Abstinence isn’t for everyone – an introduction to harm reduction

When we talk about harm reduction, safe injection sites or opioid replacement therapy come to mind for many people. But the concept of harm reduction is much broader and can be applied to any substance at any level of severity. You’re  probably familiar with the concept of harm reduction when it comes to food intake, even if you don’t call it by that term. When you choose treats that have less sugar or fat, you are engaging in a harm reduction strategy. When you decide to forgo a second helping of dinner, that is harm reduction. 

Harm reduction is any strategy that reduces the negative consequences of substance use. Some examples include consuming a lower alcohol content beverage, drinking water between drinks, eating while drinking, waiting until a certain age before using substances, or using pain management techniques other than medication, such as yoga or meditation. While some people may be willing to quit substances altogether, most people are not. Harm reduction allows all people to engage with strategies that benefit their lives. The key to harm reduction is that any step in a positive direction is a beneficial step. 

“The key to harm reduction is that any step in a positive direction is beneficial.” 

But shouldn’t some people just stop using substances? Research shows that some people who struggle with substance use benefit from abstinence, particularly if they have found substance use difficult to control over time and have experienced severe consequences such as losing jobs or important relationships. 

That being said, the majority of people do well with harm reduction approaches but do not have that option when seeking treatment. Programs that provide the option of reducing or moderating substance use are rare, and many programs require that you abstain or commit  to abstinence when entering treatment. This all-or-nothing approach prevents seeking help and is not aligned with up-to-date, evidence-based understandings of addiction treatment. 

One of the main barriers to harm reduction approaches — and the reason abstinence is often touted as the gold standard — has been a dominating belief that addiction is a disease. The main premise of the disease model is that people who struggle with substance use have a progressive and irreversible illness that stays with them forever. The research evidence simply does not support this model. 

“The research evidence does not support the model of addiction as a lifelong, irreversible disease.” 

The longest follow-up study in addiction recovery is being conducted at Harvard Medical School, where they have followed the drinking patterns of a group of males since 1940. Results show that many of the participants have continued to use high levels of alcohol for decades without progressing to a more severe state. Similarly, research studies conducted by the National Institute on Alcohol Abuse and Alcoholism have found that about 75% of people who meet the criteria for an Alcohol Use Disorder no longer do so at a later time. We now know that people who struggle with substance use fall along a spectrum of problems from low to high; it is not a matter of having or not having a disease. Most people on this spectrum tend to ebb and flow in and out of struggles with substance use throughout their lifetime. 

What are the benefits of harm reduction?

Abstinence isn’t for everyone:

Many people are not ready or willing to commit to abstinence, especially those on the mild or moderate part of the spectrum who would benefit from harm reduction. Acknowledging that there are numerous pathways to resolution can have implications for drawing more people into treatment. In an analysis of 38 articles with 40 separate samples, Linda Sobell and her colleagues found that 3/4 of the individuals who had recovered from struggles with alcohol use reported that low-risk drinking was part of their recovery. Similar evidence was found for drug use, with nearly half of the combined sample reporting recovery involving some form of continued use. 

It provides early intervention:

A second benefit to harm reduction is that it helps people earlier in the process. A common belief is that recovery from addiction requires hitting “rock bottom” and receiving formal treatment. However, programs that successfully create change in the early stages of an addictive process serve to help people who may not yet have experienced negative consequences of use. 

It’s individualized:

Harm reduction is client-centric, which means techniques are tailored to the individual and meet them where they are. Imagine if you were told today that you had to give up sugar forever? Most people would struggle with this goal, but many are open to reducing their sugar intake over time. The same principles apply to substance use treatment. Allowing people to make choices about how and when they make a change offers the best chances for success. 

It’s the natural process of change:

Referring back to the sugar example, imagine if the only measure of success for good health was to never consume sugar again? What if you had reduced your sugar consumption to only on weekends, or only on holidays? Surely that would be a measure of success? Yet historically, the only measure of success in substance use treatment has been complete abstinence. This outcome does not consider the multitude of ways that someone can change in a positive direction. Most lasting changes happen in small incremental steps over time. 

What are some examples of harm reduction?

Harm reduction can come in many different forms. Here are some ideas of harm reduction you might consider: 

What does harm reduction look like in practice?

Here’s an example of how someone has benefited from a harm reduction approach: 

Jackie likes to relax after work with a few drinks, and sometimes more when she’s feeling stressed out. On the weekends, she often gets together with her girlfriends for nights on the town and boozy brunches. But in the last few years, she feels like these habits have caught  up with her. Her hangovers are getting worse, she’s given up some of her nighttime hobbies, her spending on alcohol has been increasing, and she’s been getting anxiety around all of it. In the last few months, Jackie has been working with a coach to implement harm reduction practices. She now considers the low-risk drinking guidelines by sticking to two drinks a night, except for on special occasions. She’s decided to make Mondays to Wednesdays alcohol free days. On the weekends, she’s determined to forgo any day drinking, and when she does meet up with friends in the evenings, she leaves her car at home, so she’s not tempted to drive home after a few drinks.

Jackie never saw abstinence as a realistic option or something she needed. But making these changes in her life has given her a sense of accomplishment and improved her health and mood. As a way to continue to motivate herself, she’s been socking away the money she saves on alcohol and putting it towards monthly massages and pedicures, as well as saving for a vacation she’s wanted to take for a long time. 

How can I change my substance use? 

