Since well before the War on Drugs, we’ve been taught to “just say no.” Today we know the pitfalls of pure prohibition and denial. We know the value of “just saying yes” to sobriety instead. Still, especially during the period of craving that follows quitting, we do have to say No to ourselves. Perhaps many times a day.
What I’m interested in is the tone of voice we use to say it. And how we feel as a result.
I’ve written and spoken a lot about ego fatigue (ego depletion). It’s a well-studied psychological phenomenon: the loss of cognitive control that comes when we continuously try to inhibit an impulse. Ego fatigue is one form of emotional dysregulation. Other types of emotional dysregulation have been studied by psychologists and 
neuroscientists, and they pretty much all involve losing the capacity to inhibit impulses. Many regions of the prefrontal cortex are designed (by evolution) for inhibition. Some forms of inhibition are rapid, automatic and unconscious, some are at the borders of consciousness, and some are completely conscious. Ego fatigue may strike at several of these levels. But let’s think now about conscious inhibition: saying to yourself, “No, don’t do it!”
So there you are, craving to get high “one more time,” and saying to yourself over and over again: No, don’t do it! Then ego fatigue creeps up on you…some part of your cognitive hardware gets tired and gives up the battle. The impulse takes over. Each of the five biographical chapters in my book shows exactly how that plays out in the life of someone addicted to something. But here’s the double whammy, the Catch-22: Psychologists have shown clearly that suppression (just saying No) makes ego fatigue worse. Suppressing the impulse gives it more power. The only way to stay on top of ego fatigue is to reinterpret or reframe the situation: “that’s no fun, that’s not what I want.”
Okay, all fine in theory. But in real life, you simply can’t reframe the wish to get high every time it pops up in your brain, especially during the period of “incubation of” craving, in the weeks or months that follow quitting (see last post). You have to say No to yourself some of the time, maybe even most of the time.
But what’s the tone of that internal message? What’s the tone of the “No, don’t”? I haven’t heard much about this from other addicts or researchers, but my impression is that the tone of the internal prohibition is often one of parental authority. It’s often a tone that’s warning, disapproving, judgmental, perhaps accusing, almost menacing. “You’d better not!” it seems to say. “Or else!” it implies. It’s easy enough to dredge up images of the disaster you’re about to visit on yourself, but that might just strengthen the scolding, authoritarian voice.
So how do we feel when we receive this stern prohibition time and time again? We feel frustrated, obstructed, denied the thing we want. And what’s worse, we may feel put down, misunderstood, and unfairly punished. Don’t I deserve to get high, today of all days? No, you don’t! Be quiet!
This internal dialogue may be playing out in your head, just on the fringes of consciousness. Or maybe you are quite conscious of the sense of being denied something, the sense of being suffocated or oppressed. I know this was frequently the case for me when I ran around breaking into medical centres and stealing drugs. I felt that oppressive edict like a dark, overhanging cloud bank.
So what I would often do is rebel. I’d finally say, Fuck you, I will if I want to! And there was a palpable sense of relief, a sense of lightness, the straps of a harness being peeled off. And then I would get high for a few days. And then I would suffer.
This scenario is surely a case of ego fatigue. But it’s more than that. It’s not just a neutral signal telling you to inhibit an impulse, and then wearing thin with time and repetition. It’s also a voice that makes you feel frustrated, alone, put down, anxious, and probably angry. An ideal circumstance for going back to drugs or drink.
Our minds are full of internal voices. We are fundamentally social creatures, and our interpersonal relationships are constantly playing out, both in the real world of other people and in the private world inside our minds. When we realize this, I think we acquire the power to shift the dialogue, to make it more friendly, less hostile.
The tone of voice with which we say No to ourselves makes all the difference. It’s very possible to link the No with a Yes. To make it a message of support and hope, not just denial and obstruction. We can take on the voice of a critical parent. Or we can take on the voice of a friend, ally, loving parent, big brother or sister… Instead of saying “You’d better not…” (for which there’s a clear script inscribed on our auditory cortex), we can say, “Let’s not do this; let’s do that instead. This isn’t what we want.” Even just by making the voice say “we” instead of “you” we shift the dialogue. We make it supportive rather than punitive.
That’s one key to reframing the addictive impulse, which reduces or eliminates ego fatigue.
