REFERENCES AND METHODS FOR DIFFERENT UNWANTED
BEHAVIORS AND THOUGHTS

A few books discuss "habit control" in general: Wexler (1991), Miller (1978), Martin & Poland (1980), Birkedahl (1991), and Prochaska, DiClemente, & Norcross (1994) are among the best.

Abuse--physical, sexual, psychological--must be dealt with immediately and requires professional help. Suspected physical and sexual abuse of children (under 18) must be reported to Children and Family Services authorities who will investigate and arrange for treatment. See chapter 7 for physical abuse. See chapters 7 and 9 for sexual abuse (chapter 10 for date rape). If you fear you might hurt someone, get help immediately by calling your Mental Health Center.

Addictions, in general, were once thought to be the result of especially powerful drugs or innately defective personalities (e.g. inherited or moral weakness). Now it is more common to believe that an addictive habit often serves the purpose of distracting the victim from some painful emotion, such as feeling inadequate, being depressed, being consumed with anger or guilt, etc. In short, addictions cover up emotions that trigger the addiction. So, get your emotions under control. Birkedahl (1991), Washton & Boundy (1989) and Hirschmann & Munter (1995) take this approach.

Alcoholic Anonymous (AA) has been the standard recommended treatment for decades. AA and the 12-step programs have helped millions, but there are a lot of people they don't help (Kasl, 1992). Recently, many specialists in the area of addiction have come to believe that many ordinary experiences can become addictive, such as work, sex, exercise, eating, making money, socializing, etc., and anyone can, under the right circumstances, become addicted. This leads many experts to question the old notion that alcoholism is primarily an inherited disease and that the victim is powerless against it without God's help and a 12-step program. Actually, giving up the disease concept helps many alcohol treatment centers accept new treatment approaches, such as various new drugs as well as aversion treatment, behavioral shaping, family therapy, motivation interviewing, and many other forms of psychological treatment (Rodgers, 1994). And giving up the disease concept helps some people seek help (to control a bad habit). There is still a lot we don't know in this area, including such things as how many Vietnam veterans could just leave their heroin addictions behind them when they returned to the states. Also, why do 95% of the people who quit smoking do it on their own but only 20% of drinkers stop without outside help (while it is thought that 90% of smokers are "addicted" but a much lower percentage of drinkers considered themselves addicted)? The wholesome questioning and doubts about the causes and treatment of addictions should lead to a lot of change, experimentation, and controversy in the area of addiction treatment during the next decade.

Addiction therapists with different orientations have recently made great contributions to our society, not just in the form of treatment methods, such as relapse prevention, but also by focusing on the effects of an alcoholic family member on other members (codependents, abused children), clarifying the role of shame, and highlighting the need to take care of the hurt inner child (see codependency and children of alcoholics below).

Illegal drugs are used (1) because they help us feel good, (2) reduce unpleasant feelings, (3) aid our socializing, and/or (4) because we are addicted. For a good general reference about drugs see Weil & Rosen (1993).

Alcoholism is wide spread. It is a very serious personal and social problem (Milgram, 1993). Excessive alcohol can damage many organs of the body. About 15% of working men are alcohol dependent, 6% of working women are. 40% of all industrial fatalities are alcohol related. Alcohol is also a factor in 45% of all fatal auto crashes (almost 17,700 deaths in 1992). Non-alcoholic men, aged 45-59, earn $24,000 per year, alcoholic men earn $16,000 and 33% have work attendance problems. About one-third of people with drug or alcohol problems are also depressed. About 30% of suicides (46% of teen suicides) involve alcohol. Indeed, drug and alcohol addictions are thought to be dangerous ways of attempting to cope with emotional problems, such as shame, guilt, resentment, fear, etc.

Drug and alcohol use declined among U.S. college students between 1980 and 1992, but the amount of alcohol consumed in each separate drinking session increased. That is, college students are moving towards more binge drinking and, consequently, experiencing more blackouts, arrests, loss of friends, assaults, sexual harassment, and so on.

Alcoholism remains resistive to treatment. As mentioned, there has been a heated controversy between (a) "alcoholism is a disease" (AA groups) which supposedly can only be controlled by total abstinence and (b) "alcoholism is a learned behavior" which can, in less severe cases, be unlearned, controlled, and done in moderation (Miller & Berg, 1995; Miller & Munoz, 1976; Miller, 1978; Marlatt & Parks, 1982; Vogler & Bartz, 1985; Peele & Brodsky, 1991). Current evidence suggests both views may be partly right. For instance, there are very few ex-smokers who can occasionally light up and not get addicted to cigarettes again. This supports AA's position that total abstinence from an addiction is required (although the cigarette habit is different from the drinking habit). Certainly, persons with serious, long-term drinking problems are not good candidates for controlled drinking experiments; they need to abstain and probably get intensive treatment for the underlying emotional-personality problems. On the other hand, there are many millions of people who have been moderate to heavy drinkers but are able to get the habit under control and stay a well-controlled drinker. All potential addictions merit serious concern.