If you or a loved one has been thinking about changing your substance use, think about one small change you can make today that would move you in a positive direction. This change could include reducing the amount of substance you use or reducing the harmful consequences of use. 

ALAViDA provides a range of support options for anyone wanting to change their relationship with substances, whether that’s through harm reduction or abstinence. Support is accessed through the TRAiL platform, and includes iCBT modules, daily notifications and tracking tools, coach-assisted support, live classes, and facilitated care groups. Access the ALAViDA TRAiL.

 

 

 

Addictions—the Downside of the Digital Age

While experts show that any stimulus can lead to the formation of addiction, society tends to villainize some habits over others, in particular alcohol and drugs. Some of us may be more prone to developing sticky habits, but none are immune. What is the thing that drives our addictions? Scientists say it’s the desire to escape uncomfortable feelings or negative emotions. And that is something we all confront.

May 2-8, 2022 is mental health week, and this year the theme is empathy. It’s all about understanding another person’s feelings and experiences. At times, it’s about showing an attitude of empathy to ourselves. Learning more about behavioural addictions and breaking down stigma helps build an empathetic mindset that can shape our individual and collective mindset about mental health and substance use challenges. Let’s check-in about behaviour that tends to slip under the radar: digital addiction. Take notice of the connections you make between different behavioural addictions; you can apply empathy and techniques to other habits.

We live in a digital world, and while facing the reality of a pandemic, digital life has taken centre stage. When habits become automatic, they can go unchecked. Take social media, for example. It might make you feel awful, but it’s common to check it in lineups, spare moments, and in the bedroom. Our habits extend beyond Facebook and Instagram. Some of us re-fill and empty fantasy take-out baskets in the Uber eats app for restaurants located within a 1 km radius, ignoring the vegetables that protest from the shelves of our refrigerator. We ask Google all of the stray questions that pop into our heads. Reminding ourselves of the habits that drive our daily routines can be humbling. It helps to know how the brain works; knowing that we are wired for pleasure, self-soothing, and escape helps us to recognize our patterns. A crack forms where the light can come in: addictions do not just happen to a certain kind of person.

According to the DSM definition, the thing we are addicted to causes cravings and urges. It gets in the way of our relationships, work-life, and recreational time, and it’s hard to stop doing it. Take a moment and write a list of behaviours that apply to this definition. Still, you might be holding back. It has become commonplace to check our phones while exercising, talking to loved ones, eating meals, or walking the dog. This automatic behaviour can happen anywhere: in the middle of the night, in the washroom, movie theatre, and while driving the car. It’s simply hard to fight the buzz that comes with the ding. 

If you’re realizing that you can scroll through a whole episode of your favourite TV show, you might feel shame, but don’t. Shame, unfortunately, is a common part of addictions. Stanford psychiatrist and addiction specialist Dr. Anna Lembke, says, “Just about all of us have a digital addiction drug of choice, and it probably involves using a smartphone.”

If you’re still unsure if you’re in this group, give yourself time. Even addiction researchers and specialists were late to the trend. They were so accustomed to primarily treating alcohol and drugs, but upon closer examination, the similarities were undeniable. Let’s talk about some of them.

When clients are thinking about making changes to their substance use patterns, clinicians frequently guide them through a decisional balance exercise. You can think of this as a revamped pro/con list. It enables the client to look at the benefits of their habit and the downfalls. It gives people agency. By the time many clients have gone through this exercise, they know what course they would like to take and because they find reasons of deeper meaning, they persist through challenges and they tend to see results. You may have to do some digging to tap into your deeper reasons but you will feel a sense of conviction when you identify them.

Many of us want to feel less stressed and overstimulated. We want to reduce reactivity, dial-up kindness, and connect to the present moment. We may want more time with our friends and family, and for their passions and hobbies. The good news? It’s achievable. Behavioural addiction steals hours from your day. It’s time to reclaim the calm and precious moments that pass unremarkably with mindless consumption, but it’s normal to worry about cutting back.

What if my friends and family think I’m less available?

What if I become out of the loop?

If I leave social media, will I be forgotten?

How can I get away from my addiction if I spend 8+ hours a day online for my job?

So how do you cut back? Popular culture has made it seem as if abstinence is the only option, but many find their best fit with harm reduction. You’ve probably heard it said that if you’re trying to quit smoking, the best number of cigarettes is 0. Carbohydrates are a little bit different. While they can take their toll on the waistline, mood system, and energy, the goal with carbs is less to banish them than to change your consumption. It’s subtler; experts advise that intake is focused on complex rather than simple carbs.  Digital communication fits into the same category as carbs. In an age where routine and essential acts like banking happen online, it’s a hard sell to go screen-free. The goal is to create healthy boundaries, strong coping techniques, and to identify cravings and triggers to choose a more helpful behavioural response.

As experts become more familiar with the qualities of different behavioural addictions, the hierarchy between screens, video games, alcohol, and drugs flattens out. These are like-minded predators that hunger after dopamine and prey on the brain’s reward and pleasure circuitry. Johann Hari points out that connection is the opposite of addiction, making screen time even more complicated. We are connecting to our colleagues, friends, and family through handy devices but we lose our social capital—the coordination and emotion exchanged by social partners through eye contact. This feature of our connection separates us.

One might think that digital addictions are more benign than substances, but the evidence shows that digital habits can come with serious health consequences. Excess screen time can lead to depression and anxiety. Digital habits can activate feelings of distress, and exacerbate OCD, and ADHD. The smartphone can decimate our attention span, leaving us edgy and restless when we forget our device while running an errand. For those familiar with the vulnerable sensation of walking around phone-less, it can feel like stepping out without pants. A closer look reveals that our neurobiology has been re-jigged under the innovation of Steve Jobs.