That’s when there’s no one there to defy.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Eric Berne talked quite a lot about this, “internal dialogue” in his wonderful book the games people play. He talked about it in terms of transactions we have with ourselves and others. He used the critical parent voice as instigating a transaction with our rebellious child and vice versa. He also used nurturing parent transacting with our adaptive child. This all begins to make sense when we talk about how our internal dialogue begins to change from an adult-adult transaction to a more parent-child transaction.
Sometimes these very same transactions are played out externally as people seek help but come at it from a rebellious or adaptive child perspective. The help they may receive, if they aren’t lucky, may be from a critical and/or nurturing parent.
I remember that book well, Peter, and the resulting form of therapy, which was called transactional analysis. I wonder if people still use it. It’s something like Gestalt therapy, and I always thought it was cool.
Excellent point about eliciting the same role relationship when seeking help from others. Both excessive dependency and excessive anger on the part of the client can easily swing the “helper” into a critical-parent mode.
I gave up smoking tobacco a few years ago – I used the book by Allen Carr to help – in it he reframes the notion from that of loosing something (the buddy that tobacco was) to gaining something (health & money) – when I stopped I put $20 a day into my pocket and in 18 months brought a new car. Completely changed the attitude I had to giving up and made it so much easier. I had been through the old AA just say no school many years ago fighting alcoholism and it took 10 years to finally give it away with relapses almost every 6 months or so – it was so frustrating and personally deflating to “fail” over and over.
So that’s called Contingency Management in addiction treatment. Here’s a short review: http://www.psychiatrictimes.com/addiction/contingency-management-addiction-treatment-0
It sure gets to the heart of saying yes while you’re saying no and making the “yes” the focus. Thanks for sharing this.
In recovery circles the ” fuckits” are a well-known phenomenon and as Marc points out dear Nancy’s ” Just say no” does not work
I like the analogy described by Jonathan Haidt for ego depletion – that of an elephant and rider – the rider keeps wanting to go right and the elephant sees peanuts to the left.. the driver gets tired… you get the picture
Another way to approach this is with a MIndful Awareness Practice – be aware of what the destructive self talk is telling you and allow it until it fades and dies away
I can see you’re into India today, Bill. But I agree that mindfulness/meditation is an excellent way to let the impulse come and go without getting in its face and strengthening it. I’ve often mentioned Mindfulness-based relapse prevention on this blog (see http://www.mindfulrp.com/). But today I’m thinking about the times you really do have to say No, often when a cue comes up unexpectedly or repeatedly. Then you need to know how to say No in a comforting way.
Last night 10 mothers invited me to their monthly book club to facilitate a discussion of Marc’s latest book. The three hours we spent together resulted in no ego fatigue whatsoever – a grand time was had by all. This is not something I get to do on a regular basis, so it highlighted for me how important it is to create and participate in constructive, positive environments that make us feel good. There was no need for using any substance at all during those three hours. Now to turn towards the remaining 165 hours left in the week.
Sad smile and sympathy coming your way. That last line really does strike a chord.
heard recently that “the opposite of addiction is not just sobriety, but connection.” made sense to me…
Me too! The books of Gabor Mate, Johann Hari, and Bruce Alexander tell it so well.
All great suggestions!!
However we conceptualize it, Kahneman’s System 1 and 2, the fast brain and the slow brain, the excitatory and the inhibitory, the emotional brain and the rational brain, etc.– we are all “the man with two brains”– hopefully not as dysfunctional and disorganized as Steve Martin’s character in the movie by the same name.
In addiction, we have to move from the habit-established default position of the rational and emotional brain being in agreement– saying “yes to yes”, to use– to saying “no to yes”, then to saying “yes to no”, to eventually saying “yes to yes” when sobriety has become stabilized as the new habit, as the default “choice.” But getting there ain’t easy and we devise all kinds of tricks to self-monitor and limit the effects of ego fatigue, like the acronym HALT (Hungry, Angry, Lonely, Tired).
But when the ego fatigue shifts to defendedness and defiance, then what do we do? As Marc suggests, you have to break the pattern. Don’t deprive yourself early on. Distract yourself, and do something different. Do something different than the usual things that set a behavior chain in motion that drove us closer and closer to the inevitability of usage. That takes practice, but is more likely to lead us to a positive replacement habit than of denying our feelings, stuffing them and encouraging defiance. This is where the social support of good meetings can buy time and set up a holding pattern, a temporary substitution until we can find what we really want to do to fill that hole that losing the addictive coping behavior has left in our lives.
Be gentle. Reward yourself with other positive, attractive incentives as replacements. Don’t deny and punish. I think we’ve done enough of that already…
Lovely comment, Matt. Insightful, empathic, and damn good advice.
