Mate's Method and More for Dealing with Addictive Impulses

A participant in an online forum asked, "Is there anything you tell yourself to delay using on a taper schedule (or when completely sober and thoughts of using pop up)? Any mantras?" I answered...

Big time addiction expert Gabor Mate (pronouced "Mah-TAY") teaches a five-step method for this in his book, In the Realm of Hungry Ghosts:

1. Relabel the thought or urge to use as just a thought or urge and not any sort of accurate appraisal of actual reality.
2. Reattribute that thought or urge as nothing more than a product of what goes on in the conditioned, (possibly) in-doctrine-ated, instructed, socialized, habituated, normalized and neurally “hard-wired” default mode network in the addict's mind / brain.
3. Refocus onto a healthy distraction to give the neuroemotional energy of the urge time to dissipate... because it almost always will. (Marsha Linehan came up with this thirty years ago for the hyper-emotional victims of childhood trauma who tend to be intense reactors to triggering and addicts of one sort or another.)
4. Revalue or, actually, DEvalue the long-term consequences of rewarding and reinforcing the addiction process like poverty, wretched lifestyle, increased violence, broken relationships, wrecked careers, etc.
5. Recreate a scenario of a life that is less stressful and more comfortable.

I doubt if either Mate or Linehan would have predicted they'd be partners in solving the problem addressed in the material at the link immediately below, but they are widely regarded as the "match made in heaven" among many I know in the professional addiction and trauma treatment biospheres.

Will the Addict Ever Stop Using SOMETHING if He or She remains Depressed, Anxious & Belief-Bound?

Or that they would be the leaders of a movement that is loudly questioning the at-least-50-year-old staple of treating the two issues separately and in chronological order of addiction first, trauma second. But another big name in the field, Pia Mellody began to move in that direction in the late 1980s when she saw how many substance abusers were dangerously codependent, overly peer-influenced survivors of some form of child abuse.

I've been on board with Linehan and Mellody since the late '90s, and with Mate for the last several months due to several Reddit posts made here and elsewhere by those already familiar with his work. Low and behold, the dots seem to connect quite nicely, at least for me.

All that said, Mate's method seems to be more applicable to those at the third, fourth and (especially the) fifth of the five stages of therapeutic recovery adapted from Prochaska, DiClemente & Norcross in A Basic Addiction References List. So what can one do aside from find an expert in Miller & Rollnick's "motivational enhancement," which isn't that difficult nowadays, although -- IME -- that method is difficult for those are still in the first two stages of those five to grasp and master.

While I was already into the fifth of those stages relative to substance abuse when I hit the wall on another form of addiction a few years ago, I was able to use this mnemonic system to deal what had been a very dense default mode network around that addiction matrix. And one doesn't really have to have any more than the first six of those "down" experientially to get effective results, at least at first.

In my experience, however, it is also crucial to get involved in Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Marijuana Anonymous, Pills Anonymous or SMART Recovery as soon as possible. And to find a detox on the SAMHSA website if necessary. 

The Drama of the Gifted Child gone Hyper-Achiever, Hero &/or Rescuer

Responding to a Redditor who wrote, "I only 'love' myself when I achieve things that people admire me for," I wrote...

IME with many young adults who were precocious intellectual children (see Claudia Jankech's groundbreaking article for sure, for sure), the fast-processing but highly sensitive child in distressing circumstances often becomes the family's "duty rescuer," "golden child" or "responsible hero."

In serious, truly "committed & active" recovery since 2003, and with a lot of schooling and research, I've been able to see that Richard Schwartz's Internal Family Systems Model makes total sense, at least for me.

My mind was conditioned, in-doctrine-ated, instructed, socialized, habituated, normalized and neurally “hard-wired” to Learned Helplessness, Dread & the Victim Identity very early on, beginning to develop a case of compensatory narcissism at about 15. My brain's default mode network became so infested with that stuff that pretty much any other way of perceiving, believing and acting accordingly was blown out save for periods of extreme (often totally debilitating) anxiety and depression. But after those periods, the compensatory narcissism would reassert itself even more densely.

