
	Recovery Strategies Update Titles Recovery Strategies Update # 6: The Definition of Alcohol Dependence Recovery Strategies Update # 5: Developing Spirituality Recovery Strategies Update # 4: Goal Setting for Recovery Recovery Strategies Update # 3: Working a Program of Recovery Recovery Strategies Update # 2: Abstinence Recovery Strategies Update # 1: The Process of Recovery Recovery Strategies Updates Recovery Strategies Update # 6 The Definition of Alcohol Dependence by Stephen T. Skiffington, Ph.D. quitdrinking.com Alcohol dependence, also known as alcoholism, has been defined in many ways. A brief search on the Internet of "alcohol dependence" will provide numerous definitions within minutes. In the United States, the most widely accepted definition of alcohol dependence is the definition described in the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) which was published in 1994. In the DSM-IV, alcohol dependence is a clinical diagnosis. In the United States, the DSM-IV is used by substance abuse professionals as well as mental health professionals to determine whether or not a person is alcohol dependent. According to the DSM-IV, the criteria for diagnosing substance dependence, including alcohol dependence, follow: "A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: 1. Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect. (b) markedly diminished effect with continued use of the same amount of the substance. 2. Withdrawal, as manifested by either of the following: (a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances). (b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms. 3. The substance is often taken in larger amounts or over a longer period than was intended. 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use. 5. A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from it effects. 6. Important social, occupational, or recreational activities are given up or reduced because of substance use. 7. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)." If a person in the United States has been officially diagnosed as having the diagnosis of alcohol dependence, then it is highly probable that the aforementioned DSM-IV criteria for substance dependence relevant to alcohol were used to justify making this diagnosis. Copyright © 2007 Stephen T. Skiffington, Ph.D. Recovery Strategies Update # 5 Developing Spirituality by Stephen T. Skiffington, Ph.D. quitdrinking.com Long-term abuse of alcohol and/or drugs results in deeply ingrained selfishness. The essence of selfishness is a "me-orientation" which takes the position that "my wants and needs are the priorities". Selfishness perpetuates the abuse of alcohol and/or drugs. Anything that helps the recovering addict decrease selfishness will help the addict in his or her recovery. Developing spirituality decreases selfishness and thus is a recommended strategy for achieving recovery. Spirituality is defined here as thinking and behaving in a manner consistent with the view that something "greater than oneself" exists. This definition of spirituality does not require that a person believe in God although a belief in God is compatible with it. Spirituality will result in a certain amount of humility which is an ingredient for a successful recovery from active addiction to alcohol and/or drugs. Self-help recovery organizations such as Alcoholics Anonymous and Narcotics Anonymous encourage recovering addicts to develop and use a "Higher Power" which is a spiritual concept and is of tremendous value to recovering addicts. A Higher Power can be anything viewed as being greater than oneself that helps the recovering addict abstain from alcohol and/or drugs. An addict's Higher Power could be God, a church group, a self-help recovery group such as Alcoholics Anonymous or Narcotics Anonymous, a sponsor, a therapy group, a family, a loved one, or a multitude of other possibilities. Thus, for the addict who wants to increase his or her probability of achieving recovery, it is recommended that he or she develop a spiritual perspective, identify and use a Higher Power, and become humble. More generally, developing a spiritual perspective, identifying and using a Higher Power, and becoming humble are recommended coping strategies for everyone including people who are not addicted. Copyright © 2007 Stephen T. Skiffington, Ph.D. Recovery Strategies Update # 4 Goal Setting for Recovery by Stephen T. Skiffington, Ph.D. quitdrinking.com Many people have never learned the value of setting goals. Without goals, we are likely to make limited progress in life. Living without goals is like sailing a ship without a rudder. The ship will be directionless. A lack of goals can result in us moving in a negative direction. Goals give us direction in life and positive goals give us a positive direction. For the person addicted to alcohol and/or drugs, the recommended overall recovery goal should be total permanent abstinence from alcohol and drugs. To achieve this overall recovery goal, it is recommended that the following more specific recovery goals should be established by every recovering addict: 1. Developing and using a chemical-free support system. 2. Identifying and getting more involved in chemical-free activities. 3. Learning and using relapse prevention strategies. It is extremely important that the recovering addict develop and use a chemical-free support system because to achieve recovery the addict should minimize the degree to which he or she associates with users and should maximize the degree to which he or she associates with people who are supportive of recovery. Simply put, associating with users will make relapse more likely and associating with people who are supportive of recovery will make abstaining more likely. It is also extremely important that the recovering addict identify and get more involved in chemical-free activities which is true for a variety of reasons. First, when an addict stops drinking and/or stops using drugs he or she will have a lot of free time which needs to be put to good use to avoid boredom which could cause the addict to return to drinking and/or using drugs. Second, the recovering addict should avoid activities which he or she associates with using alcohol and/or drugs that could trigger a craving to use. Third, the recovering addict should engage in chemical-free activities in order to create new chemical-free habits and to generate positive emotional chemical-free experiences that will help the recovering addict continue to abstain from alcohol and/or drugs. Recovering from alcohol dependence and/or drug dependence is far from easy and to achieve it the recovering addict needs to learn and use specific strategies for preventing a return to drinking and/or drugging. Relapse prevention needs to include learning and using strategies for overcoming cravings for alcohol and/or drugs which every recovering addict will face and which have the potential for triggering the recovering addict to return to drinking and/or drugging. Relapse prevention also needs to include learning and using drink and drug refusal skills. In summary, total permanent abstinence from alcohol and drugs is the recommended goal for the addict. In order to achieve total permanent abstinence from alcohol and drugs, the recovering