Feeling Anxious? Try This Pandemic Version of CBT

The pandemic has created a new environment for anxiety: some of our formerly fantastical worries are now grounded in reality. Although cognitive-based therapies term unrealistic fears “cognitive distortions” and “patterns of problematic thinking,” some of what we feared might occur is actually happening in our homes, towns, and countries.

The human brain has evolved to handle hardship, however. In the brain, emotion-related regions and executive functioning regions work in synergy together, using feelings and thoughts as data to ease distress and solve problems. The term “inner wisdom” can be used to describe this brain function.

A helpful way to envision inner wisdom comes from an adaption of the concept of “Wise Mind” from dialectical behavior therapy (DBT). If feelings and thoughts are imagined as circles in a Venn diagram, the overlap between them offers the powerful synergy of each and both.

Inner wisdom

The challenge with fear, anxiety, and worry is that they highly activate the emotion-related regions of the brain, overwhelming the executive functioning regions and making inner wisdom difficult to access.

If I keep repeating worried thoughts to myself, I keep activating the emotion centers of my brain. The circle representing my feelings covers the circle representing my thoughts, limiting my access to the thinking regions of my brain, including the prefrontal cortex, and to the inner wisdom inherent in awareness of both feelings and thoughts.

Self-judgment and self-criticism – “I shouldn’t be feeling or thinking this way” – further exacerbate the dominance of my brain’s emotion centers.

Feeling anxious about feeling anxious – “Oh, no! Here comes anxiety again!” – does the same.

Trying to avoid what I’m feeling or thinking – or trying to distract myself from them – interfere with my brain’s ability to handle what’s happening. Avoidance and distraction divert me from my brain’s ability to help myself see what’s what and to do what needs to be done.

How can I stay present for both my feelings and thoughts and help my brain use its natural system to help me out during these hard times?

See if this inner narrative and these questions might help.

. . . . .

I have become aware I am having a thought about which I feel anxious.

  1. How realistic is this thought? What are the facts? (Many thoughts have some basis in reality. I can ask myself: On a scale of 1 to 10, where 10 is “It’s a fact verified by rigorous science,” and 1 is “I’m truly guessing,” how reality-based/fact-based is the thought?)
  2. How effective is this thought? Is it producing the results I want?
  3. How likely is the content of the thought to happen? On a probability line, where would I place the chances? 100% certain, a 50%-50% chance, impossible?
  4. Is my beautiful brain engaged in negativity bias, thinking it needs to more heavily weigh everything that might be a problem in order to keep me alive?
  5. Am I focusing on thoughts about one part of a situation and not taking into account other parts of the situation? Am I weighing one part of the situation more heavily than other parts? Is this merited?
  6. Have I thought this thought before? Have I given it due time?
  7. If noodling over this thought would have “fixed” it, might I have noodled enough to fix it by now? Might I try another approach?
  8. How helpful is the thought? Is it helping me feel better or worse? Is it helping me do better or do worse?
  9. Is the thought helping me feel more hopeful or more despairing?
  10. Is this thought scaring me or reassuring me?
  11. Is the thought related to judgment – which distresses me further – or acceptance, which helps ease my distress?
  12. What are the top 3 facts/realities I need to accept about what happened/what’s happening?
  13. Right here, right now, am I okay enough, at least for now?
  14. Regardless of any of my answers, how can I help myself with this?

I can feel what I feel, think what I think, and also shift my attention to thoughts that help me feel better, do better, and produce the results I would like.

. . . . .

Even attempting to formulate the words in these questions activates the thinking portions of the brain. As one client puts it – for which I’ve been given permission to share – we can purposefully “Get cognitive!” Although stated perhaps simplistically, the “thinking circle” in the brain shifts the “feelings circle” back to its place of providing helpful data and synergy for problem-solving.

The questions can help people become aware of the relationship between events, feelings, and thoughts. This cornerstone of cognitive-based therapies is often explained using an “ABC Worksheet”:

  • A – activating events result in
  • B – beliefs/thoughts and
  • C – consequences/feelings.

Here’s a .pdf entitled “ABC Worksheet – Pandemic Version” of the classic ABC worksheet with questions related to helping us through very challenging circumstances.

If you need help using these questions or want to further explore the ABC Worksheet or cognitive therapies, you’re encouraged to seek professional support.