After plowing through about 90% of what's in this earlier post from 1984 to 2013, I stumbled onto this stuff and this concept and began to understand what Schwartz was really talking about: My crushed ego had gone severely codependent and created a "protector" scheme I not only used on that ego, I used it as did so many others in the "helping professions" to put others on Karpman Drama Triangles so that my ego could "rescue" them and feel good about itself.

In time I was able to begin to Dis-I-dentify with Learned Helplessness & the Victim I-dentity (see also not-moses's answers to a replier's questions there) and have made a lot of progress into being able to use an "observing self" to spot the addiction (because, neurobiologically, it is that), get immediately into "de-shaming" via 10 StEPs of Emotion Processing, and yank myself out of that I-dentity at least some of the time, more or less in the fashion described by addiction whizbang Gabor Mate in his book, In the Realm of Hungry Ghosts. The yanking does not produce a permanent exit from LH&VI, but can be used as often as necessary to do so.

Over time, the general urge to rescue to be significant and admired in that default mode network is increasingly -- albeit slowly -- diminished via neuroplastic reconstruction, and far more quickly quashed when it is noticed, recognized, acknowledged, accepted, owned and appreciated. But, as they say in AA, it's been a case of "progress, not perfection" and "God is faithful, but He's slow."

John Bradshaw's, Merle Fossum's, June Tangney's, and (especially) Gershen Kaufman's books on the treatment of shame were helpful, along with so many others in A CPTSD Library. Alice Miller's The Drama of the Gifted Child may also be worth a look.

Connecting more Dots: "Lack of power was my dilemma."

It's a grind one hears over and over again in AA meetings.

I was shown by so many around me that one should be frustrated, resentful, angry and rageful when life didn't go the way the way they had been conditioned, in-doctrine-ated, instructed, socialized, habituated, normalized and neurally “hard-wired” to believe it should. I didn't get the toy or the Levis or the place on the team or the girl or the job or the car or the home or the respect from others I had been taught to believe I should get.

Others got righteous. They ranted and railed in their frustration, resentment and anger. They raged. Why shouldn't I?

So I did.

Others drank and used drugs and drove too fast and got in fights and wrecked relationships and lost jobs and got divorced and wound up on the streets or in the joint or psych hospital and became pariahs to their friends and families. They raged. Why shouldn't I?

So I did.

Others "caught" nasty cases of mania, depression and anxiety causing them to suffer with all kinds of physical aches and pains the pshrinques of a generation ago called "factitious," "psychosomatic" and "conversion" disorders. Why should't I?

And I did.

Others came down with Complex Post-Traumatic Stress Disorder from decades of battering their brains and bodies with the untreated results of having been trained to believe that reactive rage was the best way to deal with life's injustice. They got stuck in the "justice fallacy." Why shouldn't I?

And I did.

Others wound up with "issues" like sleep disorders, tinnitus, irritable bowel syndrome, gastric ulcers, peripheral neuropathy, vaginismus, prostate swelling and forms of cancer rarely seen until reactive self-stress began to be an epidemic about 75 years ago. Why shouldn't I?

And I did.

Others did the time for someone else's crimes. Why shouldn't I?

And I did.

For decades. Until I learned finally learned that "lack of power was my dilemma" and that righteous rage is a luxury I just can't afford anymore.

I hope it's not too late.

Resources (Just read the titles? Couldn't hurt.)

Agarwal, N.: fMRI Shows Trauma Affects Neural Circuitry, in Clinical Psychiatry News, Vol. 37, No. 3, March 2009.

Andersen, S.; Teicher, M.: Desperately Driven and No Brakes: Developmental Stress Exposure and Subsequent Risk for Substance Abuse, in Neuroscience of Behavior Review, Vol. 33, No. 4, April 2009.

Antoniak, S.: Inmates with PTSD have higher scores for mood, anxiety, somatoform, substance use, psychotic, eating, conduct, and adjustment disorders, in Clinical Psychiatry News, Vol. 38, No. 1, January 2010.

Arsenault, L.; et al: Being Bullied as an Environmentally Mediated Contributing Factor to Children’s Internalizing Problems…, in in Archives of Pediatrics & Adolescent Medicine, Vol. 162, February, 2008.

Bandura, A.: Self-Efficacy: The Exercise of Control, San Francisco: W. H. Freeman, 1997.

