“emotional sobriety”

Abstinence is getting Sober, Recovery is getting Emotionally Sober.

Posted on by alcoholicsguide

A very interesting concept in recovery is the idea of Emotional Sobriety which originated with Bill Wilson who found that after 20 years of recovery he suffered badly from  depression. His decades long association with Dr Tiebout, his psycho-analyst, led him to conclude that this was partly due to how he reacted to people. He found he either tried to dominate them or emotionally depend on them.

This emotional immaturity is something we have discussed in previous blogs and may be related to an overall problem regulating our emotional behaviour.

Our emotional responses may be related to an inherent brain allostasis which seems to affect pathological wanting in various aspects of life (not just substances or behaviours – the illness of “more”), to the common emotional and stress dysregulation seen in addicts in active use and in recovery or to habitualized, maladaptive emotional responding which is the legacy of our previous active addiction, which in themselves may have been the consequence also of maladaptive self schemata borne out of childhood maltreatment, or insecure attachment or all these in combination.

As we grow older in recovery, hopefully we also emotionally  mature or become more adaptive or healthy in regulating our emotions and in our decision making and subsequent behaviour.

Ultimately how we deal with our emotions (or how they deal with us!) depends on our motivations.

Roger B offers some great insights into how to overcome this emotional neediness and live in a more emotionally sober way.

Is My Neediness linked to My Insecure Attachment?

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I don’t know about you but I have previously been described on occasion, and still can be, as being a bit needy, a bit grasping of affection, a bit manipulative in attempting to coerce others into given me attention, affection and so on.

It is not a trait that I particularly like in my self. I believe it is directly linked to my insecure attachment based on an uncertain, unpredictable and sometimes conditional relationship I had with my mother, in particular.

My mother was affectionate at times, distant at others. You could never really count on her being there for you.

Her affection  seemed dependent (conditional) on how she felt. Given that she was probably experiencing some form of mental breakdown and had already started taking the Valium that would in later years become full blown dependence would explain her ambivalence to me and my emotional needs.

I have forgiven my mother for her many omissions but that does not mean that this forgiveness has resolved my attachment issues or heal the emotional pain I have been scarred with.

I still live with the consequence of these emotional scars and they still impact on my life, behaviour and recovery today. In fact, the longer I am in recovery the more I become aware of internal battles that I re-enact in my daily life with people in general life often playing the role of my primary care giver. I fight the same fights over and over again but with different people and in different scenarios.

The long term s consequences are also a lack of trust in others, an a time emotional ambivalence to others, a low self esteem, a feeling of “I’m not good enough” and whatever I do, “enough is never enough” This is why I think insecure attachment may be a good reason for the knawing feeling many of us have that we are not good enough, that we are lacking, that we are less than, that are missing something very important. That we have no secure internal base. Instead we have this “hole in the soul”.

attachment2

 

I fight injustice constantly. I fight bullies. I have real difficulties with feelings of rejection, even seeming rejection from people I do not particularly like, respect or admire. Thus it is not a cortical, conscious process, it is a pre-progammed emotional response to rejection per se.

I am constantly trying to be good enough, better than good enough, the best if possible. To measure up. Be the Number One guy, just like Bill Wilson who had similar problems with his mother to me. Internally I am constantly trying to show the world I am good enough, deserving enough of their love, respect and affection, often when I consciously have no real desire for these things, from these people.

It is a continual re-enactment of the efforts I made, often unsuccessfully with my mother. My early childhood has habitualised my behaviours and emotional reactions to the world. I must have found my mother’s behaviours unjust also hence my constant fighting of perceived injustice, although I am well aware of the 12 step plea not to fight anyone or anything.

Easier said than done, for me.

What I am trying to say, I guess, is that I have become aware that I am fighting the same psychic battles over and over again. The adult child is still in turmoil, reaching out for unconditional affection.

I have found that unconditional love in a Higher Power but in my illness I relapse back to this emotional insobriety.

I have recovered though. I am sane enough to know that I have other issues that  have partly driven my addictive behaviours. They have created emotional disturbance and dysfunction which “sharing” my experience with others has increasingly helped self soothe.

Anyway back to my sometimes evident emotional immaturity.

I have studied neuroscience for a number of years and see that it offers a great facility for challenging existing views about addiction and contributing to the greater arguments and debates about causes and consequences of addiction but I am also aware that it does not have all the answers and that it can veer towards reductionist views and reductionist solutions such as giving drugs to addicts to help with behavioural manifestations of addiction which can be bizarre at times.

