I thought I would introduce you to the skills that are part of this module at the end of this module about distress tolerance skills that are added to the treatment when the problem is and addiction doesn't mean these replace the other skills. But these are add ons.
You wouldn't necessarily teach these in most groups. But you would if you were teaching a substance abuse, substance use disorder group, or just focusing on addictions, even though some of these skills are useful in a larger way than that.
And it'd be a brief into introduction to these few skills. And it's part of a much larger adaptation of DBT to use of with, with substance use disorders that we can talk about in part two of the intensive.
So overview, when the crisis is addiction, there's these several things to go over. That are she calls skills, and some, in some cases, they're sort of a bigger construct than a skill.
This starts with some lists of common addictions, just to see what people can get addicted to, as it's way more than just substances, that's for sure.
Then there's this important concept of dialectical abstinence, let me introduce you to that. basic idea is that is that there's these two approaches to the you to what, what are your goals when it comes to treating an addiction, and one set of goals would be abstinence oriented goals, like total stop, whether it's cold turkey or whether you gradually get there, the ultimate goal is abstinence is not using or not doing at all.
The other way to go is called harm reduction. And that that idea is that rather than focusing all your eggs in the basket of abstinence, help teach a person all the things they can do and all the ways they can think, to make it so that if they do have relapses, those relapses are short lived, and not so damaging, and they can get back out, it reduces the harm.
In other words, it assumes harm might be done, but it teaches people skills for becoming, getting out of relapse, and it goes along with the treatment of relapse prevention. All right. Now, being a dialectical treatment, Linehan decided, you know, there are advantages, including research based advantages of each of these approaches.
A big advantage of dialectical abstinence, is that when you focus on abstinence, you do reduce the frequency of relapses. Unfortunately, though, when you do ever relapse, it's not unusual for it to be a bigger and deeper and more damaging relapse.
When you focus on harm reduction, primarily, the big advantage is that you don't have so many big deep, damaging relapses, but you do have more frequent relapses.
So she wanted to get the best of both worlds together. So the idea is that you work with a person is getting a frame of mind more than anything else, but the frame of mind of absolute is, I'm going to, I'm going to do this, even if it's, I'm going to do this 100%, even if it's to not use between now and tomorrow, or not engage in my addiction between now and next week, you know, I'm going to do that. And it's sort of a an iron clad frame of mind based on the idea that we're going to shut the door on this addiction.
Because if we don't quite shut it, something can get in there and open it up again.
So there's the focus on abstinence, state of mind and absence, which often leads the patient to say, Oh, so if I, you do my addiction, am I kicked out a treatment and said, Oh, no, absolutely not. The other half of this is that if you do something we're going to figure out quickly with you. What happened, how did it happen that way, it gets back on to a commitment to abstinence and at the same time, activate skills that will teach you for how to make that relapse not be very damaging, and be something you can get out of. So it's a back and forth thing. It's not actually that unusual when you get in an airplane, for instance, you will make the we all make the assumption we're not going to crash. That's the abstinent orientation to flying.
But they also give us instructions before we take off of all the things you will do if there is if if we crash. So that's like a harm reduction approach.
Next one, clear mind me just go over that this is another dialectical idea. If you know the mindfulness skills, it looks a lot like the mindfulness skills that has emotion mind, on one hand, rational or reason Mind on the other hand, and then why is mind in the middle? here though it's a little different, it's an addict mind. On one side, clean mind on the other side and then clear mind in the middle, you want to aim for clear mind access where activate, clear mind, what is that?
Well addict mind means that you are, your mind is driven by the addiction, the way emotion mind means your mind is driven by emotions, it's driven by the addiction, if you are in an addiction, and you're in the active stage of an addiction, you are usually either in the process of acquiring a drug, or getting to your addiction, or you're using or engaging, or you're in the process of the aftermath of engaging or using In which case, you might not be quite your best self either.
And then you cycle back into looking for the drug again, searching. So your life is dominated and your lifestyle becomes dominated by your addiction, everything starts to get wrapped around your biological addiction, clean, and then you're caught in that clean mind, on the other hand, is when you're not using or you're not engaging. And you're saying I'll never do it again. And it's it's irrational will willpower approach to this is I that's my last drink, that's my last drugs, that's the last time I'll engage in that addiction it's over, it's very rational minded, it's very clean cut. The only problem with it is that it's probably not true, and helps you to ignore that you could just be an inch away or around the corner from engaging in your addiction again. And so clean mind as a risky mind, because you're ignoring or denying what the people around you probably know about you.
