schemas

Filling the Empty Self

Posted on by alcoholicsguide

In the first part of this two part blog – we looked at how addicts in recovery move from a more negative (perhaps chronically negative) self schema to a more positive recovering self schema and how this now sense of self and the new interrelatedness with others which develops in recovery drives recovery and an increased self empowerment.

The self, via schema, is increasingly positive in outlook, attitude and action. In other words recovery does for the self schema, sense of self, what we could not do for our own selves, our own self schemas. The self and the self schema becomes a vehicle for increasing well being and not further disease and disorder.

It is a vehicle by which we recover.  For me it helped recover the person who I was meant to be, the person who had become so lost to alcoholism for so long. It in some ways introduced me to a person I did not really know and in many ways am still getting to know.

The fascinating thing also is that negative self perception, as we know from previous blogs, generates a brain frequency very similar to thinking about drinking and not similar to drinking itself. We presume a positive self perception does not and this not only does not lead one back to drinking but very much in the opposite direction.

We again cite from the same article as before (1) to demonstrate perhaps how self schema, especially, the recovering self schema, is so vital to recovery for alcoholism.

“….From this perspective, specific disturbances in the underlying structure of the self-concept are considered intermediary factors that serve as important mechanisms that link more distal factors (e.g., genetic factors, family history of alcohol problems) to alcohol
use. A person with a self-concept composed of few positive and many negative and highly interrelated self-schemas would not have the internal motivation necessary to facilitate adaptive behavior. The negative affect stemming from such a self-concept configuration
would be likely to motivate maladaptive
behavior in an attempt to escape the negative self views
(Baumeister, 1990) and “fill up” the empty self (Cushman, 1990).

Persons with a family history of alcohol problems or other risk factors for alcohol problems would be likely to turn to alcohol (versus other types of maladaptive behavior) as a means to escape the negative emotions. A core belief about the self in relation
to alcohol (drinker self-schema) would be likely to form as drinking experience accumulates and similarities across drinking-related incidents are abstracted. Such a drinking-related self-schema
would serve to motivate schema-consistent (drinking)
behavior.
According to the hypothesized model, a person in sustained recovery (long-term abstinence) would have a more well-developed self-concept—one that consists of newly developed positive self-schemas and a recoveryrelated
self-schema. The recovery self-schema is conceptualized
as central to the recovery process as it would serve to motivate schema-consistent (recovery) behaviors.

During the process of recovery, new positive self-schemas are likely to form as a result of new relationships, activities, and involvements. The development of new positive self-schemas would diminish the proportion of negative self-schemas and the overall level of interrelatedness among the self-schemas.

 

How-To-Fill-The-Inner-Emptiness-Of-Addiction-PhysicianHealthProgram

 

TESTING THE THEORETICAL MODEL

… findings provide empirical evidence that (a) young adults with early-onset alcohol dependence have impaired self-concepts that are characterized by many negative self-schemas, a tendency toward few positive self-schemas, and an elaborated self-schema related to alcohol; and (b) young adults in recovery have healthier self-concepts characterized by few negative self-schemas, a tendency toward many positive self-schemas, and an elaborated recovery related self-schema.

If further longitudinal research studies demonstrate that the self-concept configuration that we found in persons with early-onset alcohol dependence contributes to the development of the disorder,
then prevention strategies aimed at children and adolescents
could be beneficial, particularly for those children who are at risk for alcohol problems based on the presence of other risk factors (e.g., familial alcohol problems, conduct problems). More specifically, interventions designed to build a healthy self-concept (by
fostering the development of a diverse collection of positive self-schemas, thereby decreasing the relative proportion of negative self-schemas) may serve as a protective factor that buffers the effects of the more distal risk factors.

 

At the other end of the spectrum, the data from our study suggest that interventions may also profitably focus on fostering the development of a recovery self schema in persons with alcohol dependence. 

…the nature of any recovery related intervention would depend on how ready the person is to change. For a person who does not yet recognize that alcohol is a problem, the goal would not be
to foster the development of a recovery schema but to help him or her identify that drinking is a problem.

One possible way to do this is to assist the person to make associative links across the multitude of negative alcohol-related outcomes so that rather than a series of unrelated incidents, the individual begins to see a pattern of repeated, enduring, and pervasive alcohol-related problems.

…when the individual is able to pull unpleasant alcohol related episodic memories together to identify that he or she indeed has a problem with alcohol. So whereas
assisting the person to increase his or her awareness
of problems with alcohol is consistent with the basic
tenets of motivational interviewing (Miller & Rollnick,
2002), fostering the development of a recovery self schema
is not.