But I especially like your 4-stage sequence: yes to yes, using; no to yes, using; yes to no-using; then yes to yes abstinence (or whatever you’ve chosen). That captures the progression in such a clever way, and it illustrates how the mind divides itself at every possible juncture.
My last go-round with opiate addiction was getting off of methadone. The clinic really didn’t encourage withdrawal, so, if I wanted to stop peeing in a cup everyday for a dose of red goo, I had to do it myself. Luckily for me, I found something that became more important to me than addiction. I developed a huge crush on someone. In my fantasy, he was going to take me to Europe in the spring.
So, over the course of the preceding winter, I slowly withdrew from methadone because there was something that was more important. Europe never happened, but the will to pull out of the hole of addiction stayed with me. Because I chose to do it, had the will to do it, it happened. So, for me, it’s not saying “no”, it’s saying “yes” to something else, something hopeful and positive.
Absolutely, Lynn. It seems so much of addiction treatment is saying no: Don’t do this! Stay away from that! Don’t associate with them! It may be why some people seem to adopt meetings as their new habit. There needs to be a better way to encourage, and expose ourselves to positive diversions and joy so we can recalibrate our reward system instead of denying it.
What a beautiful story, Lynn. It seems to highlight a kind of internal momentum, or directed desire, that can exist at our core. It shows that this momentum doesn’t depend on staving off disappointment and it can endure radical recalibrations in our path through life. That’s a very special lesson. Thanks for sharing it.
Perhaps another option is to change the voice of the urge compelling you to use. Like most people I typically hear my thoughts in my own voice – a voice that is familiar, a voice that I trust. Who else talks to me as much as I do! And why would I lie to myself?
And yet if I can replay thoughts in another’s voice, say that of Bugs Bunny or Arnold as the Terminator, they seem easier to dismiss and therefore easier to turn myself to focus on something that I care about.
What a great suggestion! A lot of people (including Matt, above) talk about the addict voice. But I never hear of it being characterized or pitched in a certain tone. A playful approach (albeit to a sometimes dangerous dance) would have us make that voice sound caricatured, or just whacked, which fits the job description perfectly.
Hi Marc, another great post.
I came up with S.A.D.D. Substance.Abuse.Defiant.Disorder many years ago in thinking many who suffer substance abuse are in defiant of being, or becoming addicted thinking they need the medication, many times self medicating or over medicating with prescription medication or illegal drugs.
I guess SADD could be seen as someone who refuse to listen or entertain that internal dialog of alternative thoughts of using? and are being rebellious and saying to themselves HAHA I need it! so don’t go there.
All my life I was rebellious in that if some told me I couldn’t do it, I did it anyway. Not dealing with all my underlying issues lead me to many years of suffer, and hiding behind drugs and alcohol. Defiant is seeing that it was all my inner afflictions and unresolved issues that were affecting my outer actions…
https://www.linkedin.com/pulse/denial-defiant-fine-line-becoming-addict-sadd-richard-henry?trk=mp-reader-card
Respect Richard Henry
Hi Richard. One amazing thing about this blog is that I find that some of the things I think may have occurred only to me have actually occurred to many of us. Your defiance, my defiance, Peter’s insights, Bill’s group experiences….it seems that defiance makes up a big piece of the pie for many of us. We are all such children!
“Just Say Yes?”
I completely agree and relate to what you are saying in this article. Staying in the light and embracing positive self-care is so important. It’s quite amusing that we have to play all these sly tricks on our brains in order to manage addictive thinking patterns and/or impulses.
True. But we learn to do this at roughly age 6-8, playing tricks to get our way. We start out doing it to others and then we end up doing it to ourselves.
No, I don’t!!!
No longer relating to the term; “we” during discussions of addiction, could be an indicator of people recovering.
Finding out how and why people no longer relate to”we” when
people are discussing addiction, could through new light on the understanding of addiction itself.
Could you say more about what you mean but that?
Sure Matt,
Generally, communities are based on a common bond.
Identifying with “we”, can be a comforting and supporting identity for a person to embrace.
But If, and when a person relates less and less to the common bond, they may naturally relate less and less to the community, and that bonding identity of “we” may naturally dissolve, and become something they no longer relate to.
Exploring the hows and whys this happens, when addicts feel less and less addicted, could help in the understanding of Addiction, and possibly lay the grounds for a new model of addiction.
