Treating Substance Use Disorders: A Gourmet Buffet, Not Institutional Cooking

The approach to treating substance use disorders (SUD) has progressed through various methods aimed at providing effective care. However, for more than fifty years, a persistent problem in the field has been the tendency to see effective therapy as a zero-sum game. Practitioners treating SUDs are often forced to choose between treatment models as if there is only one ‘gold standard’ for treatment, leading to a “one-size-fits-all” view. This belief that there is only one “correct way” to treat substance use disorders, along with the idea that all other methods are therefore ineffective if not “wrong,” comes from focusing on the diagnosis rather than the needs of the individual presenting with that diagnosis.

Although “best practices” based on scientific research exist, the purpose of this essay is not to promote any specific “model,” but to ask: what if the SUD treatment community embraced the idea that there may not be just “one truth” or one approach to providing effective treatment? Does everyone with coronary artery disease undergo bypass surgery? Are all individuals diagnosed with depression treated only with medication? Is surgery the only method for treating cancer, with all other approaches somehow being “wrong” or at best ineffective?

It seems that it may be time for treatment practitioners to ask the controversial question, “What is the purpose of addiction treatment? To treat the diagnosis or the individual with the diagnosis?” Individuals mandated to treatment, often by a court or employer, are more likely to respond to a different approach than those who come voluntarily. However, suppose treatment professionals use the “one-size-fits-all” approach. In that case, treating the diagnosis is essentially what is done…and when individuals reject the treatment the practitioner believes the diagnosis dictates, it is deemed “denial” and confronted. William Miller of “Motivational Interviewing” fame asked an important question: Do you want to wrestle with the SUD individual or dance with them? In wrestling, someone has to lose for someone to win. When dancing, both individuals need to respond to each other, interacting proactively rather than reacting.

Sometimes, it is necessary to give people what they want to create the opportunity to provide what they need. Listening to their concerns and helping them focus on what matters most on their agendas can build trust and promote consideration of needed changes. Change occurs in stages, and as SUD treatment professionals, we are committed to meeting individuals where they are in their readiness to make a change, rather than insisting they conform to a “one-size-fits-all” approach to treatment and meet us where we are.

As professionals, especially those in SUD treatment, practitioners need to recognize that their role isn’t to ‘save’ anyone from addiction. On their best days, practitioners are fortunate if they can help someone move toward embracing change. By staying vigilant, keeping current in our field, and staying informed about the latest and most promising advances in treating addictive disorders, we may be able to contribute something to the recovery process for those who choose to work with us in counseling, but when they have discovered that change is what they want. Change is, for all practical purposes, an inside job.

Every time a practitioner chooses to intervene with someone in counseling, they have the opportunity to motivate movement towards behavioral change. As naive as this may sound, changes in behavior begin with changes in thinking, and this is what effective practitioners can accomplish. As a mason builds a brick building, skillfully placing one brick at a time, so do skillful practitioners make the case for change, one interaction at a time.

All practitioners, whether working with individuals or groups, will notice a common trait among those they treat—some hesitancy in embracing change. Some couldn’t see the need for change and were quite firm in their resistance. Today, we understand this resistance—”denial,” if you will—to reflect a “pre-contemplative stage of readiness to change,” which is the first of the stages on a continuum proposed by James Prochaska and Carlo DiClemente: 1) pre-contemplation, 2) contemplation, 3) preparation, 4) action, 5) maintenance, and 6) termination.

All individuals entering treatment are at different places along this continuum of readiness to change. Still, a common factor for all of them, regarding their position on this continuum, is some awareness of the “appropriateness” of change. This “level of awareness” is almost always connected to insight gained through experience. When we address the substance use process with those in treatment, we help facilitate their progress along the readiness-to-change continuum.