It’s not all doom and gloom. If there’s anything that’s come out of the up-and-coming research about substance-related addictions, it’s that the brain is malleable, impressively resilient, and strong-willed. So, here are some evidence-based tips and tricks that can offer you the conviction to see through the first month of your digital (or maybe even substance use) transformation.

Step 1:

Dedicate a scroll + window each day 📲

You didn’t read it wrong; it can be useful to dedicate and define screen time. Much of our use happens on autopilot, in other words, it isn’t a mindful activity.

Step 2:

🧘‍♂️Mindful Screen Use

Instead of scrolling in lineups or at crosswalks, choose when you scroll and really focus on the activity. It can also help to think about why you are opening your phone (for instance texting your teen) and then do just that.

Step 3:

Mute your Notifications 🔕

We talked about dopamine. It’s a neurochemical that can’t resist the reinforcing sound of a text tone or the sight of a banner image. Turn them off, except maybe the ring tone for your partner, mother, or child 😉

Step 4:

Section your Screen Space in the Home 🏡

Keep your space calm by deciding where your cell phone is a welcome guest. Choose a location outside of the bedroom. Let your devices charge and rest at the end of the day. If you work on the computer, try to change up your activities at the end of the day.

You can start by removing work emails and slack notifications from your phone. If it’s possible use a dedicated work computer and use a personal computer for your other activities. This simple separation can signal to your brain that a similar machine stands for a different mindset and purpose. Think of anxiety and mood as living comfortably in a box when you attend to the elements of your wellbeing: nutrition, connection, sleep, movement, and yes, digital activities. The goal is to feel calmer after disconnecting from social media.

You’ll find you are better able to attend to one task at a time without the flurry of expectations often imposed by virtual reality. Giving your brain room to breathe between the dings and pings, will help you find a healthy space for recreation at the end of the day and when you need a break. Let’s face it, we’re in a digital age. But through mindful use, you can get the calm, clarity, creativity, and kindness you crave. 

Access the ALAViDA TRAiL.

 

 

 

Tips to Survive the Holidays

The RULE for Surviving Festive Family Gatherings

The holidays are upon us. After last year’s lonely COVID Christmas, many of us look forward to gathering in person with family and friends this year. We’re so keen to socialize we may have forgotten how these events can often be fraught; full of fireworks, unmet expectations and drama.

So ALAViDA’s gift to you: we’re sharing a few of the concepts from one of the most successful therapy techniques, called Motivational Interviewing. In a therapeutic context, Motivational Interviewing is all about engaging and empowering the client to change. In Motivational Interviewing, there exists an acronym called “RULE,” which serves as a guide for how therapists should interact with clients. “Many years ago, I employed RULE to smooth over a few difficult family gatherings,” says addictions therapist and ALAViDA advisor Mike Pond, “and I was gratified at how much the dynamic changed thanks to these simple techniques.  This was not about changing anybody else’s behaviour. It was about changing myself. It also gave me a much-needed dose of humility,” he laughs. Pond shares how you can use RULE too.

Interested to read more about how to cope during the holiday season, read more here. 

The “R” stands for “resist the righting reflex.”  Often those who are prone to the “righting reflex,” may have the best of intentions.  We just know the solution to someone’s problem and are insistent on sharing it. We want to make people feel better. But in doing so, we can make them feel worse because we rob them of their own sense of agency. And there is the very real possibility, what you consider right, could very well be wrong for someone else. If someone presents a problem, just listen. Don’t jump in to solve it. Empathize. Which means saying “you understand, you feel for them.” And often that’s all that’s required.

The “U’ is “understand the person’s motivation.” Is there someone you dread being seated beside because they talk only about themselves? That person may be desperately lonely or feel their contributions are undervalued. If you can keep the question, “what’s the motivation behind this behaviour?” front and centre you’ll bring patience and compassion to this situation and feel less resentful. You’ll role-model a much-needed generosity of spirit and who knows, it might spread!

The “L” is ‘listen.” “Kind of  “no duh…” says Pond, “but I continue to catch myself not listening to people I love, never mind the people who irritate me.” We need to practice “reflective” listening, which means, summarize and restate what the person told you. Feeling “heard” is a great gift to give someone at Christmas.

E” stands for “empower.” Very likely, there will be someone at your dinner table who is viewed by the entire family as a failure. This person has suffered much needling at past dinners and probably dreads the impending pile on. Don’t let it start. Take time to consider this person’s successes and point them out. Let them know you believe in them. Cultivate a sense of hope.  Ask “how” and “what” questions, not “why” because that tends to get people defensive.

Now. Sit down and envision your Christmas gathering. Imagine the sea of faces and think about which aspect of RULE will work best with the family members you find most challenging.  You’ll be a change agent. You’ll find yourself truly living what the holidays are supposed to be about: spreading joy and goodwill.

Looking for more strategies to manage during the holidays? Read more here.

Access the ALAViDA TRAiL app.

 

Beating Holiday Cravings

Planning for the Holidays

When the days get shorter and the temperature drops, many combat the gloom with Christmas lights, holiday baking, and festive lattés. The calendar fills up. But despite the excitement, the holidays can come with a lot of pressures and expectations. It’s easy to feel grief over lost loved ones, a sense of nostalgia for the way things used to be, or feelings of comparison to friends with good circumstances.