Beck, A.: Prisoners Of Hate: The Cognitive Basis of Anger, Hostility, and Violence, New York: Harper-Collins, 1999.

Benson, H.: The Relaxation Response, New York: Morrow, 1975.

Berger, P.; Luckman, T.: The Social Construction of Reality: A Treatise in the Sociology of Knowledge, New York: Doubleday, 1966.

Brach, T.: Radical Acceptance: Embracing Your Life with the Heart of a Buddha, New York: Random House / Bantam, 2004.

Brown, B.: I Thought It Was Just Me: Telling the Truth About Perfectionism, Inadeqacy and Power, New York: Gotham Books, 2007.

Burgo, J.: Why Do I Do That?: Psychological Defense Mechanisms and the Hidden Ways they Shape our Lives, Chapel Hill, NC: New Rise Press, 2012.

Burrow, T.: The Social Basis of Consciousness, New York: Harcourt, Brace, 1927.

Carter, S.: The Tell-Tale Signs of Burnout: Do You Have Them?, in Psychology Today online, November 2013.

Centers for Disease Control and Prevention: The Effects of Childhood Stress Across the Lifespan, Atlanta, GA: CDC, 2008.

Chodron, P.: Taking the Leap: Freeing Ourselves from Old Habits and Fears, Boston: Shambala, 2010.

Courtois, C.: It's Not You: It's What Happened to You: Complex Trauma and Treatment, Dublin, OH: Telemachus Press, 2014.

Damasio, A.: The Feeling of What Happens: Body and Emotion in the Making of Consciousness, New York: Harcourt, 1999.

Deikman, A.: Personal Freedom: On Finding Your Way to the Real World, New York: Bantam, 1976.

Deikman, A.: The Observing Self: Mysticism and Psychotherapy, Boston: Beacon Press, 1982.

Dyer, W.: Your Erroneous Zones, New York: Avon Books, 1977, 1993.

Earley, J.: Self-Therapy: A Guide to Using IFS, 2nd. Ed., Larkspur, CA: Pattrern System Books, 2009.

Ellis, A.: Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy, New York: Promethius Books, 2001.

Engel, B.: The Emotionally Abusive Relationship: How to Stop Being Abused and How to Stop Abusing, Hoboken, NJ: John Wiley & Sons, 2002.

Fink, P.; Luk, J. et al: Positive association between victimization by bullies and substance abuse, in Clinical Psychiatry News, Vol. 38, No. 6, Jun. 2010.

Freud, A.: The Ego and the Mechanisms of Defense, London: Hogarth Press and Institute of Psycho-Analysis, 1937.

Goffman, E.: The Presentation of Self in Everyday Life, New York: Doubleday-Anchor, 1959.

Goleman, D.: Emotional Intelligence, New York: Bantam, 1980. mindfulness

Goleman, D.: Vital Lies, Simple Truths: The Psychology of Self-Deception, New York: Simon & Schuster, 1985.

Herten, J.: An Uncommon Drunk: Revelations of a High-Functioning Alcoholic, New York: iUniverse Inc., 2006.

Herten, J.: The Sobering Truth: What You Don’t Know Can Kill You, San Luis Obispo, CA: Sobering Truth Press, 2010.

McEwen, B.; Seeman, T.: Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic load, in Annals of the New York Academy of Sciences, Vol. 896, 1999.

McEwen, B: Mood Disorders and Allostatic Load, in Journal of Biological Psychiatry, Vol. 54, 2003.

McEwen, B.; Lasley, E. N.: The End of Stress as We Know It, Washington, DC: The Dana Press, 2003.

Sapolsky, R.: Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases and Coping, 3rd Ed., New York: Holt, 2004.

Selye, H.: Stress Without Distress, Philadelphia: J. B. Lippencott, 1974.

Wilson, B.: Alcoholics Anonymous, New York, A. A. World Services, 1939, 1955, 1976, 2001.

Wilson, B.: Twelve Steps and Twelve Traditions, New York: A. A. World Services, 1951.

Wilson, B.: The Best of Bill: Reflections on Faith, Fear, Honesty, Humility and Love, New York: A. A. Grapevine, 1986.

Wolpe, J.: Psychotherapy by Reciprocal Inhibition, Palo Alto, CA: Stanford University Press, 1958.

