Using self-trust to overcome alcohol dependence

By Margôt Tesch


A note from me (Marc):

This self-trust thing….it’s like a hardy weed. It keeps spreading, and now it’s bursting out in all kinds of places. Margôt Tesch, a member of this blog community, trusted her future self to help her curb her drinking. And it worked. This post is her description of the process she used and the impact it’s having on her life. The only thing I can add is that it makes me very happy…that an idea that emerged from my reflections on my own life can become a method for helping others. The rest is Margôt’s account:

I read Marc’s blog on Self Trust some weeks ago. At the time I read it, it resonated profoundly and sparked some immediate actions and changes in my life. Marc talked about the need to let the future self take control. It seemed to be exactly what I needed to hear at just the right time.

I have been aware of my addiction to alcohol for many years now. I try to be honest in my self-talk, i.e. acknowledge that I do have an addiction even though I manage it by constraining my indulgence so that I do not behave anti-socially. But drinking is something I do every day. That’s an addiction.

I have wanted to change my dependence on alcohol for a very long time and had even been thinking recently about my lack of self-trust in this area. You know, how you have a big night and a hangover and you decide “That’s it” … until about 5 the next day. Many of you will know the cycle. It’s ridiculous, but we act it out over and over again. Just as Marc points out, it erodes our self-trust.

I lead quite a disciplined life. I eat well, exercise regularly etc. As well, I have created a habit of goal setting and know how to push myself through to achieve things; for example, challenging adventure hikes, long distance running — the list goes on. Further, many years ago I overcame a serious food addiction which lasted over a decade. I also gave up smoking, though that was some 30 years ago now. So I have reason to trust myself. I have a sense of confidence that I can do difficult things if I set my mind to it.

I’ve always known that I could stop drinking and actually believed that I would stop. I’ve just been waiting for the right impetus, the right motivation to give me the reason to stop. Knowing that drinking habitually has health implications has not been enough. I guess I’ve been waiting for the health crisis. But when you stop and think about it, that’s pretty crazy. Why wait for the health impact to eventuate. Why not stop now and prevent it?

These thoughts had been going around and around in my head, but still I persisted to drink daily. When I read Marc’s blog in preparation for his TED talk, all this thinking came together in a moment of clarity. Suddenly I perceived “my future self” as an identity that could take control…now! I had always believed that this was possible, that my “future self” would one day do it, but Marc’s words made me realise I didn’t need to wait. My future self was actually inside me. I already believed in her. So I was able to merge the perception of my future self with the perception of who I am now, today. I/we became one. This simple shift in thinking gave me the sense of self-trust I needed to take control in a matter-of-fact way.

It worked. I had my first drink-free night for a long time. My husband even poured me a drink; I accepted it but couldn’t drink it. My future self was in control and was able to think clearly about the benefits of stopping (short term pain for long term gain).

In a way it was a relief — no more cognitive dissonance.

It’s been several weeks now. My husband also read the post and decided to join me, and I have to admit, that’s made it easier. We have achieved what we set out to do so far, no drinking during the week, and we are working to limit our weekend consumption to “reasonable” amounts (which means no hangover). So far that has probably been the greatest challenge. The first night after a period of abstinence is high risk as there is some compulsion in giving yourself permission to drink again, to over-indulge. But we are working on it.

My plan is to make this behaviour part of our routine so that it just feels “normal” not to drink every day; let a new set of habits and behaviours emerge. Already we have noticed we are more alert in the early evening and able to use the regained time for more cognitive activities, rather than just watching the TV.

We aren’t there yet and a trip overseas visiting family has set us back a bit. But now that we are home, the work begins anew.

Here are some notes that I refer to when I need to regain the initial impetus:

  • Future health gets sacrificed for immediate gratification (i.e. too much dopamine production).
  • Believe in my capacity for self-control (reduces ego depletion).
  • Maintain a dialogue between my future self and me.
  • Things will get better.

I really appreciate Marc’s thinking and theory in this area. It has helped to change my life.


Note (from Marc): Please see the new blog by Ken Anderson in Psychology Today. Ken is the founder of HAMS, a group that supports “Harm Reduction” approaches. Margot’s self-styled method is a great example of Harm Reduction.

33 thoughts on “Using self-trust to overcome alcohol dependence

  1. Kenneth Anderson July 29, 2013 at 10:18 am #

    This is a great example of exactly the kind of harm reduction plans that we teach and support in the HAMS program! Good for you! Many people develop these harm reduction plans on their own just as you did.