When everyone around you seems joyous, it’s hard to admit that you feel lonely, low, or out of place. The focus on family and relationships during the season can create a lot of pressure. And maybe once the days shorten and it becomes harder to convince yourself to go out for a walk, which impacts your mood and puts a grey lens over all of the festive spark.

Interested to read more about how to cope during the holiday season, read more here. 

As families change and children develop traditions separate from their parents, it can cause painful feelings.

Whether it’s a Naughty but Nice Christmas Cocktail, mulled wine, eggnog, or a peppermint espresso martini, alcohol tends to go hand-in-hand with the holidays. If you’re feeling triggered around the season and by memories, get-togethers, or expectations, your cravings might become more intense. Since alcohol can be an automatic pairing for many at this time of year, you might have to work harder to change your pattern and disrupt the association. So what are some things you can do to stay on track with your goals over the holiday season?

Cravings are normal. The urge to drink is no different than the challenge someone faces when they’re trying to stay on track with their weight-loss app and are tempted by the shortbread tray. Whether your soft spot is beer or the cheese board, planning, visualization, and accountability are a good place to start.

  1. Write down your plan:

It’s easy to get overwhelmed by strong emotions or anxiety, and it makes it harder to clearly articulate what part of a situation or relationship makes you more vulnerable to cravings. Writing helps because when your thoughts are down on paper, they’re concrete. You can assess them, challenge the logic, and often it is easier to identify the root of the problem.

2. Set boundaries:

It’s ok to protect yourself from triggers, even if it means going against the crowd or saying no. You can adjust plans to reduce stimulus, shorten your window of activity, or to make it easier to achieve your change goals.

3. Get enough light:

Try to time your walks for mid-day. Take a lunch break, a walking meeting, or a thinking break. Get some Vitamin D and enjoy the day while it’s bright outside! Even as the weather gets colder, try to stay active outdoors. You might integrate a walk with a friend after work once a week. Try to keep your blinds open, as well, to let the light in. It can help your sleep-wake schedule to wake with the morning light.

4. Step outside:

There’s a time in almost every family gathering where things feel a bit tense. The holidays can make you feel trapped, and a good strategy is to step outside. Not only will the fresh air clear your mind, but movement will help you relax and change your mindset. It could be a few deep breaths on the porch to cool your body temperature, or you can offer to take the family pet out for a walk around the block. If you can tap into your breathing and take deeper, slower breaths or even tune into a short walking meditation, it can help you re-set.

5. Plan time before or after the holidays when triggers are less activating:

All of your social interactions don’t have to happen in one month! You can explain to friends that the holidays are more challenging for you and arrange something more intimate in the New Year. It can feel less daunting to see a friend one-on-one for a walk with a cup of tea or hot chocolate. Pace yourself, and remember there is no one way to approach the holiday season. Additionally, talking to your friends about how you feel can normalize challenging emotions. You might find one or two of your friends have similar feelings or that their sensitivity and awareness of your experience increases after an open conversation.

6. Sleep, eat, exercise – repeat:

When we get out of our routine, the first thing to slip is our eating and sleeping schedule. The holidays are a time when exercise tends to go by the wayside too! But those are the things that stabilize our mood, energy and help us maintain a balanced outlook in a more triggering time. Naturally, parts of your schedule might change. You may be staying up later and sleeping in, and that will throw off your meal times but try to set the alarm clock for 7-8 hours from the time you go to bed and eat regular meals during the daytime. The holidays may disrupt your regular workout routine, but a brisk walk or virtual yoga while the turkey cooks goes a long way!

7. Try one of these alcohol alternatives:

If a part of your plan is to make a mocktail for a family dinner or bring one for friends, here are a couple of great mocktail suggestions for those long winter evenings. 

Christmas Punch:

Serves: 10

Step 1: Place cranberries and club soda into an ice tray and set aside to freeze

Step 2: Mix pomegranate juice, cranberry juice, and club soda

Step 3: Add in lemon juice, fresh from the lemon if you like and simple syrup

Step 4: Mix together and add your ice cubes. Enjoy!

Cherry Bombs

Serves: 6 (adults and kids alike)

Step 1: Place two cups of water in a medium saucepan and bring to high heat. Add grenadine and stir to combine. Pour mixture into two ice-cube trays. Freeze until solid.

Step 2: Fill six glasses with grenadine ice cubes. Add soda and garnish with maraschino cherries. Serve!

Mulled Cranberry Mocktail

Serves: 1 quart

Directions:

Step 1: In a medium saucepan, combine the juice, cinnamon stick, and cloves and bring to a boil. Reduce the heat and simmer.

Step 2: In a small saucepan, combine the cranberries, sugar, ground cinnamon, 2 tablespoons of water and heat over medium-low heat gently stirring, until the cranberries pop and are well coated with the sugar mixture.

Step 3: When cool, thread three or four berries onto toothpicks and pour the mulled cranberry juice into four mugs.

Chocolate Martini Mocktail

Serves: 2 servings

Directions: 

Step 1: Combine the milk, ¼ cup chocolate syrup, corn syrup, and crushed ice in a blender and blend until smooth.

Step 2: On two small plates, pour chocolate syrup and chocolate sprinkles. Dip the rim of each glass on both plates.

Step 3: Fill the glass with chocolate milk mixture. Enjoy!