And addict mind, of course, it's problematic. So what you want to get to is clear mind and clear mind is this place where you are clean, you're appreciating being clean, you're doing the hard work of being clean. And at the same time, you're aware that addict mind is just a phone call away. It's just a walk away. It's just right there. And so as long as you remember that you're not naive, you're not overly rational, you do see the power of the addiction, and you act accordingly.
Okay, next one, community reinforcement, community reinforcement. This just acknowledges the power of one's community that that will power is fine and dandy, but our behavior is driven strongly by our social settings by our communities. And so when you are an addict, about something, you pretty much seek out and live in a community that reinforces the addiction. One way or another you all the things you have the things you do that people you see the activities that you do, keep reinforcing the addiction. And so the idea is to try to pay attention to that deliberately. And notice how it will be for you to develop a community around you that reinforces abstinence.
So you need people that reinforce abstinence, you need activities, that are pleasurable without using your addiction, that reinforce abstinence, right you need things around you that reinforce apps seem to make decisions that reinforce abstinence. And you you need to as it puts in in this page, replace addiction reinforcers with abstinence reinforcers.
So you really go through this systematically for as a group, and then for each person figuring out what does this mean?
Next skill, burning bridges, and building new ones. These are two different skills actually related to the same concept, which is that when we are addicts, we do have strong bridges to our addiction through all kinds of things. So burning bridges is to recognize that the most radical level that if you're not going to use again, you're not gonna engage again, then you need to actively cut off all addictive behavior options.
You might need to stop and do an inventory, a list of things that make addiction possible.
Things that are connected to the addiction and then get rid of those things, whether it's contact information of people who are part of your addiction, get rid of all the possible cues for addiction. Anything you have around your house, your apartment, your car places you go. No you don't want anything around you that is a cue that reminds you and triggers the addictive feelings which then can take over More than you know, and list, part of this is to listen to everything you can, that's going to make it harder impossible to do it. And to be sort of ruthless about this, I mean, you beyond what you feel you might feel, well, I don't really need to do that, like, I can walk by that bar and not go in there.
This approach means you're going to burn the bridges, you're not going to walk up in front of the bar, even if it's the quickest way to get where you're going, you're going to find another way. And you're going to tell the people around you who care about you that you have quit, and you want them to reinforce you quitting. So you're burning bridges to these things. And you're trying to build new bridges to things that are non addictive stimuli. S
That includes images of things and smells of things. So that when a an addictive, memory, addictive image and addictive smell or urge comes across your consciousness, that you try them to see that that's going on and replace it with an image or a thought or as even a smell of something that's completely unrelated to your addiction, like what's the smell of being at the beach, a nice beach, and so that it helps move you in that direction, and build new bridges.
Urge Surfing is brought into this skill, which is an imagery of riding a surfboard, on the waves of your urges, noticing the urge come and go and you can still ride atop those without having to fall into them.
Alternate rebellion and adaptive denial to different skills.
Alternate rebellion is just based on the idea that some people's addictions not everybody, but some people's addictions have within them as a factor, a component of rebelling against authority against a certain person against society against the family.
And that's sort of part of the addiction is one of the functions the addiction is to rebel.
So rather than fight that, accept that you rebelling accept that you may want to rebel that you may need to rebel. And find alternate ways to rebel that are not part of an addiction that are not damaging, you know, be a pain in the ass. Be a beer reverent, wear weird clothes, shave your head, wear your clothes inside out, get a tattoo or a piercing if you feel like a dye your hair some while. color paint your face do do things that are noticeably rebellious.
Not just silly things either. It depends on the nature of your rebelliousness, rather than involving your substance use and rebelling.
And then adaptive denial. The other one is sort of a trick you play on your mind that you you're having a craving for your addictive behaviors, and you try to trick your mind.
Let logic go out the window for right now, because it's gonna sound a little weird. But when those urges to use or engage, hit, deny that that's actually what you want to say yourself. No, that's not what I really want.
As an example here, for example, reframe an urge to have a cigarette as an urge to have a flavored toothpick. And try to say that to yourself, convince yourself an urge, have alcohol as an urge to have something sweet, an urge to gamble as an urge to use alternate rebellion, and so on and keep putting off the addictive behavior using adaptive denial to keep yourself thinking that what you want is actually something like I say,
These skills are add ons to standard DBT. And in particular, to this module when you're treating someone with an addiction, and they become very important, if that's primarily what you're doing if you're doing DBT for substance use disorders, in which case, there's many things about the treatment that you modify.
And this is one of them, and you teach all the skills in the manual with an eye to what's the value of this skill in the context of addiction.
Okay, that's it for the distress tolerance skills.
I hope you enjoy these and find it useful to be introduced this way even though you've got way more information in the manual. Okay. Adios. Bye.
