Acceptance and Commitment Therapy for Substance Abuse TreatmentFern Richie, DSN, APRN-BCfernrichie@gmail.com

Serenity Prayer“God, grant me the serenity to

accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Acceptance & Commitment Therapy“I just want to be happy” – a psychological trap

of needing to “feel good” all of the timePsychological flexibility - a better goal?

Being in the present moment with full awareness and openness to our experience, and taking action guided by our values

Living a full, rich, and meaningful lifeBoth pleasurable and uncomfortable feelings will be

experiencedRather than attempts to avoid pain, ACT

focuses on Helping us make room for pain Reduce its impact Create a life worth living despite pain

More on ACT Based on assumption that many unwanted internal

experiences cannot be eliminated, so they must be accepted

Is a behavioral therapy, with an existential component

By using mindfulness and acceptance strategies, we can step back from instantaneous emotional reactions rather than use over them

By accepting, rather than fighting/struggling with aspects of our inner worlds over which we have no control, we can invest time and effort in what we can control – practice recovery strategies

Persist when persistence is useful Desist when what we are doing isn’t working

The Importance of ValuesValues are the fuel; the danger of

running on emptyValues get lost in the shuffle of livingValues and adjustment disorder

If not “living” our values, we will begin to feel uncomfortable

If feeling uncomfortable May incorrectly appraise a stressor May try to “fight the feeling” End up feeling worse, not better

What About Symptom Reduction?Emphasis of most Western

psychotherapeutic approaches is symptom reduction

ACT assumes the position that quality of life is primarily dependent upon mindful, values-guided actionThis is possible regardless of how many symptoms

you haveThrough ACT we try to change our relationship

with our symptomsThus values-congruent living is desired

outcomeUsually ACT will result in symptom reduction

We All Suffer…“Life is spelt H.A.S.S.L.E.” –

Albert Ellis“Life is difficult.” – M. Scott Peck“Life is suffering.” – Buddha“Shit happens! - Anonymous

ACT and SufferingACT aims to help people learn

and grow as a result from their suffering◦Use pain as a springboard into

creating a more meaningful life“Our clients are not broken, they

are just stuck.”What gets people stuck?

◦Fusion◦Experiential avoidance

FusionOur thoughts dominate our

behavior◦In ACT, we might say “you’re being

pushed around by your thoughts” or, “the thoughts are telling you what to do”

How workable are the thoughts?◦Does the thought help client move

toward a better life?◦No attempt in ACT to change one’s

thoughts

Experiential AvoidanceTrying to get rid of or escape

from unwanted experiencesHigher experiential avoidance is

associated with higher levels of substance abuse (Hayes et al, 2004)

Must help the client get in touch with the cost and futility of experiential avoidance

Mantra of ACTA Accept one’s thoughts and

feelings; be presentC Choose a valued directionT Take action

ACT for Substance Abuse Treatment?Sit in kindness with the uncertainty of

recoveryAccept your life as it is – but also how

it may becomeFind strength in the things that really

matter to youCommit to act in the present momentLearn how a change of perspective

can help you see yourself with fresh eyes

Wilson, 2012

MindfulnessPaying attention in a particular way:

on purpose, in the present moment, non-judgmentally

Curiosity and openness, even to a difficult moment (better than running from it or fighting it or using over it)

Helps to develop a detached relationship to thoughts and feelings

Shift from “impulsive reacting” to “skillful responding”

Six Core Processes of ACT

Defusion Acceptance Contact with the present moment Self-as-Context Values Committed Action

DefusionFusion means getting caught up in our

thoughts and allowing them to dominate our behaviorRulesReasonsJudgments

Defusion means separating or distancing from our thoughts, letting them come and go, rather than being caught up in themNoticing thoughts rather than being caught up in

thoughtsLetting thoughts come and go rather than holding

on to them

Getting to DefusionBegin to notice your thoughts

“So, what’s your mind telling you now?”“And what does your ‘thinking self’ have to say about

that?”Next, look at workability of your thoughts

“So, is that a helpful thought? If you hold on tightly to it, does it help you deal with the situation differently?”

“If you let that thought tell you what to do, will it take you in the direction of a rich, full, and meaningful life, or in the direction of being stuck and suffering?”

Notice when you are fused or defused with your thoughts“So, right now, how caught up are you in that

thought?”

AcceptanceNot the same as approval, tolerance, or

even liking somethingAccept if and when doing so enables us to

act on our valuesIs a process, not a technique

◦ Expand, make space◦ Letting go of any urge to resist or avoid what is

in front of you at the present moment This may mean “sitting with” a craving to use Recognize that a craving is just that – a craving

◦ Show self-compassion “I’m not a bad person because I am craving the dope

right now.”

Contact with Present MomentBeing in the here and now, fully

conscious of our experience (rather than being lost in our thoughts and missing out on life)

Helps us perceive more accurately what is happeningWhether to change or persist in current

behaviorThis is hard for those of our clients

who have experienced trauma

ValuesStatements about:

◦What we want to be doing with our life◦What we stand for◦How we want to act on an ongoing basis

Leading principles that guide and motivate us

Our hearts deepest desires for the way we want to be and act in the world

Is success measured by achievement of goals?

Is success measured by living out our values?

Committed ActionTaking larger and larger steps of

effective action, guided and motivated by values

Being flexible and adaptablePersist with or change behavior

to better coincide with one’s values

Steps to Committed ActionChoose a domain of life that is

high priority for change Identify the values to pursue this

domainDevelop goals, guided by these

valuesTake action mindfully

From Suffering (Active Addiction) to Vitality (Recovery)Fusion with

thoughtsExperiential

avoidance Unworkable

actions

Being presentOpening upDoing what

matters

ACT and AA/NAA perfect match? No, but a great fit.Both are into-action programs

◦We must create the life worth living Non-acceptance blocks us from doing this

Both focus on practiceBoth are traditions that are a means to an

end: the end is a better lifeBoth focus on commitment in the “here

and now,” not the future◦“In this very moment, am I engaged in right

action?”◦“Do the next right thing”

‘Having spent the better part of my life trying to either relive the past or experiencing the future before it arrives, I have come to believe that in between these two extremes is peace.◦Author unknown

Helpful Websiteshttp://www.thehappinesstrap.com

/http://contextualscience.org/act

BooksWilson, K. G. (2012). The Wisdom to

Know the Difference: An Acceptance and Commitment Therapy Workbook for Overcoming Substance Abuse. Oakland, CA: New Harbinger Publications.

Harris, R. (2009). ACT Made Simple. Oakland, CA: New Harbinger Publications.

Harris, R. (2008). The Happiness Trap. Boston: Trumpeter.

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