Self-Help Options
The founders of the Rational Recovery technique explain that what begins as a simple and pleasurable desire to ‘get loaded’ has, in many people, developed into an automatic and involuntary craving. They contend that while someone’s appetite for drugs or alcohol may feel involuntary (like the ‘need’ for oxygen or food) humans consciously control the fulfillment of that appetite through voluntary muscles in the hands, face, and body. Hence, it is impossible to become intoxicated apart from the conscious and deliberate decision to do so. In an attempt to have its way, an ‘involuntary appetite’, coming from the midbrain, will enlist the functions of the conscious brain through auditory thoughts, visual imagery, language, and a wide range of feelings.
Rational Recovery promotes the idea that everyone has the inner capacity to control seemingly compulsive behaviors. Proponents utilize a technique called Addictive Voice Recognition Training (AVRT). AVRT is based on the idea that a thought always precedes the actual action of drinking and drug using, and that it is these ‘thoughts’ preceding the ‘actions’ that can be controlled far easier than the action itself. In fact, each action is actually made up of many smaller actions that are all preceded by thoughts –making a call, looking for the car keys, starting the engine, stopping at the bank, driving to the dealer, securing paraphernalia, etc. Recognizing and derailing the initial thought is far easier than stopping the sequence of action steps and their related thoughts once they are already underway –at that point, the proverbial train has already left the station and is gathering speed.
AVRT teaches individuals to recognize the early warning signs (specific thoughts) of an oncoming craving cycle (which may begin days or even weeks before any relapse action step is taken), and to directly combat the desire to use before it becomes a seemingly overwhelming compulsion. These initial thoughts may take many forms –acknowledgment of stress, feelings of inadequacy, a desire to ‘celebrate’ upon completion of a deadline. ‘Rational Recoveryists’ refer to this ‘voice’ as ‘The Beast’.
Individuals must develop an awareness of the self-talk and mental imagery that promotes drug-using and drinking. Whenever ‘The Beast’ begins to advocate for drinking or using –at first innocently camouflaged in thoughts that acknowledge valid feelings, individuals self-trained in AVRT can make use of thought-stopping techniques, role-playing games, and other devices, combined with a firm commitment to permanent abstinence, to shut it down. Often, simply learning to recognize and acknowledge the voice (or imagery) when it occurs is enough.
Instructions for developing the techniques used in Addictive Voice Recognition Training are available online at the Rational Recovery website: http://www.rational.org
Spontaneous Remission refers to an addicted individual who stops using drugs or alcohol altogether or reduces consumption to the point where these substances are not harmful, without external intervention –treatment, therapy, 12-step programs, medications, etc. ‘Cold Turkey’ refers to doing this abruptly, typically resulting in withdrawal, as opposed to a gradual reduction of the substance over time.
Spontaneous Remission is more likely to occur in individuals who perceive their addiction as a behavioral response, rather than as a disease or disorder which can only be controlled through medication or therapy. While proponents of spontaneous remission acknowledge that involuntary changes have occurred in the brain due to drug use, they argue that the same voluntary behaviors that caused the addiction can be applied to undoing the addiction. (Alexander, 2015; Heyman, 2010; Kurti and Dallery, 2012; Schaler, 2002; White, 1996)
Many heroin-dependent individuals recover without medication, rehab or the 12-steps by weaning themselves off over time. (Fletcher, 2013; McCabe et al, 2016; Sobell, 2000) In fact, there is not adequate evidence to show that people who go to rehab or attend 12-step groups are more successful at overcoming addictions than those who do it on their own, regardless of the severity of their addiction or presence of co-occurring disorders (Fletcher, 2013). Gene Heyman, a neuroscientist at Harvard, points out that only about 15%-30% of people in remission from drug or alcohol dependence have ever received treatment. Another study reported a rate of 50% of individuals in remission have ever utilized treatment. From these studies, one can conclude that at least half, if not more, of the individuals who have achieved remission from addiction did so without treatment (Heyman, 2010; Noe, 2016; Regier, 2016).
