STOP Enabling Your Addiction and Try This Instead!

Hey there, everybody, and welcome to this video on behavior modification in addiction recovery. I'm your host, Dr. Donnelly Snipes. In this video, we're going to explore some basic behavior modification tools. You will not be a behavior analyst, but you may have some tools to help you achieve your goals. The first tool we're going to talk about is what's called backward chaining. Backward chaining helps you look back over the past 15 minutes to seven days to explore triggers and vulnerabilities that led up to this point and see the connections. What's important in backward chaining is you're looking back and you're asking my asking yourself, how did I get here? You're going to look at what was going on with you physically. Were you well rested? Were you well fed? Were you in pain? Were you sick? Was there anything that made you more vulnerable to the problem leading up to this? And if so, how can you address it or prevent it in the future? Interpersonally, what was going on in your relationships with others? Did you feel supported? Did you feel abandoned? Did you feel loved? Did you feel good about yourself? All of these things can make us more or less vulnerable to reacting impulsively and engaging in behaviors that we don't want to engage in emotionally. How'd you feel leading up to it? Now, when the event happened, you may have felt angry or scared or something else. But let's look at what led up to that. Were you already in a God awful mood or were you in a. A pretty good mood and then something happened? What emotional vulnerabilities might have led to or contributed to the reaction or the degree of the reaction? Cognitively, again, looking backwards, what thoughts did you have that contributed to your reaction? And prior to that, what other cognitive vulnerabilities were going on? Were you struggling with brain fog? Were you having difficulty thinking clearly? Were you overwhelmed with all the things that you were thinking about that ultimately ended up leading to the problem behavior? Environmentally, were there things in the environment that triggered you or supported the behavior? Maybe there were pictures or a person or a smell or a sight, something that triggered your behavior. Maybe you had gotten up early in the morning and gotten ready for work and then you spilled something on your, on your jacket and you had to change and just throughout the day and your kids were pulling at your, pulling at your coattails throughout the day leading up to that, it just seemed like everywhere you turned in the environment, it felt stressful. And that can ultimately lead up to a behavior that we don't want to engage in. And Spiritually, your sense of connection. How did your sense of connection over the past 15 minutes, over the past seven days contribute to your current behavior? And you can do backward chaining for positive behaviors too. If you're engaging in your self care behaviors, you can look backwards and go, what am I doing that is prompting these behaviors? What is building up to encourage me to engage in these behaviors? Think about the last three times that you used looking backwards. What were the triggers and vulnerabilities that ended up leading to your use? For example, environmentally, if we're talking about porn addiction, you may have been alone in your house with unsecured wireless. Those are triggers. Now, it doesn't mean you have to act on them, but if you've got other stuff going on that is making you feel more vulnerable, then you are more likely to engage in porn use. So we need to look at that so we can develop a better relapse prevention plan by eliminating some of these things that might be triggering short term chains. Look back over the day or even the week to identify thoughts, feelings, behaviors, or situations that contributed to the current behavior. A lot of people aren't mindful of what's going on. They don't pay attention to what led up to my reaction in the situation or what led up to me using. They just are on autopilot and it comes from, quote, out of the blue. Autopilot and avoidance cause many situations to remain unresolved. And this is one of the things that I harp on a lot with people in recovery is things don't happen from out of the blue 98 of the time. So let's take a look at what might have been going on that led up to this. If you're feeling depressed, what was going on that was draining your energy, that was contributing to you feeling helpless and hopeless? And that just kind of piled on. And then ultimately there was some straw that broke the proverbial camel's back. There may be unresolved situations that require energy or space in your head. So you're looking back and saying, okay, I didn't react the way I wanted to, or I chose to use because I had this thing that kept popping up in my head, this thought or this memory that kept popping up that told me I will never be able to be in a healthy relationship or relationships aren't worth the effort. Well, those are thoughts from unresolved situations that are taking space in your head and motivating you to use. When the energy and space needed in your brain exceeds what you have, it can trigger an Explosion, fight, or addictive behaviors, which are flight. So when you feel overwhelmed, when you feel exhausted, when you feel just overburdened, you may respond more strongly than if you hadn't been in that position. You're more vulnerable to impulsive reactions when you're in fight or flight mode because you're not thinking fight or flight is get to safety, not let's think about what to do next. So let's look at Sam's breakdown to illustrate this. Sam's power went out overnight and he got up late. He bought coffee to drink on the train and didn't eat breakfast. So not only is he starting with caffeine, but his blood sugar is not going to be in a good place. The train made a sudden stop and he spilled coffee all over himself. He had to go directly to work and make a presentation, stains and all. When he got to the office, he realized he had left his poster board on the train. If he wouldn't have been