Familiarity with the principles and practices of Motivational Interviewing allows practitioners to meet individuals where they are on the readiness-to-change continuum. Consequently, a practitioner might be the first to engage someone in the pre-contemplative stage in a non-confrontational discussion about their situation, showing genuine interest in the individual and understanding the situation from their perspective as someone with the SUD. This can lead the individual to consider the ‘bigger picture’ rather than fixating on their own myopic view. In short, no change can occur without these initial non-directive conversations where the individual does not feel cornered or defensive.

Although progress from pre-contemplation to action may appear slow, especially for those who view the pre-contemplative stage as a form of denial that requires confrontation, it lays the groundwork for the argument that a person’s willingness to act would not have developed without this gradual, non-confrontational progress that begins with the first conversation. Ultimately, the final step toward change wouldn’t have happened without those initial and subsequent stage-appropriate steps.

SUD practitioners must stay current with research that presents new and effective ways to approach and counsel individuals with substance use disorders. Neglecting to do so is irresponsible. Resisting new techniques because they are “different” or oppose what some believe to be “the way we’ve always done it” is similar to the stance taken by individuals we treat who are in the pre-contemplative stage of change. For this reason, these practitioners must be met where they are regarding their readiness to change their approach to treating SUDs so that they, too, can move through the continuum of readiness to change.

Therefore, this essay aims to contribute to the discussion on how best to provide services in the SUD treatment field. For some practitioners, this backdoor approach to working with individuals in the early stages of readiness to change may be dismissed as misguided or even incorrect. For others, this may not be the first time they’ve heard this argument, and they are starting to consider its validity.

There is an old African proverb that says, “The way you eat an elephant is one bite at a time.” Perhaps we should recognize that treatment should occur “one session at a time,” and the approaches we use should be tailored to the specific needs of the person we are treating rather than just the diagnosis they have received. Why must we, as professionals, be forced to choose between treatment models instead of seeing them as all being “tools in the practitioner’s toolbox”—available for use as the situation demands, different tools for different stages of readiness to change? Perhaps we should choose the most suitable tool for the job to ensure the best results upon completion.

I close with a personal experience that might be one of the most meaningful in my 50+ years of counseling individuals with SUDs. I share it both as proof that we can always make a difference and to show that change happens at different times and for various reasons, but always follows a predictable pattern.

ANY PORT IN A STORM

While on vacation on the Outer Banks of North Carolina, specifically in South Nags Head at milepost 19.5, I was walking along the beach south of our oceanfront cabin, collecting bottles and cans that had washed ashore after a storm. As I carried a handful of trash to the bin, I noticed a piece of paper inside a beer bottle—its label long gone from the dark brown glass. Having written notes and placed them in bottles as a boy, I gently pulled the paper out of the bottle, expecting to find a note from a young person with a return address I could reply to. But no young person, at least no non-addicted young person, wrote what I found.

The enclosed letter was from someone clearly struggling with sobriety. Having worked in the addiction field for 25 years, I was almost sure of its authenticity. I knew immediately it needed a response, but it wasn’t addressed to me, and even if it had been, there was no “return address.” However, my years of working with addicts at various stages of recovery have taught me that answers to prayers, and I suppose letters too, often come in unexpected ways.

Kevin’s letter follows, along with my reply to it. Whether he read it, someone who knew Kevin from the few details in his letter would read it, or another “Kevin” would read it, I felt compelled to respond to it, which I believe was given to me for a reason. The challenge was how to reply. After some thought, I decided to send his letter and my response to Recovery Times, a print newspaper serving the recovering community and those who work in the SUD treatment field, where it was subsequently published.

Kevin’s letter:

God, it’s me again, Kevin.

I’m writing to you like this because it seems like a good way to communicate with you. In a way, it seems like you’re so far away from me these days, even though I know this isn’t true.

I’m angry with you, God. It’s been about seven months since Christy died, and I’m still angry with you.

Perhaps it’s because I still don’t understand why you let her die. Maybe it’s because I feel guilty and have regrets, and I’m blaming them on you. I know I haven’t let go of her yet, but I’m trying.

You’ve kept me alive, and clean and sober through all of this. You’ve even sent angels to look over me. You’ve taken great care of my family. And I’m still angry at you. And I’m also somewhat scared of you.