I think I understand what you’re getting at…and it’s likely too complicated to explicate in a paragraph. I think we are all individuals, but also social beings. Part of the community of people with substance use disorders, or the community of people in recovery. Meetings and therapy and groups are helpful as training wheels and social grounding to buy time so we can get back to our true nature. But ultimately we have to recognize what is right for ourselves. And life is ultimately about this, experience after experience, iteration after iteration.
That’s what I like about Self-Determination Theory by Deci and Ryan. It narrows down the interactive necessities for being a healthy human to 3 things: autonomy, competence, and social relatedness. It’s important to feel like a competent, independent individual. The healthy self-evaluation of that depends on our relationship to social groups. Individual realization, as well as inclusion and validation within amenable groups. So it is all about the individual and their own self-perception, but also their healthy, inclusion in social groups. Addiction muddles and mucks this up, and effective “recovery” restores it.
So it’s not just the “I” or the “we”. It’s both.
🙂
I guess my point was that much could be understood about addiction if t people that recovered could be studied.
But due to the nature of recovery, they are not that available.
Understanding addiction is important, but understanding recovery may be equally as important, but it is not as accessable a thing to research and study.
Or even to define for that matter.
I get your point, Carlton. Sometimes I still feel like part of that “we” and sometimes I don’t. It’s not a static thing.
Matt in his lovely way simply extended this idea, or at least a part of it, to a whole constellation of knowledge about connectedness…and how it can overlap with autonomy. I get that point too.
Fantastic article, thank you. This one will be saved in my box of stuff I take with me if the house were ever to catch fire.
Phillip
Then put it by the door!
Doc,
By my door it will be… I’m using a poorly veiled alias here on your blog, but during my first few, very painful weeks of sobriety, you exchanged e-mail with me, a total stranger. I had support meds, but despite the widely purported addictive potential, I despise benzodiazepines. I needed relatively massive doses to sleep; the withdrawal related pathways/mechanisms driving the insomnia were robust. A double edged sword, I slept (more like a coma) with the meds, but the next day was so foggy that I often debated which would be worse, no sleep and restless limbs from hell (if I had to pee, had to do it while walking around the block at night, tremulous hell.. thankfully my dog is awesome wandered with me during the wee hours of the night, pun intended)….. or sleep then zombie status for the entire next day. The literature suggested that short circuiting that adrenergic rebound/overload could shorten the course of acute withdrawal, so I stuck with the meds. Unfortunately, for me they can bring along an annoying side effect of giving me a next day case of the “fuck its” and your letters played a role in helping me fight those bastards off. I too am a scientist by trade, basic education in neuroscience and graduate education in toxicology. Worked six years (in servitude) in an academic laboratory where opiates, sympathomimetics and all the related agonists were under my immature supervision. I will leave the reader to decide whether or not this policy was flawed, where teenager was in charge of a scheduled drug locker where a simple signature was the only security. My education did little to protect me from the tendrils of opiates; in fact at times I used some of the knowledge to fuel rationalization. I’m digressing, moving on… I wrote you again, fearful from the hospital room of my very sick brother where an ultra potent synthetic opiate was still rocking on the tray in its vial, moments after the nurse had used it to alleviate my brother’s pain. It was partly empty… partly. He is well now and I remained sober those days, I do not think that would have been possible without the words you sent me, again. Reattribute, distraction, revalue… all those things from a simple electronic conversation with a stranger. Though not my favorite flavor (12-step), my interaction with you reminded of the sponsor program in those groups, I think there is merit there in some circumstances. There is a saying in Japan, I don’t know it perfectly, but it says something like “a teacher can be anyone who has been doing it longer than you have.” I have read both of your books and one you mentioned by Gabor Maté is in progress, it is also fantastic, gut wrenching reality mixed with solid advice. I devoured any science-based literature I could find on the topic, from lengthy recovery management monographs to basic protocols for post acute withdrawal education. My plan was to pile as much as I could on top of the addictive thoughts (which were as strong as the desire to eat, to breathe at times), with the hope that the combined *energy* of all of those words would stick in my brain over time. And it is working. Apologies, this became far longer than I originally intended but writing all of this on the screen was in fact quite therapeutic. Thank you Marc and everyone who contributes to this blog. I am sincerely in your debt.
Phillip
Wonderful to read my way through this and hear the positive voices!
Changing the narrative in my head was both eye-opening as well as mind-opening to an awareness of “discovery” that I was not who “I thought” I was. Rumination and a continual recycling of the same old thinking keeps a person stuck within the confines of their own mind.