Using our hearts and minds, plus the power of our beautiful brains, we can help ourselves through hardships – even through pandemics.

The content of this post is informed by Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), Cognitive Processing Therapy (CPT), Acceptance and Commitment Therapy (ACT), Positive Psychology, and other work. it was synthesized and compiled by Anne Giles, M.A., M.S., L.P.C.

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.

How to Learn Mandarin Chinese Efficiently and Enjoyably as an Adult

In early 2020, at age 61, the longing to return to the study of Mandarin Chinese after a 40-year hiatus came upon me. I met once with a private instructor in early March, 2020. Then the pandemic happened. I read the suggestion of Andrea Sachs of The Washington Post to learn a foreign language online during lockdown. I consider July 7, 2020 – my first meeting with an online italki instructor with whom I continue to work – as the official start of my return to serious study.

Nearly one year later, at the end of June, 2021, to bookend my efforts, I flew to Chicago to take Mandarin Chinese proficiency exams at the first and second levels. I am scheduled to receive my scores later this month.

Anne in Chicago's Chinatown

My first year of studying Mandarin Chinese was a bittersweet one.

With two-thirds of my expected life span over, I seek efficiency and optimization in many areas of my life. With regard to Mandarin Chinese, I want to learn to speak, understand, read, and write as proficiently as possible, as quickly as possible, with the least amount of time and effort, in ways that feel engaging and meaningful to me. According to the BBC, an educated Chinese person knows 8,000 characters. That sounds reasonable to me.

To evaluate my progress, to add credentials to my curriculum vitae, and to possibly open new professional opportunities, I decided to focus on studying for the Mandarin Chinese proficiency exams administered by the Chinese government, the globally recognized Hànyǔ Shuǐpíng Kǎoshì (HSK) 汉语水平考试.

I ran into trouble from the start. The standard HSK exam prep course materials are printed in a font size too small for me to read. The most-recommended college textbook does have an online version with an adjustable font size. I found the content about students’ lives uncompelling, however, and couldn’t imagine using school-related vocabulary in my life as a counselor in Blacksburg, Virginia at age 61.

Seeking alternative study materials to these top choices resulted in hours and hours of searching and testing, hundreds of dollars in purchases, a surprising and painful discovery of orthodoxies in both the traditional and contemporary schools of thought on the teaching and learning of Mandarin Chinese, then hours and hours of reviewing the research literature on second language acquisition to try discover a research-informed path.

In sum, although I am not sure of the size of the market, i.e. English-speaking adults seeking to learn Mandarin Chinese, this product niche is unfilled (with one exception, which I describe below): outcome-proven, comprehensive, Mandarin Chinese teaching and learning materials with content of interest to adults.

In hopes of assisting other adults interested in learning Mandarin Chinese, I have written the post I wish I had found a year ago when, after finding only materials for children and students, I refined my search query to “learning Mandarin Chinese for adults.”

How to Learn Mandarin Chinese Efficiently and Enjoyably as an Adult

To increase the likelihood of efficiently and enjoyably gaining proficiency in Mandarin Chinese as an adult, a systems approach is suggested. (Here’s a Wikipedia entry on systems theory and here’s a broad application of systems theory by my father, Robert H. Giles, Jr.)

Components of an efficient, effective study plan

Create an individualized study plan for yourself that includes these interrelated, interactive components:

  • Unorthodox instructors who – either by training or intuition – understand shaping, comprehensible input, comprehensible output, the forgetting curve, and “quick wins,” and who conduct their classes primarily in Mandarin Chinese, not English.
    Notes:
    (1) I have had stellar instructors I assume can speak English but I’m not sure because I’ve only heard them teach using Mandarin Chinese.
    (2) To learn more about shaping and comprehensible input, please see the video embedded in this description of Stephen Krashen’s Theory of Second Language Acquisition.)
  • A research-informed, outcome-focused, core course.
  • Graded readings
  • Writing for real purposes
  • Grammar consultation with instructors and with AllSet Learning’s Chinese Grammar Wiki rather than direct grammar instruction.
  • People with whom to practice speaking without correction or instruction.

Product recommendations

Instructors. Outstanding, unorthodox instructors can be found among the 1,850 Mandarin Chinese instructors available on italki, through AllSet Learning, and through referrals to private instructors. Asking a version of this question – “How have you decided to teach what you teach and in the way that you teach it?” – may be helpful in identifying versatile, thoughtful instructors.