I’ve been very scared and very lonely the past few months that she’s been gone. Right now, I’m wondering how do I find the courage to let others in, and let them love me, and love them in return? I really want so much to do these things, but I’m scared to. If you’re still watching me, please help me find ways and opportunities to do these things. Please, take away my loneliness and show me that I’m really not alone and that you’re still here to help me. And please forgive me for having my doubts.

Sincerely, Kevin

Dear Kevin:

Sorry for reading your mail, but I hope you don’t mind how I came to get it. I found your letter on the beach in South Nags Head, North Carolina, near the 20-mile post, on August 9th of this year.

I know it may seem at times that God is a distant resource at best. But like someone drifting out to sea on the changing tide, believing it is the shore that has deserted them, it is often you and usually I who have strayed from the closeness of God’s presence.

You say you’re angry with God; I believe that isn’t so uncommon. What parent hasn’t felt the pain of a child’s anger in response to their actions? How many children believe that a parent’s job is to give them what they want when demanded, and so they rebuff the parent who says nothing or doesn’t respond as demanded? But, are we not all children of God, no matter how we understand God? Like a loving parent whose true awareness of what’s best for the child leads to a course of action that may go against the child’s demands, so does God sometimes answer our prayers with silence — when silence is what we need.

You ask why God let Christy die. This is an age-old question, and I do not presume to know why God does anything. But I do believe God loves us and that all things that happen happen for a reason, even if that reason escapes me at the moment. I learned a long time ago that death is a part of life, and like the night, which helps define the day, death is part of what makes life meaningful. If we believe that God creates life and that death is part of that creation, then perhaps this is why we and those we love, including Christy, die.

I know Christy’s death must hurt and has created a void that only anger seems able to fill. But anger is really fear directed outward, and I can only imagine that if I lost the “Christy” in my life, I too would be filled with anger—fearful that I could not go on, could not live, share, care, or love. And if I thought God were responsible for this loss, I would be angry—no, furious as well. But sometimes, there are no answers that make sense, at least in the moment.

You wonder if holding on to Christy is the cause of your pain. Remember, letting go does not mean forgetting, and forgetting someone as precious as Christy is not only impossible but would require forgetting a part of yourself and the life God has given you. Perhaps, letting go is recognizing that there may be another, or even many, ways to see the hand we’ve been dealt in this game called life. Kevin, what you are feeling, as uncomfortable as it may be, proves that you are alive and, I might add, working on your sobriety. Pain may be one of God’s greatest gifts to us because it is often through pain — intense pain — that we are motivated to change and grow, especially when change is the last thing we want.

It’s OK to feel scared, and there’s a difference between feeling lonely and being alone. The antidote for fear is trust, and being alone tends to lessen as we become willing to take more risks. However, both fear and loneliness are branches of the same vine that grows from a single seed called doubt -- I doubt anyone is listening, or if they are, that they care; I doubt things will ever change; I doubt there is a God, and if there is, how could He or She care about a mess like me; and so on.

Doubt leads to fear, which causes self-pity, then anger, guilt, and depression. Active addicts often find themselves trapped in this destructive cycle of fear, self-pity, anger, guilt, and depression repeating endlessly. However, it is only by destroying the `tap root’ of doubt that one can break free, because doubt fuels the cycle and the addiction, which in turn sustains doubt.

You ask that if God is still watching, He or She would help you find the courage, ways, and opportunities to address your anger and fear. I suggest that your prayer has been heard and that God has responded to your request. Your bottle could have sunk, but it didn’t. It could have been picked up by someone who couldn’t or wouldn’t understand your plight, but it wasn’t. It could have been thrown away as “garbage,” but it wasn’t.

God works in mysterious ways, often beyond our understanding. For God’s plan to succeed, I don’t need to understand it, approve of it, or alter it. All I have to do is trust that it will somehow work out. The “doubts” you ask forgiveness for are the emotional core of your addiction. Just as you don’t need forgiveness for being an addict, you don’t need it for having doubts. It’s not the `having doubts’ that is the problem, but how you choose to respond to those doubts that can cause issues. I suggest you keep tossing bottles into the sea, which is an excellent metaphor for taking risks in this life we’ve been given.