Mock Apple Cider Sour

Serves: 1 drink

Step 1: Add the sugar cube, lemon juice, apple cider and seltzer to a 6-8 ounce old fashion glass.

Step 2: Stir to dissolve the sugar

Step 3: Add the ice cube and apple chip

Step 4: Add the orange peel to the rim of the glass. Serve and enjoy!

Drinks courtesy of Martha Stewart and Food Network.

It might seem simple but planning is a powerful evidence-based strategy that can help you manage your cravings and reach your goals around reduced substance use. The great thing about planning is that it’s in your control. You can deconstruct your triggers and the challenging emotional aspects of holiday parties, family gatherings, or gift-giving rituals and make changes to support your mental health and wellbeing. Try one or two of these strategies this season. Get some sunshine, step outside, or do an online kickboxing class. And remember, the holidays may seem inflexible but any tradition can be tweaked if it means protecting your wellbeing.

Happy Holidays and make sure to connect with us if you need some support. 

Looking for more strategies to manage during the holidays? Read more here.

Access the ALAViDA TRAiL app.

Change & Relationships

Navigating Your Relationships Through Change

In his philosophical writings, Jean Jacques Rousseau wrote about a phenomenon that he coined the social contract. What Rousseau believed was that each relationship operates by an unwritten set of rules. He thought that this social contract was the thing that made society run smoothly. Fast forward and you will likely find that you may have all kinds of unspoken forms of communication and boundaries when connecting with others. You are also likely to share common interests and have a set of routines that fit your norms or what is comfortable to you. While you may go to the market and pick up a latté on Saturday mornings, you might spend Thursday evening in the summers at a friend’s backyard, drinking beers and sharing stories from the week. So what happens when this social contract is broken and the rules change? 

It may not be intentional, but when one person in a relationship changes their drinking patterns, it has direct implications on their partner. Before the change, you and your partner knew how to interpret one another’s cues, patterns, stressors, and decision making, but all of those things shift with a change in substance use. The missing ingredient is clear and open communication. When there’s a change in intentions, it’s important to discuss it openly and set parameters that feel meaningful, supportive, and achievable for both individuals. The terms of the contract change. You may have to redefine the things you do individually and as a couple, as well as the way that you share your time, and that’s normal. 

Planning is an effective way to consider the experience and needs of each partner. If you are preparing for a barbeque with friends, for instance, it helps to think ahead. If your partner is going through change, their emotions and triggers may seem inaccessible or different from your own experiences. Thinking about how you might feel if you were in their position gives you empathy for their experience. If you can imagine the kinds of situations or stressors that might overwhelm or trigger your partner, you can assess how you might approach the event differently. While this may feel like a challenging circumstance, it is not dissimilar to how some couples navigate introversion and extraversion, life changes with pregnancy, or changes to mental and physical health. Becoming in tune with your partner’s needs and communicating your own gives you the clarity to approach the situation with compassion.

In some cases, you might plan to include your partner in your regular activities but change your approach. If you regularly go for hours at a time, you might shorten the window of exposure. You could plan to bring special non-alcoholic beverages that make your partner feel less triggered and a part of the fun. 

 

You might be doing this: going to BBQs with six-packs

You could try this: Bringing non-alcoholic beverages or trying a new mocktail recipe

 

You might be doing this: losing count of your drinks

You could try this: only bring what you intend to drink and space them out with water or other non-alcoholic beverages

 

You might be doing this: the first to arrive and the last to leave

You could try this: show up just before dinner and enjoy a great meal connecting with friends and then leave shortly after. If you need an excuse, say you have an early morning workout or appointment

You can help your partner come up with a few excuses about why they’re not drinking. It’s useful to have these in your back pocket when you’re out with family, friends, or colleagues. Your partner might say they’re on a diet, have a long run planned in the morning, or are doing a no drinking challenge. You might also split up for the evening if it makes each of you more comfortable, and if you decide to do so, you can plan another time when you will do an activity together. When you reconnect, show interest and support in how they choose to spend their time. It can be helpful to cultivate new interests together that occur during drinking-neutral time. Perhaps you want to explore theatre in the city or take on a sport like tennis, jogging, or biking. If you honour your partner’s change and redefine or recreate the parts of the relationship that are important to you, it will mitigate triggers and strengthen your bond. You may also find some new dimensions to your relationships and hobbies.

Looking back over your life, you’ll find that you’ve had different growth curves and phases, and the definition of fun has changed. That’s ok. Take some time to reflect on what fun looks like for you now. Some criteria might be different. If once fun meant cutting loose, now it might mean feeling restored and balanced. Take some time to talk with your partner about their definition of fun and look for areas of overlap or ways that you can merge definitions to share time and experience. Just because you once loved live music and bustling patio scenes doesn’t mean you can’t enjoy cooking and painting now. All of that could change, but the key is to follow your inner compass and find the activities and lifestyle conducive to your definition of appropriate drinking.

Access the ALAViDA TRAiL app.

 

CBT and Brain Function

How Does CBT Change Brain Function?

What is CBT?

Cognitive behavioural therapy (CBT) is a therapeutic intervention that gives individuals the tools to examine their thoughts, feelings, and behaviours. Dr. Beck and Dr. Ellis, the psychiatrists who developed CBT, looked at the way thoughts are formed and how they shape beliefs and behaviour. Specifically, he categorized different types of thoughts such as the distortion of automatic thoughts, core schemas, beliefs, and underlying assumptions. The first role of the cognitive model was to investigate how negative beliefs maintain symptoms in depressed patients. Since then, CBT has had broad applications in mental health and substance use challenges. The premise of CBT is that many struggles are sustained by biases in thinking.  