so discombobulated by spilling the coffee on himself, he probably would have remembered his poster board. But now things are just piling up. The presentation was a disaster. His boss was disgusted with him that night. He got foul playing basketball and the ref didn't call it. Sam lost it and got ejected from the game. So we can see how any one of these things might not have led to Sam just losing it on the basketball court. But all of these things added up. It's kind of like a pressure cooker. Each one of these things turned the heat up a little bit and by the end of the day, he didn't have anything left to give. So he got fouled, it didn't get called, and that was all she wrote. Review the days that showed improvement in your use in your cravings. What was different on those days? So if you've noticed that you're feeling better and you're doing better and your cravings are less, what was different on your good days? Sleep, your energy? Did you eat differently? Was your pain better? Or maybe it was just your body is actually healing, you're giving it time. What was different, if anything, about your social supports and interactions or your anticipated interactions? If you go into a discussion with somebody and you expect it to be adversarial, then the interaction is probably going to be adversarial. If you go into it and you anticipate that it you are empowered and you are safe, then that interaction may go completely differently. Was your general mood different? Were your thinking patterns and attitudes, what were they like and what was going on in your environment, in the media. For a lot of people with porn addiction, it is really difficult to watch television because there is so much triggering stuff even on mainstream television. The same thing is true for people who are recovering from alcohol addiction. You pretty much can't watch a television show on mainstream television, prime time, that doesn't have somebody drinking at some point, which can be very triggering for people. Repeat the same process for days when the problem gets worse. Look back and identify things in your physical health, in your interpersonal relationships, in your emotions, in your thinking styles, in your environment that added stress or drained your energy and contributed to relapse thoughts or even relapse behaviors. Now, like backward chaining looks at what led up to it. Forward chaining is anticipating, is planning, like somebody to prepare, like someone preparing to scale Mount Everest. Take lessons you learned about the climb and your own needs and abilities. Combine them and create an individualized plan. Every person's plan looks a bit different. And quite honestly, using morning mindfulness, you'll be doing forward chaining. Every day you're going to think about what am I going to encounter today? And knowing myself, knowing my triggers and vulnerabilities, how can I best respond? Today we're not talking about forever, we're talking about what's going to go on today, what worsens the problem, you know what your triggers and vulnerabilities are. So how can you minimize or eliminate those in the future? And that could be minimize or eliminate those today or henceforth. There are some things that you can just get rid of completely, like not keeping alcohol in the house or not having an unsecured wireless. How can you cope with unexpected crap? Because it will happen and that can be very frustrating and anxiety provoking and it may cause you to to want to get some relief. That relief often comes in the form of addictive behaviors because that gives you a rush of dopamine and endorphins and other feelgood chemicals. But if you un understand what's coming up or you recognize the unexpected crap and you have a plan, you can feel safer, more empowered, and you can have a plan to deal with the cravings that actually start. And as I mentioned earlier, noting, when you do your backward chaining and identify what's different on your good days, take that information and apply it to the future. If you know that you have better days when you get good sleep, well, then that's part of your relapse prevention plan. Henceforth and forevermore, forward chaining helps you take what you learned from the past and what you Expect in the future to arrange triggers and supports to help you choose an alternate behavior. Triggers aren't always bad. Triggers can remind you to call your sponsor or to not do something that's going to put you in a vulnerable situation. So, for example, backward chaining data. If you know that stress at work was, you know, you had a really bad day at work, and then you got home and you were all by yourself, you sat down, you started watching tv. There was a lot of stuff on there that was triggering. You turn that off. But then realized that you had unrestricted wireless access. Bada bing. Those cravings may become really powerful. So looking back at that backward chain can necessarily eliminate all the stress at work. So what are some other things that you could have done and what are some things that you can do in the future when you've had a stressful day at work that won't set you up for relapse? As I mentioned before, triggers are unhelpful sights, sounds, smells, places, times of day, activities and feelings. Your triggers are going to be different from mine in large part. But thinking to yourself, what triggers me to want to use? And the cravings may not start until after your anger or your anxiety has been triggered. So you know that anger and anxiety is a trigger. We can deal with those in phases with backward chaining. But it's important to know what your main triggers are. Being alone. All right, well, how can you address that? Maybe keep the blinds open so you feel less alone, or having friends over or being on the phone or on video chat with somebody even if they're not there. If they're there on video, you'll be less inclined to engage in the addictive behaviors before bed. Some people engage in addictive behaviors to help them get sleepy before bed. All right, well, then that's a time of day that's going to be triggering. So what can you do