Peace,

Robert

Post Script

I wish I could tell you that Kevin contacted me after reading my response in Recovery Times, but unfortunately, that was not the case. However, several “Kevins” did, after reading his letter and my reply. When we choose to get involved and meet people where they are, addressing their needs at that moment, there’s a good chance that change can follow.

As I often told my counseling students, when the person who happens to be the counselor meets the person who happens to be the client and they connect as individuals, that’s when the magic in counseling occurs.

What Do People Believe?: The Risks of Seeing Everything as Black or White

 Recently, I read a passage from 2 Timothy in the Christian Bible, specifically verses 4:3-5. Please note that I do not include this as an introduction to a theology lesson or as a way of proselytizing my personal spiritual beliefs. Instead, the referenced passage seemed relevant given the world’s current ideological divide.

 

The referenced passage reads (from the New International Version of the Bible): 

 

(3) For the time will come when men will not put up with sound doctrine. Instead, to suit their own desires, they will gather around them a great number of teachers to say what their itching ears want to hear. (4) They will turn their ears away from the truth and turn aside to myths.

 

Reading this passage reminded me of Harry Truman’s quote, “There is nothing new in the world except the history you do not know.” With the shift in national news reports from reliable updates on current events to entertainment delivered by pundits who target an audience that St. Paul likened to those who desire to hear what their itching ears want to hear, Paul’s letter to Timothy remains a prophetic message for us in the 21^st century. 

 

Social psychologists refer to this as “cognitive bias,” which is the tendency to seek out and focus on information that confirms personal beliefs while ignoring or dismissing information that challenges or contradicts them. This bias prevents seeing the ‘big picture’ on any topic. It promotes what is known as “groupthink,” a psychological phenomenon where the desire to conform within a group results in poor decision-making.

 

Allow me to digress for a moment. Those familiar with the old PBS radio series, A Prairie Home Companion, will recognize Lake Wobegone as the fictional setting for this popular show. Its host, Garrison Keillor, described Lake Wobegone as a place, “where all the women are strong and all the men are good-looking.” This series’ tagline led to what became known as the “Lake Wobegone Effect” by social scientists studying how people rate themselves on various tasks, from driving skill to intelligence and everything in between.

 

Social scientists often find that respondents tend to rate themselves as ‘above average’ on task-oriented surveys, with as many as 65% doing so. As everyone knows, using basic grade school math, most respondents cannot truly be ‘above average,’ yet this is what researchers consistently observe. So, how can this be?

 

A partial explanation, for which I lack data to support this hypothesis, might relate to the limited sample of individuals we tend to compare ourselves with when assessing our abilities. But how does this connect to the earlier point about cognitive bias and groupthink, not to mention St. Paul’s 2000-year-old comment?

 

Suppose I only seek out people who tell me what I want to hear, and their information confirms my existing beliefs. In that case, we can start to understand the divisive ideological split in modern politics. Take this a step further, where the public now only looks for information that supports their personal views about “what’s what,” and you have a possible explanation for the source of the rancor and discord that seem to permeate today’s popular culture.

So, what can we do? Although this might be an unanswerable question, at least in the short term, we can limit our involvement in this process. Consider these steps:

·      Recognize that we are all susceptible to the Siren’s call of information that appeals to our belief that it’s true, also known as cognitive bias.

·      Recognize that the era of “just the facts” news reporting ended with Walter Cronkite, Huntley-Brinkley, and Howard K. Smith.

·      Limit the time spent on Internet and cable news feeds that offer narrow and one-sided assessments of current events.

o   Better yet, avoid those sources of information altogether and subscribe to a service that provides only headlines without biased interpretation.