Bizarre because the manifestations of addiction are more complex that observable neuro-biological processes in the brain. Attachment theory highlights this issue for me. It may impact on neuro-biology and neural plasticity of the brain but it is not necessarily the product of these. It can not be “cured” bu purely chemical means.

It seems that it can only be resolved by re-applying behaviours that were missing in the first place. In this case, earned attachment via various group therapeutic groups can help with the consequences of insecure attachment experienced in early childhood.   In other words these more adaptive behaviours can help you “manage” the maladaptive behavioural patterns ingrained in one’s brain.

We need other people not drugs or medications in other words. We tried that, it did not work. Love is what we need, we are designed, to give and receive it.

It is a fundamental force in helping develop a healthy brain.

Via neuroscience, I have never been able to get an angle on two vital aspects of my addictive personality. The “hole in the soul” what is it, where does it come from, how can it be explained? The other is why I collapse to needy behaviours?

Attachment disorders explain this for me. It also also explains the constantly fighting. Trauma also has a part to play. I grew up in a very violent, traumatising place. This can also lead to constant fighting. Constant emotional reactivty.

While in SELF, I hasten to add.

 

Equally I have found a solution to all these problems. I am generally contented, happy in my own skin. I did not used to be. Now I am. I have much love that I share with those around me. I can also receive it, mostly. I have found what I have been looking for. Love.

I have faith that all my scars will heal in time as so many already.

The results of the study we cite and take excerpts form (1) showed that there is significant difference in attachment styles and emotional maturity between opiate addicts and non-addicts. The results revealed that addicts usually have insecure attachment styles while non-addicts have secure styles. Besides, addicts enjoyed a lower level of emotional maturity compared with non-addicts.

“Addicts suffer from negative and inflexible emotions so that they are often fraught with anger, resentment and hatred. They
also suffer from loss of love, joy and intimacy. They may have not experienced hope and love for a long time. This exposes them to a serious emotional vacuum which must be dealt with in a
treatment process. A typical problem with addicts is their lack of emotional maturity and propensity to self-alienation and dependency disorder which causes a universal sense of fear and
mental insecurity.

A thirty-year old addict may perform like a ten-year old adolescent in terms of emotional functioning because most of the addicts have been forced into adulthood before they could have experienced childhood. That is because both society and family have not given them the opportunity to grow emotionally so that they have been confined within the walls of emotional crudity and feel insecure towards the outside world. Evidently, they need support to be
able to escape the confinement and interact with their environment, which requires them to be dependent on others [11].

Addicts suffer from severe feelings of disillusionment with their mothers. Mother’s disregard for the child’s emotional needs causes disruption in children’s self-regulatory processes and consequently
damages their mental structure of internal behavioral control. As a result, they will become dependent on external mediums like drugs to compensate for their emotional deficiencies.
Therefore, their harmful experiences of childhood in regard to disillusionment with their mothers may be drawn upon to account for the mechanisms which influence attachment styles.
Accordingly, mothers’ disregard for children’s emotional needs may justify the prevalence of insecure attachment styles in these children [1].

Research has shown that insecure attachment style contributes to the development of mental disorders. Developed at early childhood, insecure attachment is a risk factor for drug abuse and may also influence the treatment of drug abuse disorder. Using Hazan and Shaver adult attachment interview (AAI), Taracena et al (2006) reported that there is positive correlation between drug abuse and avoidant attachment styles. Hankin et al. (2007) conducted a study at the University of Illinois and reported that there is positive correlation between insecure attachment styles and smoking, alcohol use and marijuana use. In a follow-up research in the same
university, the results showed that there is a significant positive correlation between anxious attachment style and the prevalence of stimulant drug use, smoking and alcohol use. Haward and
Medway investigated the relationship between attachment styles, coping styles, life stresses and due responses in 75 couples. They reported that with secure styles, adults’ attachments are positively correlated with family relations but negatively correlated with negative social behavior including alcohol use, smoking and/or drug use [3].