I currently work with 4 online instructors, 30 to 60 minutes per session, 1-2 lessons per day. Depeng, Benfang, and Amy are with italki and one offers private instruction.

Core course. I recommend Mandarin Blueprint. I have explained why in detail here. I have tried more than a dozen other courses and apps and no other approach comes close to meeting these criteria: 1) uses a systems approach, and is 2) research-informed, 3) outcome-focused, and 4) engaging enough to continue. In this interview, Mandarin Chinese learner Chad Erickson cites similar reasons for using Mandarin Blueprint. William Beeman, Professor Emeritus at the  University of Minnesota, also recommends Mandarin Blueprint.

With Mandarin Blueprint, a barrier to entry was a high level of software expertise needed to use Anki, a form of spaced repetition flashcard software. I devised a paper-and-pen workaround to Anki and describe it here.

A private instructor in China has developed an astounding set of interactive slides to prepare students for HSK exams. This instructor does not have an online presence, but feel free to contact me for more information.

Graded readings. Mandarin Companion‘s characters-only graded readers are superior in content and engagement but coaching may be needed to transition from reading Pinyin to reading characters.

For example, on my computer screen, I displayed content of the Kindle versions of Edmund Chia’s Guo Guo Is Missing, then The Sports Boys (stories about kids, but if that’s the content that breaks the code of the English-pinyin-characters Rosetta Stone, so be it), interspersed with Mandarin Companion’s readers about Zhou Haisheng and Xiao Ming, and worked with instructors on deciphering characters. I can now read Mandarin Companion’s Breakthrough Level graded readers primarily on my own. I am a denizen of a nation with a loneliness epidemic, however, and prefer to read with an instructor and chat in Mandarin Chinese about the content.

The Chairman’s Bao is an online source of brief graded readings that provides characters, Pinyin, and English.

Writing for real purposes. Here is the method for writing with purpose and meaning that I am using. Added 7/24/21: I and others are writing brief dialogues about universal human concepts in simplified Chinese characters, pinyin, and English in hopes of helping people who speak all these languages understand each other a bit better.

People. Finding fellow Mandarin Chinese learners and native speakers willing to speak with learners in one’s locale can be difficult. During lockdown and afterwards, I attempted to find and form online Mandarin Chinese conversation groups that allow members to work out how to put their interior experience into words, and those words into sentences – however laboriously and however riddled with errors – without the use of English, and without correction or instruction by other members.

Paradoxically, interruptions in the name of “doing it right” may actually interfere with the brain’s construction of an inner network of understanding, termed an interlanguage. Within a group of people, extemporaneously practicing creating comprehensible output and taking in comprehensible input in Mandarin Chinese remains a yet-unrealized dream of mine.

Mandarin Chinese courses can have dropout rates as high as 95%. I posit that orthodoxy – a rigid adherence to beliefs about the way things are to be done, rather than pausing to analyze what yields results and what doesn’t – not the language’s difficulty, is the primary culprit.

For adults who are interested in learning Mandarin Chinese, or for adults who have have begun to learn and, due to troubling experiences or lack of progress, are heading towards that 95% dropout rate, I hope my hypotheses, explanations, and recommendations are helpful.

With questions or feedback, please contact me.

. . . . .

If of interest, here is more background on my thinking.

Definitions

  • I define orthodoxy as a set of beliefs and rules about “the right way” to teach and learn Mandarin Chinese.
  • In this context, I define optimize as a research-informed method to gain the most proficiency in Mandarin Chinese in the least amount of time, with the least amount of effort, with the most pleasure, such that the learner can understand and be understood by native speakers. Other methods may exist and produce results, but these methods would do so with less efficiency than an optimal method.
  • I define a systems approach as a way to simultaneously and synergistically attend to all components of teaching and learning Mandarin Chinese. Again, here’s a Wikipedia entry on systems theory and here’s a broad application of systems theory by my father, Robert H. Giles, Jr.
  • Although my untested hypotheses may have broader application, my focus is on English-speaking adults acquiring Mandarin Chinese as another language.

Origin of hypothesis about a systems approach

I hypothesize that a broadly encompassing systems approach can optimize the teaching and learning of Mandarin Chinese.