Many of the thoughts that we have occur automatically and so part of the goal of CBT is to change unconscious processes to mindful practices. The patient tests the way they see reality against available facts. Part of the process of therapy is learning that negative thoughts have consequences. Individuals learn how to describe their experience with accuracy and to rely on facts as opposed to leaning into generalizations. For instance, a therapist might encourage their client to restructure their automatic thoughts. If the client thinks, “I am a failure,” the therapist will help them reframe their thought to: “I did not achieve my goals on this specific task at this time.”

Here are some ways you can reframe your thoughts: 

When you’re experiencing challenging thoughts, it can help to focus on your breathing. There are many apps and tools which can assist you with breathing and different forms of meditation. A simple grounding exercise is to breathe in for the count of four, hold at the top for four, breath out for four, and hold at the bottom for four. You can repeat this simple technique as many times as you need to feel calm and grounded. 

An underlying goal of CBT is to move from fixed to flexible thinking. The therapist helps the individual develop the muscle to find evidence for and against an assumption and to manage uncertainty. This helps the individual with the realization that things can be looked at from different perspectives and behaviour can be modified. CBT interrupts the feedback loop that maintains problems over time. As well, it is collaborative and action oriented. The goal of therapy is not simply to feel better but to develop tools to cope with future problems. 

Scientists are encouraged by the results of neuroimaging which shows that therapeutic treatment has neurobiological effects. This helps us understand the relationship between symptoms, emotional regulation, and behaviour better. 

So How Does CBT Change the Structure of the Brain?

Let’s look at the results of a neuroimaging study examining the effects of CBT on social anxiety which can lead to drinking. 18 individuals were assessed and randomized for treatment with an antidepressant called citalopram, CBT, or a waiting list. CBT focused on cognitive restructuring, bibliotherapy, and exposure. There was no difference between the CBT and citalopram groups. Participants were assessed in a public speaking task, which activates social anxiety. Bilateral regional blood flow was assessed in the amygdala, hippocampus, and the anterior temporal cortex and there were significant reductions in regional blood flow to these areas after treatment with CBT, which meant that the patients had decreased symptoms and showed overall improvement.

CBT changes the structure and pathways of the brain. For instance, the limbic response, which is associated with emotions and triggers, was linked to long-term clinical outcomes. Other studies including phobia, OCD, and panic show promising results related to areas of the brain which become activated by disease, and this strengthens the evidence for treatment in substance use disorder. Behavioural therapies are associated with reductions in substance use and increased cognitive control, management of impulsivity, motivation, and attention.

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Defining Self-Love

Like every year, Valentine’s Day can be all about heart-shaped chocolate boxes and bouquets of roses. While some will have trouble hiding their excitement as they prepare a romantic surprise for their loved one, for a large number of people, this celebration of love may lead to distress or trigger feelings of insecurity and loneliness. Whatever the feelings, occasions such as this can often lead to a desire to drink. Despite temporarily feeling better, alcohol will eventually lead to feeling as bad or worst than you felt before you started drinking. On the other hand, love is something holistic that can go beyond relationships that bond us with a partner or family.This year, rather than focusing solely on the reasons why we love somebody else, or being hard on ourselves for not having a special someone, how about falling in love with yourself? Like any other great relationship, it takes effort, time, and it’s worth it. After all, it’s you – and there’s no better time to re-ignite that spark with yourself, than Valentine’s Day. To (re)start the love-story with yourself, here are a few things you can do:


Pamper yourself – 
Take some “me-time” to do things that make you feel good, mentally and physically. Relax to a warm bubble bath listening to your favourite songs. Order in and treat yourself to a nice meal while watching an uplifting movie. Or take a class or workshop that you’ve been wanting to go to for a long time. Whatever lifts your spirit –  make sure you pick something that truly resonates with who you are and what you like.

 


Relax –
 Sometimes the best thing we can do for ourselves is to disconnect, even if for a short period of time. To do so, turn off your phone and TV for a few hours, and spend time doing something you like and that requires your full attention. Artistic activities such as drawing, painting, singing, doing crafts and cooking are great ways to enjoy the present while expressing our creativity.

 


Laugh out loud – 
When was the last time you laughed so hard, it actually made you cry? Often we take ourselves – and things – too seriously. This Valentine’s Day, create the opportunity for a big, fun, teary-eyed laugh! Pick a funny movie, watch a stand-up comedy show at home or in a local comedy club. If you prefer something a bit more active, invite some friends to a trampoline park, challenge yourself in a parkour class, race your pals on go-kart, sing like nobody’s watching at karaoke or organize a dinner party with your friends.



Mak
plan – Take some time to plan something that truly excites you: sign-up for a course, rethink your routine, schedule fun activities, book a flight, plan a visit to family or friends who live far away, or organise a road trip. Having something to look forward to is a great way to keep ourselves motivated, optimistic about the future and happy just thinking about it.

There are plenty of ways to fall in love with yourself or awesome things to do when you’re single on Valentine’s Day that don’t need to involve alcohol.  All in all, be sure to give yourself a moment of bliss. By reconnecting with yourself, you help increase motivation levels that can help you take the next step towards an important change. And who knows… this can even turn out to be a special day that you celebrate every year as the day you fell in love again with YOU.

 



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Alcohol’s Rep.