For people who recognize that they have a problem with alcohol or people who are seeking treatment for alcohol problems, one strategy may be to foster the idea that they can be recovering persons— that is, that recovery is possible for them. Fostering communication with other recovering persons and encouraging involvement in recovery-related activities may help to form a recovery-related “possible self”—a future-oriented conception of the self one “hopes to be,” that is, a recovering person.

Imagining the self in the future by developing detailed images of what one would be like in recovery is an important part of this process. Participation in 12-step recovery programs such as Alcoholics Anonymous that explicitly foster the development of a recovery related identity may also be helpful…

In fact, one plausible explanation…for an emerging recovery related self-schema is that the alcohol dependent participants were in a treatment  facility based on such a 12-step recovery program.

 

 

Reference

1. Corte, C. (2007). Schema model of the self-concept to examine the role of the self-concept in alcohol dependence and recovery.Journal of the American Psychiatric Nurses Association, 13(1), 31-41.

Do I still have an “Alcoholic Mind”!?

Posted on by alcoholicsguide

When I first came into recovery I used to get frightened by other abstinent  alcoholics proclaim that they were so glad they did not get the “wet tongue” when they saw alcohol or people drinking alcohol.  I used to feel ashamed as I did have an instantaneous “wet tongue” or mild salivation (Pavlovian response) and still do  years later when I see people drinking alcohol. Is this a “craving” for alcohol, do I still want to drink? Do I still have an “alcoholic mind?“. Did I do my steps properly?

It used to churn me up, these so-called alcoholics who had no physiological response to alcohol-related “cues”.

Part me also thought it was linked to addiction severity, how bad or chronic one’s alcoholism become, how far down the line or how low your rock bottom was? There may some validity in that observation.

It was partly because of mixed messages from alcoholics and from various medical doctors that I decided to take matters into my own hands and do some research into my alcoholic brain.

What I have discovered is that I have an “alcoholic brain” and not a “alcoholic mind” and there is a huge difference. So if there are people out there relatively new to recovery, listen up. For chronic alcoholics there is an automatic physiological response when we see cues such as other people drinking. Mild salivation, quickening heart rate etc. These are automatic, habitual, it happens to us rather than us wanting or willing it to happen. It happens unconsciously without our say so!

If you get a “wet tongue” i.e. you mildly salivate, then this is what happens when you have crossed the line into chronic alcoholism. Loads of studies have shown there is this automatic response and have also shown there is also an attentional bias to alcohol cues. We notice alcohol cues in the environment before anything else. They have a heightened “noticeableness”.

Have ever been in a new town and counted the number of drinking establishments automatically or had a heightened awareness of half drunken bottles of alcohol lying in the street? This is an attentional bias, we notice alcohol related stuff before anything else.

Some researchers in science call this a craving. I disagree. I call this an physiological urge, distinct from craving. I think a craving is more akin to a “mental obsession” about alcohol. Alcohol has only had ‘luring’ effect on me while very emotional distressed or in the early days of recovery I was very scared that  I would drink but, looking back, I never had any desire to.

It is hugely important for recovering persons that we distinguish between urges and craving, in a clear manner that science seems to have been unable to do! Lives can depend on this. We are so vulnerable in early recover that we need sound direction on what is happening to us automatically and what we are encouraging to happen, consciously.

An urge for me is a physiological response to cues, external and internal (e.g. stress). A craving is different but interlinked.

Let me explain. If I have an urge and it becomes accompanied by automatic intrusive thoughts such as a drink would be nice, and maybe a suggestion on where to get this drink, this does not mean I want a drink. It is simply automatically prompted intrusive thoughts, the type of thought I used to get all the time and so became habitual, stored away in an automatized addiction schema or addiction action plan.

If I realize this and simply let these thoughts go, i.e. do not react to them, then they lessen and dissipate altogether.

This is not a craving. I have not consciously and emotionally engaged with these intrusive thoughts (although we often do in early recovery when they scare the life out of us!).

If I consciously engage, emotionally react, to these thoughts either because I want a drink (elaboration of these thoughts as in embellishing a desire state) or the thought scares the life out of me (averse reaction) I can end up in a mental obsession. If in recovery, we try to suppress these thoughts then they will come back stronger than before which will raise  already high stress levels and recruit a whole host of memories of why I should drink, with who, where, and how much I will enjoy it. They will also activate an Alcoholic Self Schema (different to the recovery self schema still being formed in early recovery).  Then I have a memory Hydra effect where attempting to suppress this terrible flowering of desire based memories or to cut off the heads of these thoughts and memories leads to them increasing and increasing.