That hypothesis is based on:

  1. my reviews of the research literature on the neuroscience of second language acquisition, learning, and memory, particularly of Mandarin Chinese, particularly in older adults, and the psychology of learning,
  2. my knowledge, experience, and training as an educator and counselor,
  3. my virtual attendance of the National Chinese Language Conference in April, 2021,
  4. my year of attempting to learn Mandarin Chinese primarily in isolation, paradoxically ideal for collecting case study data since diverse variables were artificially controlled by lockdown, i.e. indirect learning opportunities through natural interaction or immersion in a language-speaking environment were non-existent, and
  5. my nascent attempts to teach English to native speakers of Mandarin Chinese,
  6. my having been schooled for at least 50 years by a systems thinker.

Specifically, as I explain more fully here, learners could optimize their acquisition of Mandarin Chinese – rather than through rote learning, sequenced learning, or using a task-focused approach – by engaging in a “flow” in, around, and through the five major language learning components of Mandarin Chinese – pronunciation/tones, Pinyin, vocabulary, grammar, and characters – while listening, speaking, reading and writing.

Disclosures: I am a current customer of italki, Mandarin Blueprint, and Mandarin Companion. I have been a customer of AllSet Learning. I receive no referral fees from any company or organization mentioned or linked to in this post.

Views expressed are my own.

I am a student of Mandarin Chinese and also a mental health counselor, able to provide counseling services only to residents of the Commonwealth of Virginia, U.S.A. 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.

A Paper-and-Pen Alternative to Using SRS with Mandarin Blueprint

Mandarin Blueprint‘s founders, Luke Neale and Phil Crimmins, have invented a systematic, comprehensive, research-informed method for learning Mandarin Chinese. In an innovative application of the method of loci – a memory strategy attributed to the ancient Greeks and Romans – Mandarin Blueprint users are taught to learn Chinese characters by envisioning places from their own histories, then imagining actors interacting with props in rooms within those locations. Through this creative process, the Chinese character’s pronunciation, meaning, reading and writing are all conveyed. The founders term their invention the “Hanzi Movie Method” and report it has cleared the second stage of the U.S. patenting process.

Sample printable flashcards for Mandarin Blueprint

Reviewing Chinese characters with Mandarin Blueprint’s method is augmented with spaced repetition software (SRS) to replace printed flashcards. Mandarin Blueprint’s current choice of SRS is Anki. Mandarin Blueprint is developing its own proprietary SRS and is expecting to beta test it in July, 2021.

I used Anki effectively until I was unable to adjust the settings to limit the number of cards per review session. When I ended up with 800+ cards to review per day, a multi-hour task, I stopped reviewing cards.

Hopeful, however, that I might some day figure out Anki, I continued to use Mandarin Blueprint’s Hanzi Movie Method to create Anki cards for each character. I just never saw the cards again. (I also tried creating a list of flashcards in Skritter but, without prompts to help me remember my custom movie scenes, I found the task tedious, began to dread doing it, then quit.)

Simply through using the Mandarin Blueprint method – with no review at all – I learned to recognize about 100 characters before the forgetting curve overtook me. The lack of review cost me the ability to remember the characters well enough to read simple demo sentences.

I am a true fan of Mandarin Blueprint. I have written about the positive trajectory of my progress after beginning to use its method. I bought the full bundle of Mandarin Blueprint courses through Level 57 and happily contributed at the access level to the crowdfunding campaign to develop the Advanced Course.

I began to ponder. Making the cards in Anki worked pretty well for learning about 100 characters. I just needed to see those cards again to make the characters stick. I needed a low-tech, paper-and-pen alternative to Anki.

I used Microsoft Word to make a Hanzi Move Method data collection form to use as a printable flashcard.

Here is a .pdf of a blank data collection form (opens in a new tab), plus my imagining of a “Tone House” that helps me logically remember which tone goes with which room using the method of loci (also termed “memory palace“). The .pdf includes a list of the first four characters which are simple enough not to require individual cards. (The image accompanying this article depicts the “method of loci” well.)

Here is a .pdf of sample flashcards (opens in a new tab). They include my versions of settings, actors, props, and scenes using the Hanzi Movie Method for characters #5 – #12. As you can see, the fields are not fixed so I can write as little or as much as I want. If I can already sight read a character, I don’t make a card. The goal, of course, is to not make cards, but to learn characters in order to read!

Although Mandarin Blueprint suggests including images for compound words, I’ve included an image field for single characters if needed. For example, I’ve had trouble remembering how to write the top portions of 人 rén, 入 rù, and 八 bā and added images to these cards to try to help myself.