differently to help yourself relax and set those circadian rhythms so your body knows it's time to go to sleep? Besides, using, some people are triggered when they're bored or they're stressed. All right, if that's you, how can you prevent these things or address them when they happen? There are going to be times you're sitting on train and you're bored out of your mind, or you're sitting at home and you're bored. What are you going to do? And I encourage you to keep a list of things that you might enjoy doing. So when you're bored, you don't have to come up with something. The gym works for Some people triggers, other people. If the gym works for you, then great. Go to the gym when you're feeling triggered. If the gym is triggering, all right, how else might you be able to exercise? Or what might you be able to do instead? And then in game ads, if you play games on your mobile device, you are probably very familiar with the fact that there are more increasingly ads that are adult in nature. Even in non adult games like, you know, Match three and very benign games that kids would be playing. Be aware of that. And if that is bothersome, if you start getting those kinds of ads, it may be time that you have to switch what you're doing in order to to stimulate your brain. Instead of playing on your mobile device, you may need to do something differently. Be aware of triggers that are positive, helpful, safe sights, sounds, smells, places and activities like being around people or pictures of grandma or your kids or your mom. If they're sitting there staring at you through their pictures, it may be enough to make you stop and think. So reflect on what triggers your cravings and what reduces your cravings and behaviors. Now let's talk a little about rewards and punishments. Living beings, especially humans and animals, we do things that produce the greatest reward and and avoid things that cause pain. Rewards increase a behavior, so you can add something you like, like food, fun, free time, or maybe a little bit of access to your finances. Maybe you allow yourself to go shopping. You can also take away something unpleasant. If you don't use, then hey, you don't have to clean the house score. That will increase the behavior by rewarding it, by making it pleasurable in some way. Punishments reduce a behavior so you can add something unpleasant. For example, if you start having strong cravings, you can or intrusive thoughts. You can do a hundred push ups. You can force yourself to clean the baseboards and grout with the toothbrush. That'll keep you busy for a while. That's unpleasant and it keeps you busy, turns your attention to something else. You can also take away something that you really like. For example food, fun, free time and finances. There are a lot of things that you have the opportunity to deprive yourself of if you need to punish. However, it's usually better to lead with the carrot than try to teach with the stick. Try to make recovery behaviors as rewarding as possible. Yes, you'll probably need to have a couple of tools in there to suppress cravings. But try to focus more on punishing, correct behavior and good orderly direction. So think to yourself. Make a list what rewards and punishments will Will you use for your behavior? And you want to write this down, and you want to set it up so you can do it. And how are you going to remember to do it? If one of your punishments is to do 100 push ups when you start having really strong cravings, how are you going to remember to do that? That's up to you. You can figure out if you want to have a note somewhere or what you want to do. Three to one is also another principle that's really important. If you continually punish behaviors and eliminate behaviors, the organism has to have something to replace it with. Behavior serves a purpose. If I am throwing a temper tantrum because I feel unsafe, then punishing that behavior isn't going to make me feel any safer. It's just maybe going to get me to be quiet. So remember that behavior serves a purpose. If you punish a behavior, you must eventually provide an alternate way to meet that need. An alternate way to feel safe, an alternate way to feel pleasure. An alternate way to fill in the blank. So the need for addiction may be gratification and increasing levels of dopamine and serotonin and other pleasure chemicals in your brain. All right, that's the need. What's the behavior? Well, that's the porn addiction or the addiction to alcohol or something else is increasing those chemicals. Now, is that the best solution to the problem? No, or you wouldn't be here. So the punished behavior. If you are addicted to pornography and you watch porn, then what are you going to do to punish that behavior? Some people will punish the cravings. When the cravings start, they engage in something that's unpleasant, so they quit thinking about it. Likewise, as I said, this behavior serving a purpose. If you're addicted to something, then your brain chemical system is completely miscalibrated and your brain is craving dopamine and craving a balance in those neurochemicals. So what other behavior can you engage in that might help you feel pleasure Besides the addictive one I have on here in real life? Sex, intense exercise. Both of those can increase dopamine levels. And video games, Now I have asterisks by that, because video games can be just as addictive as other things. But for some people, that may be a reasonable alternative, at least for harm reduction, at least in the meantime, to give them something to do. Make a list of alternate alternate behaviors you can engage in to help regulate your dopamine in early recovery. What things can you do when you really start craving that are healthy and helpful in early recovery? Schedules of reinforcement represent how often and how predictably a behavior is rewarded. When a behavior is not being rewarded enough, you start to see behavior strain. The person starts becoming more frantic. You start having more cravings. This means the either the reward is too weak or there's too long between rewards. And it's important to