Alcohol seems to get a free ride – perhaps even a funded one. In a world heavily adorned by advertising and media, alcohol gets away with identities such as “the confidence booster,” “the good time” and “the free spirit.” Commercials sell us on these notions, as do movies, television shows, and other advertisements. On top of it, social media plays a role as one of the best spokespersons for defining alcohol as “the good time.” The way that we ourselves, and those around us, paint our best life experiences is often with drink in hand. We sell beverage-consuming moments as “having a good time,” or “living our best life.” However, beneath the surface, we often carry some sense that this is not quite the truth.

A few years ago, right around the time I was becoming more conscious of my lifestyle habits, I had decided to try out online dating. I set up my profile with the best pictures of myself that I could find (of course) and started swiping. One of my subsequent swipes had me match with a fellow date-seeker who, in his first line to me, made note of a recurring element in all of my photos. In every single photo, he pointed out, I held a drink in my hand. I was shocked and in disbelief, but sure enough, my large grin was pervasively paired with a glass of wine or a cocktail beside me.

Why did every single photo that I had chosen to represent me include an alcoholic beverage? At this time in my life, I had already made significant cutbacks to my alcohol consumption, and yet still, alcohol was there in all four photos.

It seems that media and advertising guide our beliefs about what moments are most worthy of photographing – and one of the most photo-worthy moments, based on mindful observation of my own past habits and of those of others, appears to be when we are consuming alcohol. These beliefs and subsequent actions reinforce the worn-out notions that we have about alcohol, and weigh heavily in our minds and on our bodies.

Media has reached into the hands and hearts of everyone with a personal device. We perpetuate the unconscious ideas about what makes for a “good life” by sharing photos aligning with these unbeneficial (and often harmful) mainstream beliefs. However, it’s not all bad news; it seems we are starting to wake-up from this tendency for blind belief in what we have been sold – consciously and unconsciously.

If we wish to take our habits back into our own hands and find our stable center without the use of alcohol (or with conscious and non-habitual inclusion of it), we can start with a few simple, honest inquiries and reflections.

  1.    Become more mindful of what you share.

Beginning to consciously reflect on what we share and why we share it is a key step towards relating more consciously to our experiences. There is no need for judgment, guilt or shame; simply by observing our tendencies, we begin to unravel the assumptions we have made about what makes a moment, or makes us “worthy.” Our choice of shared content shifts, influencing both ourselves and others.

  1.    Consciously reflect on what the media has to say.

It says a lot. More often than not, media messages conflict with one another, leaving us confused as to what is the best way to truly live a “good life.” By beginning to make note of the underlying messages that live within a traditional ‘first date scene,’ a well-crafted commercial, or any other imagery or video clip that shows up on your device, you can begin to recognize the subtleties of what is being sold – even if unconsciously placed there by the creator. This conscious reflection is where empowerment begins to stabilize its roots.

  1.    Question your inner status quo.

Questioning does not necessarily equate to interrogation or judgment; it is possible to question your inner status quo, as it relates to beliefs about alcohol, with compassion and curiosity. Consider: what messaging have you assumed as truth? What habits have these assumptions set in place? Is it possible to question your inner beliefs about alcohol without condemning or forcing yourself into so-called “appropriate” behaviour? As we begin to open ourselves to an honest inner dialogue, old belief systems naturally begin to dissolve and new ones take their place, even if feebly at first. Over time, these roots strengthen.Disentangling ourselves from mainstream messaging about alcohol takes time – but at the same time, all that is required is a day-to-day conscious reflection of what beliefs we currently carry within us. If we open ourselves to this dialogue with curiosity and compassion, we might be surprised at what new messaging naturally starts to form. Over time, we start to find that a “good time” does not come from alcohol; it comes from within.

[Editor’s Note: The author of this post is a content contributor to Alavida, and this contributor was paid for their writing. The opinions, views, results and experiences are theirs alone.]

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Family Systems

Every member of the family unit is impacted by substance use. The family system is a key structure that helps clinicians understand and treat substance use disorder and prevent relapse. The family has intimate information about the individual’s relationship to substance use, to which no one else is privy. They might know how the relationship to alcohol developed, how it is maintained, what the main triggers are, and what positively and negatively influences substance use. The family system has the power to influence both the positive and negative contributing factors to alcohol use. By determining the family’s developmental stage, it is possible to target appropriate intervention and address the emotional and behavioral patterns of the family unit. A family systems interventional approach is useful because it identifies the impact of the environment on the individual and vice versa. This intervention works on building the framework of the family with each member acting as a pillar and with their own set of responsibilities.

Let’s take a look at the family system with an example. 

Gary has been married to Linda for 28 years. They have two grown children, Elise and David. Gary started drinking heavily after losing his job and endured a long and challenging search for a new job. He felt demoralized and as if he couldn’t provide for his family. Alcohol numbed his painful feelings. When Gary entered treatment, Linda assumed things would improve quickly. Gary’s goal was to bring his drinking down from 25 units per week to 18 units, but Linda assumed that his work with the therapist would result in abstinence within a month. Linda knew that sports games were a significant trigger for Gary, but instead of finding ways to support him to meet his goals, she nagged at him as he drank beer. 

Linda and Gary’s situation is typical of families managing substance use challenges. That said, struggles differ between each family based on factors like financial situations, culture, dynamics, and values.  Let’s look at how Linda could define her role and how she might support Gary with his alcohol use. 

