not Use or Drink This Year

The only way to not use substances long-term is to find enough things to do, enough of the time, that meet enough of your needs, connected to enough people, in ways that touch your heart enough, make enough meaning for your mind – all of this stable enough but with room for change and growth – that, together, are “good enough” replacements for substances.

Nothing is likely to ever do for you what substances did. Their chemical nature gives them an other-worldly ability to offer extreme comfort, excitement, joy and relief. Managing attention, feelings, thoughts, physical sensations, and behavior during the days ahead will only work so long while holding still. The insights you gain from learning what substances did for you are necessary, but likely are not sufficient, to prevent yourself from returning to use.

Hopelessness and despair are considered to be among the root causes of addiction. You need to develop a way of thinking that helps you feel hopeful and confident. This is where religious and spiritual beliefs, and philosophical and scientific understandings might be helpful. Figuring out the values that drive your decisions can inspire a sense of strength as well. Finding even a few people with whom you feel a sense of belonging, and continuing to add people to that circle as time passes, will be crucial.

If in doubt, Google it. Knowledge and information offer power and freedom. Before drawing conclusions from the results of Internet searches, check the authority of the source. Reliable sources link to primary sources, secondary sources that report on multiple primary sources, and informed commentary.

And then there’s the money.

If you’ve had substance use issues for awhile, you probably have financial challenges. More money would increase stability. But people with substance use disorders usually can’t work more hours to make more money. Working more hours increases stress. Stress is a top predictor of return to use. Stress comes from the usual suspects – finances, relationships, and health issues among them. But boredom is a stressor. Lack of purpose is a stressor. Frustration is a stressor. So people with substance use disorder have to figure out how to make more money per hour in ways that are meaningful to them. That usually requires education and training. You may need to learn to read, to get a GED, learn a trade, or take entrance exams to go to college or grad school.

You need an it’s-who-you-know network of people to help guide you to the right information, mentor you as you go, and introduce you to people who might be able to help you. You’ll soon be a member of the “it’s-who-you-know” network. You’ll be able to help someone else who started just where you’re starting.

1. Acknowledge realities. Note what’s unlikely to be possible in the future based on physical or other limits. For example, if you want to move to a place with more jobs but have a suspended license, you’ll need to find a city with public transportation.
2. Inventory your strengths. What do you have going for you, in spite of everything that’s gone down?
3. Make a list of possibilities. Given current realities, but also given your strengths, what might be possible for you to do, that you might like to do, that would give you a sense of being meaningfully engaged with your life?
4. Rank order the list of possibilities. Which of the possibilities do you think would sustain your interest the longest and be most likely to make the most money, or result in the most satisfying volunteer work?
5. Find someone who has made things happen in his or her own life to talk with about your top three possibilities.
6. Think strategically.
7. What small, first steps could you take to move yourself a tiny bit closer to setting yourself up to have meaningful things going in your life – even if they’re only ever “good enough” – to help you not use?
8. What people in your it’s-who-you-know-network can you contact to help you with these first steps?

. . . . .

I wish I could write a guide that anticipates all the problems that might arise for you and offers solutions to them! But you are a unique, complex individual, and addiction is a complex condition. You are the guide to you.

If you would like to read more about evidence-informed, self-care for recovery from addiction, this guide’s current table of contents, with links, is here.

If you like handouts and worksheets, here is my current list of printable, evidence-informed addiction recovery worksheets.

An earlier version of this post is here.

This guide is a work-in-progress.

These words, just over 1,500 in number, are a summary of what research on addiction suggests helps most people, most of the time, better than other ways, and better than nothing, to help themselves not use substances that have become problematic for them. As you know, I use these ways, too. I am hoping with all my heart and mind that they will be helpful to you.

With the sincerest of best wishes,
Anne

Blacksburg, Virginia
January 4, 2018

“Love, evidence & respect.”
– Maia Szalavitz, in response to the question, “What treats addiction?”

Photo: “Self-hug” of Casey Sapienza by Mia Sapienza

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, 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.

For the medical condition of addiction, medical treatment is the first order of care. Following is a brief guide, informed by research on what helps people manage the symptoms of addiction, for requesting care from a medical professional.

This guide anticipates a 10-minute appointment with a primary care physician, nurse practitioner, or physician’s assistant. Given the likelihood of a short appointment, directness and brevity are essential. People with substance use disorders are encouraged to not use the appointment to explain their situations, but to ask directly for the medical help they specifically need.

“A substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use.”
– Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health, November, 2016, Page 4-1

. . . . .

Greetings, Medical Care Provider.

I have symptoms of, or have been diagnosed with, substance use disorder.

In addition, I have received diagnoses for:
______________________________________
______________________________________
______________________________________

The medications and supplements I currently take are:
______________________________________
______________________________________
______________________________________

An outline of the treatment plan I am following for substance use disorder may be included. In addition, I may be following a more specific treatment plan for alcohol use disorder.

I ask:

1. to be assessed for suitability for medications for my individual case of substance use disorder, and for other physical and mental conditions;
2. for help with feeling as physically and mentally stable as possible.