addict should develop and use a chemical-free support system, identify and get more involved in chemical-free activities, and learn and use relapse prevention strategies. Copyright © 2007 Stephen T. Skiffington, Ph.D. Recovery Strategies Update # 3 Working a Program of Recovery by Stephen T. Skiffington, Ph.D. quitdrinking.com I have worked full-time as a clinical psychologist since '83, and during this time I have had the opportunity to work with thousands of people addicted to alcohol and/or drugs. Based on my experience with thousands of recovering addicts, I have been very impressed with the value of working a program of recovery in a self-help recovery organization such as Alcoholics Anonymous or Narcotics Anonymous as an effective method for abstaining from alcohol and/or drugs. In fact, if an addict would ask me what single most important recommendation I could make to help him or her maintain long-term abstinence from alcohol and/or drugs, then I would say work a program of recovery in a self-help recovery organization such as Alcoholics Anonymous or Narcotics Anonymous. Working a program of recovery involves more that simply attending multiple self-help recovery meetings on a weekly basis. Working a program of recovery involves the following: 1. Attending multiple self-help recovery meetings on a weekly basis. 2. Obtaining, reading, and studying the basic text of the self-help recovery organization such as the Alcoholics Anonymous "Big Book" or the Narcotics Anonymous "Blue Book." 3. Learning and working the self-help recovery organization's Twelve Steps. 4. Getting and using a sponsor in the self-help recovery organization. 5. Learning and practicing the self-help recovery organization's many strategies for achieving recovery and preventing relapse. 6. Developing and using a Higher Power. If a person sincerely works a program of recovery from addiction to alcohol and/or drugs as outlined above, then he or she will definitely increase his or her probability of achieving long-term abstinence from alcohol and/or drugs. More generally, if a person sincerely works a program of recovery from addiction to alcohol and/or drugs as outlined above, then he or she will become a much healthier person psychologically. In fact, working a program of recovery as outlined above can actually enable an addict to become healthier psychologically than he or she would have been had he or she never become addicted to alcohol and/or drugs in the first place. Copyright © 2007 Stephen T. Skiffington, Ph.D. Recovery Strategies Update # 2 Abstinence by Stephen T. Skiffington, Ph.D. quitdrinking.com After the addict begins to understand that the use of the substance has caused significant problems and that something must be done to correct the problem, the usual response is for the addict to try to control the use of the substance. However, the addict will find it impossible to accomplish this goal. The attempt to accomplish this goal indicates that the addict fails to understand the nature of addiction and the severity of his or her substance abuse problem. The essence of addiction or substance dependence is a loss of control over the use of the substance and once a person becomes dependent on a given substance the controlled use of the substance is an unachievable and misguided goal. Many addicts spend the rest of their lives attempting, without success, to control the use of their substance of choice and while doing so they will continue to experience problems caused by the abuse of the substance. The appropriate and recommended goal for addicts is abstinence from the substance. Initially, abstinence is usually not an acceptable goal for the addict who has begun to realize that the use of the substance is causing problems and has begun to realize that something must be done to correct the problem. Many of these addicts eventually develop the understanding that abstinence is the appropriate goal but many of them never will. Making abstinence the goal is the third step in the process of recovery. Understanding by the addict that the use of the substance has caused significant problems is the first step and understanding that something must be done to correct the problem is the second step. Making abstinence the goal does not guarantee that the recovering addict will accomplish it but making this the goal is part of the recovery process for those addicts who eventually do achieve a complete recovery from addiction. Copyright © 2007 Stephen T. Skiffington, Ph.D. Recovery Strategies Update # 1 The Process of Recovery by Stephen T. Skiffington, Ph.D. quitdrinking.com The essence of addiction to alcohol and/or drugs is a loss of control over the use of the substance. This loss of control leads to unmanageability in a person's life. Addiction results in physical, psychological, behavioral, spiritual, and social problems. The good news is that recovery from addiction is possible although not easy. Recovery from addiction involves more than not using the substance. It involves making a multitude of changes in one's thinking and behavior. The first step in the process of recovery from addiction is becoming aware that one has a problem with alcohol and/or drugs. Unfortunately, many addicts never develop this awareness and consequently never stop drinking and/or using drugs. Usually, the awareness that one has a substance abuse problem gradually increases as the problems caused by the addiction increase. The next step in the process of recovery is for the addict to realize that something must be done to correct the problem. Ideally, the addict's awareness of having a substance abuse problem and realization that something must be done to correct the problem will lead the addict to choose abstinence from the substance which is the third step in the process of recovery. After the addict has chosen abstinence as the goal, the next step in the process of recovery is to formulate a plan for achieving abstinence. The next step in the process of recovery is to implement the plan for achieving abstinence. Initially, the addict usually does not formulate an adequate plan for achieving abstinence, but as the addict continues to pursue recovery he or she has the opportunity to realize that a better plan is required in order to be successful. After the initial plan for achieving abstinence is implemented, the next step in the process of recovery is to evaluate how well the recovery plan is working. To the extent that the chosen recovery plan is not working, the recovering addict should revise the recovery plan which is another step in the process of recovery. The process of evaluating the effectiveness of the recovery plan and then revising the recovery plan should continue until the recovering addict achieves long-term abstinence. In fact, the last step in the process of recovery is for the addict to implement a successful plan for achieving total permanent abstinence. Unfortunately, some addicts pursuing recovery never complete this last step. However, it is important to note that even if a given addict who is attempting to achieve recovery never achieves total permanent abstinence from the substance of choice, this addict will be much better off than the addict who never tries to achieve recovery. Copyright © 2007 Stephen T. Skiffington, Ph.D.