For this post, I created custom images for my sample flash cards to publish online since I don’t hold rights to other images. But I follow Mandarin Blueprint’s method and search the Internet to copy and paste images that speak to me. For example, an image of Snape will always accompany 总是 zǒng shì.

Each character’s flashcard takes 3-5 minutes to imagine then type. The layout is horizontal and I enter one to two cards per page. I print the pages and fold long cards in half horizontally, or use scissors to trim two cards per page into horizontal strips about the same height.

I can review the cards sitting at a desk or lying on the coach. I can spread them on a bed to compare differences in similar characters. I can position the cards to reveal only characters on the left and only English on the right. Flashcards for Levels 1-6 ended up as 24 pages to print.

Tone House for use with Mandarin Blueprint

I am my own spaced repetition algorithm! I sort cards into piles based on how well I know the characters. I review cards in the weak piles first, move them to the strong piles, and so on.

Would using spaced repetition software to review characters be optimal? I’m sure it would. I just couldn’t make current SRS offerings work. I’ve signed up to beta test MB’s forthcoming proprietary flash card software. In the meantime, I’m cranking through characters, heading towards a 1,530-character milestone.

For an introduction to Mandarin Blueprint’s Hanzi Movie Method, I recommend the video on MB’s home page  and this YouTube video from the course. Here’s the first entry in a set of articles describing the method.

Why do I encourage people to 1) learn Mandarin Chinese, and 2) try Mandarin Blueprint? I think the state of things in the U.S., plus the state of U.S.-Chinese relations, makes being able to speak each other’s languages an imperative. Time is of the essence. In my earnest quest to learn Mandarin Chinese in my 60s, I’ve spent countless hours researching second language acquisition and thousands of dollars on textbooks, courses, and apps. In my estimation, the most efficient system likely to produce desired outcomes in the shortest amount of time in the most pleasant way is Mandarin Blueprint.

I would love to be part of a local Mandarin Blueprint users’ group that meets in-person in the Blacksburg, Virginia, U.S.A. area. If that interests you or I can be of service in any way, please don’t hesitate to contact me. Added 9/10/21: Several MB users have joined me in the Mandarin Chinese Conversation Groups on Meetup.

I thank paleogeologist and Virginia Tech visiting scholar Tian Gan for helping me create flashcard images.

Views expressed are the author’s own and may not represent Mandarin Blueprint’s positions, strategies or opinions.

Anne Giles, M.A., M.S., L.P.C., is a student of Mandarin Chinese and also a mental health counselor, able to provide counseling services only to residents of the Commonwealth of Virginia, U.S.A. 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.

Why Am I Studying Mandarin Chinese?

When people ask me why I study Mandarin Chinese, I usually give cognitive, utilitarian answers.

But I also get a feeling from studying Mandarin Chinese.

Conceptually, I give myself 100 years on the planet to use my brain’s approximately 100 billion neurons and perhaps a similar number of glial cells. In lockdown in 2020, at age 61, I decided, after a forty-year hiatus, to return to the study of Mandarin Chinese to save my sanity and put more neurons to use. I have the contented feeling that direction and purpose can bring.

First attempt to write Chinese characters

I also have the feeling I have gotten since childhood from organizing words and pictures on pieces of paper.  If given a choice between playing Barbie dolls or paper dolls with my sister, I would choose paper dolls. When my father was a boy, he collected stamps and, in adulthood, my mother added to his collection. I was allowed to have my own collection and spent countless hours giving names to the animals in the pictures and pouring over images of exotic buildings and dress styles.

When I study Chinese characters, I have this same sense of the shapes on paper being absorbing and wondrous. If I ever get to go to China, my first stop will be Beijing, not to see the Temple of Heaven, but to head to a museum to see the first pictures-as-words carved into  bones and tortoise shells: oracle bone script jiǎgǔwén 甲骨文.

I have a hypothesis about bilingual partnership in older, single adults – for me and my anticipated partner, English and Mandarin Chinese – that I have written about elsewhere that fills my heart with longing and excitement.

I have another feeling as well. It is central and moving, bringing tears to my eyes.

In the 300,000 year history of Homo sapiens, among the 100 billion people who have ever lived, among the nearly 8 billion people currently on the planet, among the 100,000 years that people could speak and the 5,000 years people could write, among the four writing systems identified as developing independently, only one is still in use. Written Chinese is documented as 3,000+ years old.