Wolpe, J.; Wolpe, D.: Life Without Fear: Anxiety and Its Cure, Boston: Houghton Mifflin, 1981, and Oakland, CA: New Harbinger, 1987.

Workbooks Specifically on Anger Processing

Abramowitz, J.: the stress less workbook: Simple Strategies to Relieve Pressure, Manage Commitments and Minimize Conflicts; New York: The Guilford Press, 2012.

Block, S.; Block, C.: Mind-Body Workbook for Stress: Effective Tools for Lifelong Stress Reduction & Crisis Management, Oakland, CA: New Harbinger, 2012.

Block, S.; Block, C.: Mind-Body Workbook for Anger: Effective Tools for Anger Management & Conflict Resolution, Oakland, CA: New Harbinger, 2013.

Chapman, A.; Gratz, K.: The Dialectical Behavior Therapy Skills Workbook for Anger, Oakland, CA: New Harbinger, 2015.

Eifert, G.; McKay, M.; Forsyth, J.: ACT on life not anger: The New Acceptance & Commitment Therapy Guide to Problem Anger, Oakland, CA: New Harbinger, 2006.

McKay, M.; Rogers, P.: The Anger Control Workbook: Simple, innovative techniques for managing anger and developing healthier ways of relating; Oakland, CA: New Harbinger, 2000.

McKay, M.; Rogers, P.; McKay, J.: When Anger Hurts: Quieting the Storm Within, 2nd Ed., Oakland, CA: New Harbinger, 2003.

McKay, M.; Fanning, P.; Ona, P. Z.: Mind and Emotions: A Universal Treatment for Emotional Disorders, Oakland, CA: New Harbinger, 2011.

Simpkins, C. A.; Simpkins, A. M.: The Tao of Bipolar: Using Meditation & Mindfulness to Find Balance & Peace, Oakland, CA: New Harbinger, 2013.

Stahl, B.; Goldstein, E.: A Mindfulness-Based Stress Reduction Workbook, Oakland CA: New Harbinger, 2010.

Van Dijk, S.: The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life, Oakland, CA: New Harbinger, 2009.

Van Dijk, S.: Calming the Emotional Storm, Oakland, CA: New Harbinger, 2012.

When the Memories & Affects Start to Break Through

While I do want to tread cautiously for those who are still "tender & triggerable," the memories of the traumatic event and the affects (roughly "sensations and emotions") attached thereto will start trying to "break through" into consciousness. Which is what tends to happen in the second of the five stages of therapeutic recovery after the various defense mechanisms like manic rat racing, repression or even dissociation begin to sort of "wear out" the autonomic nervous system through prolonged overuse of the Fight / Flight / Freeze / Faint / Feign (or Fawn) Responses.

If I had had a better understanding of all that and the exposure therapies -- as well as how to tolerate them -- back in the '90s when I was doing everything I could to "outrun" the memories and affects the best way I knew how, I'd have dived far more deeply into that sort of thing then and there. But a) I didn't at the time, and b) it was probably just as well, even if it was very costly.

The post-millennial advances in both the techniques of exposure and the techniques of preparing patients to tolerate the temporary increases in anxiety that can occur in exposure therapy since then are considerable. Of the therapies listed in section 7c of this earlier Reddit post (skip all the borderline personality disorder stuff unless it seems relevant), DBT was the first to formalize such preparation (via "grounding" more or less this way) by using the methods developed in the therapies listed in section 7b of that same earlier post. Since then, SEPt and SP4T (for my money, the best deal out there because it is the most firmly rooted in autonomic physiology, but "results may vary," of course) have come along, and EMDR has added a pre-exposure grounding protocol.

One can be assisted by adroit use of the therapies in sections 7a and 7b to get firmly into the third of those five stages. From which, of course, stage four is then pretty much fully accessible. The end of section seven, btw, gets into how to locate therapists who are familiar with the people listed in the very first paragraph of that same earlier post, which, IMO, is really a necessity for trauma survivors.

For a sort of "review" of all this, see A Recovery Program for Someone with Untreated Childhood Trauma and How Self-Awareness Works to "Digest" Emotional Pain.

Additionally useful, from a personal body of experience: The 10 StEPs + SP4T.

References & Resources (see the continuously updated list in A CPTSD Library)