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

Section 11

CEU Question 11 | CEU Test | Table of Contents | Addictions CEU Courses
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track, we 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.

On this track, we will discuss the reason that the first step in the 12-step program works for so many clients, as well as the Pushing the Right Button exercise and the "Ritual for Release" exercise.

As you probably know, the first step in the 12-step program is for the addict to admit that he or she is powerless over the addiction and that his or her life has become unmanageable. The first step works because it makes the addict stop denying the problem. The first step aids the addict in confronting the four forms of denial that he or she may be dealing with. The four forms of denial I have encountered are grandiosity, blaming self, blaming others, and despair.

Gary, age 33, was a math teacher at a junior high school in an inner-city neighborhood. Gary had begun drinking alcohol and smoking pot to cope with the chaos at his job. At his school, students had weapons, teachers were threatened, and they had to have armed guards in the halls. Gary stated, "It’s a miracle when I can actually get my kids quieted down enough to teach them anything! I’ve got to smoke pot and drink just to get to sleep at night. Who wouldn’t drink with what I have to put up with?" Gary was in denial that he had a problem. He blamed others – the stress from students and the school environment – for his addiction.

As you know, because of denial, many addicts will not be motivated to try recovery only until they have hit bottom. In Gary’s case, bottom was a night when he got so stoned and drunk that he decided to cool off in a pond in a park near his school. By the time Gary got out of the pond, his clothes were long gone. He stated, "There I was, buck naked in the middle of the night in one of the city’s – shall we say – less than desirable neighborhoods. In fact, at that very moment I could barely make out a gang of kids coming toward me."

Gary believed he was incredibly lucky, because when the kids got close enough to see that he was naked, they decided not to attack him. Gary left the park by flagging down a police car. The officers put him in a raincoat and dropped him off at a detox center. Gary said, "After that, I was ready to recover. Damn, I was ready. The first step was a snap. All I had to do was remember that night in the park to remind me of powerlessness and unmanageability."

Hitting bottom for Gary meant that the night in the park caused him to stop denying that the pot and alcohol were creating problems in his life. As you are all too well aware, he had to admit that they were not helping him cope with the neighborhood in which he taught. For other addicts, as you are aware, it can be other events that convince them that they have hit bottom – the loss of a relationship, a drunk-driving arrest, bankruptcy and so on. With your clients who are fading in and out of denial, you might consider using the techniques of "Pushing the Right Button" and "Ritual for Release."

Three Step 'Pushing the Right Button' Exercise
Gary realized that his addiction wasn’t helping, but he did not know how to deal with the stress otherwise. I asked Gary if he would want to try a stress relief exercises. When he said yes, I asked "Wouldn’t it be great if you had a button you could push to turn off stress and a button to turn on relaxation?" I explained that to do the "Pushing the Right Button" exercise, there are three steps.

--1. I suggested to Gary, "First, remember a stressful time during this week." I asked Gary to pay attention to what his feelings and thoughts were and how his body reacted.
--2. Second, I asked Gary to imagine a dial like one on a stereo that turns down the volume. I explained, "The dial you’re imagining is one that turns down the volume of stressful thoughts. When you feel yourself reacting to troubling or stressful thoughts, turn the volume dial down."
--3. Third, I asked Gary to picture a button next to the stress dial. I said, "That is the button for instant calmness where peaceful thoughts can be heard. After you’ve turned the volume dial down on your stress, you can push the Instant Calmness button."

Gray had mentioned on several occasions listening to music, so he could relate to this visualization.

5-Step 'Ritual for Release' Exercise

I then talked Gary through the five steps of the "Ritual for Release" exercise.

-- 1. First, I asked Gary to stand with his legs shoulder-width apart and planted solidly on the ground. I stated, "Your arms should be loose at your sides. Your body should feel relaxed but balanced and strong."
--2. Second, I asked Gary to lean forward from his hips. I said, "Let your upper body hang down toward the ground. Let your arms be loose. Let your fingertips dangle toward the floor."
--3. For the third step, I asked Gary to breathe deeply and relax his body incrementally.
--4. Fourth, I asked Gary to close his eyes and visualize his body being completely relaxed.
--5. Finally, in the fifth step, I asked Gary to come up without straining his back. I stated, "Remember to roll up slowly, one vertebra at a time."

Do you have a client like Gary who has just started a 12-step program? Would your Gary benefit from a stress relief technique like the Pushing the Right Buttons exercise or the Ritual for Release exercise?

On this track we have talked about Step One and denial. We also discussed the stress relief techniques "Pushing the Right Button" and "Ritual for Release."

On the next track, we will discuss how some feel 12 step programs can actually impede the addict’s growth toward independence and a 13th step.

- Peiser, K., & Martin, S. (2000). In The Universal 12-Step Program: How to Overcome Any Addiction and Win! Massachusetts: Adams Media Corporation.

Peer-Reviewed Journal Article References:
Goodman, J. D., McKay, J. R., & DePhilippis, D. (2013). Progress monitoring in mental health and addiction treatment: A means of improving care. Professional Psychology: Research and Practice, 44(4), 231–246.

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. 

Lovsin, J. V. (1989). Review of From denial to recovery: Counseling problem drinkers, alcoholics, and their families [Review of the book From denial to recovery: Counseling problem drinkers, alcoholics, and their families, by L. Metzger]. Psychology of Addictive Behaviors, 3(2), 89–92.

Ricardo, M. M., & Henderson, C. E. (2021). The effect of the brain disease model of addiction on juror perceptions of culpability. Translational Issues in Psychological Science, 7(2), 177–185.

Sayette, M. A., Norcross, J. C., & Dimoff, J. D. (2018). Addiction training and multiple treatments for all clinical psychologists: Reply to Freimuth (2018). American Psychologist, 73(5), 695–696.

Sofuoglu, M., Sugarman, D. E., & Carroll, K. M. (2010). Cognitive function as an emerging treatment target for marijuana addiction. Experimental and Clinical Psychopharmacology, 18(2), 109–119. 

Online Continuing Education QUESTION 11
Why does the first step work for some of your clients? To select and enter your answer go to CEU Test.

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