Conquering Any Kind of Addiction or Craving

The Main Contents

The Self-Help Information in the Article

Part One
Encouraging Ourselves and Thinking About Our Skills

Samantha thinks:

I must remember that the first thing Rebecca said to us new group members was that before we try coming off what we're addicted to, we ought to go and see our doctors to ask if it's safe to come off on our own, or whether we need any medication to help us cope with any withdrawal symptoms, or whether it's best to come off gradually. I'd better do that soon.

Rebecca said she's just been reading a book by a therapist, that she hopes will help her lead the group.

She said that one thing the book said that might be helpful is that we should think of and hold onto all the things that are giving our lives meaning in spite of our addictions. She said it can help if we make notes of that kind of thing regularly for a few weeks, taking time to think of the things in our lives that are going well and that we'd like to keep going.

She said that besides anything else, that could include any improvements we're making with our addictions, such as any times we resisted the urge to indulge in our addiction even though we could have done, and how we managed it, or whether there were several hours when we didn't crave what we're addicted to, and what we were doing during that time that kept it out of our minds. Then we might be able to work out what kind of thing to do more of in the future.

That's an interesting idea, because I know there are times when I don't think of drinking. I think they're times when I've felt more competent, as if I'm doing something well. If I know I'm doing something well, I get all enthusiastic about it, and I don't want to drink at times like that. I'll look out for other times when I don't want to drink, or when I manage to resist the urge to drink and what helps me do it.

And if I write notes of those things and keep them all in the same place, I'll be able to remember what I've thought of, and I can read them back to myself every so often to remind myself of what's going well. Maybe it'll help me do more of the things that are going well.

And Rebecca said that if we come up with any creative ideas that turn out to help us, it can help if we make a note of those as well to remind ourselves of them, and to prove to ourselves that we have the skills to invent things that work for us.

She says that whenever anything works for us and cuts down the time we want to spend doing our addictive behaviour, it'll be good if we can tell people at the meeting about it next time. She said that not everything that works for us will work for others, but lots of things will be worth a try, and we might be able to give other people valuable tips that end up working for them. And anyway, it'll be encouraging to tell the group what we've achieved and to hear other people's stories. And we can all congratulate and support each other.

Even When Addiction Problems Aren't Going Away, It's Still an Achievement If They're Not Getting Worse

She said that even at times when our addiction problems don't get any better, but we manage to control them enough so they stay the same, not getting any worse, we can congratulate ourselves, because it can be a big achievement just making sure they don't get worse, especially since it can feel so unrewarding, like someone using a rowing machine all day, ending up in the same place as where they started, having used up a lot of energy just to stay in the same place. She said it's easy for people not to appreciate our efforts not to get any worse and criticize us for not getting any better; but actually, just not getting worse is a big achievement in itself, so we can be encouraged about that.

I'm glad to hear that, because there have been times when I have resisted cravings to drink, when I haven't got any better, but at least I haven't got worse. But I still felt guilty at not getting better. So it's nice to know that just not getting worse can be considered a worthwhile achievement in itself.

She said that if we can think through what techniques we've been using to stop ourselves getting worse, we might be able to put some of them to work in getting ourselves better. And even if we only manage it in small stages, every gradual improvement can be something we can be pleased with ourselves about.

Looking Forward to the Future

Rebecca said that something that can help motivate us to kick our habits is for us to imagine the positive things that could happen in the future when we're not addicted any more. For instance:

• How our health will improve;
• what effect our getting better will have on our friends, family and anyone else we know;
• how we expect them to respond when they find out we've given up what we were addicted to;
• in what ways our relationships with them will improve;
• in what ways it will improve our lives when we're getting on better with the people around us;
• what we'll be able to do then that we can't do now, for instance when our health improves and when we have more money;
• and anything else we can think of, like ways we could improve our lives and relationships when we don't have to devote time and money to the addiction any more, and our senses are in better shape because they're not being affected by any substance we're taking.

Well, for a start, I know that when I cut down the drink or stop altogether, I'll be able to go out with my friends again, because I won't be embarrassed about the amount I drink and want to hide it any more. So my social life will improve. And I won't be at risk of losing my job any more, hopefully. And I can make up with Lisa and she'll let me see her children again. That'll be nice, because I did enjoy playing with them and speaking to her, so I'll enjoy doing that again when I've stopped drinking.

And I know I'll care for the patients better at my work. And actually, when I'm thinking more clearly, I can complain to the management about what's upsetting me about working on the ward, and go for another job if they don't do anything. It was because I didn't sort out the problems before that I got depressed and started drinking. But I think I'll sort my life out instead now.

Part Two
The Reason People Are Vulnerable to Addiction

The self-help book I've bought seems interesting so far. I'm going to read more of it soon. Then hopefully, I'll be able to change my life.

Building Up a Tolerance to Addictive Things

It says that it's typical for people to have to have more and more of what they're addicted to, whatever it is, and yet the same amount doesn't give them the pleasure it used to, so they think they need more.

Yes, that's happened to me.

It says that as we have more and more but it doesn't satisfy, or even seem to do much to us at all, that means we're really building up a tolerance to it, but if it's a substance like drugs or alcohol, we can think it's not affecting us because we're not experiencing the same feelings we did before with the same amount; but actually, it's doing our bodies damage without us realising it.

It says there's a reason why tolerance happens. It's part of nature's design, meant for something else. It says once we know why it works the way it does, we know what to do to make it work for us instead of against us like it is now.

Withdrawal Symptoms

It says that after a while, the enjoyment goes out of what we're addicted to, but we feel we have to keep taking it because we get withdrawal symptoms if we don't. But a lot of what gives us withdrawal symptoms is to do with our own minds, so we can mostly control them when we know how.

It says when people have withdrawn from things that aren't substances, for instance gambling, they can still get withdrawal symptoms. They can find themselves becoming agitated, uncomfortable, unable to concentrate, depressed, restless, or they can have a physical sensation associated with what they think of as a loss. So that shows that a lot of what gives us withdrawal symptoms is to do with our own minds. And when we know how we get them, we'll know how to control them to stop them being so nasty.

That doesn't mean all withdrawal symptoms are in the mind. Sometimes people will need medical supervision to withdraw from a bad alcohol addiction or drugs, because the brain has temporarily stopped producing certain chemicals because substitutes for them have been supplied by the alcohol or drugs, and the brain has mistaken them for the real thing, so the brain won't be making them for a while when people stop taking them, and the lack of them will cause some nasty symptoms, some dangerous and even life-threatening.

But the book says not all withdrawal has to be nasty.

It says that usually, withdrawal effects are the opposite of the effects of whatever we were addicted to: if Drinking makes us feel relaxed and confident, then not drinking will make us feel tense and edgy. Those who get high on cocaine will feel very depressed when they come off it. Anyone who gets a lift of mood for a little while when they eat comfort food or engage in an addiction to gambling or sex or anything else will feel down when they're not doing that. But it says withdrawal symptoms don't need to be anywhere near that bad.

It says we can understand why, when we understand why addiction happens. It says it's a misuse of a mechanism in the brain that's perfectly natural and desirable, in fact crucial to human survival.

Why Addiction Makes Nature's Design Work Against Us, and How It's Supposed to Work

One of the authors of this self-help book says he wondered for some time why it is that people stop getting so much pleasure out of something that gave them pleasure at first, so they feel they have to take or do more of it, and why people get such unpleasant withdrawal symptoms when they stop doing an addictive thing that's harming them. But there's a good explanation, which is that the mechanism in the brain, when allowed to work as it was intended, is designed to coax people to do more and more sophisticated things to increase their quality of life, by making them dissatisfied with the same old thing; but at the same time, it stops them giving up doing things that are essential for survival by giving them discomfort when they do, although nature intended our withdrawal symptoms to be much milder than they often are.

For instance, a long time ago, someone once picked up a stone and carved it into a tool. And they must have felt a great rush of pleasure when they'd done that, because it was a new achievement that was going to make their lives easier. But once they were familiar with making tools that way, they wouldn't have got so much pleasure out of it. But they would have got a rush of pleasure again once they'd discovered how to make different tools, or to use the same tool for new things.

So the rush of pleasure at doing something new and the diminishing of pleasure when it became commonplace would have spurred mankind on to do new and better things. Without it, mankind might have been fairly content to live in the Stone Age forever. But mankind's chances of survival have gone up because we've continued to develop new things, spurred on by the reward system in our brains that gives us a rush of pleasure every time we invent new things or new ways of doing things.

But nature had to make sure we didn't drop what had worked before and what was still essential for our well-being, in a search for newer creative things. That's where withdrawal symptoms come in. We had to experience some discomfort on dropping activities that were no longer pleasurable but were still necessary, because they might be essential for our survival, and so we couldn't just drop them when we got bored of them.

The book uses exercise as an example. It says that someone might start walking a mile a day to keep fit, and when he starts, it might feel like a lot of work, but after a while, it might make him feel full of energy and good feelings, so he might gradually increase the distance, all the while feeling better and better. But then when he gets used to it, he might get a bit bored, and there might be days when he can't be bothered to go out. But it says that he'll feel a bit of discomfort at missing his exercise, and that'll make him want to carry on. The discomfort will be the withdrawal symptom, kicking in in the way nature intended, to urge people to do more healthy things.

But because he's bored with the exercise, because nature's designed boredom with things into the system to spur people like him on to more inventive things, he'll invent something to keep him interested, like walking with a friend, walking different distances each day, varying his route, doing a different exercise than walking, maybe an enjoyable sport, or something.

It says that doesn't mean we'll have to vary everything. For instance, cups of tea can be enjoyable however often we have them. But it says that we all do need a certain amount of variety in life to keep us happy. People wouldn't want to eat the same food all the time or have the same conversations all the time, for instance. And everyone finds that one of the best natural highs can be got from doing or achieving something new, if it's enjoyable.

But it's as if addictions hijack the system. It says that the more curious people are to try out new things, the more vulnerable they are to addictions, because they keep wanting new experiences and to try out different things. But it's as if addiction's like a con-man, deceiving us into believing it's offering something good, when it will really waste all that curiosity, injuring our physical and psychological health, perverting our natural learning system that keeps us wanting to try new things and feeling uncomfortable when we don't, and destroying our confidence and self-esteem, and also our relationships with others.

So it says that the way out of addiction is to find natural highs, healthy things that'll satisfy and please us and give us good feelings and improve our lives and relationships with people important to us.

Well that's interesting. I must tell the group!

It says that there must be a reason that while people are so vulnerable to addictions, most people don't develop them, or not full-blown ones anyway. And it says that it's because most people get enough important needs met in their lives that they don't succumb to addictions. People experiencing natural and healthy ways of lifting the mood won't be attracted to doing things compulsively.

Part Three
How We Need to Get Our Emotional Needs Met to Keep Addiction Away

The book says that the needs it's talking about are emotional needs that we all have:

• the need to feel secure;
• the need to give and receive attention;
• the need to feel we're in control of our lives and are free to make our own decisions within reason;
• the need to feel we're valued in some way;
• the need to feel we can get emotional support from others when we need it;
• and the need to be able to use our abilities creatively, so we're not just like machines doing the same old thing, and so we can feel we're doing something worthwhile so we have meaning in life as individuals.

The book says that if those needs are being met, we can have a gratifying feeling of fulfilment in various parts of our lives. If we have a warm relationship with people around us, and we do things with our lives that we enjoy and that will challenge us so we get a buzz from achieving new things, and if we do things that will absorb us, so we're focused on how much we're interested in them rather than thinking about ourselves and we get a good feeling from doing them, and if we have new experiences and opportunities to do new things we'll enjoy and that will challenge us to more healthy creativity, and if we have our share of responsibilities and duties to do to make us feel we can respect ourselves and that will give us value in life, then we won't succumb to addiction.

It says addictions stop us getting our needs met in a healthy balance, and people instinctively know they will, so people who can easily get all their needs met avoid doing too much of something pleasant if it will interfere with something else in their lives. Not doing it will have more emotional attraction for us than doing it. For instance, if there's a family celebration next day, we won't want to stay up most of the night watching television, because we'll want to be at our best.

Addiction Means Something's Missing In Our Lives

It says that sometimes, everyone will get so absorbed in something that they do far more of it than is sensible and suffer for it afterwards; but if the behaviour continues even when relationships are suffering or a job is at risk of being lost or something, it must mean there's something missing in our lives that we're trying to replace with the addiction.

It says that when our needs are being met, we'll be protected from becoming addicted to things.

It says that some people might be well aware of what's missing in their lives and what they're trying to replace with their addiction, such as if they're drinking because they're lonely or eating because they're bored; but very often, people don't realise they're seeking the high of addiction to compensate for something not going right in their life. They might think they're perfectly satisfied or happy with it, and that doing the addictive thing's the behaviour they most want to do, perhaps thinking they just like to use it to relax after work or after the children are in bed, not realising that they're using it to dull their discontentment with their job or to compensate for the thought that they're no longer free to go where they want when they want, now they've got the children. Or they might not realise what's missing, because they've filled their lives with their addiction and have surrounded themselves with friends who are also addicts, like alcoholics, gamblers and drug addicts often do.

But it says that even if they don't recognise it, they will be doing what they're doing because they're not getting all their emotional needs met in a healthy way. If they were getting them met, they wouldn't have time to fit their addiction in.

It says addiction is the learning mechanism of the brain that was designed to keep us wanting and inventing new things to improve our quality of life switched to destruct mode instead, doing the opposite of what it was supposed to, making it more difficult for the emotional needs to be met that were being met before in a healthy way, and stopping real satisfaction from being found.

It says the sense of something missing in people's lives will often make them just swap one addiction for another when they want to give one up, even if they think they're doing something healthy instead. So perhaps someone might give up smoking or gambling or drugs, but then they might start exercising far more than is healthy for them, or over-eating, or doing so much yoga they haven't got the time to sort their family relationships and other parts of their life out to make them more satisfied all-round. If what was originally missing in their life is still missing, they'll just turn to another addiction.

It says people often become addicted to things or return to an addiction they had in the past when they experience a major loss in their lives, like bereavement, the loss of a job, or if they get a disability or damage to their health. That's because their emotional needs will have stopped being met in the healthy ways they were being met before, so they need to compensate. It says that addiction often goes together with depression, which also comes on when people's emotional needs aren't being met, and when they think problems are going to be much more difficult to solve than they really will be.

Eating Disorders Are Addictions Too

The book says it's clear that things like anorexia and bulimia are addictions, since people are willing to risk their health and even their lives for them, and they give people highs. It says starving oneself can create intense feelings of satisfaction that come from the feeling of having power and control over oneself or others, and also feelings of goodness and purity. It might also cause the release of endorphins, the feel-good chemicals the body can release to make pain more bearable. Since endorphins are natural opiates, they could make the addiction more powerful. So it isn't really the perfect body people who do that want, but what can spur them to carry on is the high that comes from what they do.

It says that thinking about bingeing, buying food, and then eating it, all produce an increasing rush of emotion. Many people with bulimia say they don't even taste the food, and people with anorexia say they're not aiming for a particular body size, but just enjoy the process of getting thinner.

Addiction to Smoking

The book says that most people start smoking when they're teenagers, at a time when it's usual to experiment with things and to be uncertain about one's role and place in the community and to want to feel accepted as part of the group. So if a group a teenager hangs around with smokes, they're likely to start smoking as well, to fit in more, so they'll be accepted as one of the crowd. But then it becomes a serious habit.

The book says smoking can be an easier trap to fall into than other addictions, because until recently, it was widely accepted in society, and it doesn't cloud a person's judgment like addiction to drink and drugs can, so people can do it while they're doing ordinary everyday tasks. And it doesn't usually lead to the loss of a relationship or job.

But it says that still, although people might have started smoking to meet some of their needs, to carry on smoking stops needs being met. It can stop people concentrating fully, in spite of smokers saying they think it helps them stay focused on one thing. And it can damage people's social lives, since smokers might sometimes avoid social events where people will disapprove if they smoke or where they won't be allowed to. They might miss out on getting jobs with companies who have non-smoking policies. And if they're in a non-smoking environment, they might spend a lot of time wishing they could get away for a smoke, instead of devoting their attention to enjoying themselves.

