The Psychology of No – Why It Causes Problems for Addicts

Posted under Addiction Treatment on September 9, 2009

Think about what it means to say no. Of course, no is the opposite of yes, but there’s a lot more to it than that. To say no implies a choice – and just as much of a choice as if you say yes. Many of us have trouble saying no. But when someone is addicted to alcohol or drugs, saying no is next to impossible. What is it about the psychology of no that causes so much trouble for addicts?

No Is a Difficult Choice For Addicts

In order to make rational and logical choices, the human brain needs to function at optimal levels. It can’t be clouded by a fog due to impaired memory, blackouts, brownouts, or cells damaged beyond repair as a consequence of sustained drug and/or alcohol abuse. When you can’t even remember what happened yesterday, or last week, or last year, how can you recognize the difference between good and bad choices, let alone make an intelligent decision? Although the dilemma may not be verbalized by an addict, the fact is they are simply not able to overcome conditioned cues to using alcohol and drugs. Instead of saying no, they say yes.

Addicts Will Never Say No Without Treatment

Unless an alcoholic or drug addict enters treatment, they will never be able to say no. Even if the will is somehow there, the brain and the body will not obey. Cravings for drug and alcohol, rooted in the brain’s pleasure center, combine with impaired cognitive ability, lack of impulse control, poor judgment and other factors to defeat any attempt to abstain from alcohol or drugs.

Studies have shown that persons who undergo detoxification from alcohol and/or drugs and do not go on to receive rehabilitative treatment go right back to their pre-detox patterns of alcohol and drug abuse.

Medications can be used during detoxification to help minimize the sometimes severe withdrawal symptoms and reduce or eliminate cravings. During the detox period, the patient learns about addiction, and some of the triggers that cause them to use. The glimmer of hope is faintest at this point, but it is there. If they persist in their treatment, they have the potential positive outcome of being clean and sober – and able to say no.

• In the case of alcohol addiction, medications allow brain cells to readapt to a normal nonalcoholic state. This helps the patient to stabilize, be able to think more clearly, enhance their self-esteem, be more receptive to positive emotional responses, helps strengthen their coping mechanisms, and increases their motivation to change.

Medications are also useful in many cases post-detoxification as a means of preventing relapse as cravings occur weeks and even months after quitting alcohol and/or drugs.

Treatment Techniques to Help The Addict Say No – And Mean It

After alcohol and drugs are removed from the body during detox, the addict typically enters the next treatment phase. This generally involves a multi-disciplinary approach using a variety of therapeutic techniques.

Treatment varies depending on the type of substance abused, the length of time the addict has been abusing, the age of the patient, general health and other factors. Treatment also varies from one facility to another, but all are tailored specifically to the individual. There is no one-size-fits-all treatment program. Some treatment programs address the needs of young people, while others are designed specifically for the older patients who may have prescription drug abuse problems.

There are specific treatment protocols that have proven very successful in treating alcohol and cocaine abusers. Treatment for methamphetamine addicts is very difficult and currently evolving. Since meth is a stimulant, some of the medications that have worked with cocaine addiction may prove helpful in treatment for methamphetamine abuse. Research is also underway through the National Institute on Drug Abuse (NIDA), which has established the Methamphetamine Clinical Trials Group (MCTG). This network, designed to provide new clinical research teams west of the Mississippi in areas where meth use is of greatest concern, will work on the development of new medications specific to methamphetamine addiction treatment.

• Matrix Model – With funding support from NIDA, the Matrix approach was developed in Southern California by the Matrix Institute on Addictions. The approach combines various elements of treatment: positive reinforcement techniques, cognitive-behavioral therapies, relapse prevention, motivational interviews, individual counseling, psychoeducational learning, 12-step efforts and regular urine testing. The approach involves individual and group meetings 3 times per week over a period of 16 weeks and is followed by 36 weeks of continuing care support and participation in 12-step meetings. Over the past 20 years, more than 15,000 cocaine and meth users have been treated with the program.

• Behavioral Therapies – These help patients to cope with drug cravings as they participate in drug treatment. The drug may be street or prescription or alcohol. The patient’s underlying causes for their behavior are examined. The patient learns ways to avoid drugs and to prevent relapse, and what to do should relapse occur. Behavioral therapy also works in helping to improve relationship, parenting skills and communication, as well as family dynamics.

• Medications For Alcohol Abuse Prescribed By Medical Practitioners – Since cost and other considerations (social stigma, employment concerns, lack of family support, etc.), may make inpatient alcohol treatment programs impractical, treatment from a medical practitioner may be a viable alternative. The Treatment Improvement Protocol series has been developed to aid medical practitioners in providing medicated assistance for persons with alcohol use disorders. This program supports the mission of the Substance Abuse and Mental Health Services Administration (SAMHSA) to promote recovery for people who are at risk of substance abuse. The medications are approved by the Food and Drug Administration (FDA) and include acamprosate (Campral), disulfiram (Antabuse), oral naltrexone (ReVia and Depade), and extended-release injectable naltrexone (Vivitrol).

The Goal of Treatment for Addiction

Whatever the type of treatment program, the end goal is always the same: Treatment seeks to enable the patient to return to society and live a clean and productive life. It helps foster the ability for the individual to be able to say no to drugs and/or alcohol, to say no to former drug and alcohol-abusing friends, to say no to a downward spiral of pernicious drug cravings and use. It also gives the individual the strength to recognize that if relapse does occur (according to NIDA statistics, 40 to 60 percent of addicts relapse), it isn’t a failure. It only means they need to redouble their efforts to again be able to say no. Continuing aftercare support and participation in 12-step meetings is critical to maintaining an ability to say no.