I would like to request:

_____ Physical exam, with screening for skin/soft tissue infections and stigmata of endocarditis.
_____ Diagnostic lab work for:

• infectious diseases, including STIs, hepatitis C, and HIV
• liver functioning
• endocrine system organ functioning, particularly thyroid and adrenal gland (thyroid malfunction, chronic adrenal insufficiency, or excess glucocorticoid production can present as mental illness symptoms)
• routine labs (blood count, electrolytes, lipid panel, hemoglobin, A1C, etc.)
• other tests as indicated and recommended.

_____ Referral to a psychiatrist.
_____ Referral for psychological and neurological testing, as indicated.
_____ Other: ____________________

From the following list, I have placed checks by the additional concerns for which I request help. Below each, I have provided a brief description of my concerns.

Diagnosis and treatment, including assessment for medications for:

_____ Substance use disorder*

Primary substance(s) of concern:
___________________________________________
Secondary substance(s) of concern:
___________________________________________

_____ Physical illnesses:
______________________________________

_____ Mental illnesses:
______________________________________

_____ Physical pain:
______________________________________

_____ Sleep disturbances:
______________________________________

_____ Tobacco/nicotine intake:
______________________________________

_____ Caffeine intake:
______________________________________

_____ Hydration/water intake:
______________________________________

_____ Nutrition, diet, weight:
______________________________________

_____ Movement/exercise
______________________________________

_____ Appointments and referrals for follow-up care and additional treatment

Thank you for your help.

Name: ___________________________
Date of birth: ______________________
Date: ___________________________
Phone: __________________________

*If you would like a history, I may have a copy of a timeline listing: first use of caffeine, cigarettes, alcohol, marijuana, and/or other substances; substance use history: substances used, when, how much, and for how long; any trauma, including deaths in the family, losses, moves, neglect, abuse, witnessing or experiencing an occurrence as memorably shocking or alarming, witnessing emotional, physical, or sexual violence, community violence or natural disaster; onset of any significant physical illnesses or occurrence of any physical injuries; onset of any mental illnesses; substance use and mental health treatment received.

A shortened version of this guide as a printable .pdf is here (opens in new tab). The .pdf was last updated 10/17/18.

. . . . .

Suggestions:

• Prior to the appointment, make a personal timeline that includes the information listed by the asterisk (*) above.
• Take a copy of the timeline, not the original, to the appointment.
• Some medical professionals are unfamiliar with medications for substance use disorder. You can find more information about medical treatment for substance use disorder in the Surgeon General’s Report, Chapter 4, and for alcohol use disorder here.

Sanjay Kishore, M.D. contributed to this post.

Latest revision 10/26/18

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.

When I feel something, I really feel it. When I think thoughts, they’re decorated. My sensitivity, intensity, and creativity are the primary traits that create a rich and wondrous life for me.

Sensitivity, intensity, and creativity are associated with the development of substance use disorder, not because the traits are liabilities in themselves, but lack of ability to regulate them is. Intense feelings that stay intense for a long time can be experienced as discomfort, even pain. Creative, untamed thoughts can generate alarming, worst case scenarios. If I didn’t get help, starting in infancy, with learning how to ease my highs and lift my lows, regardless of what I’m thinking or what’s happening, then normal, human life can cause me on-going distress. Shocks can leave me writhing. If I don’t have skills to help myself, substances, mercifully, help me.

Maia Szalavitz introduced the metaphor of a “volume knob” to represent one’s inner experience in Unbroken Brain: A Revolutionary New Way of Understanding Addiction. It’s a hugely useful way to convey the problems and problematic behaviors associated with emotional dysregulation, including trauma symptoms, and the power of emotional self-regulation to help create a sense of stability and well-being. Emotion dysregulation is predictive of addictive behaviors.

In my community, we imagine our inner emotional states, take two paper plates and a paper clip, do a little snipping and coloring, and create representations of our own inner volume control knobs.

First, each of us imagines a range of emotion that is individually stable for us. My range of stability, for example, is closer to “max” than “min.” I’m naturally curious and energetic, so I need a higher level of intensity to feel normal than others may. Another person with the same traits may feel more stable with a lower level of intensity that balances these traits. Each individual is unique and complex, and each case of substance use disorder is unique and complex. What will be meaningful to each individual will be one-of-a-kind.

After we envision a stable range of emotion for us, we use the large paper plate to serve as our scale, and we draw in our stable range at the top. Then we locate our own maximum and minimum points (by convention, max is clockwise but individuals are urged to depict what works for them), snip the other paper plate in a shape to serve as a pointer, then color as we wish. We poke a hole in the center of the “scale” plate, then poke a hole in the pointer, slip a large paperclip through both, and start adjusting our volumes!

Then we, together, practice the basics of emotion regulation. We walk through situations that create intense feelings for us, dial the pointer really high or really low in reaction, pause to identify and name the feelings, then talk through what might help shift the volume to a stable range. We use the best of our hearts and minds to help ourselves.

