Acceptance and Commitment Therapy (ACT) in Addiction Treatment
As humans, we will often go to great lengths to avoid pain. We will avoid it even when the measures we take cause more harm in the long run. Unfortunately, pain avoidance is one of the driving factors in substance abuse. The instant gratification and pleasure found in alcohol and drugs – accompanied by the temporary relief of pain – creates a vicious cycle. This cycle often culminates in the development of an addiction.
Psychologist Carl Jung astutely identified the core issue when he coined the phrase, “What you resist, persists”. Drinking, popping, snorting, smoking, and shooting up substances will never make problems go away. Instead, they often lead to more problems over time. Acceptance and Commitment Therapy is specifically designed to address this underlying issue.
Acceptance and Commitment Therapy (or ACT for short) is a form of behavioral therapy. It teaches individuals to accept without judgment – rather than resist and avoid – painful thoughts, feelings, and experiences that are a normal part of the human existence and commit to taking values-based actions that help create a fulfilling life.
Unlike most traditional Western therapies, ACT doesn’t attempt to reduce “symptoms”, nor does it label them as pathological or problematic. Rather, it teaches individuals to face and embrace them using mindfulness techniques. This ultimately helps relieve symptoms by helping people change their relationship with negative emotions and unwanted or troubling thoughts.
Learning and practicing the components of ACT can help individuals become clean and sober. They can also help individuals maintain sobriety for years, once they complete a treatment program.
History of ACT
Clinical psychologist Steven C. Hayes and his colleagues developed Acceptance and Commitment Therapy in the early 1980s. Dr. Hayes is a prolific author and renowned psychology professor. He’s received multiple awards for his work, including the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies. He has published hundreds of articles and written over 30 books. He’s best known for the popular self-help book Get Out of Your Mind and Into Your Life.
Based on Relational Frame Therapy (RFT), ACT is essentially a combination of mindfulness practices and classic behavior therapy. Experts consider it one of several “third generation” or “third wave” types of behavioral therapy. Traditional behaviorism was the first wave and cognitive behavioral therapy was the second wave. Other therapies in this third wave category include dialectical behavior therapy (DBT) and mindfulness-based cognitive therapy.
Nearly two decades after it was first developed, Hayes and his colleagues began using ACT as an experiential treatment for individuals with substance use disorder. Compared to other, more traditional, approaches to addiction treatment, ACT is still relatively new. It’s based on the premise that individuals who are struggling need supported, not “cured”. Compared to other therapeutic approaches, ACT focuses more on helping people change the way they think about psychological pain to improve their lives and less on addressing mental health “disorders” as defined by the DSM.
Three Key Components of ACT
Three key components of acceptance and commitment therapy are:
- Creative Hopelessness
- Psychological Flexibility
In ACT creative hopelessness occurs when individuals reflect upon all the things they’ve tried in an attempt to alleviate their pain and improve their situation. By confronting the futility of everything that hasn’t worked in the past they’re left with the uncertainty of what to do next. This primes them to contemplate creative new strategies for improving their life. Individuals can move forward when they realize and accept that it’s impossible to try to eliminate all of life’s suffering and pain.
Mindfulness has become a widely popular concept in recent years. It essentially means being fully aware and present in the moment rather than going through life mindlessly because we’re functioning on auto pilot. Individuals who practice mindfulness are not only living life consciously but also accepting whatever is happening in the moment without judgement.
Increasing psychological flexibility is the primary goal of ACT. This flexibility enables individuals to handle life’s challenges and negative thoughts and emotions without engaging in unhealthy coping mechanisms. Psychological flexibility means having the ability to be mindful and choose actions that align with one’s true values. The 6 core processes of ACT, dicussed below, enhance psychological flexibility.
