Rationale

The following paragraph is inserted between the first and second elements of the Monti et al. rationale:

Recovering alcoholics need to be aware of a state of mind that can predispose them to a relapse—a state of mind characterized by certain dangerous attitudes and thought processes.

This state of mind is often described as “negative tapes.” These thought processes and attitudes are dangerous because they induce alcoholics to relax their guard (decrease vigilance).

Stinking thinking, as the saying goes, leads to drinking thinking, and then, usually, to drinking without thinking. It is not the thinking itself that creates the problem, but how people deal with it.

If alcoholics can learn to dismiss this thinking from their minds whenever it appears, recognize it for what it is, or counter it with contrary thoughts, it need not lead to a relapse.

The following items are added to the list of situations that may lead clients to have thoughts about resuming drinking:

Escape. Individuals wish to avoid the discomfort aroused by unpleasant situations, conflicts, or memories. Failure, rejection, disappointment, hurt, humiliation, embarrassment, discontent, or sadness all tend to demand relief. People get tired of feeling hassled, lousy, and upset. They just want to get away from it all and, more to the point, from themselves. It is not necessarily intoxication that is sought; rather it is numbness, the absence of problems, and peace.

Relaxation. Thoughts of wanting to unwind are perfectly normal, but they go awry when they are coupled with the expectations of this happening immediately, without the benefit of doing something relaxing. Rather than engaging in a wide variety of possibly enjoyable and relaxing activities, the individual may choose the more immediate route induced through alcohol.

Socialization. This overlaps with relaxation but is confined to social situations. Many individuals, shy or uncomfortable in social settings, may feel a need for a social lubricant to feel more at ease and decrease the awkwardness and inhibitions they feel around others.

Improved self-image. This situation typically involves a relatively pervasive negative and low self-esteem. When individuals start becoming unhappy with themselves, when they are feeling inferior to others, when they regard themselves as lacking in essential qualities, when they feel unattractive or deficient, they often begin to think again of alcohol, through which they may have previously achieved immediate and temporary relief.

Romance. Individuals often indulge in adolescent fantasies. When bored or unhappy with their lives, they yearn for excitement, romance, the joy of flirtation, and the thrill of being in love. This is usually the kind of thought that, when engaged in too seriously, requires a drug like alcohol to sustain it and make it more vivid and real.

To hell with it. Some individuals seem to have lost all incentive for pursuing any worthwhile goals. Their thoughts express disillusionment; nothing really matters. There is no reason to try. Why should they give a damn? Such an attitudinal set leads these individuals to be less vigilant and not care whether they remain sober.

No control. This represents the other side of the coin from the “Testing Control” script. Just as believing in one’s ability to handle alcohol is usually a setup for relapse, the opposite attitude of not being able to control one’s cravings virtually insures it. Individuals give up the fight, conceding defeat even before they have made any effort to resist. Alcohol is seen as one of the few viable options available.

This differs from the “hell with it” attitude. In that situation, individuals do not necessarily feel powerless; they just do not want to exert the effort to continue what they have been doing.

[NOTE: The major portion of this session is based on the corresponding session in Monti et al. (pp. 79–83). A number of additions made to the original materials are derived from Ludwig (1988). © Oxford University Press. Used with permission.]

Skill Guidelines

The following introductory paragraph is added:

All recovering people have thoughts about drinking at one time or another. The thinking itself does not create the problem, but how people deal with it. If alcoholics can learn to dismiss this thinking from their minds whenever it appears, recognize it for what it is, or counter it with contrary thoughts, it need not lead to a relapse.

There are three general and overriding prerequisites for an individual to cope effectively with thoughts about drinking: (1) one needs to be firmly committed to recovery in order to choose to remain abstinent and not give in to persistent thoughts; (2) one must be aware of the persistent aspects of thinking that would allow the individual to rationalize and justify (and provide guilt free) drinking; (3) one must maintain a high level of vigilance, always anticipating potential risks to relapse and never assuming that one is immune from the prospect of giving in to urges, cravings, or thoughts of drinking.

Add the following paragraph after the first skill guideline:

An important aspect of challenging possible thoughts about drinking (as well as forms of thought distraction and substitute behaviors incompatible with drinking) is not to visualize what one is not going to do but to picture a substitute or opposing behavior that one is going to do. To begin a new habit, individuals should have a behavioral image of themselves engaging in the new behavior, not just on occasion but every time the unwanted habit pops into mind.

The following paragraph is added after the third skill guideline:

The individual is asked to think beyond the more immediate pleasure associated with alcohol, to play out the mental image of the possible drinking episode to the end, and to include all the detrimental consequences that could arise if drinking occurs.

In skill guideline number 8, the reference to calling one’s AA sponsor is eliminated in Project MATCH to reduce overlap with the 12-Step facilitation treatment.

Introducing the Practice Exercise

The practice exercise in Monti et al. has been modified somewhat. The following paragraph replaces the one on page 83 in Monti et al.:

Ask clients to write out lists of (1) the 5 to 10 most anticipated positive consequences of sobriety and not drinking, (2) the 5 to 10 most negative personal consequences associated with drinking, and (3) the 5 to 10 greatest stumbling blocks or high-risk situations that will make it difficult to achieve or maintain sobriety.

Then, ask clients to use this information (the positive benefits of sobriety and the negative consequences of drinking) to rate how committed they are to stop using and to stay sober. The rating of the person’s perceived level of commitment ranges from 1 (no commitment) to 10 (extremely high level of commitment).

Practice Exercise

The following composite Practice Exercise incorporates the modifications to the one in Monti et al.:

One way to cope with thoughts about using alcohol is to remind yourself of the benefits of not using, the unpleasant consequences of using, and the stumbling blocks or high-risk situations that may make it hard to keep your commitment to abstinence.

Use this sheet to make a list of the 5 to 10 reminders in each category, then transfer this list onto a pocket-sized index card. Read this card whenever you start to have thoughts about drinking.

Positive benefits of not using:

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Unpleasant effects or negative consequences of using:

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Stumbling blocks, or high-risk situations, to keeping commitment to abstinence:

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Overall level of personal commitment to remain abstinent:
None   1   2   3   4   5   6   7   8   9   10   Extremely high

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Source page:
http://pubs.niaaa.nih.gov/publications/MATCHSeries3/core.htm