·      Seek out others with different opinions to discuss important issues, and listen to understand their point of view rather than to prepare a rebuttal.

o   Keep William Shatner’s (Captain Kirk) quote in mind: We meet aliens every day who have something to give us. They come in the form of people with different opinions.

 

And when involved in one of these conversations, many open-ended questions can help stimulate the discussion:

·      To clarify the conversation: “What do you mean by…” or “Tell me a bit more about that.”

·      To probe the other’s opinion: “What led you to that conclusion?” or “How does this opinion align with your other beliefs?”

·      Perspective-taking questions: “How does this opinion affect others?” or “What might be some other ways to look at this situation?”

·      To explore emotion: “Tell me more about that,” or “Please elaborate on that point.”

·      To find more examples of “conversation enhancers,” prompt your favorite search engine with, Questions to help understand another’s opinion

 

Think about how different conversations would be in Washington or your state’s capital if questions like those just mentioned punctuated the dialogue. There's another quote from the Hebrew Bible that addresses this topic: A person’s thoughts are like a deep well, but someone with insight can draw them out. Proverbs 20:5

May – A Time for Mental Spring Cleaning

 

(Graphic by Josh Hild on Unsplash)

Of all the things May is known for—often overlooked, perhaps considered, but not directly associated with May—is the season of spring. Spring is a time of renewal and, to cite the oft-quoted cliché, a time for spring cleaning. I recently reread Richard Carlson's popular book, Don’t Sweat the Small Stuff, and It’s All Small Stuff, and realized it was time to engage in some personal mental spring cleaning. 

In this collection of short essays, Carlson examines various common sources of daily stress, frustrations, and life's troubling idiosyncrasies that tend to diminish the joy of genuinely appreciating the wonders of our God-given privilege known as life.

Understanding the Philosophy

As the book’s title exhorts, “Don't sweat the small stuff” encourages us to keep daily challenges and minor annoyances in perspective. Most of the stress we experience is temporary and often insignificant in the grand scheme of things. 

Why We Sweat the Small Stuff

Human nature tends to exaggerate minor problems, making them appear more significant than they are. Stress and anxiety often arise from concentrating on details beyond our control. Carlson suggests asking ourselves how we will feel in a week, a month, or a year about what frustrates or stresses us today.

Likewise, he adds these practical suggestions for not sweating the small stuff:

·       Practice gratitude: Focus on what is going well instead of what is not.

·       Choose your battles: Not every issue requires your time and emotional investment.

·       Mindfulness: Stay present and refrain from ruminating or overthinking trivial issues.

Benefits of Letting Go

·      Reduces stress and anxiety, leading to better mental and physical health.

·      Strengthens relationships by minimizing conflicts over trivial matters.

·      Frees up energy and focus for what truly matters in life.

The Big Picture

• Reverend Megan, the Episcopal priest where I attend, closes all her services with the following benediction, which is particularly appropriate given this essay: “Life is short, and we do not have much time to gladden the hearts of those who travel with us. So be quick to love, and make haste to be kind. Rest assured that God is infinitely more concerned with the promise of all our futures than with any mistakes of our pasts. And now, may God, Father, Son, and Holy Spirit bless you and remain with you always.” Not sweating the small stuff creates more room for joy, creativity, and meaningful connections.

Encouragement

• Remind yourself: “It’s all small stuff.” Most worries fade with time. Daily annoyances are like a "pebble in your shoe"—uncomfortable, but easily removed and rarely life-changing.
• As you reflect on that annoyance, stressor, or frustration that has prompted your anger or worry, talk to yourself—or better yet, write a letter to yourself as if you were advising a friend on how to handle the situation. We are skilled at offering advice to friends, yet we seldom extend the same consideration when speaking to ourselves.
• Cultivating resilience and a sense of humor—sometimes, finding the humor in the little things that annoy us is the best response.

Conclusion:   
Adopting the "Don't Sweat the Small Stuff" mindset doesn't mean ignoring responsibilities but choosing where to focus your energy. By recognizing that most things are "small stuff," you gain freedom, peace, and a more positive outlook.