Cooper (1994) explains alcohol use in terms of reinforcement: internal positive reinforcement (feeling more relaxed, more assured, more powerful...), internal negative reinforcement (avoiding unpleasant feelings, such as loneliness, depression, anxiety...), external positive reinforcement (being accepted, being praised, making friends...), external negative reinforcement (avoiding unpleasant experiences, such as rejection or failure--because you never tried). This theory suggests drinking can be changed by changing the reinforcement one gets from drinking or not drinking. Surely to some extent, drinking follows the same laws of learning as all other behaviors.

College students often believe that (1) learning to refuse unwanted drinks, (2) setting time limits on drinking, and (3) avoiding heavy drinking buddies can help you control your drinking, if you are not yet addicted. Sounds reasonable but there is some reason to question just how well college students actually control alcohol consumption, e.g. college students consume an average of 34 gallons of alcohol (mostly beer) per person per year. That's drinking more alcohol than soft drinks. Alcohol use in college has steadily gone up since 1975. On the other hand, millions of the potential addicts in college become sober parents who vigilantly guard their teenagers against the fruit of the vine.

Alcoholic women are more likely to be depressed and anxious; alcoholic men are more likely to have anger and an antisocial personality disorder. Social pressure to drink is more common among men; women drink alone more often than men. Among adolescents, problem drinking is associated with delinquency, violence, and lower grades. Alcohol is a serious threat to a developing fetus; please, never drink when pregnant.

In temperance cultures (where alcohol is viewed as a dangerous addiction from which you must totally abstain), drinkers tend to binge to get drunk, rather than drink beer or wine with meals every day. In cultures where drinking is accepted as a daily part of life, people seldom get drunk, and when they do have health problems from drinking, the family simply helps them get back on a healthy diet. "Demon alcohol" is not blamed and a religious solution, like AA, is not prescribed.

Men are five times more likely than women to be addicted to alcohol. The slippery slope of alcoholism is pretty predictable for men: by mid to late 20's, there are binges, morning drinking, and job problems; by early to mid 30's, blackouts, shakes, car accidents, DUI arrests, poor eating habits, terminations at work, and divorces; by late 30's to early 40's, there are serious medical problems, such as vomiting blood, hepatitis, hallucinations, convulsions, hospitalizations, and life is a wreck. The earlier you get off the slope, the better. It is a slow suicide, with your only "friend" in the end being a bottle. DO SOMETHING, NOW!

Controlling the intake of alcohol requires (1) high continuous motivation, (2) development of a new life-style, with new friends and family support, and (3) carefully planned relapse prevention. You will need to change your environment (Method #1 in chapter 11), i.e. avoid bars, drinking buddies, parties, etc. Join a self-help group, like AA or Rational Recovery, for support and turn to your family for support. Keep your motivation high (Methods #5 and #14 in chapter 11). Constantly remind yourself of the reasons for drinking less--health, money, greater effectiveness, better relationships, etc. Specifically rehearse how to handle invitations to "have a beer" or "come with us" (Method #2 in chapter 11). Most importantly, prepare for possible lapses (this chapter and Method #4 in chapter 11). Reward your progress and be proud, it's a tough undertaking (Methods #16 and #19 in chapter 11). This is a short paragraph but there is a lot here.

For hundreds of books about alcoholism and the 12-step (AA) program write Hazelton, Box 11, Center City, MN 55012. Yoder (1990) lists many recovery resources. Even the almost 60-year-old AA "bible," which has helped millions, has been updated (J, 1996). Many of these books focus on chronic drinkers, but actually more people are "problem drinkers," i.e. have some problems due to drinking (arguments with spouse or friends, late to work, etc.) but are not totally dependent on alcohol, yet. Sobell & Sobell (1993), Fanning & O'Neill (1996), and Miller & Berg (1995) have developed self-management programs (sometimes administered in cooperation with therapists) for problem drinkers who haven't become addicted, yet. If anger seems to precede your relapse, see Clancy (in press). Everyone seems to agree that support from an understanding group is helpful. Kishline (1995) has started a self-help group for problem-but-not-chronic drinkers; the emphasis is on moderation, not on life-long disease and total abstinence (see her book for help in finding a non-AA group).