We then take turns offering each other surprise situations. This helps us practice pausing – even when caught off guard – to become aware of feelings. We don’t judge the feelings as good or bad, right or wrong, just name them and assess their magnitude. We don’t try to avoid or change our feelings, nor do we dwell on them, since these processes can actually intensify feelings. If our reactions or responses to the hypothetical situations keep us in a stable range, we keep going. If not, we pause, identify and name feelings, and start brainstorming ways that might shift the volume to a more stable range.

High highs and low lows are human. The birth of a child creates a normal high, and the death of a loved creates a normal low. But if I have substance use disorder, I can’t risk staying out of my stable range for too long. I can visit these places, but I need to live at home in a stable range.

Imagining a decorated inner volume control knob – whimsically and delightfully unique to me – helps me simply adjust the magnitude of my experience to a state that is helpful to me. My own traits strengthen me.

. . . . .

This exercise is an attempt to distill and apply the principles of emotion regulation derived by Marsha Linehan as a component of dialectical behavior therapy.

• Marsha Linehan, DBT Skills Training Handouts and Worksheets, Second Edition, 2014
• Marsha Linehan, DBT Skills Training Manual, Second Edition, 2014

“People may not have caused all their own problems, but they have to solve them anyway.”
– Marsha Linehan

Emotion dysregulation is predictive of addictive behaviors.

This post is part of a series on evidence-informed, self-care for addiction. Self-care is NOT an evidence-based treatment for the medical condition of addiction. With evidence-based treatment scarce or denied, however, people with addiction must take treatment matters into their own hands.

The table of contents is here and posts are published in the category entitled Guide.

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, 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.

The feeling of anger simply lets a person know something is wrong. When individuals can become aware they feel angry, they can then pause to figure out what’s wrong, think about options, and choose what to say or do next that would be helpful or useful.

Some people find themselves:

• spiking quickly to intense anger,
• reacting with immediate anger to words, actions or situations that may or may not be a problem,
• feeling flooded with anger and unable to think,
• staying extremely angry for longer than desired,
• having trouble easing themselves back to a steady state,
• having trouble choosing their behavior when they are angry,
• finding themselves speaking and acting automatically, and harming themselves or others,
• and finding this happening more often than desired.

Since anger lets a person know something doesn’t seem right, attempting to “control anger” or to learn “anger management” may actually work against a person’s normal survival instinct. Instead, research on the brain and anger suggests gaining a nearly instantaneous awareness of the presence of anger may be more useful.

Awareness engages the “thinking” function of the brain, adding it to the “feeling” function of the brain. This awareness balances and stabilizes one’s inner experience. Then, the best of one’s “feeling” and “thinking” can inform one’s inner wisdom, termed “Wise Mind” in dialectical behavior therapy. An individual’s Wise Mind can determine the magnitude of what’s happening, then decide what next steps would be most helpful and useful for themselves and others.

Having the ability to immediately become aware of anger in the heat of the moment requires prior practice and training.

1. Become aware, and stay aware, of what’s going on within you all the time. Become curious about, and interested in your feelings, thoughts, physical sensations, and what captures your attention. As you observe them, practice naming them to yourself. Examples: “I am aware I am feeling angry.” “I am aware I am thinking that I don’t like that guy.” “I am aware that I feel a trickle of sweat on the back of my neck.” “I am aware I am giving my attention to buzz of the air conditioner.”

2. Suspend judgment. Feelings, thoughts, physical sensations, and the subjects of one’s attention are neither good nor bad, neither right nor wrong. They are simply information to consider.

3. About feelings, imagine an inner volume control, then ask, “What adjustments, if any, do I need to make on my inner volume to keep myself in a range that helps me stay aware and stable?”

4. About thoughts, ask, “Do facts support this thought?” and “Is this thought helpful or unhelpful?” Use your answers to guide you. Ask, “Have I thought this thought before?” If so, consider this thought: “I have given this thought due time and I will now shift my attention to something else.”

5. About physical sensations, ask, “What adjustments, if any, can I make to increase to make myself more comfortable?”

6. Practice engaging one’s attention with an object, then disengaging, shifting, and engaging one’s attention with another object, preferably one that engages a sense.

7. Return your attention to the present. If you are reminded of past events or concerned about future ones, say to yourself, “That is not happening now. I am here and this is what’s happening right now.”

8. Anticipate anger. Having practiced the above skills, be ready to become aware of anger, thus adding your “thinking mind” to your “feeling mind.” Watch in wonder as your inner wisdom – your Wise Mind – skillfully handles the situation in ways you never thought possible.

9. Practice radical acceptance. Acknowledge that people say and do stupid and cruel things, that we say and do them, too, and so do our loved ones. Accept that anger and other emotions don’t prevent or change that. Affirm that it’s what we say and do about what’s happened that determines the quality of our lives and our relationships.

. . . . .

A printable worksheet accompanies this post: Becoming Aware of Anger (.pdf opens in new tab).

. . . . .

This post is part of a series on evidence-informed, self-care for addiction.

The table of contents is here and posts are published in the category entitled Guide.

The views expressed are mine alone and do not necessarily reflect the positions of my employers, co-workers, 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.