Yes, Sharon said she's had those kinds of problems.

Part Four
How People Can Be Very Motivated to Give Up Addictions When Their Needs Are Being Met

The book says the long-term answer to addictions is to create a more satisfying lifestyle for ourselves where our emotional needs are being met in a healthy way. It says it's the best way for us to help ourselves to keep on with the discipline necessary to make sure we beat the addiction and stay off it, and it's a pleasurable way to conquer addiction.

The book says there's no need for a lot of suffering when we withdraw from what we're addicted to. By increasing our pleasure, we won't miss our addiction nearly so much, and it's missing it that causes a lot of the suffering.

Examples of How Addictions Can Become Unattractive When Emotional Needs Are Being Met

The Vietnam Veterans

The book says that it was found by researchers that half the American soldiers in Vietnam in the 1970s were taking heroin. The authorities were very worried about what would happen when they all came home at the end of the war, so they monitored them closely. But they were surprised to discover that only just over one in ten continued to take heroin once they'd got back with their families and had taken up their old lives again. 80% had given up within a year, half with help from clinics and half by themselves. The ones who didn't manage to give up either had post-traumatic stress disorder or came from broken homes and so didn't have a comfortable environment to return to.

Natural Recovery From Addiction

The book says there is a massive natural recovery from addiction.

It says that For instance, alcohol consumption is by far the highest in the 18-34 age group; but many people cut down dramatically in the two decades after that.

Hang on, not everyone who drinks a lot is addicted to drink.

It says half of recovery from addiction is achieved by people giving up what they've been addicted to without the help of therapists or other professional people.

That's nice to know.

It says most drug users are between 14 and 25 years old, and sometime during those ages, most will stop, again without professional help.

Then again, not all people who take drugs are addicted to them either, at least some drugs. The statistics in the book sound encouraging, but I wonder if they're quite as good as they seem.

The book says it's no wonder that young people have a high tendency to do things that are addictive, since it's during adolescence and young adulthood that we make the transition from having our needs provided for by others to having to take responsibility for our own well-being, and that can cause a lot of insecurity. But it says drug use changes and mostly stops as young people get further up career ladders, form lasting relationships and start families. It says people who carry on using drugs tend to be those who have been socially excluded, emotionally or physically abused, haven't got family members around them or jobs, and suffer emotional difficulties.

Inaccurate Beliefs That Can Stand in the Way of Addictions Being Shaken Off

It says there are several myths about addiction, like that once you're an addict, you'll always be one unless you watch yourself very carefully, and that you have to surrender to a higher power because you're incapable of coming off what you're addicted to on your own; but it says the research proves that beliefs like that just aren't true. People can come off what they're addicted to themselves successfully and stay off once they know how.

It says that what will help us most in overcoming addiction is to build on positive qualities and talents we already have that can help us, and to spend time with people we know like family members, friends and colleagues who are living healthy, productive lives.

It says it isn't true that people need lifelong support to stay off what they were addicted to. People can move on with their lives and forget it. It says a lot of people do find long-term support helpful, but for some, constantly talking about their addictions can keep them stuck thinking they're an addict instead of thinking of themselves in a more positive way, and people can become addicted to the support group, since it can fulfil their needs for attention and social contact. It says the fact that so many millions of smokers around the world have given up successfully without help proves people don't need support groups, since they don't feel the need for them. So we can really get over our addictions and then just move on and perhaps never even have to think about them much again.

Part Five
Giving Up Addictions by Increasing Pleasure, Not Enduring Suffering

I have every sympathy with the American who was so horrified by what he has read of the effects of smoking that he gave up reading.
--Lord Conesford

Why Withdrawal Symptoms Don't All Have to be Nasty

The book says that withdrawal symptoms can often feel like agony, overwhelming to the point that some people even leave the house at midnight in freezing rain to buy more of what they're addicted to. But it says the withdrawal symptoms don't have to be like that at all, because what makes them so powerful is our expectation of how good indulging in the addiction's going to be, and how it tricks us into believing we need it. If we can learn to overcome those things by thinking about the addiction differently, it'll lose a lot of its power over us.

The Story of the Panicky Smoker

The book says that withdrawal symptoms in themselves have to be mild, because they're part of nature's survival mechanism that stops us giving up essential activities like exercise, and if they really were agonising, they'd hinder our survival, not help it, for instance if we hadn't exercised for a while, and we got such bad pains that we wanted to exercise even less.

But it says it's not referring to medical symptoms that can be brought on by sudden withdrawal from something the body's built up a huge tolerance to over time. Some people need to be medically supervised when withdrawing from substances because of that.

Not Feeling Discouraged If We've Tried to Break Free From Addiction Before Unsuccessfully

The book says it does take time for people to adjust to not being addicted to something, since people build their lifestyles around their addictions, so quite a lot might have to change in their lives before they're happy not being addicted.

But it says that although a quarter of people successfully manage to break free from their addiction the first time, of those who take several attempts, the more times they try to come off what they're addicted to, the more they're likely to succeed, because each time, they'll have become more knowledgeable about what works to keep them off what they're addicted to, so they can put an increasing amount of knowledge into practice each time they try to give up.

So it says we don't have to feel discouraged if we've tried several times to give up but couldn't manage it before. It makes us more likely to succeed the next time.

Sharon will be pleased to hear that, because I know she's tried to give up smoking before.

Part Six
What Causes Cravings, And How Knowing That Can Help Overcome Them

We shall not refuse tobacco the credit of being sometimes medical, when used temperately, though an acknowledged poison.
--Jesse Torrey, (1787-1834), The Moral Instructor.

Luck never gives; it only lends.
--Swedish Proverb

In most betting shops you will see three windows marked "Bet Here," but only one window with the legend "Pay Out."
--Jeffrey Bernard

Lottery:  A tax on people who are bad at math.
--Author Unknown

You know horses are smarter than people.  You never heard of a horse going broke betting on people.
--Will Rogers

No dog can go as fast as the money you bet on him.
--Bud Flanagan

I met with an accident on the way to the track; I arrived safely.
--Joe E. Lewis

The book says that when we know what's going on in the brain when we crave something, we'll know how to stop it happening. It's already explained how addiction hijacks and perverts a natural system in our brains that was designed to help our survival and help us improve our quality of life by making us want to experience new and better things; and now, it says it's going to explain exactly how it does it.

Things That Go On in the Brain When a Craving Comes On

The book says that when we understand what an addiction does in the brain to make it so powerful, we'll have the power to stop it.

Well that's good, because often, I just haven't got enough optimism to believe I'll manage to stop it. I just feel like a failure. Still, everything in this book and in the group seems hopeful so far, so hopefully, I'll soon come around to believing I can do it.

It says that near the front of the brain, there's a bit called the dorsolateral prefrontal cortex. It's the bit that contains our awareness of who we are and what we want out of life, and contains memories of what we're doing from moment to moment. It's the bit we use to plan and make decisions and form our expectations of what's going to happen in our lives. The book calls it the boss, since that's kind of how it functions. It says we can think of ourselves as the boss really.

It says there's another bit of the brain called the anterior cingulate, which is like the boss's secretary, because it takes care of all the routine matters, making the ordinary decisions that don't need special thought. It's what's in charge when we're doing things we can do almost automatically without giving careful thought to our every move, because they're routine, like making a cup of tea or driving. The book says that when that part of the brain's active, the part it calls the boss is inactive, as if the boss is out to lunch. But the boss can easily be called upon if something unexpected crops up that needs more specialist thought.

It says there's another part of the brain a bit further back called the hippocampus, which is like the storehouse of all our important personal memories that we can bring to mind when we want to.

The book says that next to that, there's a part of the brain called the amygdala, which stores our memories of the way situations have made us feel in the past, and how it thinks we need to respond to them in the future when they come up, based on how we've felt about them in the past. So for instance, if we've run away from something in the past, when we encounter it again, the amygdala will bring out the fear emotion we felt before and make us want to run away again, because it jumps to the conclusion that we must be in danger, because we ran away before. It's responsible for our immediate survival. So the book calls it the security officer. It says that every time we sniff a smell or hear a sound or see something, the information is flashed to the security officer so it can quickly match it to its memories of how it makes us feel, if we have any, so it can get an idea of how to react to it.

So, for instance, if we smell a nice smell we recognise, it'll send out signals that make us think that stopping to sniff it will be a good thing to do, whereas if it's a smell of something mouldy in our fridge, it'll put us on the alert. And if it's a smell we've never smelled before, it might make us want to investigate further.

An Example of How the System's Supposed to Work

The book gives an example of how the bits of the brain communicate with each other when something happens.

It says that, for instance, if we have a cup of coffee that doesn't smell right, the brain's security officer, the amygdala, might recognise that something's wrong, based on its/his memories of how something has made us feel before when the coffee hasn't smelled right. So it'll/he'll go on the alert and flash a message to the boss's secretary. But to get her attention, he has to mark it urgent. He does that by attaching a brain chemical called dopamine to it, which works like cocaine and spurs people to want to take action. The more important the security officer thinks a situation is, the more dopamine he'll add to it to make it stand out as more and more urgent, so we get more emotional charge the more urgent he thinks it is.

The types of emotional charge we get when the security officer thinks something new ought to be drawn to our attention can take the form of fear, disgust, anger, sadness, joy, or a range of other things, depending on the situation.

So with the cup of coffee that didn't smell right, the emotion we got would be disgust.

So the security officer in the brain flashes the message that the coffee isn't right to the boss's secretary, along with a feeling of disgust. But the boss's secretary knows the security officer can often over-react, because he takes his role as a protector very seriously. So to find out how important the message really is, she contacts the memory storehouse, to find out what similar situations have happened in the past.

Soon the message comes back that the last time the coffee smelled like that, we'd put gravy granules in the cup instead of coffee by mistake!

So what the security officer's stopped us from drinking is a cup of boiling water with gravy granules, sugar and a bit of milk in it!

When the boss's secretary realises that, she commends the security officer for his good work and orders that the concoction be tipped down the sink.

When the Amygdala/Security Officer Takes Over

The book says that in serious situations, where we're at immediate risk, such as if we think a tree's about to fall on us, the security officer doesn't need to consult with other parts of the brain. It just sends out chemical alarm signals to the rest of the body and we run away before our conscious brain even really realises what's happening.

It says the same kind of thing often happens when something familiar happens that we're used to reacting to in a certain way. For instance, if someone starts eating a chocolate bar or lights up a cigarette, the desire to do the same will be immediately triggered by the amygdala/security officer, because it recognises that as something that gives us pleasure because it has before. So we can start eating a chocolate bar or light up a cigarette ourselves before the conscious part of the brain, the boss or boss's secretary, have really registered what's happening. We just do it automatically.

An Example of What Happens in the Brain When Someone's Trying to Resist a Craving for Smoking

The book says all this is very important to our understanding of addiction, because it helps us understand what happens then.

It says that when people are trying to give up an addiction to something, the same process happens; but it uses smoking as an example.

It tells us to imagine a man who smokes thirty cigarettes a day, and takes a cigarette out of its packet and lights it several times a day without even thinking about it; it's grown to be so much of a habit that he does it automatically without even thinking, like he'd rub his eyes if he was tired. But he becomes concerned about his coughing which is getting worse, and decides to give up smoking. He's full of optimism and determination about it. Today's the day he's decided to give up smoking.

He usually has his first cigarette with his cup of coffee in the morning. When he picks up his cup, the security officer in his brain realises something's different, because it compares what's going on with previous days and on all those, he's taken a cigarette with his coffee. But not on this one. So it thinks something's not right and gives the man an urge to smoke to make him remember he hasn't done part of his normal routine yet.

But today in his brain, the boss has said the man's not allowed to have any cigarettes. So he resists the urge and just carries on drinking his coffee.

But because he's not doing something he normally would, and because he'd usually light a cigarette as soon as an urge came on without even thinking about it but he isn't today, he then experiences a withdrawal symptom. At this point, it's only very mild, maybe a slight nagging feeling or a slight sensation in the mouth or stomach like a mild hunger pang. So the man resists giving in to it.

But by the time he gets to work, he'd normally have had at least three cigarettes. So a part of the brain near the amygdala, the hypothalamus, which is like a piece of equipment next to the security officer's desk that checks all systems are running smoothly, since it monitors the levels of different substances in our blood, shows that the man's blood nicotine level has fallen below normal. Because nicotine is in the man's blood all the time, the piece of equipment has been programmed to behave as if it's supposed to be there. So it sends out an alert to the security officer that reads, "Top up on nicotine!" That also triggers a mild withdrawal symptom.

The security officer also assumes the nicotine's supposed to be in the blood, so he questions whether the boss could have got it wrong when he said there were to be no more cigarettes. So he decides he'd better try to persuade the boss's secretary to try to change the boss's mind. He sends a message to the boss's secretary marked with the highest level of priority, that is, the highest amount of dopamine he has available to him, saying, "Please let us have another cigarette. We need one!!!"

All this happens extremely quickly.

The book says that the boss's secretary gets a lot of post, communication from various areas of the brain, but the more dopamine a message is tagged with, the nearer the top of the pile she'll put it and so the sooner it'll get attention. Dopamine creates motivation and desire; it spurs people to action.

But even so, on receiving the message, the boss's secretary thinks she needs to investigate it further to find out how accurate it is, just as she'd do with the cup of coffee that doesn't smell right. So she wants more information to help her make a decision. So she sends a message to the memory storehouse to find out what smoking cigarettes has done for the man in the past. She gets sent back a file from the storehouse full of memory clips of past experiences of smoking. At this point, images flash through the man's mind about how much he's always enjoyed smoking, how painful it's always been when he's tried to cut down or give up, and how smoking seems to be linked to all the important events in his life.

The book says that this kind of thing will happen whatever the addiction is.

It says that when the boss's secretary looks at the file, she's alarmed to discover how important smoking seems to have been, in fact essential, judging by the number of memories there are. So she thinks it's highly important that the man has a cigarette that minute, so she must get the boss's attention immediately. But rather than asking the boss's permission to smoke, she really wants to grant the permission herself, because she likes running things. So she writes a quick letter granting permission and sends it to the boss in an envelope marked for extra special priority, marking the note with a request for him to sign it straightaway. In other words, the chemical message is marked with another load of the chemical dopamine.

So when the boss receives it, it's got so much dopamine attached to it that he just can't resist the request. The man smokes.

The book says it's the same with any addiction at all: addiction to Internet chat rooms, to over-eating, to gambling, to shopping, to bullying or whatever. It says people have mildly uncomfortable sensations when they refuse to indulge the desire, but it's only when our brains start generating fantasies about how pleasurable we think the addictive activity is and how painful or uncomfortable we imagine it's always been to deny it to ourselves that we start feeling miserable.

But the book says that when we know that, we can work out what to do about it and find a way of escaping from the temptation.

It says that expectation of good things is what fuels the desire for what we're addicted to, whether we get good things in reality or the addiction ends up disappointing us. But we can use our power of expectation to get ourselves into the habit of expecting something bad if we carry on with our addictions. So bearing in mind how powerfully our power of expectation makes us want what we're addicted to now, we can train it to work for us instead of against us, working against the addiction, convincing us it's a bad thing before all those fantasies make us think it's good and something we really want. The book says it's going to explain how now.

Part Seven
How Addiction Fools Us

Wine is a treacherous friend who you must always be on guard for.
--Christian Nevell Bovee

One reason I don't drink is that I want to know when I am having a good time.
--Lady Nancy Astor

One drink is too many for me and a thousand not enough.
--Brendan F. Behan

I drink to forget I drink.
--Joe E. Lewis

The book says if we can stop in its tracks what happens when we start to crave something, before it gets to the stage where we're feeling a lot of emotion attached to it, then our withdrawal symptoms won't be nearly so bad.

It says that under normal circumstances, if we're getting all our emotional needs met, the system works very well, with the dopamine making us want to do new things or the same things in new ways, and then another chemical giving us pleasure sensations that reward us when we do. Normally if we keep doing the same thing in the same way, we don't get so many reward sensations, so we want to do more new things.