6 Core Processes of ACT
Acceptance and commitment therapy teaches 6 “core processes” – psychological skills – to help individuals develop greater psychological flexibility. They are:
- Cognitive Defusion
- Being Present
- Self as Context (The Observing Self)
- Committed Action
Acceptance is the opposite of avoidance in ACT. Many people go through life exerting energy trying to avoid pain and suffering. But these are normal aspects of the human experience. Substance abuse and addiction frequently stem from the urge to avoid discomfort in any form. Acceptance involves consciously choosing to let go of this avoidance impulse and experience, in the present moment, the uncomfortable thoughts and feelings – with compassion and without judgment.
For example, individuals struggling with depression or anxiety learn to feel the negative thoughts and emotions that accompany it instead of defending against them.
Acceptance isn’t a goal in ACT; rather, it’s a method to help bring about positive change through values-based action.
To defuse something means to reduce the tension or danger in a given situation. In ACT, cognitive defusion involves the process of recognizing that one’s thoughts are merely thoughts and don’t necessarily represent facts or reality. When individuals learn to interact with their thoughts in a detached manner it takes away the power attributed to those thoughts as well as their believability.
For example, someone with depression might change the thought “I’m worthless” to “I’m having the thought that I’m worthless” (or, “I’m thinking I’m worthless”). The first is stated as a fact that tends to elicit negative emotions. The second is merely the recognition of a particular thought. When stated out loud, the latter statement has far less power than the original statement. Distress is reduced by changing the language of the thought, creating detachment, and taking away the power of the negative thought.
Cognitive defusion also involves learning to stop labeling negative thoughts and emotions with words that trigger avoidance, such as “awful”, “dangerous”, or “bad”. Doing this makes it easier to stop trying to resist them.
Being present is a common concept in mindfulness-based therapies. Drugs and alcohol are frequently used to escape the present moment. Trying to avoid the present moment is known as “experiential avoidance” and it often leads to harmful choices (e.g. using substances).
In ACT, being present is the practice of paying attention to and fully experiencing whatever is happening in the here and now – not fretting about the future (“what if”) nor stewing about the past (“if only”). The only thing any of us has, for certain, is right now – the past is behind us and can’t be changed, and the future isn’t guaranteed and could play out in an infinite number of unpredictable ways.
Being in the present allows individuals to focus on doing things that align with their true values. It also involves refraining from judging the experience.
Self as Context
This core process of self as context involves recognizing that our experiences don’t define us. In other words, we aren’t what we experience. We are simply the one having the experience. Self as context allows us to detach from our experiences while being aware of and fully present in them.
Values in ACT refers to the things that matter most to an individual; those things that give their life meaning. Our values guide all our decisions. ACT helps individuals take action that aligns with their deepest values rather than make choices based on avoidance. It’s important to note that values are not the same as goals; rather, they are the foundation for setting goals.
Commitment to Action
Once individuals have identified their values, they can start setting meaningful goals and commit to purposeful, effective actions that will help them reach those goals. Part of the commitment in ACT involves committing to taking action knowing full well they’ll likely experience negative feelings and thoughts at times during the process. The psychological flexibility they have developed will enable them to keep moving forward towards their goals even when there’s discomfort.
How ACT Helps with Addiction Recovery
The inability to cope with negative thoughts and feelings (both psychological and physical feelings) is often a driving factor in the development of substance abuse problems and addiction. By strengthening the psychological flexibility of individuals with a substance use disorder, ACT helps them learn to accept and handle discomfort and pain without turning to self-destructive coping mechanisms, such as getting high or intoxicated.
Alcohol and drugs can provide a quick and simple way to alleviate unwanted thoughts and feelings. But they inevitably cause more harm – and more unwanted thoughts and feelings along with new problems – as the individual continues to use them as a quick fix. ACT teaches strategies that enable individuals with a substance use disorder to tolerate unwanted feelings and experiences, including cravings and the urge to use. These strategies can assist individuals during their treatment program while also giving them the tools to avoid relapse and stay on the path of recovery once they leave treatment.