    • Margot Tesch July 30, 2013 at 7:28 pm #

      Thanks Kenneth!
      Love your HAMS program. Will have to share around.


  2. Jordan O. July 29, 2013 at 11:17 am #

    Great stuff, Margot! Reminds me of a cheesy one-liner from my favourite yoga DVD – “the future you thanks the present you”.

  3. Shaun Shelly July 30, 2013 at 6:24 am #

    Really cool in many so many ways:

    1) I love seeing the theory applied in practice. Without practical application, the theory is meaningless for me.
    2) Great to see Margot achieving her goals
    3) Good to see Kenneth Anderson here, who’s work has been an inspiration to me, even though I am here in Africa!

    This approach reminds me of Scott Kellog and Andrew Tartasky’s work as well, and the principles of gradualism. (see an article here about their approach

    Also, I use similar techniques based on Victor Frankl’s logotherapy – the imagining of future self, and the discovery of personal meaning in line with Nietche’s statement ““He who has a Why to live for can bear almost any How.” Once the afflicted can see the future self, a self with purpose, they can bare the temporary discomfort of abstinence.

    One of the exercises I do is to encourage the patient to create an image of future self and describe the characteristics such a person would have. We then look at current self, and discover that even in active addiction the individual has displayed many of these characteristics, albeit in a less beneficial manner. So it becomes a case of re-directing these already present traits and behaviours in the direction of future self.

    Unfortunately, many treatment programs link personal identity with the “addict cliche” identity – how can one then trust one’s self if our identity is so inexorably linked with something so dysfunctional?

    • Margot Tesch July 30, 2013 at 7:37 pm #

      Hi Shaun
      While I personally don’t perceive addiction as a mental illness, I did like the idea of “Strengthening the Inner Leader” and see correlations with my experience in bringing the future self to the present.
      Thanks for sharing.

      • Shaun Shelly July 31, 2013 at 2:54 am #

        Hi Margot

        Again, thanks for the great post! Indeed, I don’t necessarily see addiction as a disease, or, in many cases, as a mental illness, but for us guys in the treatment field we tend to see people with severe substance use disorders, and even if these are not a disease as such, they need to be treated within the mental health framework.

        • Margot Tesch August 1, 2013 at 2:41 am #

          Okay. I understand. It is a complex social problem, I do see that. And so sad to see lives taken because of it. Anything that works should be pursued by those in need.

  4. Nicolas Ruf July 30, 2013 at 8:40 am #

    Harm reduction is a real achievement, and drinking only on weekends instead of every day may well represent it. I do not want to discount or minimize Margot’s accomplishment, and I sincerely wish her every success. That said, no definition of addiction I know of uses frequency of consumption as a criterion. What all the definitions with which I am familiar do use is what happens when one uses. Control is the key:who’s got it?
    I can’t help thinking about poor Audrey Kishline, the founder of Moderation Management, for whom it took commission of a vehicular homicide, to persuade her that she wasn’t a good candidate for MM. So, while it may be harm reduction to create wreckage in one’s life only one or two days a week rather than seven, the goal is no wreckage, and let’s hope that if this is the case, that the harm reduction is a step toward harm elimination.
    Time will tell whether this approach to limiting not just days of drinking but out of control drinking will work. Best wishes Margot.

    • Margot Tesch July 30, 2013 at 7:43 pm #

      Hi Nicolas
      You make some powerful points that I really appreciate. The whole concept of “harm” reduction is new to me but gives me a broader perspective of my own behaviours and of those around me. Kenneth shared that link which I reviewed in a cursory manner but still have it open as I really want to dig into it and share it with my husband … and some good friends.
      The goal is “no wreckage” … absolutely!
      We are going fine so far but it still doesn’t feel “normal”. I think when we achieve that, the risk of weekend “wreckage” will reduce. Actually there has only been one night so far, that we really over-indulged after a week of abstinence. So that is a good track record I think!
      So far so good!

    • Marc August 4, 2013 at 7:45 am #

      Nick, This is completely false logic! Margot did not say or imply that she had reduced wreckage creation to two days per week. She said that her problems with alcohol involved frequency and degree of use. She is dealing with those problems by reducing both. Obviously shooting heroin two days per week has a different implication than drinking on weekends — for may people! And that’s the crux of it. For some, drinking on weekends is a segue for falling back into a total loss of control. For others, it is nothing of the kind.