But it says that when our emotional needs aren't being met in healthy ways, so we've got fewer ways of using our talents, and not so many healthy ways of enjoying ourselves and getting support for our needs, we keep trying to get satisfaction from the same old thing, like cigarettes. But we stop getting pleasure from it after a while, so eventually, we only do it to avoid the withdrawal symptoms we'll get if we don't.

But it says that we always assume we're going to get pleasure out of it, so when we don't the first time, like after the first drink if it's an addiction to drink we've got, we'll want another one, because we'll still be getting a dopamine rush which will be making us think that we will get the reward sensations if we just do what we're doing some more. So we'll have another drink or whatever it is, and when that doesn't satisfy us, the dopamine will be giving us an urge to have another one, as if our brain thinks we will get a reward next time, and it carries on like that, with us not getting the reward, until we feel sick or tired or something, so we have to stop.

But the book says that the memories that will come to mind when we get a craving for what we're addicted to won't normally be the ones where we felt sick or were disappointed at not getting the pleasure sensations we were expecting, because the memories we'll usually get first will be the ones with the most dopamine attached to them, the ones that spur us on to desire the craving more.

But it says that those memories might be distorted or even false. For instance, someone might have a memory of how she'd had a lovely time at a party after she'd been drinking a few weeks before, talking in a lively way to people and demonstrating her talents, thinking all the people who weren't drinking were boring and too timid to have a laugh and looked fed up all night. But that memory might be deceiving her, because it was what she imagined was happening when she was drunk, whereas what was really happening was that she was talking utter nonsense, singing to people in a voice that was horribly out of tune, and all the people who weren't drinking were getting fed up with her because she was disturbing the interesting conversations they were having with the nonsense she was making them listen to.

The book says that even without dopamine, memories naturally get distorted over time, with us often forgetting unpleasant details and thinking good ones were even better than they were. So that gives us even more of a distorted impression of what our addictive behaviour does for us.

The book says that addictions are really just a temporary way that we can forget that our emotional needs aren't being met properly. But if we're all focused on trying to forget they aren't being met, we won't be focused on trying to do something about it, which is what we should really be devoting our energies to.

It says that when we recognise all the bad things addiction's really doing to us rather than allowing ourselves to be deceived by the distorted memories of good times, then any will power we need to break free of our addiction won't be something we have to muster up in a great battle, but it will come easily.

Wow, this is interesting stuff. I'm going to have to tell the group about this! I don't think I'll remember it all though. I don't think I could make a big speech about it. Maybe I'll just tell them about the bits I remember and recommend they buy the book! And I'll tell them more about it when I've read some more next week and the week after that and so on.

Other Things We Can Forget About Our Addiction When We Get the Craving For It

The book says that addiction deceives us into believing it's a good thing, but there are bad things about all addictions that don't normally tend to come into our minds when we get the craving for what we're addicted to:

We think it makes us feel good, but when we really think about it, we can realise that the good feeling is only short-lived, if it's there at all. Then the addiction makes us feel bad, because we'll be worrying about how much money we're spending on it, what it's doing to our health and family relationships and our career and social life, and how badly it's affecting our self-esteem. It says no one likes to feel they're in the grip of something they can't be in control of.

Thinking about how that's what addiction's doing to us will make us feel bad, so it will counteract the good memories that make us want what we're addicted to.

We think it helps us deal with stress. But in the end, it causes us far more stress than it relieves. And we can be fooled into believing it's calming our stress when all it's doing is relieving a withdrawal symptom we're having because we haven't taken it or done it for a while.

For instance, it says that smokers think smoking makes them less stressed, but actually, smoking makes the blood pressure go up, not down, and if smoking really did make people less stressed, then smokers as a group would be less stressed than other people, and this has been proved not to be the case. Smoking might fool them into believing it's calming them down, again because they feel temporarily better because any withdrawal symptoms they're having go away when they have another cigarette. But if they give up smoking, they'll get to the point where they're not having withdrawal symptoms any more, and so the discomfort from them will go away permanently.

Sharon might be interested in that.

It says that addiction can be a way to relieve distressing feelings like anxiety, depression and anger. But those feelings will be caused by our emotional needs not being met, and it's far more rewarding to sort our lives out so our needs are being met than it is to get involved in an addictive activity to mask them and end up with two problems, our unmet emotional needs and our addiction.

The book says we can also think we just can't enjoy social occasions unless we have a drink, or smoke, or use drugs, or whatever. But it says that when we think about it, we'll know that isn't true. Young children don't need substances to enjoy parties. People who aren't taking those substances don't have less interesting conversations than people who do, and they're not less likely to dance or join in games. We would have enjoyed the occasion anyway even without the substance, since there are several things that can cause us to enjoy social occasions, like when we find someone we find interesting to talk to. And we might have been enjoying it even more if we weren't doing what we're addicted to, because we wouldn't have the guilt afterwards and any unpleasant physical after-effects.

The Woman Who Was Pleasantly Surprised the Day She Went Out and Didn't Drink The book says there was a woman who came for therapy with one of the authors for a drink problem, and she told him how once, she'd been invited to a party in the evening, and a barbecue in the afternoon on the same day. Even though she usually drank a lot on social occasions and knew she tended to drink too much, she decided not to drink at the barbecue, because even she was appalled at the idea of turning up at the party already drunk. So she drank orange juice all afternoon. She said she found she really enjoyed the afternoon. She met several new people, a couple of whom she got on really well with. She really enjoyed the food, which was a nice change from normal, since once she'd got the craving for drink, she didn't usually bother with food, which of course made the alcohol's effect on her worse. She enjoyed herself so much that she stayed into the evening and was reluctant to leave and go to the other party. Because she was surprised and encouraged that she'd enjoyed herself so much without alcohol, when she did go to the other party, she decided to only have a couple of drinks instead of her usual six or eight. Later, when she was trying to come off the drink, she made a point of remembering that day, to help and encourage her.

The Idea of Staying Addicted to Keep Friends

I'm going to tell Jane about that story. She said she feels as if she just won't enjoy going out if she doesn't take drugs. But she might. It might be worth her experimenting with not taking any to see if she does enjoy herself. I think she's worried that she won't feel confident going out with her friends without drugs. Maybe what she needs is to learn a few confidence-building skills. I wonder if they teach us those at the group. I think part of the reason she takes drugs is that her friends do, and she's worried they'll disapprove if she doesn't. Maybe if she was more confident, she could stand up to them a bit and wouldn't care so much if they disapproved. It'll be nice if we learn a few assertiveness skills in the group. Maybe that's what she needs. I could do with those myself for when I go and speak to the management people at the hospital about how things need to change on the wards if I'm going to be willing to carry on working there and if the patients are going to be made more comfortable.

But a couple of the others were saying they're worried about losing their friends if they stop doing what they're addicted to. But it was interesting what Mike said about how he used to be an alcoholic and would go to the pub every day as soon as it opened, and he'd be at the bar all evening talking to people, thinking they were his friends. But then he went into hospital for several weeks to be treated for alcoholism and depression, and none of the people he'd thought of as his friends visited him. So he thought they couldn't have been his friends really after all.

Yes. If Jane told her friends she wanted to give up the drugs because she was concerned about what they were doing to her health and they made fun of her or didn't like her any more because of it, what kind of friends are they anyway? Maybe she can find some better friends somewhere else. After all, there might be lots of interesting things to do in the neighbourhood that we've just never investigated because we're in the habit of doing the same old thing all the time. Perhaps we could see what's going on in this area, and then go out together to local events sometimes.

The book says it's not saying that anyone who likes a drink or two at a social occasion to relax them shouldn't drink at all, or that anyone who has a problem with over-eating shouldn't enjoy the food there, or anything like that. It's saying that the amount we have ought to be within our control. We should be able to be the masters of what we do, rather than letting addiction govern our behaviour.

Other Inaccurate Beliefs We Can Have About Addiction, and More of the Ways It Can Fool Us

Smoking Helps People Concentrate?

The book says that something else smokers often think is that smoking helps them concentrate and become less tense. But it says research has found that smoking often actually makes people less able to concentrate; and as for tension, it doesn't relieve it, but simply stops people thinking about it when it isn't too bad, and pacing the floor or playing with worry beads can do exactly the same thing.

Liking the Taste of What We're Addicted To?

It says that some people say they like the taste of the substance they're addicted to; but actually, alcohol and cigarettes are an acquired taste. It says most people don't like them when they first try them. They only get to like the taste because they associate it with the pleasure they've been led to believe by other people and by their first experiences of it that they'll get from it. But since it stops giving pleasure after a while, those expectations become false.

The Feeling of Control Drugs Can Give

The book says that some people say they take drugs because when they feel stressed or out of control, it makes them feel in control again. But it says that the feeling will only be an illusion. It says that really, drugs take away people's control over their lives, since people end up having to shape their lives around the drug. It can control their lives so much that they end up having to worry about and find ways to be secretive about it all the time, to finance the habit, and to physically make the effort to get hold of and use the drug, and they can end up feeling guilty about taking it and everything they have to do to get hold of it.

Addiction Makes People Want More

The book says that some people keep kidding themselves that they'll only have one of what they're addicted to and there isn't any harm in that; but addiction makes people want more and more, so people tend not to stop at one.

Deserving Pleasure

It says that some people think they deserve a bit of pleasure after what they've been through. But addiction isn't pleasure. One or two drinks, an occasional chocolate bar or an hour or two a week at the gym might be pleasure, but when people over-indulge in things compulsively, they stop being pleasurable. For instance, some people binge eat, but say they don't taste what they're eating.

Not Caring About Health Consequences

It says that some people justify their addiction by saying that they don't care if it affects their long-term health, since it's the quality of life that counts for them. But when they realise how much addiction is damaging their quality of life, they want to stop their addiction and get the quality of life back that it's taking away.

It says that some people say they don't care about what their addiction might be doing to their health, since after all, they could be hit by a bus tomorrow. The book asks why we bother doing anything worthwhile if that's the case. It says that actually, the odds that we'll be hit by a bus tomorrow are very small, while the odds of having health damaged by addiction sooner rather than later are high.

Setting a Date for Giving Up the Addiction

It says one way addiction stops us giving it up is by fooling us into setting a date for giving up, perhaps tomorrow, perhaps next week, at the beginning of next year or whatever. But it says that what tends to happen is that in the meantime, we indulge in as much of our addiction as we can, since we think we've only got a limited amount of time left to do it, and we think it can't do much harm since we're giving up soon, and so our habit's got worse by the time we try to give up, and so our brain thinks we need what we're addicted to even more, so it's even harder to give up, so we're more likely to fail, and then we're just left with an addiction that's worse than it was before.

Thinking About Living Without the Addiction

The book says that some people think they just can't live without their addiction. But it says that anyone following the steps it teaches will be able to do that easily. And it says that even if someone wanted to come off it the hard way for some bizarre reason and experience withdrawal symptoms at the most agonising they can be, they'd still survive.

It says we should remember that addiction never delivers what it promises. So often, it leads us to think we're about to get pleasure from something, but then it disappoints.

Part Eight
The Way to Cure Addiction

  Take your life back from the tobacco companies. They don't own you anymore.
--Duane Alan Hahn

  We make a ladder for ourselves out of our vices when we trample them.
--St. Augustine

The book says that just deciding to stop an addictive behaviour won't work, since our emotions can be so strong that they can easily overwhelm a decision we make when a craving comes upon us. But opposite emotions can help us much more, because they can be just as strong, or stronger. We can help ourselves if instead of associating the wish to do an addictive behaviour with the promise of something good, we can come to associate it with guilt, fear of what it might be doing to us, and disgust and shame at what it's already done and what a bad habit it is. But not only that, we can at the same time come to associate thoughts of being free of the addiction with emotions of happiness, hope and confidence that we'll soon have got rid of it.

Once we really come to think of our addiction as disgusting, all those old memories that were fooling us by making us think we were getting more out of the addiction than we really were will have to be updated in the brain to include the bad things, and we'll start thinking of the addiction as something harmful instead, so the cravings will lose their power.

So the book says we should program into our memories thoughts of how revolting and harmful our addictions really are, by often bringing to mind thoughts of the bad things they're doing in our lives. Also, we have to often think thoughts about how much better things will be when we're not addicted any more, like the things we can do with our money and time that we can't do now because our addiction takes up so much of it; how much more healthy we'll become; what we'll be able to do better than we can now, and so on.

It says that when the bad memories of our addiction become more of an influence on us than the good ones, our cravings will never reach the point where we can't resist them again. And soon, we'll stop even wanting to do the addictive activity, because we won't be expecting it to fulfil our needs any more, and our brains will stop thinking we're supposed to be doing it. So our withdrawal symptoms, which could have been agonising if we thought we were withdrawing from something that was going to give us a lot of pleasure, will only be mild.

The Experiment Before the Wedding

The book says he tried the same thing out on other social occasions, and the same thing happened, and he thoroughly enjoyed being there.

The book says that the more unpleasant feelings we have at the idea of carrying on the addiction, the easier it will be to stop. So if we have bad feelings about the addiction now, there's no time like the present, because it'll be easiest to get the feelings to override the lies the addiction's telling us about how good it makes us feel.

Part Nine
What Has to Happen For Us to Be Able to Break Free From Addiction

  Children have never been very good at listening to their elders, but they have never failed to imitate them.
--James Baldwin

  When a behavior is perceived to be the norm, kids are more likely to think it's OK.
--Peter Mulhall

  For the first time, our investigation shows tobacco is not the only smoked substance that sets in motion the molecular events which can lead to lung cancer.
--Dr. Sanford Barsky

Wine is a turncoat; first a friend and then an enemy.
--Henry Fielding

I'm not so think as you drunk I am.
--John Squire

The book says that all successful strategies people use to beat addiction have three components:

1. We need to get into the habit of remembering that the expectations of good things addiction hooks us in with aren't real;
2. we ought to make efforts to sort out what's wrong in our lives and improve our lifestyles so we're getting our emotional needs met more successfully;
3. We need to work out when we'll be especially at risk from temptation and plan a range of strategies we can use to help us cope.

The Emotional Needs Everyone Needs to Have Fulfilled

The book says that everyone has several emotional needs that have to be met if we're going to feel a sense of well-being that'll make addiction less appealing to us.

Actually, I think it's said this before. Oh, but I think it's going to talk more about them now.

It says they include:

• Security: We need to be able to feel safe, so as to live our lives without unnecessary fear; and we need to have a place where we can enjoy privacy;
• Volition: We need to feel in control of what's happening in our lives, and to feel we have the power to make decisions for ourselves;
• Attention: Both giving and receiving it;
• Emotional connection to others: That can include fun, friendship, love and intimacy;
• Connection to the wider community: That means feeling a sense of belonging in something bigger than ourselves;
• Status: We need to feel valued and accepted in our home or community, or in another group we belong to;
• A sense of competence and achievement: That'll make sure we don't suffer from low self-esteem;
• Meaning and purpose in life: That comes from activities we find stimulating and challenging.

It says nature has given us resources we can use to meet those needs, such as the ability to think things out and make new plans, the ability to use our imagination to dream up a more positive future we can then plan to try to make a reality; the ability to befriend other people, and the ability to learn new things.

It says that whenever one of our emotional needs is seriously unmet, or whenever we're misusing one of the resources we have that were intended to help us meet those needs, like misusing our imagination to think up all kinds of worrying things about what could happen to us, even though they probably won't, whether we know we're misusing our resources or not, we'll get signals in the brain telling us we need to change something, in the form of mental distress like anxiety, depression or anger. That'll be the brain telling us we need to change something in our lives.

It says the less well our needs are being met, the more likely we are to start doing things that might at first mask our distress, but which later become addictive.

It says that sometimes, addiction can be a way of relieving feelings of distress at being bullied or worrying about the future or something, but at other times it can be a way of seeking a buzz to give us feelings we'd be getting naturally if we had fulfilling lives where we were getting absorbed in things we enjoyed and being challenged to achieve things that made us feel good once we had. But once we know what's motivating us to indulge in our addiction, we'll hopefully be able to think of other ways to fulfil those needs.