Therefore, attachment styles can influence drug abuse disorders through the processes of familial interaction, social control, emotional regulation and self-efficacy. Marlatt et al. (2002)
investigated the factors contributing to the frequent relapse of addition and reported that encounters with negative emotions and events are most effective in addiction relapse. It seems
that insecure individuals more frequently resort to drug use as a self-treatment mechanism to relieve their negative emotions and experiences comparing with secure individuals. Shakibaie
(2000) studied 137 people and reported that 91.3% of the participants suffered from at least one mental disorder. Accordingly, 68.7% of the participants experienced decreased libido, 59.3% had
hypersomnia, 58.7% suffered from major depression and 24.7% suffered from apprehension.
Therefore, in line with previous studies, the present research aims to investigate the relationship between attachment styles and emotional maturity in both addicts and non-addicts.

Hogan and Roberts (1998) contended that immature emotional
behavior includes: impulsive behavior, fuzzy temper, impatience in facing failures, incongruence between specific visual stimuli and responses, inability to forgive others, and too much dependence on others. The present findings showed that there is significant difference in attachment styles between opiate addicts and non-addicts,  that addicts suffer from lack of emotional maturity more than do non-addicts. In
addition, the difference between addicts and non-addicts was significant in all the subscales of emotional immaturity.

Torberg and Lyvers (2005) investigated the relationship between attachment, fear of intimacy and differentiation of self in 158 volunteers including 99 individuals registered in an addiction treatment program. As expected, the patients under treatment who suffered from alcoholism, heroin dependency, amphetamines dependency, cocaine or hashish abuse reported high levels of insecure attachment, fear of intimacy and low levels of secure attachment and differentiation of self comparing with the control group.

Insecure attachment, fear of intimacy and differentiation of self may indicate vulnerability of drug abuse.

Besharat (2007) reported that there is significant difference in attachment styles between Iranian drug addicts and non-addicts. There were also significant negative and significant positive
correlations between the severity of drug dependency with secure and insecure attachment styles, respectively. Consequently, attachment styles can influence dependency on drugs through the
processes of familial interactions, social control, emotional regulation and self-efficacy.

 

 

References

1.  Mortazavi, Zeinab, Faramarz Sohrabi, and Hamid Reza Hatami. “Comparison of attachment styles and emotional maturity between opiate addicts and non-addicts.” 

 

Maintaining emotional sobriety (and sanity) via Steps 10-12

Posted on by alcoholicsguide

When I have did my steps 4-7, noting the situations, the people, the institutions  that have caused persistent resentments in me, then examining what parts of my self have been affected,  I also, thanks to one sponsor was asked me to,  put down exactly what “sins” or defects of character I also experienced during these resentments. This jotting down of the exact sins I was in during these resentments  has proved to be very useful in my recovery ever since.  What I noticed was that I had the same array of sins or negatively (immaturely) expressed emotions in relation to all resentments regardless of the situation or the person I had the resentment, the same web of sins was weaved in every situation.  For me this shows clearly how I do not process and regulate my emotions properly, how it has a canalized form of reaction.

I have found increasingly in recovery that when I want someone or something to be the way I want it and it doesn’t go that way or I want something to stay a certain way or I believe someone is threatening to interfere or take away something that I have (when I am controlling basically), I find I respond by either being dependent or dominating of the person or situation. This is what Bill Wilson also found out in ten years or so of psycho-analysis with Harry Tiebout.

Immature emotional response I call this, followed by emotional reasoning. I rarely react in a balanced manner to these prompts. The situations invariably provoke a fear based response in me which somehow also leads to me suddenly becoming dishonesty in my thinking. It is as if this self centred fear as cut me off from the truthful sunlight of the spirit and I am suddenly in the dark shadow of dishonesty. In fact, according to Father Ralph honesty comes from the Greek to be at one with God funnily enough.

Then I feel shame as the result of my pride being hurt, which can lead to self pity it if I let it. I may also feel guilt. Then I may decide to strike back via being arrogant, impatient or intolerant, in behaviourally expressed sometimes as putting others down to elevate one self. Again immature emotional response. I am obviously also being self centred and selfish while in this process. I can also be envious or jealous of others in the midst of this for taking what I wanted or threatening what I have, like a child in the park or playground with friends. Other ways of fixing my feelings rear their heads and I can be gluttonous as a reaction or become greedy. Eat too much or go on a shopping frenzy. All instead of processing the emotions which are driving this behaviour I react, act out of distress based impulsivity. I can be so distressed that I can tend towards procrastination, which is sloth in five syllables. These sins or negatively expressed emotions truly grip me and these sins seem to  hunt in packs.

