Individual Therapy > Mindfulness in Action: Steps to Curb the Addictive Urge

Mindfulness in Action: Steps to Curb the Addictive Urge

By Dan Pollets, PhD

Carl is often on the receiving end of extreme and toxic judgments and criticisms from his “inner critic.” It has been said that an addict needs shame or shaming like a fish needs an umbrella.  In fact, the addictive cycle is powered by self-blame, which leads to depression and self-hate that creates more of a need to self-medicate and therefore escape these painful feelings.  Instead of blaming yourself for having addictive parts that seek relief, place the blame squarely on your brain.  It goes like this: “This is my brain sending me a false message.”
 

In the case described above, Carl struggles with his compulsive addictive “part” that hijacks his behavior looking to provide relief and “pleasure.” The progression of addiction if unrestrained whether to pornography in this case or alcohol or substance is inevitably harmful to self and relationships. In my journey through the literature of addiction, I came upon Gabor Mate’s five step process to recovery (see “In the Realm of Hungry Ghosts”), largely based on Dr. Jaffrey Schwartz’s book, “Brainlock: Free Yourself From OCD”. Below, I describe these steps and integrate them with insights I have garnered from mindfulness practice and Buddhist psychology.

There is a strong literature available on how mindfulness meditation training can help in the addiction recovery process.  John Kabat Zinn, the foremost researcher who popularized mindfulness practice defined Mindfulness as a special quality of attention; that is, the capacity to pay attention to what is happening in the present moment without judgment.  It is non-reactive, present moment awareness.  If our thoughts and feelings are activities of the mind, awareness is the light that illuminates these activities without distortion.  Awareness is available to all of us and can be cultivated through the practice of meditation (or other mindfulness awareness practices like Tai Chi or yoga).  Just as one goes to the gym regularly in order to increase a baseline level of fitness, one can sit and meditate to develop the mind’s capacity for present moment awareness.  Let’s look at the steps to curb the urge through a mindfulness lens.

Step I: Relabel

Carl is challenged on a regular basis by what he perceives as a powerful need to view pornography.  In all addictive or compulsive behavior there is the “part” that takes over and overwhelms any discipline or will power and drives the addict along the self-defeating path seeking relief or temporary pleasure. This dynamic of course is very powerful and very reinforcing.  Step I is when you stay grounded and reframe the urge. Try to remember that the urge to use is simply a thought.  This urge may be powerful but you need not mistake it for reality. You are NOT your thoughts. Carl could say that I have a belief that I should view pornography but this a choice I make.  Your awareness is distinct from your thoughts. When mindful, you practice noticing the activities of your mind. Thoughts, feelings, beliefs, sensations, and attitudes are distinct from awareness.   

You can cultivate this capacity for awareness through meditation.  It then becomes easier to differentiate or “unblend” from addictive urges.  The strong need you feel at the moment that might feel overwhelming is only an obsessive thought. It will change and mitigate if not indulged.  It is not a real, objective need but a false belief.  Your thoughts are real, in the sense that they are really happening, but they are not true, in the sense that they are a genuine reflection of reality.  There will be no catastrophe if you do not act on your urge.  Nothing urgent is going on. What is going on are thoughts about what might happen or has happened but is not going on in the present moment.  

Whether you call this capacity of mind the “impartial spectator” (Adam Smith) or the “compassionate/curious witness” (Gabor Mate), the ability to observe the urge with conscious attention without assigning the habitual meaning to it (“I must act or catastrophe will happen”) is mindfulness in action.  It is not a “need” that must be acted upon but only a dysfunctional thought that can be recognized and allowed but not given into. Try reminding yourself of your intention to avoid the compulsive behavior.  Cultivating and sustaining strong mindful awareness will eventually result in beneficial changes to brain patterns, thoughts and behaviors.  

Step II: Re-attribution

The urge to use originates in neurological circuits that were programmed into your brain long ago when you were a child.  Traumatic events, physical and sexual abuse, abandonment, neglect, or the simple failure of normal attachment results in what is called “dopamine hunger.” In other words, childhood attachment experiences affect the brain and the person’s inner capacity to regulate emotion.  Dopamine is the neurotransmitter that is associated with well-being or emotional equilibrium. When our biological needs for attachment go unmet or when we are exposed to overwhelming stress, our brain’s dopamine system reflects this deficiency and seeks relief outside the self. Through no fault of our own, we grow up lacking the capacity to “self-soothe”. The addictive urge is our way of trying to bring ourselves back in balance.    

Instead of self-blame, use mindfulness or the capacity for “compassionate curiosity” towards the self to offer “loving presence”.  Calmly ask why these desires have such powerful hold over you.  It is not moral failure of character weakness.  You are not inadequate or a failure or unworthy or any other derogative labels your “inner critic” uses to shame you.  The addiction (or obsession/compulsion) is just the effect of circumstances over which you had no control.  It is not your fault!  What is your responsibility (if you wish to recover that is) and what you do have some control over, is how you respond to the compulsion now. Connect with your innate intention to care for your body, mind and spirit. Remind yourself that you are worthy of a good and fulfilling life.  Then with strong mindfulness, conceptualize (relabel) the compulsive urge as only a thought, an attitude, a belief, a feeling arising from automatic brain mechanism (reattribute) which belongs to ancient unmet needs.  You can observe it consciously with attention and compassion and then practice letting go.