Part Ten
Thinking Through What Addiction Really Does For Us, or Does to Harm Us

Having a smoking parent increases a child's chance of getting an ear infection by 50 percent. The particles in tobacco can cause chronic congestion, which makes it harder for the Eustachian tube to drain fluid from the middle ear and sets the infant up for an ear infection. Some parents don't smoke in the same room as the baby, or smoke outside, but this doesn't help because the baby can still breathe in smoke from your hair and clothes. It's difficult to quit, but use your infant's health as the motivation.
--Anne Beal, MD

On CBS Radio the news of [Ed Murrow's] death, reportedly from lung cancer, was followed by a cigarette commercial.
--Alexander Kendrick

The book says that one way we can work out what needs aren't being met healthily in our lives is to think about what our addiction does for us, and then we can think about how to have that need met some other way.

It says that after that, we can think of all the down sides of addiction, and then weigh up whether it's worth carrying on with it.

It suggests that at some point when we're feeling calm, we sit down with a pen and paper and think a few things through. It asks some questions to help us:

What We Think Addiction Does For Us

The first question it asks us to think about is what addiction does for us. It says we can help ourselves answer that if we think of answers to questions like:

• why we started in the first place;
• why we're doing more of it than we used to, if we are;
• what it is about our addiction we enjoy;
• whether we enjoy it less now than we used to;
• what particular occasions make us want to do it more;
• what goes through our minds when we're feeling like doing it;
• and what we think it gives us, such as confidence or relief from anxiety or boredom.

Our Concerns About Our Addiction

It suggests we then think of all the bad things about our addiction, so we're less likely to let it trick us in the future into believing it's a good thing.

Concerns About What Addiction's Doing to Our Health

So it asks us whether we have any concerns about our addiction. To help us think of them, it says we can consider questions like what effect it's having on our physical health, not only how much it puts us at risk of disease, but also on our sleep, on whether we want to eat, and on whether we want to exercise properly.

What Addiction's Doing to Our Relationships

Then it says we can ask ourselves what it's doing to our relationships with family and friends: whether it's making us argue with people more; whether it's making us uncomfortable because we have to lie and hide our behaviour; whether we spend less time with them than we'd like to because of it; or embarrassing or irresponsible things we've said or done while under the influence of it.

Any Emotional Problems the Addiction Gives Us

Then it suggests we ask ourselves whether we get any emotional problems because of our addiction, like if we get edgy or depressed when we haven't done what we're addicted to for a while; whether being addicted has made us more anxious or stressed, or whether we feel guilty or unhappy about what it's done to our relationships.

The Effects of the Addiction On Our Work

Then it asks whether it's affecting our work, such as damaging our ability to perform at our best, robbing us of ambition or motivation to achieve greater things, or making us lose interest in what we have to do.

The Effects of the Addiction On Our Social Life

It asks us if the addiction damages our social life, maybe because we don't go to places where we won't be able to do what we're addicted to, and no longer see so much of friends who don't share our addictions, or whether we've stopped doing things we used to enjoy because we're so busy with our addictions, or whatever.

The Effects of the Addiction On Our Finances

It asks whether our addiction's affecting our finances, such as reducing the amount of time we can spend earning money, or whether we have to spend so much on our addiction that we can't spend money on other things we'd like, or on things we and people we're responsible for need; or it asks whether we're in debt because of it.

Any Illegal Acts Committed Because of Our Addiction

It then asks us to consider whether we've ever done anything illegal because of our addiction, like stealing to fund it, or whether it's made us more prone to commit violence, like alcohol can. It says that criminal acts can become addictive in themselves.

Well, I've never done anything wilfully illegal, but I need to get off the drink quickly, because I know I haven't treated people in the hospital with as much care as I should have. It upsets me to think about that.

The Effects of Addiction On Our Self-Esteem

The book asks us to consider whether our addiction's having any effect on our self-esteem, that is, whether it makes us feel better or worse about ourselves, whether it affects our ability to do things that'll make us feel good about ourselves like doing things that display our talents and abilities, and whether it affects the amount of control we have over our lives.

Well, my addiction's certainly started affecting my self-esteem. It's not very nice to know I'm neglecting the patients I used to care about and that I've been told by my own sister that she doesn't think I'm safe around her children!

The Concerns Others Might Have About Our Addiction

Then it asks what concerns other people might have about our addiction! It recommends that we take a moment to list who those people are and what their concerns are, for instance if they're concerned about our health, our relationship with them, the amount of time we spend on our addiction, changes in our behaviour and attitude, whether we're as efficient at our jobs, what it's doing to our finances, and other things.

The Effects of Our Addiction On Our Hopes for the Future

Then it asks us to consider how our addiction's affecting our hopes for the future. For instance, whether it's affecting our chances of being promoted at work, or achieving success at something we once set our hearts on, whether it's affecting our chances of being able to study for a new career if we're unhappy with the one we've got, or whether it's affecting our ability to form meaningful new relationships with people, or buy things we really want, or improve things around the home, or give any children we have good chances in life, or see more of grandchildren. It asks whether perhaps it's stopping us doing something we'd love to do like going on a dream holiday, or whether we'd like to get involved in community activities of any kind but it's stopping us.

It asks what we'd like to do with our future if we aren't addicted any more.

It asks whether, if our addiction isn't getting in the way of anything we want to do now, we can foresee that it might in the future.

It asks us what we'd like to change so we can achieve all the things we'd like to achieve in the future.

It asks how we might feel physically if we stopped or cut down on what we're addicted to, and how we'd feel about ourselves if we stopped or cut down.

Deciding Whether The Addiction's Worth it

The book says that if the concerns we have about our addiction are outweighing the amount of things we think it does for us, then we can be even more certain that it's a good idea to give it up.

Also, we can look at the things we think it does for us again to see if it really does do those things, or whether we've been fooled by it into thinking it does when it doesn't really.

For instance, the book asks whether we think our addiction makes us more confident in social situations; and if we think it does, it asks whether we can be sure of that, or whether it isn't in fact true that we've proved we can be confident without it, because we're sometimes with groups of people where we can't indulge our addiction, and yet still we can be confident.

I think I'll say that to Jane, because she feels as if she has to take drugs to be confident, and yet she seems perfectly confident in the group, even though she hasn't taken any.

The book recommends we ask questions about all the things we wrote about what our addiction does for us, asking ourselves whether what we think it does is really true, or whether we've proved sometimes that it isn't.

But it says that if we find ourselves defending our addiction and what it does for us, we shouldn't try to argue with ourselves, since the more we try to defend the addiction, the more we'll crave it, because the more attractive it'll seem. So it advises us to stop thinking along those lines if that starts happening.

But it says that if we recognise how much the negative things about the addiction outweigh the positives, and feel emotionally that we want to give it up as well as wanting to with our minds, then we're "halfway to success".

Setting Our Minds to Solving Our Problems

It says that the greater the expectation we have that life will be better without the addiction, the easier we'll find it to give it up. So the more things we think we'll be able to achieve when we're no longer addicted, the easier it'll be to stop.

But also, if we can sort out the problems in our lives that made us get addicted in the first place or make us continue to rely on what we're addicted to, we won't find addiction attractive any more.

It says that although people can often be introduced to what they go on to become addicted to on a fun occasion, it's when we're under stress or pressure that we increase our indulgence in it and it becomes addictive.

So the book asks us to think about what isn't going right in our lives at the moment, so we can think through ways of solving our problems so we stop feeling the need to try to escape them with our addiction.

So it recommends that we take some time when we're feeling calm and we probably won't be disturbed, to think through what we can do about the problems in our lives.

It suggests we do this by thinking through all the needs the book says we have to have met to be emotionally healthy, and seeing what's missing in our lives.

Well, I know what's missing in mine. But maybe there are some other things as well, and it'll be useful to read this so I can tell other people about it.

Part Eleven
Working Out Which of Our Needs Isn't Being Met and What We Can Do About It

Pharmaceutical companies will soon rule the world if we keep letting them believe we are a happy, functional society so long as all the women are on Prozac, all children on Ritalin, and all men on Viagra.
--Terri Guillemets

The public health authorities never mention the main reason many Americans have for smoking heavily, which is that smoking is a fairly sure, fairly honorable form of suicide.
--Kurt Vonnegut

I'm tired of hearing sin called sickness and alcoholism a disease. It is the only disease I know of that we're spending hundreds of millions of dollars a year to spread.
--Vance Havner

The book asks us to consider and note down answers to several questions, to help us work out which of our emotional needs isn't being met:

Security

First, it asks whether we feel safe. For instance, it asks us whether we feel safe at work or whether there's anyone we don't trust or whether we're being bullied; or whether we're being bullied somewhere other than work. It asks whether there's a relationship we don't feel safe in. It asks whether we feel secure in the family, or whether parents are splitting up.

It asks whether we're using the addiction to try to bury strong emotions caused by a past trauma that keep resurfacing, or perhaps to cope with nightmares and flashbacks.

Or it asks whether we're using the addiction as a substitute for something we don't do any more because we've been put off it by a bad experience. For instance, it says someone who's been raped might avoid intimate relationships after that, but might use an addiction to get a high that they would have got from a close relationship if they'd had one.

Intimacy

It asks whether we have people in our lives who are important to us, and who we're important to.

It asks if there's at least one person we can be ourselves with and share our joys and anxieties with.

It asks whether we feel understood by people close to us.

It asks whether we've withdrawn from people around us because of our addiction, and whether we've lost touch with friends or stopped seeing them.

It asks if we've lost someone close to us recently, for instance through a death or relationship break-up, and whether we're still mourning the loss.

Well, I'm still upset about breaking up with my boyfriend.

Connection to the Community and Other Things

It asks whether we know anyone beyond close family and friends. It asks, for instance, whether we help other people, such as elderly neighbours, or whether we're involved in any kind of voluntary work. It asks if we do any kind of community activities, or leisure pursuits like being in a drama group or aerobics class.

It asks whether our work brings us into contact with other people.

Well, mine does, unfortunately ... for them. I wish it didn't sometimes. Well, it isn't the people who are the problem. But I think this book might mean do we meet people at work who we can enjoy passing the time of day with and who help us take our minds off our troubles. Well, sometimes the staff I work with can, but then, they've got the same troubles as me, when it comes to not being able to do our work as well as we'd like. But then, some people don't seem to care so much about the people we're supposed to be looking after. Actually, I'm beginning to get that way, but I don't like it.

Anyway, it asks whether we've stopped participating in activities that gave us a decent social life before, because of changed circumstances like unemployment, a newborn baby, a disability or chronic illness or something.

It asks whether we've withdrawn from activities that gave us pleasure more and more because of our addiction.

Well, I don't go out with friends any more because I don't want them to see how much I drink. But I know that makes me feel isolated and that makes me want to drink more. So maybe as I get rid of this addiction, it would help if I started seeing more of them.

Status

The book asks if we're comfortable with the status we have, for instance, whether we feel good about the way we think of ourselves and the way we think other people think of us.

It asks if we feel suitably rewarded or appreciated for what we do.

Well, I think I do so badly that I don't think I deserve reward or appreciation. Maybe if I changed my job, I'd be able to do something better suited to me where I could do better.

It asks whether other people recognise our achievements.

Well, I don't think I've done anything to shout about recently, although I don't think not achieving what I'd like to is all my fault. I can only do the best with what I've got. If they haven't trained us to be able to help people more, I can't do what I'd like to do if I'm expected to do something but haven't been trained in the skills to do it. I'm sure there are things that could be done to make people more comfortable and less unhappy, but we just don't have enough skills or time.

Anyway, I think my thoughts are going off the point.

It asks whether we feel as if we should have achieved more, or whether we think others have done better than us.

Probably. I'm beginning to think how nice it would be to be in a job where I could use my brain power to think up interesting new ideas, and where I could be with other people who were doing that kind of thing, so it was more exciting and positive, rather than being in a job that just drags me down all the time because I can't sort people's problems out.

It asks whether we feel we fit in, or whether we feel inferior to others or hostile towards them.

It asks whether we're jealous of others or whether we long for something we haven't got.

Competence and Achievement

It asks whether we have a sense of competence and achievement. For instance, it asks whether we're doing what we want to with our lives. It asks whether we feel competent using the skills we've learned.

Well, I certainly feel incompetent! But I think it's because I don't know enough and aren't allowed to do enough to help people as much as I'd like. And now I've started doing even what I can do badly because of the drink! I don't think I do a very good job at all!

The book says that people who don't feel competent will have low self-esteem.

Well, that certainly describes me!

It asks if we feel satisfied with the way we spend our time, and find things pleasantly mentally stimulating, and enjoy the challenges we face, or whether we think we've taken on more than we can handle and think the quality of what we do has deteriorated.

Well, that definitely applies to me. I don't feel competent to handle my work, and I know my standards are getting worse.

It asks if we feel unsatisfied because we're bored or feel unchallenged, maybe because there's nothing further that will give us a sense of achievement at work, or we don't know what to do with our lives and feel stuck in a rut because children have left home.

It asks if we resort to our addictive activity if we can't see a way out of a problem, or if we feel frustrated.

Perhaps I do.

It asks if our addiction is the only thing we get satisfaction from.

Control Over Our Lives

It asks if we have enough responsibility at work, or too little or too much.

Too much, definitely! Or really, I think it's that people expect me to do more than I can, and then they're disappointed or feel bad when I can't. And that makes me feel like a failure, because I don't know what to do. Family members of people on the wards sometimes ask me if the dose of painkiller their loved ones are on can be increased, and I feel awful knowing I have to say no, but I don't know what else can be done to relieve their pain. And then the old people themselves sometimes beg for more pain relief and I don't know what to do, or they say they're lonely and need someone to talk to and I haven't got time to talk to them, and that kind of thing. I feel as if I'm doing the equivalent of giving people aspirins for broken legs when they're expecting me to make them better or at least a lot more comfortable sometimes.

Actually, I've heard of palliative care teams, that go into some hospitals and support people who've got life-threatening illnesses, trying to make them as comfortable as they can and helping them relieve their pain, and giving them emotional support. I've heard they support the family emotionally as well, even after the patient's died. And while the patient's alive, they try to help them live as fulfilling a life as possible given their illness. We could do with one of those palliative care teams in our hospital! Working there would be so much less stressful if we had one. I'd feel so much happier knowing the patients were being cared for more. I think I'll write a letter to the management or something explaining how much we need one and asking if we can have one. I'll see what they say.

The book asks if we have the power to take important decisions in many important areas of our lives, and whether someone we know has too much power or influence over us.

Well, I'm fed up at not knowing what to decide for the best a lot of the time. And the system's run by people who expect me to do my job well despite all the things I think are wrong with it. So I think that describes me.

It asks if we recently lost our sense of control over our lives, perhaps because of unexpected illness, or because of the arrival of a new person at work or a new baby at home, or difficult in-laws.

It asks us whether we think we ought to be able to control things that realistically, we can't control, like the amount our children study; and it asks whether we feel a failure when they don't study hard.

It asks whether we feel our addiction's controlling us.

Attention

The book says we all need attention, but we need the right kind and amount. It asks if we spend too much time alone, or whether the opposite happens and people are making too many demands on our time, wanting to see us more often than we want to see them, sapping our energy in the process.

Or it asks if we're shy and so we stay in the background at social occasions so we don't enjoy ourselves meeting other people.

Or it asks if we feel we can't really be ourselves and get all the attention we'd like because we're being overshadowed by someone we spend time with who grabs all the attention in public.

It asks whether one thing we get from our addiction is the attention from other people with similar addictions we get when we're doing our addictive activity with them, and whether we get most of our attention from people we're with when we're doing our addictive activity and that's the main reason we do it.

Well, I don't. I drink when I'm on my own. But Graham at the group was saying he was worried about giving up the drink for a while because he thought it would mean giving up all his friends, since they all like to meet up where they can drink, and if he couldn't drink, he wouldn't want to put himself in temptation's way by being there. But at least he's getting some new ideas about what he can do when he stops drinking now, so he'll make new friends, and some of the old ones might be interested in doing the new things with him.

The book asks us how much sincere attention we give others, and whether we get attention by having people close to us worrying about our addiction.

Meaning and Purpose in Life

The book asks whether we have a sense of meaning and purpose in life. For instance, we might be getting it from being needed by people. It asks whether if we are needed, whether we're meeting the need.

Well, I'm doing worse and worse at meeting the needs of my patients!