I found this fascinating when I first discovered this during my steps. It seemed to map the reactions of my heart when I react via resentments to the world. They describe accurately how I relate to the world especially when the world does not give me what I want or I have stood on it’s toes.

What else is this but an immature emotional reaction based not just on me being the same age as I started drinking  but also on the fact that the regions of the brain which govern emotional regulation in the brain of the alcoholic are immature, are smaller, not connected as well or do not function as well as healthy folk.  This is according to many academic studies and also seen in the brains of children of alcoholics, so our emotional brain regions may never have worked properly and thanks to years of alcohol abuse have gotten a whole lot worse.

When I am not in charge of my emotions they are in charge of me, in other words. They are controlling me and not the other way around. This type of emotional immaturity happens throughout the day sometimes. So there is no point waiting to the end of the day to do a step 10, to see when have I been fearful, dishonest, resentful or selfish. I have to do it continuously throughout the day to maintain my spiritual and emotional equilibrium, because it needs constant attention and maintenance, because I have no naturally maintained balance. I have to manage it. I impose homoestasis to an allostatic system. There is not naturally resting place. I am in charge of my serenity.

So I spot check continuously to ensure my emotional sobriety. Another word for sober is sane. I ike this because  while I am in emotional dysregulation or immaturity, I am far from sane. In fact, I am strangely deluded, distinct from from any reasonableness. I need to do my step ten to be restored to sanity.

The other problem with this emotional lability and dysregulation is that it send streams of distorted thinking into my head. I remember ringing my sponsor in early recovery, a few months in, with the startling relevation, to me,  that my thoughts were all leading me to a place of emotional pain. My emotional dysregulation leading to cognitive distortions which leads to further emotional dyregulation etc.  Spot the negative emotions underpinning these thoughts and they disappear like wispy evaporating clouds. This has similarities here with the practice of mindfulness.

Image

I do this all in a very simple way – I simply ask God to remove my sins, which are usually fear, dishonesty, pride, shame,guilt, self pity, leading to intolerance, arrogance and impatience and so on, warmed in a dendritic spreading across my heart and polluting of my mind with stinking thoughts.

It is interesting that in the 5th century a religious man called Evagrius Ponticus suggested that one gets rid of troublesome thoughts by pinpointing the negative emotions which were somehow underpin then and weight these thoughts in one’s mind, like anchors weighing down lassoed clouds. I do the same effectively.

I ask God to remove these emotions after I have first identified them and offered them to Him for help in removing. What I am doing, in a sense, is also identifying, labelling and letting go (processing) of the negative emotions that have kept these thunderous grey black clouds of thoughts in my head, and striking my heart with forked pain. I am asking God to help me do what I cannot do for myself it seems; namely emotional regulation.

People outside AA often wonder how this spiritual program can help people recover. As  I blogged about recently recently it does so, I believe partly, because it helps us learn how to practice identifying, labelling  and processing emotions (often by verbalising them to someone or via step 10)  in a way that is not only healthy and adaptive but in a way I was seemingly never able to do prior to coming into AA.  Or had never been taught to do.

I have learnt all these development skills not in my childhood but in my surrogate home of AA.  How many of us have come home in AA?

Euphoria Re-experienced not Recalled?

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I never, never want to drink again, I would rather kill myself.

This does not mean I will not drink again however.

A possible relapse is thus not down to desire for a drink, it is because something in my brain and in my heart goes awry.

I remember being in early recovery and thinking the following line from the Big Book of Alcoholics Anonymous was very strange  “Remember that we deal with  alcohol—cunning, baffling, powerful! Without help it is too much for us”

What did they mean, alcohol was cunning, baffling, powerful? Surely they meant, alcoholism was cunning, baffling, powerful? Right?

Alcohol itself has not got magical powers? It isn’t a ghost or a spirit that can come and get you lured you back into drinking? Why be wary of a substance?

I suffer from alcoholism not alcohol, don’t I? ISM – I, self, me, the internal spiritual malady treated formerly by alcohol. Right? Alcohol was symptomatic?  “Bottles were only a symbol”

Now what is it to be?

In AA, I used to think alcohol got off light, considering the damage it causes to the brain. I always felt alcohol and it’s comprehensive deleterious neuro-toxic effects on my brain have greatly contributed to my difficulties with emotions and thinking and memory and perception etc. The list does go on and on.

