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10 CEUs Substance Abuse: Growing Beyond 12 Step Program Dependency
Substance Abuse: Growing Beyond 12 Step Program Dependency

Section 10
Overcoming Adolescents' Resistance

CEU Question 10 | CEU Test | Table of Contents | Addictions CEU Courses
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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On the last track, we talked about the addict’s Dream of Dependency and the three reasons an addict may have this dream. The three reasons for the addict’s Dream of Dependency are that their parents led them to believe someone would take care of them as adults, that their parents failed to teach them the skills necessary to take care of themselves, and that they never learned to feel capable of being responsible for themselves.

On this track, we will discuss Internal Resistance. In my experience, there are three key issues causing internal resistance for addicts. These Internal Resistance Issues are: the fear of pain of emotion, the fear of the inability to learn, and the belief that success is impossible. These emotional resistances cause the addict to feel embarrassed, anxious, helpless, and often hopeless.

Three Internal Resistance Issues

Issue#1 - Fear of Pain of Emotion
The first form of internal resistance is the fear of the pain of emotion. Kyle, 24, became addicted to crack in college. After finding himself in a park, holding a switchblade to the neck of an elderly woman, he decided to enter rehab. A few months after leaving rehab, he had a relapse.

Kyle told me, "Before my relapse, even if I was happy, I'd get, like too happy. Or I'd get so bored I'd be ready to do anything to break the feeling. Or sad, thinking of how I'd screwed myself up, thinking how I don't have any friends anymore because I couldn't hang around my old drug contacts anymore- you know, I'd get so sad I couldn't stand it."

As mentioned in track 5 regarding the addicts myths about expressing feelings, Kyle felt that he wasn't safe from his feelings, so he turned back to his crack addiction to escape. Recovery was a frightening process; staying off of crack meant facing the painful feelings he was trying to escape.

Issue #2 - Fear of the Inability to Learn
The second form of internal resistance is the fear of the inability to learn, which breeds resistance to failure, and  feelings of unworthiness. As mentioned on the previous track addicts often come from families that prevent the development of healthy risk taking, problem-solving, and self-confidence.

Addicts come to fear that they are unable to learn new, safe coping skills, or that learning to be autonomous is not only painful but also impossible. As you know, this creates a mental block in the addict that makes them resistant to learning tools and techniques necessary for living without their addiction.

Issue #3 - Belief that Success is Impossible
In addition to the fear of the pain of emotion and the fear of the inability to learn, the third form of internal resistance is the belief that success is impossible. Eric, 29, had been in AA for several months, told me "I got drunk one night and threw a beer into my 80-year-old grandmother's face because I was convinced she hated how long my hair was. I looked through my past and saw nothing but shame and disaster. I'm a fraud- how did I ever convince myself I could change?"

Eric felt that there was no hope for recovery; he described himself as a "monster" incapable of change. Eric was displaying the false belief that success was impossible, resulting in internal resistance regarding learning how to cope without drugs and alcohol.

Technique: Awareness, Learning and Forgiveness

I asked Eric to go through the "Awareness, learning, and forgiveness" process with me. As I describe this process see if playing this track would be beneficial to your Eric.

-- Step 1 -
First, I asked Eric to become aware of his destructive thoughts and behaviors. I asked him to list these thoughts, then helped him write new, reassuring thoughts next to each one. This drew attention to his frightening, false thinking.

--Step 2 - The second step after become aware of  destructive thoughts is learning. As you are aware and as discussed on previous tracks, addicts are lacking in three skills necessary for learning: risk-taking, problem-solving, and self-confidence.

I suggested small steps for Eric to take in between our sessions. By building these three skills slowly, learning to cope became a less frightening process for Eric, and his resistance to developing new skills began to fade.

--Step 3 - After awareness and learning, the third step in the process is forgiveness. Many addicts have never experienced forgiveness, and, as you know, this makes them unable to forgive themselves, creating a cycle of shame and helplessness.

I explained to Eric that healthy forgiveness is not the same as accepting destructive behavior. After working with Eric consistently on learning to forgive himself, he made fewer statements about "being a monster", and his resistance to the idea that he could change his behavior lessened.

On this track, we have discussed the addict's three forms of internal resistance to change. The three forms of internal resistance to change are the fear of the pain of emotion, the fear of the inability to learn, failure, and unworthiness, and the belief that success is impossible.  We also discussed the "Awareness, learning, and forgiveness" process

On the next track we will talk about the reason that the first step in the 12-step program works for so many clients.

- Newhouse, E. (2001). Alcohol: Cradle to Grave. Minnesota: Hazelden.

Peer-Reviewed Journal Article References:
Crano, W. D., Siegel, J. T., Alvaro, E. M., & Patel, N. M. (2007). Overcoming adolescents' resistance to anti-inhalant appeals. Psychology of Addictive Behaviors, 21(4), 516–524. 

Donaldson, S. I., Graham, J. W., Piccinin, A. M., & Hansen, W. B. (1995). Resistance-skills training and onset of alcohol use: Evidence for beneficial and potentially harmful effects in public schools and in private Catholic schools. Health Psychology, 14(4), 291–300. 

Hallinan, S., Gaddy, M., Ghosh, A., & Burgen, E. (2021). Factor structure and measurement invariance of the Revised Brief Addiction Monitor. Psychological Assessment, 33(3), 273–278.

Kang, D., Fairbairn, C. E., & Ariss, T. A. (2019). A meta-analysis of the effect of substance use interventions on emotion outcomes. Journal of Consulting and Clinical Psychology, 87(12), 1106–1123. 

Shih, R. A., Miles, J. N. V., Tucker, J. S., Zhou, A. J., & D'Amico, E. J. (2012). Racial/ethnic differences in the influence of cultural values, alcohol resistance self-efficacy, and alcohol expectancies on risk for alcohol initiation. Psychology of Addictive Behaviors, 26(3), 460–470.

Stolzenburg, S., Tessmer, C., Corrigan, P. W., Böttge, M., Freitag, S., Schäfer, I., Freyberger, H. J., & Schomerus, G. (2018). Childhood trauma and self-stigma of alcohol dependence: Applying the progressive model of self-stigma. Stigma and Health, 3(4), 417–423. 

Online Continuing Education QUESTION 10
What are the three forms of internal resistance that many addicts experience? To select and enter your answer go to CEU Test.

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