When I attempt to speak Chinese or to read a Chinese character, I feel connected to the swell of hearts and minds of the whole100 billion. I see their mouths opening and their hands holding slim tools. When they could utter words, what did the first humans choose to say? What did they choose to write? I, too, reflect deeply about what to say and write.

. . . . .

I write about my experience learning Mandarin Chinese in this category.

Please contact me if you have ideas, suggestions or feedback.

I am a beginning student of Mandarin Chinese and also a counselor, able to provide services only to residents of Virginia, U.S.A. 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.

Do You Provide Research-Informed Care?

This is the central question I urge people to ask counselors, program directors, and other potential providers of treatment for substance use concerns:

“Do you provide research-informed care?”

The common belief is that people who overuse substances need to “go to rehab.” Estimated rates of return to substance use after attending in-patient treatment are 70% or higher in the first three to six months. Recent discussion about the effectiveness of vaccines helps give this number perspective. Rehab has a 30% effectiveness rate. Out of 10 people who attend, only 3 become “protected.” With this poor showing, would we even consider this procedure “effective,” much less offer it nationwide as a “treatment”?

So why don’t rehabs “work”? Why do few “treatments” for substance use concerns reduce or eliminate use?

Because people use substances for reasons.

If the needs and wants met by substance use aren’t identified and ameliorated, if individually meaningful alternatives aren’t found, the reasons still exist and substances will continue to work to address them.

Brain automaticity and other features of substance overuse revealed by neuroscience – usually termed “addiction” – add an additional layer of complexity. Many of these mechanisms can be assisted with medications.

Even if, hypothetically, all the brain mechanisms involved in addiction could be stabilized or reversed, the reasons the person used substances still exist. Particularly if substance use provides relief from physical, mental, or emotional pain, the likelihood of return to use, and perhaps overuse, is high.

For example, given the initial euphoric, then sedative effects of ethyl alcohol, it is perfectly understandable that Americans increased their use of alcohol during the worst year in the past 100 years of the nation’s history.

A humane, logical, science-informed program for overuse of substances would provide:

  1. substance use-focused medical care, including a physical, substance use-specific lab work, consideration of medications, and assessment for co-occurring mental disorders, particularly for post-traumatic stress disorder (PTSD), since two-thirds of people with substance use concerns have experienced trauma, particularly in early childhood.
  2. humane counseling to help discover and address reasons for use,*
  3. humane cognitive behavior therapy (CBT) to help the person learn to override brain automaticity, and
  4. financial support so the person can focus on addressing what can become life-threatening overuse of substances.

I know of no program like this. (With great difficulty in a rural area, I attempt to cobble together such a program through my solo practice and through coordinated efforts with other health care professionals.) The only description of a program I can find that comes close is Alltyr in Minnesota and services are offered outpatient-only. I know of no one who has received services at Alltyr so I can’t offer more than a link.

Let’s say a person were handed a brochure describing a program that included numbers 1-4 above. Why might people balk at engaging in such a program?

First, they probably wouldn’t believe the description or the claims. Little about what the treatment industry, media, most health care professionals, one’s family, and people in line at the grocery store have to say about substance use engenders trust. The American way is to blame individuals for causing their own health problems. When I seek treatment for myself or accompany others who seek treatment, I mentally carry a length of 2″ x 4″ in my purse to get providers to back off. I am grateful when what is said is merely insensitive or uninformed. It’s usually cruel.

Second, no one wants to have a stigmatized condition. Substance use, “recovery” from substance overuse, having had “a problem with substances” – all of these are stigmatized, i.e. people lose face and status in society, and can lose or be denied jobs, lose custody of their children, even lose their freedom.

Third, the ardent wish of people that things aren’t the way they are, plus their fear of what they believe overuse of substances may mean about themselves and their lives, are powerful forces. Acknowledging realities as they are takes bravery beyond the pale.

Let’s say the person does enter the humane program and the providers speak humanely and informedly.

The deal on offer is still a bad one.

A cost-benefit analysis shows why.

The purpose of substance use is to take the brain where it can’t normally go by itself. Never again having that experience through abstention, or having a lesser experience through reduced use, plus brain structures involved with bonding and attachment, all create an experience of painful, irreparable loss.