It asks whether we're involved in any activities that interest us and that we find challenging in a nice way. It says that might be particularly important for people who've retired and have a lot of time on their hands.

Well, I don't do anything like that with my free time. I feel too exhausted. All I want to do is just relax, and drink to stop being so upset about things. But if I get a job I'm happier with, it might be worth thinking about things it might be fun to do.

The book asks if we have a commitment to something bigger than ourselves, like involvement with a cause we care about, or a school we want to help, or some kind of community work or political campaigning.

It asks if our addiction is draining away our sense that life is meaningful and making us focus on ourselves all the time so we're not getting a sense of purpose in life from being involved with the outside world.

The Importance of Meeting Needs

It says that if even one of those needs is seriously unmet, it can be enough to attract us into an addiction. So it's worth us thinking about what we can do to get them met more.

But it says we may discover that lots of parts of our lives are actually working well, or could be with a bit of thought, but we haven't paid attention to them because we're so preoccupied with our addiction. It says that the more we focus outwards on to other people rather than on ourselves, and the more we engage in activities where we serve and help other people, the better we'll feel about ourselves, the more value we'll think we have, and the more free of our addiction we'll feel.

Well, that's presuming we try to help others in a way we can manage, and aren't made to take on responsibilities we haven't been trained to deal with, like me!

Oh dear! I'd better not pour out my troubles to the group! They'll all feel as bad as me by the end of it! And we're supposed to be encouraging each other and looking forward to a brighter future!

The book says that people with addictions will often think they're worthless, perhaps because of horrible things people said to them when they were young, like that they weren't any good. And we might over-react to one thing going wrong in our lives and think we must be failures because of it. But if we find something we can do well, we can change our image of ourselves.

Or it says we can slip into an addiction in response to one setback in our lives that would have only been temporary, but our addictive behaviour goes on to damage our lives even more and damage our self-esteem. But our self-worth can come back if we start doing activities that make us feel we're achieving something worthwhile.

Part Twelve
Planning Whether to Cut Down Our Addiction or Stop Altogether

I asked a coughing friend of mine why he doesn't stop smoking. 'In this town it wouldn't do any good,' he explained. 'I happen to be a chain breather.'
--Robert Sylvester, (1907-75) US writer

The book says that if we've worked out what needs we have that aren't being met, we can work towards getting them met, by planning what to do.

It says there are two things we should plan to do with giving up the addiction: One is whether to cut down the amount we do of what we're addicted to and if so how much, or whether to give it up altogether; and the other one is what to do instead.

The Amount of Time Addiction Wastes

It says addiction takes up a lot of time, so when we decide what to fill the time with instead, we'll have to think about more time than just the time spent doing the addictive activity.

For instance, it says that alcoholics won't just be devoting the time we spend drinking to the addiction, but also the time we spend getting to and back from the place where we drink, and recovering afterwards. Drug addicts need to spend time thinking through how to get the money for their habit and then getting it somehow. Even addiction to smoking, which we think of as something that can be done alongside anything else, takes up lots of time - time spent buying cigarettes, looking for mislaid packets or lighters, walking to a smoking area at work, and so on.

And it says that besides all that, with every addiction, a lot of time is wasted thinking about it. For instance, someone who drinks too heavily might spend time thinking about where they can get the first drink of the day, or looking forward to when they can next have a drinking binge; and if we're prevented from drinking by duties or responsibilities for a while, we might be thinking about how much we want a drink. But then sometimes, we might be spending lots of time wishing we didn't drink so much and resolving to cut down.

Yes, that sounds like me. It'll be nice if my mind can be filled with more interesting and worthwhile things.

It says we can plan how to fill the time with better things that meet our emotional needs.

Choosing Whether to Cut Down Our Addiction or Stop Altogether

It says that some people will obviously have to cut down what they're doing rather than stopping altogether, such as people who over-eat or work too much, and so they'll have to decide how much to cut down by. It says people don't have to cut down all in one go, but they should be aiming to eventually be able to do the activity but not compulsively.

The book reminds us that one thing that'll help us cut down is building up other things that'll help us meet our emotional needs better, so that'll help with any withdrawal symptoms.

Being Specific About How to Go About Cutting Down

It says we should be specific about what we plan to do. For instance, a workaholic wouldn't have something definite to aim for if they just decided to work less, but they would if they planned exactly how much less to work and how to go about working less, for instance deciding to leave two hours earlier than normal every day for the next month, and then work a bit less each day for the next month till they were leaving at the time most people did; and then decrease the amount they work further by coming in to work ten minutes later each day for the next month, till they were coming in at the time most people did as well. And they might decide from the start not to take any work home with them, or to take some home but work for only an hour a day on it to start with, and gradually cut that down to nothing over the next month.

It says that a workaholic couldn't be expected not to be realistic; if they had a deadline to meet, it would only be reasonable that they should work more to meet it; but things like that should be the exception, not the rule.

It gives another example, saying that someone with an addiction to over-eating wouldn't really know how they were going to go about things if they just made up their minds to eat less; but one way they could cut down would be perhaps to resolve first of all not to eat anything after 8 pm, or to eat one bar of chocolate a day instead of several, or to have just one helping of any course at a meal. And then over an amount of time they choose, like a month or two maybe, or something they feel fairly sure they can manage, they can decide to cut down the amount of unhealthy food they eat by a planned amount a day, and at the same time increase by a planned amount the amount of healthy food they eat.

It says that if we're specific about what we want, then we can keep optimistic if we know we're achieving what we set out to achieve, so we'll feel like keeping going.

Being Realistic When We Decide What to Do

The book says that if what we're addicted to is something that it will be possible to stop altogether, then if we just decide to cut down instead, we need to be honest with ourselves about whether we think we can really do that, or whether our decision to only cut down comes from an attachment to the addictive activity that makes us unwilling to give it up because we don't think we can face life without it. If we try to cut down but still think about our addiction and have an urge for it the rest of the time after we've been reminded of it by doing it some of the time, then we won't succeed in quitting.

It says we might be making a rational decision to only indulge in it sometimes, such as only having one cigarette a day, after the evening meal, but a plan to do that will only work if we don't spend the rest of the day thinking about it and looking forward to the time when we can have it.

But it says that some people have managed to successfully cut down doing what they're addicted to instead of stopping, if their emotional needs have been met at the same time. For instance, heavy drinkers have still wanted to spend time with their friends, and have sometimes managed to just have two pints of beer and make them last the whole evening, and go to the pub perhaps one night of the week instead of six. And people who used to drink way too much coffee have stuck to just one a day, first thing in the morning when they enjoy it, cutting out all the rest that they didn't enjoy but they just hoped in vain that it would make them concentrate better or help them with stress.

Stopping an Addictive Activity Altogether

It says that stopping altogether, if it's practical to do that because our addiction isn't something that's an essential and healthy thing to do in moderation, can be an advantage and easier to do, since we won't keep being reminded of it and having our appetite for it awakened again by having or doing it sometimes. The book tells us to remember that if we switch our usual expectation of pleasure at the thought of the addiction to one of pain, then our withdrawal symptoms will only be mild, and soon, they won't even reach consciousness. So we'll be free of the addiction, rather than having the hassle of having to handle it, as we will if we only cut down.

Starting Off Doing One Thing and Then Changing to the Other

The book says that sometimes, people have just wanted to cut down at first, but then they've been so encouraged by their progress that they've lost interest in their addictive activity and decided to give up altogether.

Or some have started by wanting to just cut down, but found that it was difficult, because doing their addictive activity some of the time made them keep thinking of how much they wanted to do it, and they were yearning to do it more often. So they were really battling themselves, instead of resolving to start afresh with the addiction behind them and going on to new and more healthy things.

So it advises us to think carefully about what we plan to do. But it says that if we first try to cut down and then decide to give up altogether, or the other way around, it won't matter. It won't mean we've failed if we start off trying one thing and then have to switch to the other; it'll just be part of the learning process where we're finding out what works best for us.

Part Thirteen
Working Out How to Revamp our Lives to Get Unmet Needs Met

Have a variety of interests. These interests relax the mind and lessen tension on the nervous system. People with many interests live, not only longest, but happiest.
--George Matthew Allen

The book says that as well as deciding whether to cut down or stop our addictive activity altogether, the other thing we need to do is to work out how to improve our lifestyle so we're getting our emotional needs met.

Improving Our Social Life

It says that most people who get addicted to something, with a few exceptions like smoking and coffee-drinking, tend to withdraw more and more from activities they used to enjoy, and from leisure pursuits that involve people who don't share their addiction. It says that even cigarette smokers and people who drink too much coffee might be having more than they did before because they're spending too much time alone.

It says that if we think any of that's true for us, one of the things we ought to do is to think up ways to start meeting people again socially and doing things that don't involve our addiction, for enjoyment.

It says we don't just have to do things we used to do before. We could try something entirely new, or we could do both.

It suggests a number of things we might get enjoyment out of, and asks us to think which ones we could do or we'd like best:

• Phone an old friend we've been wanting to get in touch with for some time and suggest we get together.
• Go out for a walk or a meal with our partner.
  Well, I haven't got a boyfriend anymore; but some people might find doing that nice. I once heard of a couple who started walking together and found they got on a lot better after a while because they spent more time communicating with each other about what was important to them, and exercise can make you feel better anyway.
• Take our children to the park, and join in their games.
  Well, I haven't got any, but I know some people in the group have.
• It suggests that if childcare is a problem, people could arrange a babysitting swap with someone they trust, so they each take turns looking after the other one's children while the other one goes out for the evening.
• It suggests we could invite a friend or two for a meal at our house.
  Well, I'd have to tidy up a lot first and get rid of all those drink bottles! Still, I could do with getting around to doing that anyway.
• It suggests we take up an activity again that we used to enjoy, like perhaps swimming, art classes, dancing, joining a gardening class or a drama group.
  I know my brother was in a couple of drama groups when he was a teenager and really enjoyed himself. I remember when he played that bad-tempered vicar. It was funny! And that time when he played the back end of a pantomime cow with someone else being the front! That was funny too! And it was funny when they went down the high street like that to promote the pantomime! I've never fancied being in a drama group myself, but it could be fun.
  I used to do swimming. It might be nice to do that again. Maybe there's some kind of group I can join. It might be more fun being with other people than going on my own. I'll see though.
  I remember doing folk dancing for a while when I was at school, the kind of dancing where you fling yourself around the room! Well, perhaps it's not quite like that. But that was fun. It might be nice if there was a local group doing that that I could join.
• It says we can walk our dog when a neighbour's walking theirs, or walk with a neighbour who's walking their dog, for exercise and someone to talk to, even if we haven't got a dog ourselves.
  Well, I haven't got a dog, and I don't often see anyone else walking theirs. I think the people round my way walk theirs at midnight, hoping no one will see when their dog messes all down the alleyway. ... No, actually, that was just one man. And he did get found out. ... No, I don't see people walking their dogs, but going out for more walks would probably be good for me.
• It suggests we could invite work colleagues to have a drink or a coffee with us after work, if neither one of those is our addictive activity.
  Well, drinking's mine. I suppose I could invite someone out for a few carrot sticks in the local grocer's. ... No! How about a strawberry ice-cream! Getting better. ... Well, I could probably think of something. I used to enjoy going out sometimes with my friends from work in the evenings, but they like to drink a bit. Still, if I get to feel as if I'm really put off drink, I'd feel allright around them when they did, and I could have soft drinks myself.
• It suggests we could invite someone to see a film or a play with us.
  It might be nice to see what's around. I don't like anything with violence in it though, so that rules most films out, I think. I'm not sure though.
• It suggests we could book a holiday where we'll see new things and meet new people.
  I'm not sure I've got the money for much of a holiday. But I might have a look sometime to see if I can find any good offers. I don't think I'd want to go too far away though.
• It suggests we could join an evening class where we'll be learning something that interests us.
  I think I'm too tired and miserable at the end of the day at the moment. But when I sort my job out or find a better one or whatever, I might. If it was something I could look forward to all day, perhaps it would keep me feeling more cheerful and lively. And I could do with something to occupy my time in the evenings.
• It suggests we decide on a charity we'd like to help and make sure it involves being in direct contact with people, such as serving hot food at a soup kitchen for homeless people, working with disabled children or visiting an old people's home.
  No thanks, I think I've done enough of that kind of thing in my work! Thinking about it though, if I do change my job, I'd still like to work with people, just in a way that doesn't stress me out so much. Actually, thinking about it, I did do some voluntary work a few years ago where I was playing with children, and doing things for fairly healthy old people like reading to them, and that wasn't stressful. So it might be possible to do the things the book suggests without getting stressed.
• It suggests we could go on an activity weekend where we'd meet new people.
  I wonder where we'd find out about those, and what kind of activities they do.

It recommends we start off by doing just one or two things like that, instead of feeling under pressure to do lots all at once. It says they should meet our needs for social and emotional connection with others.

It says we should make sure we're doing things for other people as well as for ourselves, because then we'll feel valued and worthwhile and our self-esteem will go up.

Well, I think it depends on what we're doing for them! Trying to cope with things we haven't been trained to handle will make our self-esteem go down when it makes us feel like failures! But I think I understand what it means. There are probably a lot of things people can do to help other people that can make us feel good.

So there might be lots of projects going on where groups of volunteers can get together and do good things for the community while they're enjoying themselves together at the same time. When I've done something about my job so I feel better, maybe I'll have a go at finding out more.

Being Creative About Meeting Unmet Needs

The Cocaine User who Quickly Stopped

The book tells an interesting story. Well, it tells a few, but I think this one's especially interesting. It says a man came to one of the authors for therapy because he had a problem with growing dependence on drugs. He was in his mid twenties with a wife and young child. He had a well-paid job, but he risked losing it because of his drug habit. He had started off just using cannabis, to "chill out" at home in the evenings, but then had started using cocaine. He was beginning to miss deadlines at work, and occasionally had even missed important meetings. He often had severe arguments with his wife, and he was starting to have blackouts sometimes.

But still, he loved to think of himself as a cocaine user, because he loved the euphoria and confidence cocaine gave him. Every weekend, he went clubbing with colleagues who were single or had broken marriages. He wanted to keep on doing that, but on the other hand, he didn't want to lose his job or his marriage. So he was very agitated when he came for therapy.

So the first thing the author who saw him did was to calm him down with some relaxation techniques.

Then, the author encouraged him to start thinking of himself as separate from his cocaine use, rather than thinking the identity of cocaine user was part of his personality. The author did that by talking about the addiction as if it was something separate from him, like something outside him that was intruding into his life. He talked about how the addiction was affecting him, and how the addiction was lying to him, and so on.

The book says the man soon realised that he was using his addiction to avoid the feeling of frustration at being "tied down" with a young child when he was only young himself. But though he was frustrated, he genuinely loved his wife and young daughter. When he weighed up the costs and benefits of his addiction, he realised that his fear of losing his family was greater than his fear of being a family man.

The author showed him that he didn't need to feel frustrated with his family, so it wasn't a choice between being tied down and going after his addiction. If he worked hard at earning money, he could make enough so they could all do interesting things and go on nice holidays together.

The book says that before the author did that though, he got the man to relax and then encouraged him to bring to mind all the horrible things about the addiction, to put him off it. So he encouraged him to concentrate on actually feeling the shame and disgust of spending his time and money on a mere dream - the illusion that he was carefree and single, instead of spending it on things that really mattered, improving his family's quality of life and improving his career.

After that, the author encouraged him to focus on imagining the good things about giving cocaine up, like the return of his health and the love of his family, self-respect, the respect of others, and the wonderful feeling of achievement he'd get from doing new things and making decisions free from the addiction.

The author showed the man how he could think of his family life in a positive way, and do new and interesting things with them.

The author also told him a story to move him and help him realise what really mattered, about a merchant who sold cloth.

The author says that at the end of the therapy session, the man agreed to think of the horrible things cocaine can do to people whenever he was tempted to go clubbing with his friends, to give him a more realistic perspective on what it was doing to him; and he agreed to plan for interesting places he could go with his family at weekends, as well as planning for the occasional weekend away just with his wife. And he decided to save for a dream holiday with his wife one day.

The author says the man only needed three therapy sessions, mainly just to keep him motivated and to talk through any problems.