Ah, yes...a bit of mental spring cleaning does wonders for the soul :)

 

To read Carlson’s book, you can borrow a copy from your public library or purchase a used copy affordably online at addall.com. 

Rewriting Your Life Story: The Art of Cognitive Reframing

 We cannot solve problems with the same thinking we used when we created them.

Albert Einstein            

I’ve had many worries in my life, most of which never happened.

Mark Twain                

We do not see things as they are; we see them as we are.

Anais Nin                    

 

Who among us reading this has never found themselves in a situation where the cards in the game of life are stacked against them? As stress and frustration mount, it seems logical to believe that what lies ahead will be the same. However, this belief stems from what social psychologists call the availability heuristic, which occurs when our most recent and readily available events and experiences come to mind vividly. It is like someone (1) trapped in the passenger seat of a car, (2) careening down a steep, winding mountain road, (3) without brakes, and (4) realizing that the only possible outcome is the inevitable, fatal crash at the bottom.

 

But wait, I am only in the passenger seat, not to mention in a car without brakes on a particularly dangerous mountain road devoid of options because I scripted the scene. What if I rewrote the scene so that I am in the driver’s seat, even if there are no brakes? Might I then have options? Could I drive the car into a ditch, against the guardrail, or veer off the road into a snowbank…did I tell myself it was snowing? Better a broken arm or expensive auto repairs than what awaits in the originally scripted ending. Better yet, what if my rewrite has me notice a runaway truck off-ramp with barrels of antifreeze at the end to absorb the impact?

 

The point is that much of what I often catastrophize about stems from my thoughts- the “script I wrote”- which generates the negative self-talk that contributes to my emotional distress. I forgot that thoughts are not facts.

 

This essay discusses the art of cognitive restructuring, or in everyday language, “reframing” or “rewriting” the script that influences our emotional state. In no particular order, the following suggestions include identifying, evaluating, and utilizing this approach to challenge negative self-talk.

             Recognize the power of cognitive reappraisal.

• Recognizing that changing your thoughts can greatly influence your mood is a crucial step in identifying negative self-talk. We tend to "feel the way we think." In other words, if I feel upset, depressed, stressed, or otherwise out of sorts, it serves as a strong indication that negative self-talk is at play.
• Once recognized, confronting negative self-talk becomes possible. A simple question like, “Where's the proof?” when faced with thoughts such as, “I can’t stand this” or “I’ll never be able to do this,” can transform the underlying beliefs that lead to negative emotions.

Identify the stressor

• Recognizing negative self-talk is crucial, but it is situation-specific. Something—an event or another stimulus—triggers the toxic thought, and identifying that trigger allows one to act on it rather than simply reacting in the future.
• Acknowledge your emotional response to the stressor after identifying the specific event or situation causing stress. As many social media gurus paraphrase, “To be found, you must first admit that you are lost.”

Challenge your initial interpretation.

• As noted above, “thoughts are not facts,” and examining the validity of negative thoughts presents a chance to rewrite your life’s screenplay. Reflect on whether your current situation perspective is the only possible interpretation. This process starts with the simple question, “Where’s the proof?”
• Rephrase the negative self-talk in three or more ways, then identify a more likely explanation for the misinterpreted event. This “reframe” is likely to be more plausible and less distressing.

Look for potential benefits.

• Reframe stress as a potential enhancement, viewing pressure as fuel for performance. Richard Bach wrote in his book* Illusions*, “There’s no such thing as a problem without its gift inside. The reason we have problems is that we need their gifts.”
• Reflect on how overcoming this challenge can encourage personal growth and learning.

Adopt a balanced perspective.

• To follow up on the previous suggestion, economists recommend conducting a cost-benefit analysis when facing a challenging situation. This approach is sometimes called the “Theory A vs. Theory B” method. Evaluate your self-talk's “costs” and “benefits,” then determine its usefulness.
• This approach allows you to examine the veracity of your negative self-talk as fact (Theory A) by questioning its accuracy by asking, ‘Where’s the proof?’ - Theory B.
• Compare the evidence for both theories to gain a more balanced perspective.