Professional psychologists (Santrock, Minnett, & Campbell, 1994) consider Twelve Steps and Twelve Traditions (1990) by Alcoholics Anonymous World Services to be one of the best self-help books available, although the AA approach is considered highly religious and almost "cultish" by many (it still helps more than any other single method). Psychologists also approve of approaches very critical of AA, such as The Truth about Addiction and Recovery (1991) by Stanton Peele & Archie Brodsky, When AA Doesn't Work for You: Rational Steps to Quitting Alcohol (1992) by Albert Ellis & Emmett Velton, and Alcohol: How to Give It Up and Be Glad You Did (1994) by Philip Tate.

For personal help and treatment, call your local Drug and Alcohol Abuse Treatment Center or seek individual therapy. For referrals, call AA (212-686-1100) or Nat. Inst. on Drug Abuse (800-662-HELP) or Nat. Inst. on Alcoholism (212-206-6770 and 301-468-2600). Social support clearly helps prevent relapse.

Spouses and children of alcoholics should know about Al-Anon and Alateen which help relatives of alcoholics (see Yellow Pages for numbers). There are many reactions to living in an addictive family; thus, in addition to behavioral approaches, there are personal growth and insight approaches (see Black, 1987; Bradshaw, 1988, 1989; Gravitz & Bowen, 1986; Woititz, 1983). Professional psychologists consider Claudia Black's (1981) It Will Never Happen to Me to be the best self-help book for children and spouses of alcoholics (Santrock, Minnett, & Campbell, 1994).

Lack of Assertiveness is discussed in detail in chapters 8 and 13 (Alberti & Emmons, 1986).

Attention Deficit Disorder (ADD) is most common among young boys, although some doctors think girls with ADD tend to daydream (and not pay attention) rather than becoming over-active, restless, impatient, impulsive, and rebellious, like boys do. About 50% of people suffering from ADD get over it at puberty, the other 50% have some symptoms of ADD all their lives. Medication and cognitive-behavioral therapy are usually helpful. About 70% of 5-year-olds to teenagers benefitted from Ritalin. It is also beneficial to develop a more structured life and self-instructions for controlling the impulsive distractibility. This means that an ADD patient will need to see an MD and a Ph. D. A good general reference for adults is Hallowell & Ratey (1994). High school and college students should look up Quinn (1994, 1995). As parents of an ADD child, see Taylor (1994) or Barkley (1995). Recent theories about self-regulation in ADD are in Milich & Nietzil (1994). For less technical information and references, write CHADD (Children & Adults with ADD), 499 NW 70th St., Plantation, FL 33317.

Bedwetting can usually be controlled with an apparatus that signals the first drop of urine. Eventually, the person learns to detect bladder tension and wakes up (Yates, 1970; see Sears catalog for bedwetting alarm). There are medications to help and even a self-help picture book for children with this problem (Mack, 1989).

Codependency is the action of a person who becomes addicted to an addict and in the process devotes her/his life, without success, to supporting, tolerating abuse, caring for, and attempting to "save" the addict. Anyone caught in this trap should get help (see Beattie, 1987, 1989; Norwood, 1986).

Coffee drinking is primarily an attraction to caffeine, according to Morris and Charney (1983)--so why do I only drink decaffeinated? This attraction to caffeine is probably true if you drink a lot of brewed coffee. Gradually switch to instant coffee (it has 1/3 the caffeine), then to decaffeinated, then reduce the number of cups, then drink orange juice.

Compulsiveness is a result of insecurity. All of us are faced with our limitations; we fear making mistakes. If we are secure within ourselves, we can handle our weaknesses and errors (but we may be quite orderly and careful). The insecure person is likely to excessively compensate for his/her real or imagined limitations by becoming overly compulsive. Thus, many mild compulsions are beneficial; some serious ones are terrible handicaps (most addicts are compulsive); others are merely bad "habits" which can be dropped with a little conscious effort. Obsessive-Compulsive disorders are dealt with in chapter 5.

Compulsive spending or impulse buying is another way to handle emotions (call 212-484-0998) and see the budgeting section of chapter 13. A book by Mellan (1994) deals with this.

Disorganization is a handicap but you have your own unique style, so you need solutions tailored to your personality (see Schlenger & Roesch, 1990). Gleeson (1995) helps you become efficient at work.