Sorting Out Unmet Needs That Are More Difficult to Meet, Bit By Bit

The book says some unmet needs will take more planning before we can meet them.

It recommends that if we're unhappy with our job or a relationship or something, we write down all the possible options we have, and then perhaps discuss them with someone we trust.

Oh yes. I remember someone in the group saying a good way of handling worries is to write down exactly what we're worried about, and then write down all the possible solutions we can think of, even if they don't seem that promising at first; and then we take each solution in turn, and think of all the pros and cons of it. And then we can decide which one has the most going for it and the least against it.

The book says it's important to do things bit by bit rather than rushing to change everything at once, since trying to do too much in one go could become stressful.

It suggests that maybe we could start by researching alternative areas of employment, or looking into what choices we have to sort our relationships out, or starting off gradually with whatever we want to do.

It says that if we often immerse ourselves in our addiction when we get angry or frustrated or have a difficult problem to solve, it might be just as well to look into learning better problem solving skills or anger management or assertiveness techniques.

Difficult Circumstances

The book says that sometimes, people fall into addiction because they're in very difficult circumstances where other people's needs have to be taken into account as well as their own and they don't know what to do for the best, and feel incapable of making a decision.

But it says that sometimes, it's best to just put off making a decision till more facts are known, and things tend to change all the time anyway, so making a decision might cause difficulties now, but when things change, it might be easier. So sometimes it's best just to wait a while.

In the meantime, the book says it's best to try and fill gaps in our lives in healthy ways rather than dealing with problems by indulging in addiction, for instance by keeping busy with worthwhile things to keep from brooding on problems and just getting more miserable, staying active, eating properly, and being with people we care about.

Part Fourteen
Using Relaxation Techniques to Calm Down and Feel Better

If a man insisted always on being serious, and never allowed himself a bit of fun and relaxation, he would go mad or become unstable without knowing it.
--Herodotus, Greek Historian, c. 484 B.C. - c. 425 B.C.

No matter how much pressure you feel at work, if you could find ways to relax for at least five minutes every hour, you'd be more productive.
--Dr. Joyce Brothers

Put duties aside at least an hour before bed and perform soothing, quiet activities that will help you relax.
--Dianne Hales

For fast-acting relief, try slowing down.
--Lily Tomlin

Sometimes the most urgent and vital thing you can possibly do is take a complete rest.
--Ashleigh Brilliant

The book says it's important for people with addictions to do relaxation exercises, or to do other things we know will relax us. It says that when we want our addictive substance or activity but can't have it, we can get too emotional to calmly think through all the reasons why it might not be a good idea to have it. The brain's telling us we absolutely must have it now, and it's difficult to think of anything else. But the book says it doesn't have to be that way.

The book says that some people feel sure they won't be able to relax without what they're addicted to, but people can. It says the authors have never met anyone who couldn't be helped to relax.

It says that once people have learned relaxation skills and have become familiar with the way relaxation feels - since some have forgotten - then relaxation can come easily, although it might take practice at first. But being able to calm down at will can be such a good thing that it's worth it.

It says it's going to tell us about a few relaxation techniques. It says they're easy to learn. It says it might help if someone else talks us through them the first few times we do the techniques so we can concentrate on relaxing, but it isn't that important, since they're easy to remember. It says we can do them on our own whenever we want.

Calming Down the Breathing

It says that a lot of people find that the easiest way for them to relax is to concentrate on their own breathing. So it gives us a slow breathing exercise:

It advises us to sit or lie somewhere comfortable where we hopefully won't be disturbed. It advises us to have loose clothing so it won't be restrictive or a distraction, and to sit in a relaxed posture, legs uncrossed, and with our hands in our lap or by our sides.

Then it advises us to close our eyes.

It says we should concentrate on becoming aware of the feel of our feet on the floor, of the feel of our legs and arms on whatever they're resting on, and our head against the pillow or chair back or whatever it's resting against, and let our body go limp.

It says we should start to breathe out for longer than we breathe in for. It says that doing that stimulates the body's natural relaxation response. It says one way we can do that is to breathe in to the count of seven, then breathe out gently and more slowly to the count of eleven.

It recommends we do this about ten to twenty times. It says we'll relax more each time. It advises us to focus on the counting and not to let our minds wander off, and to feel the welcome sense of increasing calmness as it flows over us.

It recommends that we become aware of how much less tense we feel, just by slowing our breathing and calming our thoughts, so we can recognise the feeling of growing relaxation more easily in the future.

It says we can use this technique for instant relaxation as well, just breathing in rhythm a few times, wherever we are, whenever we get the feeling that we can't cope without a fix of our addiction, or feel so wound up that we can't make a simple decision, or if we're nervous, or if we feel like bursting into tears, or whatever.

It says we don't have to stick to breathing in and out to the same numbers if we don't want to. We can choose whatever numbers we like, like three and five, for example. But it recommends we just breathe out for longer than we breathe in for.

Tensing and Relaxing Our Fists

It recommends we settle ourselves comfortably and then clench our fists as tightly as we can. It recommends people only do that if their hands are undamaged and move easily.

Hmmm! Wouldn't it be painful anyway? ... Well, perhaps we could try it and only clench our fists as much as it feels reasonably comfortable.

It advises that we look at our fists carefully as we squeeze them harder and harder and notice the sensations in them, observing any whiteness of the knuckles, the feeling of our nails against our palms, the pressure of our thumbs against our forefingers, and so on. It says we should notice the tension moving up our arms towards our elbows.

It says we should keep squeezing our fists like that and concentrating on the sensations in them for a minute or two.

Then, to help us concentrate, it says we should close our eyes.

Then it says we should have all our concentration focused on our hands as we very slowly unwind them. Still with our eyes closed, we should feel the enjoyable sensation of relaxation spreading naturally through our fingers and hands and along our arms as the tension drains away.

Isn't that a bit like banging your head against the wall so you can enjoy how much nicer it feels when you stop? ... Well, maybe this exercise will be worth a try anyway. I'll see how I feel with it.

The book says that as our body relaxes, so will our mind.

Relaxing Muscles All Over the Body

It recommends that we tense and then relax each muscle group in the body in turn, focusing on the enjoyable sensation of relaxation flowing over them as they relax. We can tense each one for roughly ten seconds before we relax it.

It says it doesn't matter what order we do them in, but doing them in an orderly way will help us remember which ones we've done and which ones we haven't.

So perhaps we could start with the feet, bending one downwards till it's tense and then relaxing it, and then doing the same with the other one. And then we could move on to the legs, holding one straight for several seconds, slowly relaxing it, feeling the relaxing sensations in it, and then doing the same with the other one. And then we could bend one leg up till it's tense for several seconds before slowly relaxing it, and then do the same with the other one. And then we could hold our stomach muscles tense for a while before relaxing them. And then we could do the same with the arms as we did with the legs, tensing each one by first straightening it out before relaxing it, and then bending each one up for several seconds and relaxing it.

It says that all the while, we should focus on the sensations in the muscle groups, particularly the feeling of relaxation as we let go of the tension in them.

Going Away to a Pleasant, Peaceful Place in the Mind

The book says that relaxation can be even more enjoyable if we imagine going to somewhere really nice while we've got our eyes closed, either somewhere we've invented in our imagination, or somewhere we've been to before and really liked. It says that a lot of people like imagining they're walking along empty beaches by the sea, or in the mountains, or by a nice little stream, or sitting in a beautiful garden. But we can choose what we like. It says the scene can either be peaceful or lively. It says that if we tend to feel more relaxed when other people are around, we can imagine there are other people with us in the nice place. Or if we really enjoy a sporting activity or something, we can imagine we're doing that.

It says whatever we imagine, we should try to make it as realistic as possible. It says if we're good at day-dreaming vividly, then we can imagine lots of detail, like the colours of the flowers or leaves or trees or grass we imagine around us, and the soothing sounds of the waves of the sea or a stream bubbling along, or the rustling of leaves, or the voices of people around us enjoying themselves, or whatever. We can imagine feeling the textures of things around us, and smelling the scents of flowers and things.

It says we should imagine whatever scene we choose in detail, so we can make it our very own special place to go to in the mind, somewhere we'll always be able to enjoy imagining going to when we're relaxed, or to use to help us relax quickly when we need to be calm, such as before going into an interview, maybe, or before handling a difficult situation.

Using Relaxation to Combat Addiction

The book says we need to remember to calm ourselves down using one of those relaxation techniques whenever our addiction starts playing tricks on us, making us anxious, thinking we can't do without it, but before it starts to do it so well that it overwhelms us. It says that just as a muscle can't be tensed and relaxed at the same time, we can't be all anxious if we're relaxed. And when we're calm, it'll be much more easy for us to think clearly and recognise the harm addiction's doing us and the disappointment it often causes, so we can more easily realise it isn't worth it.

Part Fifteen
Changing Our Expectations of What Our Addiction Will Do for Us

Champagne, if you are seeking the truth, is better than a lie detector.  It encourages a man to be expansive, even reckless, while lie detectors are only a challenge to tell lies successfully.
--Graham Greene

The first thing in the human personality that dissolves in alcohol is dignity.
--Author Unknown

If you wish to keep your affairs secret, drink no wine.
--Author Unknown

A drinker has a hole under his nose that all his money runs into.
--Thomas Fuller

The book says that if we've had our addiction for a while, we might even have thousands of memories that make us think it's a good thing, and there might be many things that remind us of the addiction and make us crave it. So it's extremely important that we have some unpleasant memories to remind ourselves of, so when we get the craving, we can quickly realise and be reminded that our addiction isn't all it promises. That'll make the cravings go away again. So the memories could be embarrassing ones or ones that make us feel guilty, anything that'll put us off indulging in the addiction, hopefully things that'll make us feel strong emotions of disgust or guilt or whatever towards the addiction so they'll really put us off it.

It says we don't need to conjure up as many bad memories as we have good ones; the same few will do every time we start craving our addiction, whatever it is that's sparked off the craving. In fact, it says the more we think about the same bad memories the better.

It says we should never let a good thought about our addiction go unchallenged by a negative one. But we don't have to just remind ourselves of the negative things about the addiction; merely doing that would be just mustering up the will power to go without it. So we should follow the bad memory or thought in our minds with a nice one about how much more rewarding life will be without the addiction - how many more worthwhile things we'll be able to get done, maybe, or how much more of life we'll be able to enjoy once we aren't hampered by the addiction any more, or whatever. So we'll be making a positive choice that it's best not to give in to the craving, and that will get rid of withdrawal symptoms once we're used to doing that.

How it Might Work With Someone Trying to Cut Down Their Coffee Drinking

The book gives an example of the thoughts that could perhaps flash through a person's head when they're trying to resist having a cup of coffee because they have a craving for one but they're trying to cut down. This is the kind of thing the person might think:

"I just must have a cup of coffee right now!"

"When I have too many cups of coffee, I can feel my heart beating really fast, and it scares me. And I'll probably have a headache by the end of the day, and I don't like that! I don't want to drink coffee when that's likely to happen!"

"Oh yes, but just think of that lovely coffee smell and that nice feeling of pleasure and relaxation when you start drinking it!"

"Perhaps if I didn't drink it, I wouldn't be so in need of something to relax me, because at least part of the reason I'm feeling a bit anxious is because the coffee makes me feel like that! The pleasure I get from starting to drink it only lasts a few seconds, and then the coffee causes me to get shaky if I don't have another one soon afterwards. I remember that awful time when I nearly started panicking ..." ... or whatever the bad memory is. It says the worse memories we can think of the better. So it goes on:

"Yes, it was horrible. I had three cups of strong coffee one after the other because I wanted to be alert so I could work quickly, and my heart started beating so hard that I was scared I was going to have a heart attack! And anyway, I've heard that coffee reduces the absorption of calcium, and that could give me osteoporosis when I'm older. I know some people who've got that, and I don't want it!"

"But you know how much you love a cup of coffee!"

"It's not worth it. I'm sticking to my three a day - one at breakfast, one in the middle of the morning and one when I come in from work. Then I'll be able to look forward to not having headaches all day, and I know I'm going to love drinking more of those fruit juices they're selling in the canteen. I really like them, and they've got lots of vitamins in them so they'll make me more healthy!"

An Example About Giving Up Smoking

"I'll die if I don't have another cigarette!"

"No I won't. I'm more likely to die if I do have one."

"Oh, but doesn't that girl over there smoking a cigarette look happy. And isn't that cigarette smell enticing!"

"Now I'm giving up so I haven't been smoking all the time, I realise that when the smell of smoke gets stale and it clings to your clothes, it isn't nice. And I don't want to smoke. I don't want to have to worry about lung cancer and all the other cancers smoking increases the risk of, like throat cancer. And I don't want to have to worry that smoking's increasing my risk of heart disease and breathing problems like emphysema and bronchitis. And there's the risk of having your legs amputated because you can get clogged arteries that can cause circulation problems. And it makes your skin look old before its time. It gives you more wrinkles. I bet that girl wishes she could give up smoking but she doesn't know how."

"But remember the good old days, having a laugh with the other smokers. Think about what it was like!"

"Actually, it feels good waking up in the morning without a sore throat. I love being able to be at work or to go and see a film without longing to get out for a cigarette! It's nice that my clothes and hair don't stink of smoke any more! I love feeling powerful enough to beat this addiction and in control of what I do! And I can enjoy everything I used to just as much as I did before when I was smoking. I don't need to smoke to enjoy things."

Alcohol

The book says it would be the same for alcohol, with us reminding ourselves about all the horrible things alcohol can do for us and the embarrassing ways we've behaved while we were drunk in the past, and then reminding ourselves of things that have improved since we started giving up, such as meals out with friends where we've actually been able to have intelligent conversations instead of probably talking nonsense because we were drunk, and then thinking about how nice it was to wake up the next morning without a hangover.

It says some horrible things about what drinking too much can do to us! It says that not only does it damage the liver, but it shrinks the brain!

Shrinks?? What?! I'll need my brain! Well, I knew it killed brain cells, but that sounds worse! Then again, if brain cells die, the brain's bound to shrink a bit. I wonder how much it can shrink by, and whether it can grow again when you give up drinking. I hope so!

The book says drinking heavily can increase the risk of fits as well, because of the brain shrinkage.

Well, I never knew that! I'm glad I've never had any fits! I don't want any either!

It says drinking too much can cause memory loss when it kills off brain cells. In fact, it says it's the third highest cause of dementia.

It says even just drinking three small glasses of wine or the equivalent of that a day can almost double the risk of throat and mouth cancer.

Oh no! I hope I don't get anything like that! Some of the old people I try to look after in the hospital have got cancer, and it can be a horrible way to die!

It says just drinking the equivalent of five small glasses of wine a day increases the chances of getting breast cancer by 40%!

And it says too much alcohol can lead to strokes and heart attacks.

It says drinking too much over time can cause inflammation of the pancreas that can give us stomach pain.

It says too much alcohol weakens muscles, joints and bones.

Well, I hope my muscles and bones aren't being weakened! Maybe they are! I haven't really noticed a difference, but perhaps the effects come on gradually! It's beginning to scare me now.

It says heavy drinking can lead to osteoporosis.

It says that because the liver can't process all the alcohol we might drink, some comes out in the breath and sweat, creating a strong stale smell of alcohol, that makes it unpleasant for other people to be around us.

Yuck.

So it says we should remind ourselves of things like that when our craving for alcohol comes on, and then remind ourselves of how nice it is to be conquering the craving, and how much more healthy we'll get when we've stopped drinking, and things like that.

Part Sixteen
Reminding Ourselves of What We Can Use to Help Us Overcome Addiction

Many a woman drives a man to drink water.
--Author unknown

The book says it can be helpful if we remind ourselves of all our abilities, positive personality traits and past achievements, because that will make us more confident that we're competent to beat our addiction.

And we can remind ourselves of all the sources of practical support available to us in getting our lives back on track if we need them.

It recommends that when we think about our past achievements, we think about how any of them gave us skills that we can put to use in overcoming our addiction. It says even if we tried to give it up before but only managed it for a week or even a day, it'll still be an achievement, and it will have taught us valuable things about what worked for us and what didn't, that we can use as experience to learn from to know what to do and what not to do this time around.

