Addictive behaviour is by definition incredibly hard to overcome. Although motivation and willpower are important ingredients in recovery from addiction, it takes more than these two ingredient alone to recover. People who struggle with addiction problems are often already motivated to change their lives. Addiction to gambling, drugs, alcohol, pornography, or even the Internet, often causes major problems in life and moves people away from the type of life they would like to live. Even though it might be difficult to muster the motivation to work on an addiction, I always assume that the people I work with are highly motivated to have a better life. That said, what else is needed for people to overcome addiction?
I would argue that another critically important ingredient is behavioral skills. Treatments for addiction often involve helping people with several different types of skills. Some people need interpersonal skills so that they can say no to alcohol and drugs when they really need to. Other people need skills to tolerate and ride out urges and cravings. Still others need skills to effectively manage or regulate their emotions without the use of substances. As it turns out, DBT includes all of these types of skills. Further, the research so far has indicated that DBT is a promising treatment for addiction, particularly among people with borderline personality disorder.
In her new DBT skills training manual, published last Fall (Linehan, 2015), Dr. Marsha Linehan has introduced several helpful new skills for people struggling with addiction. One of these skills is called alternate rebellion. This skill is based on the idea that one of the big draws of addictive behaviour is that it is risky, elicit, and kind of exciting. Engaging and alcohol use, drug use, gambling, and so on, can be a way to rebel against societal conventions. This is not the case for all people, but for some people, being a bit of a rebel is one of the bonuses of engaging in addictive behaviour. For these people, the skill of alternate rebellion involves finding an alternative way to rebel – a way that does not involve harmful addictive behaviour. Some examples might include getting a tattoo, colouring your hair, shaving your head, not bathing, wearing really casual clothes to important meetings, engaging in exciting sporting activities, and so on. The exact form that alternate rebellion takes will be different person to person. The basic idea is that if addictive behavior is filling the need to be a rebel, there are other less harmful ways to be a rebel. More on addiction skills from DBT in a future blog. Alexander L. Chapman, Ph.D., R.Psych.