The earliest empirical evidence that opiate users achieve remission, despite never receiving treatment, was based on a sample of male soldiers who had used opiates in Vietnam and then decreased or stopped their use after returning to the U.S. In response to environmental stressors, half of all enlistees reported using opiates (35% using heroin) in Vietnam, and approximately half of the total users (20% of heroin users) became addicted –that is 20% – 25% of all U.S. troops in Vietnam were addicted to opiates. Upon returning home, only 1% – 2% remained addicted one year after their return. Of those addicted, approximately 7% had stopped and then relapsed at some point within the first 10 months of their return. Less than 10% of those who stopped became re-addicted to opiates sometime in the 3 years after their return to the U.S. The usage and addiction rates of returning veterans essentially decreased to near pre-Vietnam levels of 1% – 2%. (Heyman, 2010; Price, 1993; Price et al, 2001; Robins et al, 1975)
Behavioral theorists contend that there is a tug of war going on between the addicted brain circuits and the rest of the brain. The reward system of the brain drives the individual in the direction of addiction and increased substance use. However, both environmental and neuro-biological factors associated with aging and maturity drive the individual in the opposite direction. The evidence shows that in the majority of cases the addiction loses and maturity wins.
Developmental changes in the brain render high risk behaviors such as heavy drinking or shooting heroin far less attractive to the mature brain of the 25 year old than to the sensation-seeking adolescent brain of the 16 year old. The older you get the more likely you are to quit an addiction because the less likely you are to find high risk behaviors to be attractive. Maturing out of addiction is a reflection of normal brain development. (Alexander, 2009; Heyman, 2010; Szalavitz, 2016; Peele, 1991, 2016; White, 2012)
Peele (1991, 2016) and White (2012) have noted environmental factors such as graduating from college, attaining full-time employment, marriage or cohabitation, and having / raising children as influences which lead the majority of collegiate substance users to give up their heavy involvement with substances and either abstain or become moderate users over time.
Even for heroin – surely the gold standard of addictiveness – most addicted people grow out of their addiction by age 30, quite often without treatment. (Alexander, 2009)
The commonality in success stories of spontaneous remission from opioid dependence, including the Vietnam veteran and college student studies, is that when other goals in life (work, family, caring for children) became incompatible with continued drug use, those who were addicted decided to quit and did so successfully (Heyman, 2010). The logic here is that the ‘brain disease’ view can be ‘falsified’ by cases of severely addicted individuals who quit successfully on their own. (Hart, 2013; Price et al, 2001; Peele, 1991, 2016; Szalavitz, 2016)
Walters (2000) evaluated the principal reasons people gave for spontaneously remitting. Individuals cited “health concerns, pressure from friends and family, and extraordinary events as being instrumental in initiating spontaneous remission, while social support, non-drug-using friendships, willpower, and identity transformation were pivotal in maintaining change.” A plethora of written personal testimonies exist citing numerous variations on this theme to further support this research. (Sindewald, 2017; Szalavitz, 2016; Walters, 2000)
High rates of spontaneous remission imply that existing drug abuse treatment is either unnecessary or ineffective. “Without insights into drug abusers’ thinking and decision making regarding changing their behavior, their needs for intervention may continue to be insufficiently met” (Price et al, 2001).
‘Cold Turkey’ refers to the abrupt cessation of opiate use, typically resulting in withdrawal, as opposed to a gradual reduction of the substance over time. It is described as a horrific and painful experience and is often avoided for this reason. The period of intense withdrawal is determined by whether the opioid is short-acting or long-acting. With short-acting opiates, like oxycodone, hydrocodone, codeine, heroin, morphine, or fentanyl, withdrawal will typically begin 12 hours after last use, increase in symptoms, and become the most severe 3 and 4 days after last use. By the 5th day, the acute symptoms will begin to subside. With long-acting opiates, like methadone or buprenorphine, the acute withdrawal begins about 30 hours after the last dose, with the worst symptoms appearing by the 7th day and lasting through the 10th day. (Finch, 2017)
Methadone is known to have the most severe withdrawal due to its long-acting properties, and may last for several weeks. It is for this reason that many detox facilities will not admit individuals addicted to methadone unless they are using doses below 30 or 40 mg. Insurance will not pay for the extended length of time that it takes to detox patients off methadone. It is not uncommon for methadone patients seeking detox to taper themselves off with street heroin in order to enter a residential detox program once the methadone is sufficiently out of their system.
Following the acute phase of withdrawal, about 90% of opiate users experience Post-Acute Withdrawal Symptoms (PAWS) –depression, anxiety, insomnia, pain, etc., which can last several months to several years. Good nutrition and exercise can often ameliorate the worst of these symptoms.