ACT for Addicts

Hi Ted,

A large percentage of the population my program treats have substance issues, past and current. From an ACT point of view substance use of any kind is an avoidance of suffering behavior, which puts the behavior in the category of lots of other "away" behaviors. So one might avoid going to the movies to avoid anxiety, or one might drink to avoid anxiety. The trick is to set up a scenario in which the person can find out if the substance use "works" for the long term to get rid of unwanted mental experiences AND works to move toward values.

To set up this scenario we use the Matrix diagram:

............................5-Senses Experiencing
.................................(behaviors)
.
.
.
Away.........................Noticing.......................Toward
.
.
.
..........................Mental Experiencing

In the left, lower quadrant is Suffering; things like sadness, anger, anxiety, etc.
In the left, upper quadrant are Solutions; things done to "solve" sadness, anger, anxiety, etc. "Solve" is in quotes because the solutions are short-term avoidance behaviors; none of them get rid of suffering for the long term. Alcohol and other substances are part of those solutions.

In the lower, right quadrant are Values (a mental construct) and in the upper, right are Committed Actions.

So, with substance users, the clients' task is to discover if the substance use is a long-term solution for getting rid of suffering that also works as a behavior (committed action) to move toward values.

It does not take long to set up this analysis and we have had many fabulous discussions using this. Our program evaluation data shows that the vast majority of people who are using when they start our program stop, using. That's their choice, not ours.

One great thing about this intervention is that we are not saying, "You should stop using." Instead we are simply saying something like, "So you are using X to move away from anxiety, how does that work for the short-term? (It works.) And how does it work for getting rid of anxiety for the long-term? (It doesn't.) Okay, and how does it work to move you toward your values?"

We really work at not labeling "Away" moves, including substance use, as negative. Nor do we label "Toward" moves as positive. They are all just part of life. The question is, "What moves work for a valued life?"

Once you are in the exercise you can emphasize defusion, noticing and values as needed.

So that's how my team has done it. Works well for us.

Kevin

Kevin L. Polk, Ph.D.
www.drkevinpolk.com