One only has to look at a brain image from a fMRI scan to realise  that the damage to the brain wrought by alcohol is extensive and some of it irreversible although there is extensive repair in certain regions of the brain in recovery. I have felt for some time that alcohol gradually help change, over years,  how I felt and thought and perceived this world.

Alcohol literally moulded my brain. If I emotionally reacted or  thought in the same distorted way as I did while drinking or perceived this world in the same jaundiced way I did while drinking ,but while in recovery, then the same behaviours would soon follow.

I would drink.

Like a lot of alcoholics, I had a terrible sense of self, a very negative self perception in other words. I thought I was the lowest of the low, that I had screwed up my life and squandered my talents, that I didn’t even deserve recovery or to recover. I was not even worth that. It was this shame and guilt-fuelled lack of self esteem, this devalued sense of self that helped drive my drinking and which threatened to ruin any chances of recovery.

But what does this have to do with alcohol being cunning, baffling, powerful I hear you ask? Lots, is the answer. This negative self perception, I have had since early childhood,  well since I could reflect on my self and the product of emotional and mental abuse and traumatic parenting is ingrained in my brain.

Even now when I reflect on myself I have a tendency to think negatively or poorly about myself and my achievements, I have a negative bias in my thinking about me. It could depress me even, if I indulged in thinking about me for too long.

Again what does this have to do with alcohol? Well these negative perceptions, ingrained in neural structures in my brain have had more than a helping hand by alcohol. Alcohol has helped reinforced this faulty image of my self.

Alcohol had helped colour this jaundiced view of my self and this can has serious repercussions in recovery. This distorted view was partly the result of staring at my refection on the warped  glass of a wine bottle or on a glass of beer.  It cemented this view or “concretized” it in my self perception neural networks. Every drink helped dig the grave of my self worth.

I have seen many people in recovery relapse after a period of negative self reflection, after not thinking they are good enough to recover. It is immensely sad, tragic but nonetheless true. That is why they need love more than anything when they come into recovery. Not orders or dictats but love, plain and simple, make them feel part of, that they belong, that they have found their place, their surrogate home.

I have seen countless people who were so severely abused that they could not face the self disclosure at the heart of the 12 step program of recovery. I have seem than unconsciously “choose” to drink rather than take the steps. Part of this is something deep inside whispers a barely audible solution. To drink again.

Why is it barely audible? Because it is. It doesn’t actually have a voice. It is the whisper of a neural ghost (1). It is ghost that lives in the machinery of the brain. As alive as you are. It will probably remain to haunt you as an alcoholic  in some form  and at some time of weakness. Never think otherwise!

It is like a euphoria recalled but also it isn’t!? It may be worse than that; it is actually to a very great extent re-experienced.

Euphoria re-experienced not simply recalled.

Euphoria wasn’t just the pleasure you received but also relief from…negative emotions surrounding the self. Negative self perception, emotional distress and so on. It appears that negative affect (emotions, mood, anxiety) can automatically prompt thoughts of alcohol or drugs (2) and that the neural circuitries of affect, reward, memory and attention are taken over or ‘hijacked’ in the addiction cycle and often prompted into activation by emotional distress so that attention is directed to alcohol to relieve distress, with the resultant ‘craving’ coloured by numerous memory associations ingrained in the brain linked to habitually drinking to relieve negative emotional states.

Also, pertinent to this blog, negative self perception may also prompt relapse. I partly reconcile alcohol being cunning, baffling, powerful and alcoholism by reference to an article I read a while back by Rex Cannon(3).

His observations about a possible role for negative self perception in relapse was based on a study conducted  on recovering alcoholics. It found that by measuring their brain frequencies, when thinking about drinking and when thinking about self perception that there was a change in the frequency of their brain waves. In both cases, thinking about drinking and negative self perception, Cannon et al observed that widespread alpha power increases in the cortex, commonly seen by use of certain chemicals, were also present and in the same areas of a common neural circuitry for his study group during their reports of ‘using’ and ‘drinking’ thought patterns as well as in negative self perception.

These reports of ‘using’ and ‘drinking’ thought patterns as well as in negative self perception which appeared to bring the brain into synchrony, if only for a brief period of time, suggesting this to be the euphoria addicted individuals speak so fondly of and one possible reason for difficulty in treating these disorders.

In relation to using thoughts they suggested that “if the brain communicates and orchestrates the affective state of the individual in response to contents and images relating to self and self-in-experience – it is plausible that a large scale feedback loop is formed involving not only perceptual processes but relative automatic functioning.