Step III: Refocus

In our clinical example above, Carl will experience distress or negative emotions or the need for pleasure that is not available to him in his present life situation and impulsively go online.  He becomes unconscious and driven by his need for relief.  When you refocus,  you are able to create some space from the urge to act and buy yourself some time.  The impulse will burn out or lose its power if held in awareness and not acted upon.  Again, differentiate between feelings and actions.  As Dr. Schwartz points out, “It’s not how you feel that counts; it’s what you do.”  What can really help at this point is to practice what Tara Brach, a noted mindfulness teacher and psychologist, calls the “sacred pause.”  Allow your awareness to find your breath and become aware of the sensations of breathing in and breathing out deeply.  Place your hand over your stomach and note it rising and falling.  This is diaphragmatic breathing and it will trigger the parasympathetic strand of the autonomic nervous system (ANS).  This is the part of the ANS that calms us down, as opposed to the sympathetic nervous system, which is activating and associated with “fight or flight” response.  A few minutes of deep breathing, a pause, allows a space to open up, a crossroads, as it were, to consider doing something other than acting on impulse.  Choose something that you enjoy and that will keep you active, preferably something healthy and creative, but anything that will please you without causing greater harm. Take a walk, get on an exercise bike, call a friend – you just need 15 minutes.  Physical activity seems to be especially helpful, though anything  enjoyable can do the trick.  

The purpose of refocusing is to teach your brain that it doesn’t have to obey the addictive call.  This can be called exercising “free won’t” (as opposed to free will).      As you are doing the novel activity, stay aware and appreciate that you are doing something other than the problematic addictive behavior.  Even holding out for a short time is an achievement.  Don’t self-shame if you relapse.  Get back on the horse and keep trying; this is the most important thing -  to break the pattern and teach your brain new tricks.  Support this crucial attempt in the right direction.

Step IV: Revalue

The purpose of this step is to have a very clear idea of why you’re going through all this trouble to free yourself from the addictive behavior and imprint in your mind the negative consequences of continuing on the path of addiction.  In fact, it is more of a devalue then it is a revalue.  In a formal intervention in addiction recovery, friends and family who have been negatively impacted by the addict’s behavior gather and share with the person how the addictive behavior has made it impossible to have a relationship with him or her.  Also, the group shares what will happen if the behavior does not cease and what their fears are.  This step of revalue is like an ongoing inner intervention you conduct towards the part of yourself that seeks relief despite consequences.  This addictive part’s role is like a “firefighter;” it seeks to extinguish some pain that has not been acknowledged or dealt with by the aware functional adult parts of the brain.  This addictive part has been fooled into making the object of your addiction the highest priority and has hijacked the reward and incentive circuits of your brain.  Instead of love, productive pursuits, and vitality being reinforcing and rewarding, addiction dominates and behavior is directed in this direction and avoiding pain or seeking relief.  In this step, you work to devalue this false god and to assign it its proper value – less than nothing. 

You can ask, what has this addictive part done for me? List the negatives. It is extremely helpful to write this out and make the details explicit.

Get very specific about the damage addiction has wrought in your life, on your health, relationships, work, legal situation, friendships, family, spirit and emotional health.  Has it not caused you to betray your true values and disregard your goals? 

As you write out this inventory be very mindful of how you feel when you recall these events.  Again, remember this list with clarity and feeling when the urge to use compromises you and leads to a destructive situation.  Get in touch in an honest way of what will lie ahead for you if you continue to act on the urge to use.  Try your best to do this exercise without judging yourself or slipping into toxic shame.  You are gathering information not conducting a trial with your Self held in contempt.  Allow your mindful awareness to see clearly what has happened and what will be the future if change is not embraced.  Here again mindfulness is your guardian.  

There are two important issues that Dr. Schwartz emphasizes that bear repeating: anticipation and accept.   Recovery is an ongoing process and relapse and slips are part of the territory.  It helps to anticipate that the compulsive urge to engage in addictive behavior is likely to return.  Refuse to give in to defeatism and indulge in self-shaming if you slip.  Remember the AA slogan, “one day at a time” and get back on the wagon and return to the practice of the previously described steps.  Every day that you are able to remain sober is a triumph and a slip is no catastrophe.  Accept the fact that addiction exists – not because there is something inherently defective about you but because you have parts that have had to adapt to an inherently dysfunctional early environment and was programmed in this way.  What is within your control is how you “manage” the addictive part and respond to it in the present.

Step V: Re-Create

In Step V, the perspective shifts from telescopic focus on the present moment experience of the addictive part to the wide angle: examining your values and if you are being true to them.  As you relabel, reattribute, refocus, and revalue, you are relearning patterns that have held you captive.  These parts that have such a hold on you are unconscious and programmed adaptations that help you to self-regulate (esteem, emotion, stress, etc.).  It is now time to re-create, to choose a different life.  Gabor Mate says it best: “In place of a life blighted by your addictive need for acquisition, self-soothing, admiration, oblivion, and meaningless activity, what is the life you really want?  What life would you choose to create?”  

In the service of forging a new beginning, Mate suggests that finding a pathway to some form of expression or creativity would be life affirming and stress reducing.  He quotes Hans Seyle, the famous stress researcher: “What is in us must out, otherwise we may explode at the wrong places or become hopelessly hemmed in by frustrations.”  Write down your values and intentions and do so with conscious awareness.  Connect with your intentions about how you want your life to go - the bigger picture or North Star to which to orient yourself.  Re-create your life as you dream it can be.  Mate reminds that we all stumble forward, as of course we are all imperfect beings, fragile, and vulnerable and above all else human.  And then take the four steps plus one again. With practice and mindful self-acceptance, you will eventually succeed.

Dr. Dan Pollets is an ASSECT credentialed sex therapist and well trained in cutting edge couples, individual and group therapies. 

Dr. Pollets is in private practice in Medford, Massachusetts and treats patients from Boston, Cambridge, Arlington, Winchester, Somerville, Melrose and the greater Boston Metro MA area.  He is Associate Clinical Professor at Boston University School of Medicine and a published author in the Psychology Today web site.