Terminology
What Is Dialectical Abstinence?
Dialectical abstinence is a relapse prevention approach that incorporates a synthesis of focusing on absolute abstinence whenever one is abstinent even for a moment, and harm reduction following every slip even when it is very small.
Dialectical abstinence is a two-step process.
False; it is a 3 step process.
Name the three steps for dialectical abstinence
First, participants must find a way to make a strong commitment to abstinence. Second, they need to plan for how to stay abstinent. And, third, they must plan for harm reduction if a lapse occurs.
Name the 7 ways to plan for abstinence.
1. Enjoy your success, but with a clear mind; plan for temptations to relapse.
2. Spend time or touch base with people who will reinforce you for abstinence.
3. Plan reinforcing activities to do instead of addictive behaviors.
4. Burn bridges: Avoid cues and high-risk situations for addictive behaviors.
5. Build new bridges: Develop images, smells, and mental activities (such as,
urge surfing) to compete with information associated with craving.
6. Find alternative ways to rebel.
7. Publicly announce abstinence; deny any idea of lapsing to addiction.
Name the percentage range that genes play on addiction.
40%-60%
What is abstinence?
Abstinence here means complete abstinence, which is never again engaging in the addictive behavior at any time for any reason.
It's okay to only be abstinence 99% of the time.
False; Because the urge to engage in addictive behavior is so strong, your commitment must be 100%.
Anything short of that would set you up for failure.
What is the ‘abstinence violation effect’?
‘This can occur after a lapse when a person feels guilty, ashamed, and out of control, and wants to give up and give in.
List 14 steps for harm reduction.
1. Call your therapist, sponsor, or mentor for skills coaching.
2. Get in contact with other effective people who can help.
3. Get rid of temptations; surround yourself with cues for effective behaviors.
4. Review skills and handouts from DBT.
5. Opposite action can be rehearsed to fight guilt and shame. If no other option works, go to an anonymous meeting of any sort and publicly report your lapse.
6. Building mastery and coping ahead for emotional situations, and checking the facts, can be used to fight feelings of being out of control.
7. Interpersonal skills, such as asking for help from family, friends, sponsors, ministers, or counselors, can also be helpful. If you are isolated, help can often be found via online support groups.
8. Conduct a chain analysis to analyze what prompted the lapse.
9. Problem-solve right away to find a way to “get back on the wagon” and repair any damage you have done.
10. Distract yourself, self-soothe, and improve the moment.
11. Cheerlead yourself.
12. Do pros and cons of stopping addictive behaviors.
13. Stay away from extreme thinking. Don’t let one slip turn into a disaster.
14. Recommit to 100% total abstinence.
How long does it take for alcoholism to develop?
Anywhere from 3 months to 30 years
What is harm reduction?
Harm reduction, as the term is used here, has as its goal minimizing the harm done by a slip into the addictive behavior. It acknowledges that there may be slips, tries to minimize the damage, and is sympathetic to failures of complete abstinence. The basic goal is to manage lapses such that a lapse does not turn into a relapse.
It is important to plan for lapses and failure.
True.
What is adaptive denial?
Adaptive denial refers to adamantly convincing yourself that you don’t want to engage in the addictive behavior when an urge hits, or that the addictive behavior is not a possibility.
Accept at the most radical level that you are not going to engage in addictive behavior again, and then move actively to cut off all addictive behavior options is also known as?
Burning Bridges
What year was the first addiction gene discovered?
1990; the DRD gene was found often with severe alcoholics
What is dialectical tension?
“The dialectical tension here is that on the one hand, you have agreed that you value living up to your potential and building a life worth living, and that your addictive behavior is incompatible with this goal. On the other hand, even with this commitment, you accept that you might have a lapse and once again engage in the addictive behavior. Thus you need a harm reduction plan.”
It is possible to do these two seemingly contradictory things—commit to absolute abstinence from addictive behavior, and accept a lapse should such behavior occur.
True
What is alternate rebellion?
Finding another rebellious but nondestructive behavior to substitute for the addictive behavior.
Describe 4 ways to burn a bridge
1. Make an absolute commitment to abstinence from the addictive behavior, which is (describe addictive behavior). Then walk into the garage of abstinence and slam the garage door shut. (Remember that the tiniest slit of space can let an entire elephant in.)
2. List everything in your life that makes addiction possible.
3. Get rid of these things:
Throw out contact information of people who collude with you.
Get rid of all possible cues and temptations.
4. List and do everything you can that will make it hard or impossible to continue your addictive behavior.
Ruthlessly and at every moment, tell the truth about your behavior.
Tell all your friends and family that you have quit.
What percent of college students binge drink?
37%
Name the pro and con of abstinence.
The pro of abstinence is that people who commit to abstinence stay abstinent from their addictive behavior longer. The con of abstinence is that it usually takes people longer to recommit to abstinence once they’ve slipped.
You need to accept a lapse before you have one.
False; It will undermine your commitment to say to yourself, in the back of your mind, ‘Oh, I guess it is really OK if I go ahead and engage in my addictive behavior, because if I do, I’ll just do a chain analysis and recommit.’ The possibility of a lapse must be buried somewhere outside of your awareness.
Name a pro and a con of harm reduction.
Pro: When a slip does happen, people can get back “on the wagon” faster.
Con: People who commit to harm reduction relapse quicker.
Describe 1 way to build a bridge
Build different images or smells to think about. Try to keep these images or smells in memory when you have an unwanted craving. For example, whenever you crave a cigarette, imagine being on the beach; see and smell it in your mind to reduce the craving.
When you have unwanted cravings, look at moving images or surround yourself with smells unrelated to the addiction. Moving images and new smells will compete with your cravings.
“Urge-surf” by imagining yourself on a surfboard riding the waves of your urges. Notice them coming and going, rising high, going low, and finally going away.
Name the symptoms of post-acute withdraw
tachycardia, transient visual, tactile, or auditory hallucinations and illusions, psychomotor agitation, grand mal seizures, rapid pulse, sweating, increased body temp., hand tremors, anxiety, depression, insomnia, nausea, vomiting