This process reinforces the addicted person to become habituated to an aroused cortical state (i.e. increased alpha/beta activity) and when there is a shift to ‘normalcy’ (or recovery/sobriety) it is errantly perceived as abnormal thereby increasing the desire or need for a substance to return to the aroused (perceived as normal (or desired)) state”.

This would surely have a profound impact on addicts attempting to contain normal negative emotions when there is an automatic desire state suggesting, unconsciously, an alternative to wrestling with these torturous sober realities.

I have seen a similar process but over a much longer time frame in some alcoholics in recovery who relapse. They seem to disappear into themselves, right in front of you, like they were being lured by some internal, inaudible siren, into a self drowning.

Letting go of the life boat trying to keep them afloat. I have seen it many times, the dimming of the eye’s light, the turning inwards to the alcoholic darkness. A submerging into this illness.

It may be that indulging in one’s negative self perception recreates a neural based virtual reality. One is almost bodily transported back in time. Back to a drinking period. In a neural sense, back in the drink and not fully in sobriety, however fleetingly.

It does leave a neural taste for it, a torturous transient desire.

I remember it, particularly in early recovery, when the ‘recovery’ script was not written yet and I did not have a habitual recovery self schema to automatically activate, to pull me out of this neural reverie, this most bio-chemical vicarious pleasure.

The problem is that it happens to you without you asking it! You can be invoking a negative self schema automatically without wanting to reawaken this  ghost.

But that is alcoholsim in a nutshell. It happens to you without your express permission. It takes over the brain step by step, while impairing ones’ ability to observe this progression.

That is why we are are the last to know. It is not just denial, it is brain impairment and limited ability to reflect on what has happened to one’s self.

The self has been ‘hijacked’ so it is nigh impossible to figure this out without the help of others.

It is others that lead you out of the fog, as one has become lost to oneself. If nothing else, in early recovery especially, before the steps are done, it is a dangerous place to visit, the self and it is safer to spend as much time as possible outside of it and working with others!

It is a horrible, frightening experience, the limbo between addicted self and recovery self schemas. It is fraught with danger! I remember bumping into people places and things from the past and experiencing the most excruciating cognitive dissonance of literally being caught in between two worlds and not knowing if I was a drinking or a recovering alcoholic; the sense of self as a drinking alcoholic was much stronger than the recovering self. I would hurry to my sponsor or wife to help pull my sense of self as a recovering alcoholic to the surface, out of the neural swamp of my drinking alcoholism.

But it felt alien as Cannon observes, this sober self.  All new, awkward, pained, exposed and frightened.  A constant vacillation between two worlds, that of active use and that of recovery. Recovery had not become “concretized” in my neural networks!

This left an oscillating experiential schism, with one caught in two realities almost simultaneously.

I see people relapse because they have no emotional sobriety and they seem to be emotionally drunk before they are actually drunk. Emotionally drunk seems to be like a virtual drunk, brings up the similar feelings or neurochemical reactions as actual drinking.

The best way to stay sober is to act sober and develop this habitual schema so that it can be retrieved instantaneously, automatically, without thinking. We achieve this schema through our actions, so in a sense is also an action schema. Tiffany (4) states that alcoholics and addicts are prompted to relapse by automatized schemata surrounding drug and alcohol use rituals, so we must have automatized schemata surrounding recovery rituals. Such as ringing a sponsor, mentor, friend, doing a  step ten, praying, meditating, working with others, letting go and letting God, re-appraising distress, regulating emotions, putting thoughts of others before thoughts of ourselves, living outside self.  There are so many automatic schemas in AA and other therapeutic regimes.

Either way, whatever path you choose, make your recovery  tools automatic, so that they come to hand without yourself having to think about them.

 

 

References 

 

1.  Zack, M., Toneatto, T., & MacLeod, C. M. (1999). Implicit activation of alcohol concepts by negative affective cues distinguishes between problem drinkers with high and low psychiatric distress. Journal of Abnormal Psychology, 108(3), 518.

2.  Cannon, R., Lubar, J., & Baldwin, D. (2008). Self-perception and experiential schemata in the addicted brain. Applied psychophysiology and biofeedback,33(4), 223-238.

3.  Tiffany, S. T. (1990). A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes. Psychological review, 97(2), 147.

4.  Adinoff, B. (2004). Neurobiologic processes in drug reward and addiction.Harvard review of psychiatry, 12(6), 305-320.