  1. Communicating on the definition of appropriate alcohol.

A good place to begin is defining what it means to have an appropriate amount of alcohol. Linda may think that having one beer a week was suitable whereas Gary’s definition was to have one every other day. Communicating these definitions can be helpful in working together to create tangible goals at home. This is a conversation that can happen with the guidance of the therapist or medical doctor and between family members. In Gary’s case, he was engaging in gradual reduction. It would have been helpful for him to state his goals with Linda, and keep in mind that change doesn’t happen overnight. In this way, Linda could celebrate small successes, change her perception around milestones and progress, and leave room for ambiguity and challenges. 

2. Creating a safe environment with triggers in mind.

Families can play an essential role in identifying triggers. One of Gary’s biggest triggers was sports games. He tended to drink heavily. Planning is where success begins and Linda and Gary could have worked together to ensure that they only stocked the fridge with the alcohol they intended to drink. Linda and the kids might have made special snacks and mocktails for the game and worked to create a safe and comfortable, non-judgmental environment for Gary. 

Now, what if Gary drank too much?

Since Linda and the kids can’t change how much Gary has consumed, it’s best to focus on what they can do at the moment. Rather than egg him on with belittling comments, they can be a strong pillar of support until he sobers up. The next day, they can have a candid and caring conversation about Gary’s goals, and help him get back on track. When you take shame out of the equation, you make room for vulnerability and change can occur at the level of substance use, and within the family system. It is also vital for Linda to remember to take time for herself and engage in self-care. That way, she can continue to support Gary and won’t experience resentment or burnout. 

Linda could connect empathetically with Gary. She might say:

“I noticed that yesterday was a hard day for you. How can I support you best?”

“A game is coming up, how can we plan as a family to support you?”

“How was your day?”

Since they are a family of four with unique personalities and attributes, it is helpful to assign different roles. Gary’s daughter Elise might be more patient when Gary has had too much to drink. At this time David, a good moderator, can support his Mom and later help to facilitate a conversation as a family. When you know your role in a family system, it is easier to take a step back if you feel out of your depths to make room for someone else who can navigate the situation better. If Linda gets heated, she can practice handing the reins to Elise and focusing on taking space in the moment so that she doesn’t further provoke Gary’s drinking. 

Understanding the nuances and roles within a family system takes time, observation, and patience. When it comes to substance use, family systems can be the key to understanding the pattern of drinking and moderating the role that environment plays.

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Pressing the Pause Button

Have you ever said or done something that felt like it served you in the moment but horrified you later? Chances are, you were led on by impulsivity. It’s a trait many of us have, at least in certain circumstances. It’s hard to keep from buying chocolate when you’re in the candy aisle of the grocery store, and it’s equally as challenging to hold yourself back from sending an impulsive email. But when you do fall down the rabbit hole of impulsivity, it can feel terrible. Often, you find yourself ashamed and ruminating on your regrets. It’s a loop and it’s closely related to the craving cycle, which causes you to give in to the urge to drink. 

Impulsivity can be defined as a “rash response in situations where a considerate response is more appropriate” and often leads to acting in the spur of the moment, not focusing on the task at hand, and not planning or thinking carefully. When you break it down at the biological level, impulsivity involves failing to inhibit a potentially risky impulse. From a cognitive perspective, it is the inability to inhibit behavioural impulses and thoughts. One of the most significant challenges about impulsive tendencies is that the individual who experiences impulsivity cannot evaluate the consequences for themselves or others. They may not even know that they are acting impulsively because impulsivity has a way of tricking you into thinking that you are taking the most essential action. 

There are three components of impulse: 

  1. Motor (action without thinking) 
  2. Cognitive (quick cognitive decision making)
  3. Non-planning (decrease in orientation toward future factors)

It’s essential to know how to reign in impulsivity to avoid risky and negative outcomes. That’s where the pause button comes in. The pause button is just as it sounds—a break from stimulus. You might go for a walk, lie down and engage in box breathing, turn off your devices, or take some time before you take action or respond. It gives you the space you need to evaluate, reflect, and decompress before reacting. 

The pause button is most effective when you engrain it into your reaction system as a pattern. This means that each time you are driven to action, you remind yourself to take an intentional pause, and over time, this behaviour becomes automatic. This is especially useful when it comes to drinking. Impulsivity is a significant risk factor for initiating and continuing alcohol use. It can be provoked by acute intoxication as well as long-term substance use. Studies have shown that highly impulsive individuals use alcohol to regulate negative emotional states. This is not surprising since the brain regions of impulsive behaviours and emotional experiences overlap. When you take a pause, you can identify and label your emotion. It allows you to make a different and healthier decision. In other words, you get ahead of the emotion and the drive to action. When you take a pause, it’s an opportunity to identify your emotions or how you’re feeling. Oftentimes, our mood can indicate our behaviours and it’s another way to take action in our journey to change. 

This week, commit to using the pause button. When you get heated and feel the drive to act as your craving system kicks in, commit to taking a small break. You can walk around the house, hold a plank, close your eyes, or throw a toy for the dog for ten minutes. Interrupting your impulsive mental state is often enough to slow you down, allow you to reassess, and change your course. It can be challenging, but it is also helpful to check in with a family member, friend, or colleague about how they perceive your impulsivity. An outside perspective can be the best real-time input on your emotional and cognitive state. As well, your confidante can play the role of an accountability partner and keep you on track. Impulsivity is alluring at the moment, but it has painful aftermath. The pause button can give you the grace you need to show up as your best self.

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