Practice perspective-shifting

• Consider viewing the situation from another person's perspective. This reflects a professional interpretation of the adage about walking a mile in someone else’s shoes. One effective way to achieve this when faced with upsetting behavior from others is to challenge yourself to identify three or more alternative explanations for why the individual acted or spoke as they did. Doing so can help reduce the stress response and provide new insights.

Focus on controllable aspects.

• Identify the elements of the situation that you can influence or change. This recommendation is simple but not necessarily easy to follow. In Alcoholics Anonymous, each meeting begins with the Serenity Prayer: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Once you grasp this, direct your energy towards these actionable areas.

Develop a new narrative.

• After reflecting on these steps, you are ready to create a more empowering narrative about the stressful event—“to talk sense to yourself.”
• Focus on your ability to adapt and learn from the experience.

Practice self-compassion

• Indeed, this is merely “psycho-babble” unless you approach your journey through the reframing process with kindness and understanding for yourself.
• Acknowledge that stress is a common human experience.
• Remember, not all stress is bad; only that generated by negative self-talk, known as distress, is. Just as muscles that remain unstressed atrophy, so do one’s self-esteem, self-worth, and self-respect.

These suggestions can help you better understand your distress and frustration, potentially leading to a more positive emotional state and an enhanced ability to cope with challenging situations.

 

Riding the Wave: How Urge Surfing Encourages Personal Change

Image courtesy UC Irvine

 

Who hasn't felt an urge to do something? An urge is a strong, pressing desire or compulsion to act, often presenting as an intense physical or emotional impulse that can be hard to resist. It resembles a sudden, powerful need to act, like a push or pull toward a specific behavior. While most of us can relate, urges pose a significant threat to efforts aimed at changing personal behavior, particularly when that behavior involves a “bad habit” or even an addiction.

 

So, what’s someone to do when wanting to change a personal behavior but knowing that urges to lapse will likely occur? Numerous articles and books based on various theories explore the answer to this question. To do them justice would require adding another article, if not a book, to this collection. There are techniques, however, “tricks of the trade,” if you will, that may help manage these urges when they arise.

 

One effective technique developed by psychologist Dr. Alan Marlatt is Urge Surfing. This method encourages individuals to observe and experience their urges as if they were waves in the ocean. It is a powerful mindfulness practice for managing cravings, impulses, and negative emotions without succumbing to them.

 

The core principle of urge surfing is based on the understanding that most urges and cravings typically last less than 30 minutes if left unaddressed. Unfortunately, when faced with the urge to abandon our efforts, many of us who genuinely want to change our behavior try to suppress it or even fight against it. Regrettably, as Carl Jung noted almost a century ago, what you resist persists. Instead of suppressing or opposing these impulses, which can often amplify them, urge surfing encourages individuals to experience these sensations with curiosity and without judgment.

 

Urge surfing requires full engagement in the present moment. A commonly suggested method for achieving this is deep breathing and focusing on one’s immediate surroundings, like breathing itself. When an urge arises, the individual observes it without acting immediately, concentrating on the physical sensations, thoughts, and emotions connected with it. Similar to feeling a cramp or a "stitch” while exercising, pausing, taking several deep breaths, and remembering that, as members of AA say, this too shall pass can provide a sense of detachment and a degree of control by visualizing the urge as a wave that rises, crests, and eventually recedes.

 

This technique may help address the negative emotional states and physical or emotional triggers that generate these urges. Placing space between these precursors of urges and the behavior they historically evoke breaks this cycle. 

 

Urge surfing has demonstrated potential in dealing with issues like addiction recovery, managing impulsive behaviors, and coping with intense emotions. It decreases emotional reactivity by encouraging a calm, detached approach to urges, reducing their emotional impact and making them easier to handle over time. Essentially, it permits one to “act on” urges rather than “react to them” by lapsing into old behavior.