recognize this. If you start having cravings or engaging unrestrained in the behavior, then that tells me that the new behavior wasn't being rewarding enough. You know, staying clean and sober just wasn't cutting it for you. So we need to look at why that was so much less rewarding and what we need to do to make it more rewarding. An extinction burst is a reaction to a behavior strain, and it is a stress response. Usually takes the form of fawning where the person's trying to do anything. I'm going to do whatever I need to do. I'll find something that'll make me feel better. Sometimes this comes out as a tantrum. They know they can't watch porn or drink alcohol, so they just get angry. And that's the extinction verse. That's the brain saying, the body's out of calibration. This is stressful. We need to do something. And intense cravings may also be the brain's way of saying, hey, we need more dopamine over here. Come on. What are you going to do with it? Giving into an extinction burst will make the next one that much stronger. You fed the wrong wolf. It can be really tempting to give in to urges and cravings. But if you ride that wave, urges and cravings generally peak after 10 to 15 minutes and start to subside. If you haven't fed them, if you haven't rewarded them or given into them, if you give in, then the brain knows, hey, this is how intense. I've got to fuss before I can get the person to do what I want. So I'm just going to start up here next time. And your progressive extinction bursts are going to become even stronger. Rewards should initially be very frequent, and goals to get rewards should be very small and achievable. Recovery is all about baby steps. Sometimes it's an hour at a time, not even a day at a time. If you notice an extinction burst, you start having really intense cravings. For example, adjust. Recognize what's going on, and instead of getting angry about it, recognize it. Say, okay, I've got a silence, that addicted voice in my head, and do what I need to do in order to get into a place where I'm safe. Competing responses are also super helpful in recovery. You won't engage in the addiction when you are, fill in the blank. So, for example, you won't watch porn when you're at the dog park without your phone. Kind of hard to do it. You may start spending a lot of time at that dog park. You won't watch porn while you're driving. Okay, you get an urge at 8 o' clock at night and you're all by yourself and it feels overwhelming. Maybe you're going out for a drive. You won't masturbate while woodworking or exercising. Okay, that's just common sense, but it gives you something to do if you're feeling those urges, those cravings, then maybe you get your butt up and you go to the gym. These are competing responses. They're things that you can't engage in the addictive behavior while you're doing these. So make a list of the competing responses for watching porn, masturbating, excessively edging or, or engaging in any other addictive behavior and response prevention. We have competing responses. You could do it, but you're doing this other thing instead. Response prevention means creating conditions that you just can't do it. You can't drink alcohol, you can't watch porn. For example, use computers at the library in a very open location. You can't edge while you are doing that. Ideally, open location in front of the librarian's desk. Make sure you have secure networks at home and ideally figure out if you can turn off data on your phone. Make sure you've got a nanny app on your phone. If you are trying to avoid online gaming, gambling, pornography, all of those things that can be accessed through the Internet. Put the computer in the living room and open the windows. Now, this doesn't work as well for gambling, but for pornography and edging, especially if you're on the first floor, it's probably going to be hopefully going to be less comfortable to think that your neighbor may be walking by and seeing. And for pornography and sex addiction, wearing a chastity device is an option that some people use. They're wearing that device, especially if it is a metal one. They are less likely to engage in masturbation and release. Now, yes, they can still watch porn, but there is going to be no happy ending. So what conditions can you create so you're less likely to engage in the behaviors? And even if you are triggered, what things can you do to prevent that response? It's not even a choice, it's you just can't do it. And reconditioning this means reprogramming stimuli to trigger the desired behavior. So reconditioning women to be thought of as sentient beings instead of objects. Reconditioning your sexual arousal to people in real life instead of porn. Reconditioning computers so when you see them, you don't automatically think porn, you start thinking something else. YouTube videos on woodworking or something. But you're reconditioning those stimuli so they are no longer triggering obsessions thoughts about porn. You're reprogramming stimuli to not trigger the undesired behavior. You don't want women or computers to trigger cravings to watch porn, to trigger use of porn and masturbation, or to trigger anxiety, depression or anger. Porn and solo masturbation need to become associated with distress. It's important that these two behaviors become less enjoyable and less less palatable. And that when you're engaging in sexual activity, it's with a real life partner. Is solo masturbation in itself a problem? No, not for a lot of people. But for people who have an addiction to compulsive masturbation or watching porn, edging and, and release, then solo masturbation is often a sort of a gateway activity, if you will, and can become problematic in itself. And healthy coping, interpersonal and sexual behaviors need to be rewarded. It's important to increase the reward instead of just punishing the addictive behavior. Scaffolding generally requires the support of someone else through although YouTube videos may be a partial substitute self awareness of what's going on. Now I can say self awareness till the cows come home, but you're like, okay, well