The Four Steps, Plus One

It feels good to be back. I have busy with many things, but still managed to sneak in a 426-page book. I loved In the Realm of Hungry Ghosts by Gabor Maté so much that I had to share more with you. One of his later chapters, “The Four Steps, Plus One”, is the quasi-culmination of his research in and experience dealing with addiction, both in himself and with his patients in Vancouver, BC. He borrows from Dr. Jeffrey Schwartz at UCLA, who first conceptualized the Four Steps as a way to help OCD patients. They can be used to overcome negative thought patterns, harmful addictions, or unwanted habits. I will use the example of smoking cigarettes to introduce the steps.

Step One: Relabel
When a harmful thought or addictive craving arises, you relabel it as a dysfunctional thought rather than an actual need. Conscious awareness is key to this step.
“I don’t need a cigarette right now. It is a false belief with imaginary urgency.”

Step Two: Reattribute
Maté believes that addiction is “hardwired” into our brain in our earliest years, influenced by our environments, how we were raised, and the stress levels or addictive habits of our parents. An early environment lacking in nurturing, stress-free support and abundant love may cause some children to seek outside sources for comfort, through food, thumb sucking, television, etc. Because the child didn’t develop self-regulation of his or her serotonin and dopamine release and re-uptake (the neurotransmitters associated with pleasant, happy, and comforting feelings), he or she begins to rely more heavily on external sources of comfort, possibly leading to addictive habits later in life. In this step, one places the blame on the brain.
“I feel that I need a cigarette because this “need” is deeply ingrained in my brain, and is triggered when I am tired, stressed, lonely, or bored.”

Step Three: Refocus
Allow yourself 15 minutes of not having that cigarette. Instead, do something else, something that you enjoy doing. Physical activity is especially helpful, but not required. Celebrate every minute that you hold off on your addictive impulse.

Step Four: Revalue
Why are you doing all this hard psychological work? It’s important to remember the value of quitting something like smoking. List the people who are affected, unpleasant memories associated with that behavior, and how your own life is affected.

Step Five: Recreate
What could you be doing without the power of addiction influencing your decisions and actions? List how you creatively express yourself. Imagine a life you create instead of letting life create you.

Addiction should not be shameful. Addicts should be accepted with open and gently helped to recovery with compassion, understanding, creativity, and intelligence.

What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood. – Alice Miller, Breaking Down the Wall of Silence

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