 

By regularly practicing urge surfing, individuals become more self-aware and emotionally stable and can make proactive choices as they reassert control over their change plan. This technique enables those seeking to make personal changes to manage discomfort without surrendering, encouraging positive behavioral changes and improving mental well-being.

The Art of Constructive Criticism: Building Bridges, Not Walls © 2025

 Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.

Winston Churchill.

 

There is no failure, only feedback.

Robert Allen

 

As a college professor, writing assignments represented a significant part of a student’s grade in my courses each term. Therefore, I created a grading rubric for each assignment in which writing accounted for 15% of the overall grade; this was often enough to distinguish between higher and lower grades.

 

At the end of each term, students completed anonymous course evaluations, which included space for subjective comments on the course and my role as its instructor. Although generally relevant to the course subject matter, I occasionally received remarks about my grading. I recall one such student’s feedback that made me smile as I read it. It stated that Dr. Chapman seemed to have forgotten that this was a counseling course, not one on writing.

 

Since my students frequently struggled with writing mechanics, and many planned to attend graduate school after graduation, I took great care to provide feedback on how they could enhance the effectiveness of their arguments simply by attending to their writing, focusing on spelling, punctuation, syntax, and clarity in the expression of their ideas.

 

So, why is constructive criticism so difficult to accept? Why do we hesitate to seek feedback on our performance or react to it with embarrassment, if not resentment, when received? The answer is evident if the criticism is spiteful or malicious, but what about sincere, heartfelt, constructive criticism? 

 

Psychologists and therapists offer a myriad of answers to these questions. However, they all generally fall into one of four categories: (1) threats to self-esteem and identity such as ego-defense, fear of rejection, or personal experiences; (2) emotional reactions and triggers, including shame, anxiety, or “negative self-talk”; (3) misinterpretations and communication barriers, like perceived intent, lack of trust, or communication style; and (4) underlying beliefs and mental health issues, including personality disorders, perfectionism, or low self-esteem. 

 

To prepare students to receive feedback in my counseling classes, I would ask students to take several deep, calming breaths and think about someone in their life, whether present or past, alive or deceased, whom they greatly admired and held in high regard. This person could be a parent, a coach, a mentor, an instructor, or a friend. I would give them a moment to focus on that person and then pose three questions: (1) Did this person always tell you what you wanted to hear? I would see numerous heads shaking in response, “No.” (2) Did this person ever say or do something that upset or annoyed you? This time, the heads would nod in agreement. (3) Did this person ever say or do anything that made you so upset or angry that you didn't speak to them for an hour, a day, a week, or even longer? Again, heads would nod in agreement. I would then ask, “So why is it that this person, who didn’t always tell you what you wanted to hear, sometimes upset or angered you, perhaps even to the point of not speaking for an extended period, was the one who “popped” into your mind when I asked you to think of someone you hold in high regard and respect?”

 

The most plausible explanation for their experience is that this individual offered feedback, guidance, or advice in a way that ultimately helped them realize that a sincere concern for their well-being and a commitment to their growth and development motivated this feedback. 

 

In the first of two quotes introducing this essay, Churchill suggests that, like pain, criticism—or "feedback"—is crucial for preventing harm and realizing our full potential. In the second, Allen observes that there is no such thing as failure; instead, all our experiences, whether positive or negative, provide learning opportunities that guide us in what to repeat or how to approach things differently in the future.

 

In his book The Culture Code, Daniel Coyle discusses research showing that using 19 words as a preface when delivering feedback can significantly increase the chances of its acceptance and, most importantly, use. These 19 words are I’m giving you these comments because I have very high expectations and am confident that you can reach them.

 

This straightforward introduction to providing feedback allows the recipient to recognize that what they are about to hear comes from someone committed to the pursuit of improvement and growth, someone who believes in their ability to achieve these goals.

 

While we can control our wording when giving feedback, we cannot control how the other person interprets it. Nevertheless, this 19-word preface offers any feedback we'd like to provide to enhance the chances of it being received and acted upon instead of dismissed or resented.