It was important, for me, to change my thought patterns because long before I ever developed a “drinking problem” I first developed a “thinking problem about drinking”. The way in which alcohol was modeled and used, within the context of my family, was you only drank for one purpose and that was to “get drunk”. It was also quite normal that if you got drunk you may be arrested for drinking under-age, drunk and disorderly and you may or may not remember due to blackouts.
All of these things happened to me and more, however, facing the face in the mirror, imagining the possibility of another way of being and just plain sick and tired of the constant inner turmoil. August 17th, 1988 I made a decision and reached out for help and never looked back. Saying “No” isn’t always a verbal expression but perhaps in the way you walk, take responsibility, embrace reality, help others, love your true self, be grateful, this, for me, was a discovery process which has no end.
“No” meant changing my thinking about what I thought drinking and drugs could do for me and fully acknowledged what they had done to me and others. “No” is an inside job initiating a “life-style change” that allows one to see beyond the dimensions of the self and ego.
“Yes”, actually coexists with “No” for you could not know one without the other and this in reality is a gift. Perception has been an integral part of my journey and no matter where I am going, “here” is the only place I can ever be.
In summary, I wouldn’t be so quick as to condemn “No” or “Yes” they are just different sides of the same coin such as; using and cessation, light and dark, love and hate etc…
As Jiddu Krishnamurti says…”Be A Light Unto Yoursel”!~
PEACE!~
What a treatise, Gary! We hear a lot about the “thinking problem” from the ancient mists of 12-step lore, and it makes a lot of sense. But there’s much additional wisdom in seeing the No as the flip-side of a Yes. A Janus-faced entity, maybe, like the two sides of a coin coexisting. Or the entrance to a rabbit hole that falls upward, not downward.
I also used “No” as a conduit or transition into a path of productivity and optimism, a present-tense I valued. I wrote the word “no” on a piece of paper, stuck it to my wall, and read it many times a day. That’s actually how I quit at the age of 30. I would go out into the park at night, all alone, practice Tai Chi and just be with myself. Within a year I was back in graduate school and every month brought new possibilities, new freedoms.
Hi Marc – read your ‘Biology of Desire’ book with great interest. I took Emotional and Cognitive Development with you at OISE about14-5 years ago – best course there in my opinion. I’ve been retired and doing some private practice recently but have been using the self organization concepts pretty consistently in working with not only substance mis/use but also with anxiety, depression, abuse, chronic pain, etc. The key for me has been pairing the concept of the attractor basin (the attractor being addiction/anxiety/flashbacks, etc.) and using mindfulness to “sit on the edge of the basin, accept that you are there; be curious and interested in what got you there, and then physically get up and do something different to break the neuro-pathway that leads to the basin”. My sense is this fits very nicely with Matt’s post above, citing you saying to ‘distract yourself; do something different’. Another key concept I use is that of the “burn” which I wrote about in a paper for your course. This is the experience of, for me, a cold, empty burning sensation located in the pit of my stomach. Virtually everyone that I’ve worked with for many years recognize some form of this sensation, and over time, people have helped me associate it with the (usually early) experience of profound powerlessness, most often various forms of abuse. This also ties in with the adverse childhood experiences you mention in your book. This is a powerful book you’ve written and I look forward to reading your earlier one. Also enjoyed and am using Norman Doidge’s “The Brain’s Way of Healing”, using neuroplasiticity and the notion of change being inevitable, therefore shape your change.
This post reminds me of a wonderful Ted talk https://www.youtube.com/watch?v=IvtZBUSplr4 on self compassion. Changed the way I think and talk to myself.
So true! The internal dialogue is such a struggle and a few tweaks to the language can show positive results. “I hear you but let’s do X instead” also works. It makes the victories of refraining sweeter and more enduring.
Yes, tweaks to the Language can lead a person to life-changing realizations during their individual recovery process.
For instance, sometime during my own recovery period, I said to someone,
“…I could not have gotten this far in life, without drinking”
and without a beat, they replied:
“Or, you could say… that you have gotten this far in life… despite the drinking.”
At the time, I poo-poo-ed this as a cute and clever use of semantics, but I re-visited and ruminated about those two very different viewpoints of one thing, many many times during the recovery process.
These types of paradoxes, or “tweaks” of Language are easy to say, and an easy to think, but the profound shifts of realizations that your feelings experience, due to these simple tweaks, can be life changing.