It says that thinking of things we've done successfully in the past can give us more confidence that we can fulfil our unmet needs as well. For instance, if loneliness or boredom was what made us develop the craving for our addiction, it might be that we're missing out on close relationships or a social life. It says that if our self-esteem's low, we might think we're not competent to build a close relationship or have a good social life. But if we think back to any relationship we've successfully kept alive for some time, we'll know that we are capable of doing that.

It says that if we've had a caring relationship with anyone at all, such as children, parents or as a professional carer, then we'll know that we're capable of building a rapport with people, and if we've put others first in the past, we'll know we can do that again. It says that addiction makes us selfish because it makes us want things right then and there so much that everything else becomes less important. But if we've been unselfish in the past, we'll know we can be again, so we don't need to believe we have a selfish personality; it's just addiction that's made us like that, and when we get rid of it, we can go back to the way we were before.

I'm glad to read that! I know I've done some bad things recently, wanting the drink more than I want to help people in the hospital who want me to do things for them, and not concentrating that well so I've even been a safety risk to them. There was that horrible time when I nearly injected a patient with the wrong thing. And yet I drank just as much the day after. That makes me feel really bad! I've been telling myself I must be a horrible person for doing things like that. But it's at least nice to know that it's just the way addiction makes people go. At least I haven't done anyone any serious damage. But I still feel guilty, so I want to get off the drink as soon as I can. So I'm glad the book says it's the addiction that's made us like that and it hasn't become part of who we are. I'll be happy if I can go back to the way I was before.

The book says that if we've studied for exams or things like a driving test in our lives and passed them, or if we have skills that it took time to learn, like playing a musical instrument or typing or whatever, that proves we have the dedication and staying power we need to keep going till we manage to get what we want, overcoming our addiction and getting our needs met. It says that at one time, while we were still learning about the skills we've developed or learning what we needed to learn to pass the exams, we were working towards goals we wanted to achieve. And if we could do it then, we can do it now.

It says that if we know we've persevered in anything else, we'll know we have the ability to persevere in giving up our addiction. And we can think about other good qualities that could help us along the way like a sense of humour.

Writing Down a List of Things that Can Help Us Over Our Addiction

The book recommends we write down a list of everything we've got going for us, no matter how big or small, that might help us overcome our addiction and go on to a better life.

If we just try to remember all the things we think of, we might forget them. But if we write them down, we can remind ourselves of them, and encourage ourselves by looking at them.

It recommends we write about all our positive characteristics and personal strengths.

Well, it's difficult to think of any now. I don't feel any good about myself at all at the moment. But maybe I'll think of some things in the coming days or weeks, and I can write them down as I think of them. Perhaps I'll carry a notebook with me.

It recommends that we also make a list of what we've got going for us outside ourselves that can help us, like the support of friends or family members, or having enough money to spend on taking a new class or learning a new skill, or whatever will make our life more interesting and enjoyable.

Part Seventeen
Things That Can Trigger Off a Craving For Our Addiction

The Spanish ladies of the New World are madly addicted to chocolate, to such a point that, not content to drink it several times each day, they even have it served to them in church.
--Jean-Antheleme Brillat-Savarin (1755-1826) ‘The Physiology of Taste’ (1825)

Asthma doesn't seem to bother me any more unless I'm around cigars or dogs. The thing that would bother me most would be a dog smoking a cigar. --Steve Allen

If you must drink and drive, drink Pepsi.
--Author unknown, as seen on a bumper sticker

When We Get a Craving For Our Addiction Because of Reminders of Past Things

The book says that whenever something happens, part of our brain makes snap assessments as to how to respond to it, going by how we've responded to it in the past. It's programmed to do that quickly, because if something was threatening, we'd need to get out of the way quickly. But it means we can get cravings for our addiction when things happen that are like things that made us decide to do the addictive thing before.

For instance, someone who once turned to drink when her husband stormed out of the house in the middle of an argument, leaving her with lots of bad feelings she couldn't express, might manage to come off the drink after a while, but then have a strong urge for it again another time when her husband storms out of the house in the middle of an argument, because the part of her brain that responds to things really quickly will remember that that's what she did last time and think that must be the way to deal with things.

The book says we should plan various things we can do that make us feel better, so if we get a strong craving for our addiction, we can do something else instead to satisfy the need we wanted it to fulfil when we had it before. So, for instance, someone who got a strong craving for alcohol after her husband stormed out of the house in the middle of an argument because she had lots of bad feelings that needed venting could do something else to get them out of her system, like going for a run or a brisk walk to work her anger off and calm her down, or maybe doing something energetic indoors that would help to do that, like moving furniture. Or perhaps she could do something calming like relaxation exercises, or listening to soothing music, or something distracting like watching something good on television or phoning a friend.

Arguments and Addiction to Sex Chat Lines

Thinking about arguments and addiction, it was interesting what Brian said in the group last time about the reason he became addicted to sex chat lines. He said his wife was really upset when she found out about his secret phone sex habit after finding the numbers on their itemised phone bill. She hated the thought that he'd been masturbating while listening to other girls talking sex talk, and threatened to leave him and take their baby with her, unless he got therapy immediately.

He said that when he first went for therapy, he was confused about why he rang the chat lines, but after a bit of discussion, when he thought about what happened just before each time he got the craving, he realised he always got it after he had a serious argument with his wife. He would always go and lock himself away and start phoning a sex line. He found it helped to calm his emotions.

He said he talked to the therapist about how he hated arguments and didn't feel as if he could cope with them, and was scared of them. He said that when he'd been a child, he'd often been terrified listening to his parents angrily arguing downstairs, often throwing pans and even chairs at each other. He said his mother was often beaten by his father, and his father hit him as well sometimes. His father left when he was ten and never came back, but Brian had got a strong impression by then that disagreements always led to anger and violence and needed to be avoided at all costs.

He said the therapist helped him realise that there are conflicts in every relationship and what he needed to do was to learn more effective ways of handling them.

He said the therapist taught him some ways of dealing with arguments calmly, such as how to listen without interrupting till the other one's finished, and some negotiation skills, such as taking turns with the person you're arguing with to speak; being clear about what you want rather than just hinting at it and expecting them to guess, or not mentioning it, while you at the same time take into account what the other person wants; and other skills, like not resorting to name-calling or other insults; not bringing up irrelevant past hurts; and other things.

The therapist also suggested that if Brian's emotions got too much for him during an argument, he did something to calm down like going for a walk, before coming back to carry on listening and negotiating.

The therapist used relaxation techniques with him, and then got him to imagine having an argument with his wife where they did both listen to what each other was saying carefully and take turns to speak, and where they were talking to each other sensibly, with both of them just wanting to reach a solution that they were both happy with.

Brian said he'd also been worried about what would happen if he stopped earning as much money as he was, being self-employed, since he had a wife and baby to support, and he worried about what would happen if his wife got pregnant again. One of the reasons he used the sex lines was to push his worries out of his mind for a while, forgetting while he was on the phone how expensive it was to phone them, though he worried about that afterwards. The therapist showed him how he was misusing his imagination to create worrying things that were actually unlikely to happen. He was getting a lot of work and demand for it was increasing, and his wife was using contraception.

But the therapist encouraged him to use his imagination in positive ways, thinking up ways he could make the future better for himself and his family.

Once he'd lost his fear of arguments, he lost his craving for his addiction. He started using the money he saved to take his wife out for dinner once a week. He only needed to see the therapist once.

Other Things That Can Trigger Cravings Off

The book says that another thing that often triggers cravings for addictions off is seeing someone else indulging in something we're addicted to, like seeing them having a drink, a chocolate cake for people addicted to over-eating, a cigarette for smokers, and so on. And it can also happen when we see something that makes us think of our addiction.

Yes, I know I always get a craving for a drink if I happen to see a pub or someone else drinking.

The book says that that kind of thing happens for the same reason as the reason we might have a craving for our addiction when something happens that's similar to something that's made us crave it in the past. The part of our brain that makes snap decisions about how to react to things recognises it as something we've done before and thinks it's something we enjoy, so it thinks we need to do it again. So it sets off a mild withdrawal symptom, and that thing the book was talking about earlier happens where if we think of our addiction as a good thing, our memories of good things will be giving us the craving before we even know what's happening. That's why we have to re-train our brains to associate our addiction with bad things instead.

It says it's important to keep those bad thoughts and memories in mind even years after we've come off what we were addicted to, since sometimes, even ages afterwards, something can remind us of the addiction for the first time in a long time and we get the craving for it again.

Telling Our Addiction We'll Think About Doing it Later Rather Than Saying No Right Then

The book says that since urges to indulge in our addiction can be strong, we can think the addiction's more powerful than it really is, and it can be easy to give into it or start planning to before we even really know what's happening. So one way of stopping it pestering us is to say to ourselves that we'll wait about fifteen minutes, and if we still want it as much as we do now, we'll give in to it or start planning to give in to it then. It says sometimes, the impulse to indulge in the addiction can be very strong for a minute or two and then go away, and in any case, during that time, we can do something to calm ourselves down, like relaxation techniques or whatever, and when we're calmer, we can make a rational choice to reject the addictive impulse.

Part Eighteen
Using Our Imagination to Break the Power of Addiction

After fifty years as a Prohibitionist, I am more convinced than ever that we need a good party, not just good men and good women. Most public officials are united in the war against terrorism. They, like we, are outraged at the deaths of some 3,000 Americans on September 11. Yet, most are willing to give unqualified support to the traffic in liquor and tobacco in exchange for campaign cash. Those products jointly claim at least 600,000 American lives each year. Two hundred die each year from use of alcohol and tobacco for every one who died in the September 11 attacks. Need another reason for being a Prohibitionist?
--Earl F. Dodge

  If you took 1,000 young adult smokers, one will be murdered, six will die on the roads, but 500 will die from tobacco.
--Richard Peto

  Secondhand smoke is an environmental trigger of asthma, the cause of an estimated ten million missed school days for children in the U.S. It is estimated that up to 1 million children have aggravated asthma symptoms caused by secondhand smoke.
--Martha Casey (adapted)

There are people who think that smoking a lot of marijuana leads to divine guidance, but the only thing it leads to is cancer and a clouded mind.
--Duane Alan Hahn

My smoking might be bothering you, but it's killing me.
--Colette, (1873-1954) French novelist

The book says our imagination's very powerful, since it can bring to mind strong emotions that can have a big influence on us. It says that sometimes, our imagination can make withdrawal from addiction a really painful experience, because of all the memories of good times we can have and thoughts of what we're missing out on. But we can make our imagination work for us to make withdrawal from addiction virtually painless, if we regularly take time out to imagine the bad things our addiction could do to us in the future if we keep on indulging in it, but then imagine good things happening if we give it up. If we expect to be miserable without our addiction, we're more likely to relapse; but if we expect to have a new and improved life, we'll do things that are more likely to make that happen, because we're expecting success.

It says one powerful thing we can do to help us come off what we're addicted to is to have sessions where we regularly relax and then fantasize about the bad things our addiction could do to us, but then cheer ourselves up and make ourselves feel optimistic by day-dreaming about how nice it'll be to come off it. It gives us instructions on how to go about doing that.

Thinking About the Bad Things About the Addiction First

It recommends we take about fifteen minutes when we're unlikely to be interrupted, when we'll both fantasize about the bad things about our addiction and day-dream about how nice it'll be to get over it.

It advises that first, we relax ourselves. It says we can use one of the relaxation techniques it mentioned earlier if we need to.

It says that when we're relaxed, first of all, we should think for a while about the horrible things about our addiction, and try to conjure up emotions that put us off it, like disgust, guilt, embarrassment, fear at what it's doing to us and so on. We can perhaps imagine ourselves going through our addictive activity from beginning to end, imagining all the bad things about it. Then we can fantasize about suffering the horrible effects of it in the future.

An Example of the Way the Technique Could Work For Someone With Bulimia

For instance, it says that someone with bulimia could first of all think about how greedy they feel when they begin to binge eat. Then they can think of how they have no enjoyment in the food they binge on; how bloated and disgusted with themselves they soon feel; and how disgusted they are when they make themselves sick. They can imagine themselves seeing their teeth beginning to rot because of the acid in their vomit; and imagine they can smell their breath after they've been sick and how they feel about it; and then remember how embarrassed they felt whenever someone suspected what they were doing, and they can bring the feeling of embarrassment to mind along with the other feelings they're thinking about; and then they can remember how bad they felt afterwards, and how they felt just as upset and lonely as they did before they started. Then they can think back to any bad experiences they had because of their addiction.

It says that then, they can think forward to bad things that might happen in the future, the worst they can think of. They could imagine developing diabetes because they didn't give up their addiction, or having a heart attack, or suffering other internal damage. It says they can imagine being left by their husband or wife or partner who's become too disgusted with them to stay. Then they can imagine dying of some avoidable illness at a fairly young age, so they can't bring up their children and watch them go through life.

This is horrible!

It says more horrible things about the things bulimia can cause here! It says it can cause low blood sugar, which can lead to dizziness, headaches, tiredness, irritability, weepiness, anxiety and depression.

It says it can cause increased risk of cancer of the oesophagus.

It says it can lead to muscle weakness and numbness caused by potassium deficiency.

It says it can even lead to heart failure in the end.

Things that Smokers, Drug Users and Alcoholics Could Think About

It says that smokers or drinkers or drug-takers could bring to mind every article we've ever been disturbed by about the harmful effects of drink or cigarettes or drugs. It says we shouldn't spare ourselves from imagining the horror of having those things wrong with us. For instance, smokers can imagine having lung cancer and hardly being able to breathe; some of us could try to imagine having cancer of the throat or mouth, or having a massive heart attack or needing a liver transplant. It says we should imagine the grief and distress suffered by our loved ones as they watch us die at a younger age than we should have done.

Things that People Addicted to Activities that Take Up Lots of Money or Time could Think

It says people addicted to an activity rather than to a substance should imagine as vividly as possible the guilt they feel when they've done something like spent hours on the Internet instead of with their family, or they can bring to mind the feelings of let-down and guilt they feel when they've brought home another expensive thing from the shops that they can't afford and just put it in a cupboard; or they can do the same for whatever they're addicted to. They can picture the disappointment or horror on the faces of their loved ones.

It says they too can day-dream about horrible things that could happen in the future, such as their home being at risk of repossession or their loved ones suffering because they've wasted so much money they're deep in debt. It says they should come up with their worst possible fears about what could happen. For instance, someone stealing to pay for their habit could imagine going to prison, and make up stories about horrible things happening to them there.

Nicky could fantasize about scary things like getting into serious debt and losing her husband, when she's day-dreaming about the horrible things about her shopping addiction. I'll tell her about this.

And it says some horrible things about what cannabis use can do to you as well here, so maybe Jane could bring those to mind as well as thinking about what happened to the person she knows who got psychosis. I know she says that cannabis makes her feel more relaxed and comfortable in situations and happier, but maybe she could learn to feel comfortable and relaxed anyway. And the book says cannabis does some horrible things.

The Harmful Effects of Cannabis

The book says that regular cannabis use can increase the risk of depression and psychosis.

It says certain types of cannabis, skunk in particular which is stronger than other types, can significantly increase the chances of getting psychotic symptoms. And it says it can give you paranoia and memory loss.

It says cannabis can make you feel lethargic so you don't want to be bothered to do anything.

It says long-term cannabis use can reduce intellectual abilities.

So it can damage career chances and social life, so it makes people less satisfied with life, not more.

It says cannabis can cause people to judge things like distance inaccurately, long after the cannabis high has worn off, so quite a lot of car accidents are linked to cannabis use, and an increasing amount of industrial accidents.

It says cannabis can cause cancers. In fact it says it's a bigger cancer risk than cigarettes.

It says it increases the risk of bronchitis, and that affects people's quality of life.

It says it increases the appetite as well, which can lead to weight gain.

The Harmful Effects of Smoking

The book says that about 90% of lung cancers are found in people who smoke. It says smoking can also cause or increase the chances of cancers of the mouth and throat.

It says smoking can increase the chances of heart disease and heart attacks a lot.

It says that every year, some people have limbs amputated because the veins have got so clogged because of smoking that the blood can't circulate properly.