what does that mean? How do I do it? Well, you can go on YouTube and you can watch videos on how to develop self awareness, or you can find a coach or a counselor that can help you learn that skill and help you implement it. And that's one of the things we do a lot of times in counseling is help people complete the process. They started to become self aware, but they missed big things. And the counselor or the coach or the sponsor can say, all right, well that's good that you are aware of this stuff, but what about this stuff out here? And gradually the person becomes better at becoming self aware of their triggers, their vulnerabilities, their urges, etc, processing stuff. It's another one of those things that you may be able to do a little bit, but you have difficulty actually effectively completely processing something. So working with a coach or a counselor or a sponsor, or Even watching some YouTube videos may help you learn tools to process your stuff. Same thing is true for coping with cravings or interpersonal skills. Just like learning to tie your shoes. Most people don't see it done once and then automatically they can tie their shoes and they see it, they understand what's supposed to happen. And then the child may start by, okay, I've made, I've made the bunny ear, now what do I do? And then they learn that, okay, I've made the bunny ear and I've looped it around. Now what do I do? And scaffolding is when the parent or caregiver steps up and says, okay, great, you made it this far. Let me help you the rest of the way. So what skills do you need to learn and who can help you learn these skills? Baseline charting. I use the mnemonic Fido. You're going to look at frequency, intensity, duration and options. Besides the hair of the dog that bit you. That is to say, what things did you do each day to prevent, tolerate, or improve the problem? And I have an example down here of craving. So the frequency this person is craving is two times a day. The intensity was four out of five. The duration was for one hour. Okay, the next day they were. The frequency was five times a day, but the intensity was less. The duration was still an hour. The next option, if you will, or the next day, the frequency was still five times a day. The intensity was a four out of five, but the duration was only 15 minutes. So you can see that there was improvement on each of these examples, but the improvement was different. One, it happened less frequently. Another example, it happened less intensely. And another example, it didn't last as long. It still was happening a lot and still pretty intense, but it wasn't lasting nearly as long. All of those are evidence of improvement. It's important not to get too caught up in charting too many things, but charting can help you see your progress. For frequency, you can chart the craving, the frequency of your cravings, the frequency of your in real life arousal to human beings, or even the frequency of your moodiness. You can also chart the intensity of those things or the duration of those things. Pick two or three things and monitor so you can watch for evidence of progress. What two or three things you pick will largely depend on the two or three symptoms that are probably most bothersome to you right now. You can keep a log that looks something like this where it has the days of the week across the top and then frequency, intensity, duration and options. So it happened five times this day. That would be the frequency. The intensity was a three out of a five. It each time it lasted for about 15 minutes. Okay. And then options represents what did you do to deal with it? Or what could you have done to deal with it? And then you can repeat the same thing. If you're charting irritability at the end of the week, review your logs. Was there a decrease in the frequency, intensity or duration of your symptoms? And it's going to vary. Some days it may be more frequent but less intense. And the very next day it may be less frequent but more intense. But what you're looking for is improvement over time. If there was a decrease in the frequency, intensity or duration, were you using new tools to cope with distress? Or is it evidence of your body healing? Or both? And successive approximations encourages us to look for progress, not perfection. For example, going an hour without thinking about it, that's where you start. Eventually you may go for a week without thinking about it or a month without thinking about it. But start small. Another example would be being able to work on a safe computer without total distraction. Okay, that's a start. You may have occasional thoughts and urges, but you're on a safe computer, you're in a safe space, you're able to get your work done. It's hard, but you're able to do it. Eventually you're able to work on a safe computer without having any cravings or distraction. It's just doesn't even come into your mind. Getting slightly aroused in a healthy real life situation at first is progress. If you start out where you can't get aroused in a real life situation, you can only get aroused by porn. Then any evidence of getting slightly aroused in a healthy real life situation, that's progress. And then moving up to eventually desiring intimacy and connection with somebody in real life and find the final example. Making eye contact may be the first step. And then the next step is you congratulate yourself when not only do you make eye contact, but you introduce yourself to somebody. Once you get to the point where you're comfortable doing that and you're able to introduce yourself, you're not asking anybody out yet. Then you get to the point where you feel comfortable and confident. And confident in making eye contact, introducing yourself and asking them out. So you start to feel really good about yourself when you take that final step. These are very basic tools to help you change behavior. These tools will often not totally address all of the underlying issues, but they're very helpful for relapse prevention. A counselor or certified behavior analyst can help you learn how to implement these tools.