 

Image

Then there are lots of these memories driving you crazy and scaring the life out of you.  And this is in someone who does not want to drink but wants to remain in recovery!!? The other guy who is embellishing these thoughts is kinda thinking about drinking or toying with the possibility, so but again he is reacting cognitively and consciously to these intrusive thoughts. He is elaborating on them. He is using a different more cognitive part of the brain and a different memory system to those activated when he was simply having unconscious, habitual, automatic intrusive thoughts. He is now involved in this process rather than it simply happening to him.

So what I am saying is that there is no simple urge state that automatically leads to drink. We have to cognitively and emotionally react to it.

In my time in recovery, I have rarely heard of or witnessed  someone lured siren-like by a cue to a drink and when I have it is because he wanted to drink really, was testing their alcoholism, or e was in huge emotional distress and went “to hell with it!”

As we will see in later blogs, stress and cues certainly do not mix but again there is still a cognitive-emotional reaction which mediates between an urge and a relapse!

Intolerance of Uncertainty

Posted on by alcoholicsguide

Like many recovering alcoholics I know I have a real problem with “Not projecting into the future” but staying in the moment or even the day. Why is this? When I “project” or even consider a near future event I can feel distressed by it. I want to do something about it now! Not later.

The future seems to be urgently now.

I have long researched why this is? I seem to become overwhelmed at times by future tense and it is not even due to future events being that distressing in themselves. I just have this constant need to act now rather than later. I have an urgency or a negative urgency or in other words a  distress based impulsivity which prompts a desire to act now, make a decision now rather than later. I call this a compulsion to act  because a distress state compels me to make a decision to act now.

As I have mentioned in previous blogs, alcoholics appear to have a bias in decision making towards choose the short term solution over a long term one, even though the long term solution will yield greater gains. There are various  theories on why this is so. Sometimes it appears like a “fight or flight” response!

My theory is that I am very poor at tolerating uncertainty and what is the future but uncertain. I have  an “unconscious” negative bias about the future, linked at times to a tendency to then catastrophize.

This intolerance of uncertainty is seen in other disorders, such as anxiety, obsessive-compulsive and post traumatic stress disorders as well as in eating disorders but it is rarely researched in alcoholism.

I believe when confronted with a decision about the future I often make a decision to relieve a distress which manifests as an unpleasant feeling state which compels me, via a stimulus response to act now. Distress is the stimulus, acting now is the response.

I am not saying that I have to be in a negative frame of mind for this to occur. It is simply a decision making bias I have when left to my own devices.   It is the reason I speak to others when making important decisions in life because the need to relief distress can show in the mind as a good idea when it is often on reflection not such a great idea.

This is due to distress being a stress-fuelled experience and excessive stress reduces the awareness of future consequence of a decision. It seems like a good idea at the time because it relieves distress. To the brain this is a good idea.  It is a automatic response of the dorsal striatum, an implicit memory (procedural) system, that requires one to retrospectively rationalise and justify the automatic responding of this area of the brain, it justifies a previous action in other words, thus a decision is represented in the mind as a good idea, what was most urgently required!

These rationalisations and justifications through time can become automatic schemas and are automatically activated following a compulsive response. Some of us are probably familiar with these schemas being a big part of our alcohol and drug use. As we needed to use, we had automatic addiction schemas following shortly after our decisions to head to the pub or to score some drugs or even to propel some decisions, as the consequence of distress states. It is these habitual response, based on distress states which bias decisions making to acting now, even in recovery.

I came across an article (1) which looked at this intolerance of uncertainty in relation to decision making and came up with similar conclusions to the above. “high IU (intolerance of uncertainty) predicted shorter wait times and more frequent selection of the immediate, less valuable (and riskier) reward. We take this tendency as evidence that IU was associated with an aversion to waiting in a state of uncertainty. One might argue that choices for the more immediate, less valuable reward might reflect an aversion to waiting per se…, the delay associated with the more valuable reward in the
current study appears to have magnified the unpleasant affective responses to uncertainty… delay is provoking unpleasant affective responses, choices for the smaller, immediate reward can be seen as avoidance of distress.” Decisions are thus like an “escape route” and more based on emotional avoidance.  “That is, the affective consequences of uncertainty may play a more central role in determining behavior than uncertainty itself…decision  making tendencies among those high in IU may be maintained through negative reinforcement…to  reduce or eliminate affectively unpleasant circumstances that accompany waiting in uncertainty.”

These “unpleasant affective responses” are distress based and lead to a negative urgency to act now.

References

1. Luhmann, C. C., Ishida, K., & Hajcak, G. (2011). Intolerance of uncertainty and decisions about delayed, probabilistic rewards. Behavior therapy, 42(3), 378-386.