It says it can cause diseases that affect the breathing badly like emphysema, that can stop people walking because it's too much effort or might bring on an attack.

I could tell Sharon all this! I don't think she'd be very happy. Maybe I'll just give her the book and let her look at it herself, telling her that it recommends that people think all about the bad things about their addiction, but then think about the good things about coming off it and staying free from it.

Imagining the Good Things About Being Free of Addiction

I'm glad we can think of nice things after all the horrible ones! Otherwise, it could leave us really depressed!

It says that when we've made ourselves feel really bad by thinking about horrible things, it's important that we calm ourselves down again before thinking about nice things about being free of our addiction. We can maybe use those relaxation techniques again that it told us about.

When we have, it suggests that maybe we could imagine ourselves feeling physically better, if we will feel more healthy, and imagine in what ways we'll feel better. And we can imagine looking better because we're eating and living more healthily. We can imagine the good feelings we'll get from knowing that.

We can imagine having time to spend on enjoyable activities that we didn't have time for before because of our addiction, whether old ones we used to enjoy that we could take up again, or new ones we like the idea of. We could day-dream about doing them and how much we're enjoying ourselves, and look forward to them.

If we'll have quite a bit more money because we're not spending it on our addiction any more, we can imagine how much we'll enjoy spending it on things that will improve our lives and our family's lives and make them more pleasurable. We can imagine the feelings we might get when we do.

We can imagine our friends and family being a lot happier now they don't have to worry about the problems caused by our addiction.

And we can imagine having much more energy, and being glad we sleep a lot better.

We can imagine we're feeling really pleased at being in control of our lives now instead of having to give in to the addiction all the time and worrying about what it's doing to us.

It says that again, we should imagine these things as realistically as we can, thinking of them in as much detail as we can. We should really try to feel the delight of having given up the addiction.

Repeating the Day-Dreaming Often

The book says we should sit down to imagine all those things as often as we think it's necessary. It says the trouble with just trying to think positively is that emotions are stronger than thoughts, so when they come on, they'll be a much bigger influence on us than any thoughts we've had. But conjuring up emotions that are just as strong will really be fighting the emotions the addiction uses to trap us with ones as strong or even stronger than it. And the addiction will fade once the stronger emotions come to mind easily, because it won't be instantly bringing up positive memories to bring on our craving, but it'll be immediately remembering the horrible things to put us off. And because we're not craving it any more and feeling as if we're missing out, our withdrawal symptoms will be mild and fade away.

It says that the brain might keep bringing up positive images of our addiction that will tempt us sometimes for quite a while. It says that if our addiction was really bad, it might be as long as a year before we reject addictive impulses automatically before they even reach consciousness and they totally fade away, since we'll have so many tempting images and we'll have thought of them so often before; but each time one comes up, we should challenge it just for a moment with some negative thoughts about what our addiction might do, and then nice ones about how much better it'll be to be free of it, and how pleased we can be to be in control of it. If we don't challenge our addiction whenever a thought comes up about how nice it is, we risk it becoming more and more tempting and taking over our lives again. But challenging it will make it fade away more and more.

Part Nineteen
Planning Things We Can Do When We're Really Tempted By Our Addiction

Why is it drug addicts and computer aficionados are both called users?
--Clifford Stoll

Did you know America ranks the lowest in education but the highest in drug use? It's nice to be number one, but we can fix that. All we need to do is start the war on education. If it's anywhere near as successful as our war on drugs, in no time we'll all be hooked on phonics.
--Leighann Lord

The book says it's vital that we plan for what we can do when we're in our most tempting situations. It says that if we do, we already know we'll be far more likely to control the addiction then.

It says it's important that we think of what triggers off our most tempting cravings. We can write the things that do down so we'll remember them. Then we can go through the list we've just written and plan how to deal with them when they come up.

It gives us a list of things to help us think of what triggers our addictions off:

• Being with particular people? If so, who?
• Being in certain places? If so, where?
• Doing particular activities? If so, what?
• When we're experiencing strong negative emotions, such as if we're feeling upset, depressed, worthless, angry, lonely or bored?
• When experiencing very positive emotions, for instance excitement or joy?
• When experiencing sensations that remind us of our addictive activity? If so, what are they?

Well, I know it's being at work and feeling demoralised that makes me most tempted.

The book says that if we realise we have strong cravings for our addiction when we're with particular people or in a particular place, we don't need to avoid those people or places to stop ourselves giving in to the addiction, unless the only reason we go to that place is to indulge our addiction, or the people don't share any part of our lives except our addiction. But it says we do need to do things that will stop us being so tempted, if we're going to put ourselves in situations where the temptation will be strong.

It gives an example of what we could plan to do. It says that for instance, if we were stopping smoking, as well as being ready with our thoughts about how horrible addiction is and how nice it'll be to break free of it, we can also make sure that the first time we go out with a group of smokers, there are some non-smokers with us, so we aren't the only one refusing a cigarette, so we don't feel so awkward. Or it says we could decide to get ourselves away from the tempting situation for a few minutes every now and then, maybe by going for a walk around the block or making a phone call or something, to give ourselves time to calm down and think more fully about the truth about what addiction does to us, and muster up a few negative emotions about it and positive ones about giving it up.

I'm sure that could apply to other addictions as well, like drinking too much.

It says it's also a good idea to think beforehand of an explanation to give to people who used to do our addictive activity with us and now want to know why we're not joining in anymore.

It says that if we know we give in to our addiction when we're alone and bored, we should make sure we've always got something to do that we'll enjoy, like maybe doing a bit of gardening, doing a jigsaw puzzle or a crossword, reading an absorbing book, cleaning out a cupboard or redecorating the house, having a friend willing to be phoned up for support, or whatever. It says it's no good us telling ourselves things will be really good when we've given up our addiction if we don't have something we can use to immediately satisfy our emotional needs in a healthy way when we start to feel down unexpectedly.

Major Setbacks In Life

It says that everyone has tragedies and unforeseen circumstances that mean adjusting to major changes in life every so often, like losing jobs, losing loved ones, being injured or whatever. It says we'll be tempted to use addiction to cope with them, but we don't need to. After all, many many people go through things like that without resorting to addiction.

So it advises that when something like that happens, we should ask ourselves how it'll really help us or those around us if we resort to our addiction again. The answer should be that it won't help us, because even if we think it's helping in the short term, it'll cause a load more problems. And it won't really take the pain away anyway.

Part Twenty
Improving Our Physical Health

This is the great fault of wine; it first trips up the feet: it is a cunning wrestler.
--Titus Maccius Plautus

The book says it's important to keep physically healthy as far as possible as well as looking after our emotional needs. Keeping healthy will make us feel better in ourselves.

So it says we all need a good diet and regular exercise. It says even if our addiction is exercising too much or eating too much or too little, we need to find a healthy balance.

It says that a good diet does a lot to undo the damage that addiction caused, and makes it less likely that we'll relapse.

It says that addiction to stimulants such as coffee, tea, fizzy drinks, sugar, chocolates, cigarettes and certain drugs can make us a lot less healthy by causing the depletion of various vitamins and minerals in our systems that we need for health. It says that junk food is designed to be addictive, but harmfully affects the moods and physical health of adults as well as children.

It says that alcoholism can cause us to become low in some of the nutrients our bodies need. It says of course anorexia does that too because people deliberately don't eat.

It says that people whose addictions take up a lot of time like workaholics often forget to eat properly.

Eating Healthy Food

It says that as well as cutting down on unhealthy foods, we should make sure we eat healthy foods to feel better and have more energy and help our body repair itself, like lots of fruit and vegetables, nuts and seeds, wholegrain foods, and fish such as herring, salmon or fresh tuna. (It says we could take fish oil supplements instead of eating fish if we like, if we're worried about the pollution in the sea.)

Exercise

It says that exercise puts us in a better mood as well as keeping us fit. It says that getting into shape and the good feelings we'll get from the exercise will help us be happy without the addiction. But it says we should make sure we enjoy the type of exercise we decide to take up, and that it'll be good if we can do one that brings us into contact with other people we can make friends with. It says that then, the exercise will become a way we can get absorbed in something outside ourselves that'll stop us thinking about our addiction, and we'll hopefully enjoy ourselves with the new people we meet.

Part Twenty-One
Not Letting Relapses Get Us Down But Picking Ourselves Up Again

Self-pity is easily the most destructive of the non-pharmaceutical narcotics; it is addictive, gives momentary pleasure and separates the victim from reality.
-- John W. Gardner

The book says we shouldn't be too hard on ourselves if we relapse, since it's very common for people to relapse when they're trying to break free from addictions. It says there are things we can do instead to try to get back on track quickly and to make it less likely to happen again.

It says it's a good idea to go away from the place we relapsed, and think about what happened.

It says we shouldn't allow ourselves to panic, even if we feel scared or shocked by what we've done. We need to keep calm to find out why we allowed our addiction to take over again for a while. It says we shouldn't allow ourselves to start feeling down with guilt and blame, but we ought to focus instead on what we can do next to move on.

It says there will probably be a simple explanation for why we relapsed. It gives some ideas on questions we could ask ourselves to help us find out what it was, like:

• Did we just experience a strong negative emotion that we usually try to push away with our addiction, or a strong positive emotion that we've liked in the past to make even better with our addiction?
• Has something bad happened to us recently that made us less enthusiastic about giving the addiction up?
• Did we do something recently or experience a sensation that strongly reminded us of a time when we indulged the addiction which gave us an overwhelming craving to do it again?
• Did the addiction trick us into thinking it was safe to test ourselves, to prove to ourselves that we were no longer addicted?

Our answer will let us know something important: when and where we need to be more careful in the future, and that we still have to be careful.

Staying Positive

The book says it's important for us not to feel defeated and hopeless, thinking perhaps that now we've had one cigarette or drink or whatever, we've failed, so we may as well have twenty or so. It says that instead, it's the time to remind ourselves that we've chosen not to be enslaved to addiction any more and make a fresh commitment to beating it. We can consider our relapse as just a warning that we still need to work on challenging the lies addiction tells us about how good it is with more realistic thinking.

But we should remind ourselves that the time between when we decided to give the addiction up and the time we relapsed was a time when we successfully managed to keep the addiction at bay. And if we could be successful then, we can be successful again in the future.

It says we can also remind ourselves that addiction is a strong opponent. It can use powerful methods to try to suck us in again. But we have even more powerful things to defeat it with, if we let them work for us.

Planning What to Do Next

It recommends that we just think of our relapse as a temporary hiccup, and decide to get our lives going in the right direction again.

It says we should think about whether any of our emotional needs isn't being met; and if any of them aren't, we should think through and plan how we can get them met better, since when they are, we won't feel the need of our addiction.

It suggests that another thing we can do if we like is to seek support from family members and friends who have our best interests at heart. (It says we should avoid any who might think it's good that we've relapsed for some reason.) It says that asking for support will also reassure family and friends that we still mean to get off what we're addicted to and haven't decided to go back to it permanently.

Well, this book seems nice and optimistic and helpful. I'll try what it says, and let the group know about it.

Notes and Links

The Backstory

The Way Things Are Before They Begin to Improve

Samantha's Growing Drink Problem

Samantha is a nurse, working on a ward for elderly patients. But she has become increasingly depressed and overwhelmed by the number of them she sees dying in pain, or who are living the last days and months or years of their lives feeling scared or lonely. She feels a failure because she's a trained nurse, and yet she can't give them adequate pain relief, because she isn't allowed because they would risk overdosing. So she has to see them in pain a lot of the time and doesn't know what to do to help.

And she doesn't have the time to comfort them and give them companionship as much as she'd like. When she does, she often goes away feeling hopeless, because some of them have led troubled lives and are going to die with worries and griefs about their relationships with family members hanging over them, and having missed out on the good things in life they could have enjoyed if only they'd had help with their problems earlier. Samantha knows there isn't anything she can do about it, and they're often just as miserable when she leaves as they were when she went to them to try to give them some companionship. So she feels helpless, as if she's letting them down.

She begins to feel more and more demoralised, and increasingly turns to comfort food and alcohol as a way of trying to ease her depression and sense of failure for a while.

She has a boyfriend, and she often tells him about her concerns and they go out quite a lot to try to cheer themselves up. But they break up, and the misery of that, added to the demoralised feeling she has at thinking she's letting her patients and their families down, makes her drink more and more.

The problem is made worse because she isolates herself from her friends in the evenings, because she doesn't want them to know how much she drinks, so she stays in on her own and drinks. But that means she drinks more, because she hasn't got anyone who can help take her mind off her troubles and who she can confide in to ease her mind, and she gets more miserable because she's lonely.

She begins to feel terrible at work because of her hangovers, and since her work makes her miserable anyway, she begins to feel she just can't survive the day without drink. So she begins to bring it into work. But she worries she'll lose her job if she's found out.

As time goes by, she begins to be more concerned about drinking than she is about caring for her patients, and she begins to neglect their care. She also becomes a safety risk to them. But whereas before she started drinking to excess she was so concerned about her patients that she became depressed at not being able to help them as much as she wanted, now, she becomes so absorbed by the craving for alcohol when she thinks she needs a drink, and her sensitivities are so dulled by it afterwards, that she doesn't seem to care about them any more. So her standard of care falls dramatically.

Her family become concerned about her, because sometimes, some of them visit her at weekends, and find her drunk. One day at a family celebration, she drinks far too much, and her sister, Lisa, becomes so concerned that she tells Samantha that unless she stops drinking, she'll never let her see her children again because she's a safety hazard and a bad example.

Samantha's upset by this, because she loves Lisa's children. She really stops to think about what she's doing. For some time, she's felt guilty about drinking at the hospital, but the craving for drink seemed too strong for her to resist. But now, she decides she needs to try to get help.

When Things Begin to Look More Hopeful

Samantha finds a little local support group, set up for people with all kinds of addictions. People are told to read self-help books, and then bring the ideas they get from them to the group meetings and discuss them with others.

Samantha goes to the group and finds it friendly and helpful, with several people coming up with good information. After the group meetings, she thinks about what they've said, and buys a self-help book herself to talk to about with the people there.

She makes three friends in particular at the group. One's called Sharon, who's a heavy smoker but wants to give up because she's concerned about the health of her very young children who are developing breathing problems. Another one's called Jane, who's tried various drugs for fun, but now feels she's becoming too reliant on them and wants to give up because a friend of hers was a heavy cannabis smoker but developed schizophrenia-like symptoms, and now Jane's scared about what the drugs might be doing to her. The other one's Nicky, who's got an addiction to shopping, and who's joined the group because her husband threatened to leave her if she didn't stop spending so much money.

So when Samantha's reading the self-help book she buys, she particularly looks out for things that might help them, although she looks out for things she hopes will help everybody.

The group's run by Rebecca, whose best friend had become addicted to tranquillisers and had experienced problems with anxiety when she tried to come off them. Rebecca had felt helpless at first because she didn't know what to do to help, but she started researching addictions and ways of recovering, and she ended up feeling enthusiastic to help people addicted to things break free from their addictions.

More About the Group

The group's called Kick the Habit. Rebecca says she didn't want the word addiction in the title, because some people don't like to think of themselves as having an addiction, since then, they have to think of themselves as an addict, and they think of an addict as someone with a serious problem who's become too ill to work, and they're not like that. But Rebecca says it doesn't matter what words people use; if they have a problem resisting a craving, or they find it difficult to stop a behaviour once they start, or they want to stop it because they're worried about what it's doing to them or those around them, then no matter what they call it, they're welcome in the group.

In fact, she says it's best for people not to think of themselves as "addicts", because that makes it sound as if the addiction is part of their personality and so will be harder to get rid of. She says if people think of themselves as just having an addiction instead, they can think of it as being something outside themselves that they have the power to control and get rid of. She says if people think of addiction as something outside themselves trying to dominate them, they can think of themselves as separate from their addiction and ready to master it.

She says that anything at all can be addictive if it's used as a way to try to lift the mood. So that could even include work, studying and exercise. But she says all addictions work through the same pathway in the brain, and people can get rid of addictions and build a more satisfying life for themselves instead using their own natural abilities.

Samantha goes to the next group meeting and enjoys it. She feels sure the information she picks up from the group in the coming weeks will be useful.