A program has to offer what substances offer, or near enough, to make the trade worth it. Plus, the program has to offer a way to co-travel with grief. In other words, the benefits of reducing use or abstaining from use have to outweigh the costs. That’s not moral or spiritual. That’s plain ol’ human logic.

“If they truly loved me, they would stop.” That statement is hardest to hear from children, but I hear it from partners and parents as well. Substance use isn’t about love. Substance use is complexly and dynamically about the needs and wants that substances fill, plus the brain structures and functions that create longing and automaticity.

Alcohol overuse is particularly problematic, especially if the person has been to a 12-step meeting. Step 1 states, “We admitted we were powerless over alcohol, that our lives had become unmanageable.” On the contrary, self-efficacy – the ability to intend to do something and to do it – relies on gathering and using personal power. A meta-analysis conducted by Lance Dodes, M.D., calculated that 14 out of 15 return to use of alcohol if they use a 12-step approach as  “treatment.”

If rehab is the plan, however, in addition to asking, “Do you provide research-informed care?”, I urge people to ask potential providers these questions;

  1. What is your outcome data? a) What percentage of people who enter the program complete it? b) How do you define “success” or remission? c) Among those who complete the program, what percentage are “successful”/in remission one year later?
  2. What medical professionals are on-site 24-7? What medical care do you provide? What medical care do you coordinate with outside providers?
  3. Is your program abstinence-based? Do you offer moderated use and/or harm reduction options?
  4. Is support group attendance required? Do you offer support group meetings other than 12-step? Which ones?
  5. Are your patients with opioid use disorder allowed buprenorphine? [The only evidence-based treatments for the medical condition of opioid use disorder (OUD) are the medications methadone and buprenorphine. Denying people medication for OUD can result in their deaths.]
  6. Do you screen for trauma? If so, what counseling protocols do you use to address trauma? [Cognitive Processing Therapy (CPT) and Cognitive Behavior Therapy (CBT) for PTSD are the protocols with the largest evidence base. Other protocols have vocal fans and may have some research to support them, but why use lesser protocols when gold standard protocols are readily available?]
  7. Are patients allowed to smoke?
  8. Are patients allowed to have phones?
  9. How many individual counseling sessions are offered per week? What counseling protocols do your therapists use in individual sessions? (Listen for CBT and DBT, the only protocols with extensive research backing to assist with substance use disorder.)
  10. How many group sessions are offered per week? What counseling protocols are used in group sessions? (General group counseling has been shown to not be an effective approach to addressing substance use concerns.)
  11. When patients aren’t in individual and group counseling sessions, how do they spend their time?

The topics in these questions are the usual sticking points that differentiate a belief-based program from a program that is at least trying to align itself with science.

In sum, interrogate rehabs before committing to losing that much money from a house or retirement fund or taking on a second mortgage, to having in-patient treatment in one’s personal health record for the rest of one’s life, to losing that much irreplaceable time at work and/or with partners and families, all the while having a 3 in 10 chance of achieving desired outcomes.

According to research, most people reduce use naturally, on their own, without treatment. How? In a nutshell, they figure out what substances do for them and find other ways to get those things done, or they discover more meaningful, rewarding, and/or engaging things to do. Any effort, whether through informal means or a formal program, that doesn’t help people with the reasons they use substances, is unlikely to be very helpful and, as is often the case, can cause harm.

I use the word “humane” often and deliberately in this post. In my experience, humanity is rare in the treatment industry. But, humans have used substances for over 12,000 years and, for between 70-80% of people who use drugs, there’s no issue. When people overuse substances in ways that harm themselves or others, this is a very human concern which, in my opinion, merits our deepest humanity.

As a public service, I have posted a free, online course on Udemy for people with substance use concerns: Research-Backed Ways to Reduce or Eliminate Substance Use. Here’s an introduction to the course and here’s the direct link.

*To independently consider the reasons one might overuse substances, completing these might be helpful:

  1. Self-Care Checklist
  2. Awareness Skills Self-Assessment
  3. Checklists to Assess Needs, Wants, Strengths and Preferences
  4. Values and Priorities Exercises

Other posts on this site may be of assistance:

 

“It’s my life. Don’t you forget.”
– It’s My Life, Talk Talk

With any questions at all, please contact me.

Watercolor by Jesi Pace-Berkeley

The views expressed are my own. 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.