      Having chatted with you for many (inspiring!) hours, I know that you know when logic gives way to rhetoric, and this slippery slope is, I think, quite harmful to the foundational concept that one size does NOT fit all.

      • Margot Tesch August 7, 2013 at 1:55 am #

        Interesting to re-read these comments after some distance. It is interesting to define “addiction”. Perhaps we have confused addiction with abuse? I don’t know, I’m raising the question. I see my dependence on alcohol (my desire to consume it everyday) as an addiction. I guess you could define this as “using” alcohol rather than “abusing” alcohol because it does not cause wreckage in my life, because I am in control … to a point. But the control I desire to achieve is greater than I have already. The danger is, as Nicolas points out is that we can’t always “see” the wreckage, when we are addicted we are at risk of denying the wreckage and damage to ourselves and otherwise. We deny that our “use” is “abuse”. I strive to keep an honest eye.

    • Hannah March 4, 2019 at 12:47 am #

      Audrey Kishline was pursuing abstinence and in AA when she committed vehicular homicide. The choice was precipitated by a binge that ended in hospitalisation.

  5. NN July 31, 2013 at 11:30 am #

    Thanks Margot, for your account. It’s great that you’re finding your own path.

    Nicholas Ruf strongly implied that harm reduction does not work, and that Margot if she continues will not succeed, like “poor Audrey Kishline, the founder of Moderation Management.” This is a kind of kneejerk move, which doesn’t look at evidence, but only anecdote. There are, of course AA folks who lapsed and drank themselves to death. And those anecdotes, too, prove nothing, except that like any human treatment for any disease or problem, it sometimes fails, to an extent we do not know. I do know what some friends from AA say: They’re not unhappy with a 30% success figure for those who’ve attended at least a year. But again, anecdote.

    One needs to look at the big picture: empirically, what is the evidence for a given treatment, looking at all cases, *including the dropouts.*

    As to the Kishline ‘old chestnut,’ Stanton Peele addressed it well, at

    “After the crash”
    by Stanton Peele

    [verbatim, first paras of article]

    At 6 p.m. on March 25, Audrey Kishline was driving west on the eastbound side of Interstate 90 near Seattle when her Ford pickup truck collided head-on with a Dodge coupe occupied by Richard Davis, 38, and his 12-year-old daughter, LaSchell, killing both of them. Kishline had a half-empty vodka bottle on the seat beside her when police found her, unconscious, in her truck. Her blood-alcohol level was 0.26 percent, more than three times Washington’s legal limit for drivers. Three months later, she pleaded guilty to two counts of vehicular homicide in Kittitas County Superior Court.

    The crash, however tragic and avoidable, would have been no more newsworthy than the thousands of other drunk driving accidents in which Americans are killed each year were it not for the fact that Kishline is the author of the 1994 book Moderate Drinking and founder of Moderation Management, an organization aimed at helping problem drinkers control their alcohol consumption. (I wrote an introduction to the book and served as an adviser to M.M.) To longtime critics of the “controlled drinking” Kishline espoused as an alternative to the abstinence urged by Alcoholics Anonymous and its imitators, the crash was a vindication.

    The National Council on Alcohol and Drug Dependence (NCADD)–a private group that, like A.A., considers alcoholism a disease that can be controlled only through abstinence–gloated in a press release that Kishline’s crash taught a “harsh lesson for all of society, particularly those individuals who collude with the media to continually question abstinence-based treatment for problems related to alcohol and other drugs.”

    Yet Kishline’s one brief statement to the press revealed some facts that ran counter to the NCADD’s interpretation. “Two months before the crash,” The Seattle Times reported, “she dropped out of the [M.M.] program and joined Alcoholics Anonymous. But it wasn’t long before she was consuming so much wine at night she would drink herself to sleep.” In other words, Kishline, who belonged to A.A. before founding M.M., had returned. Only then, it appears, did her drinking veer out of control.

    Of course, it is as unfair to blame A.A. for the Kishline tragedy as it is to blame M.M. She was apparently experiencing family and financial difficulties that had thrown her life off kilter after seven years of moderate drinking. While M.M. attracted media attention, it had never provided a reliable source of income. Kishline’s husband was an itinerant businessman, and she had moved with him four times in the previous seven years. They and their two young daughters ended up living with her in-laws in a small town outside Seattle. But whatever the circumstances of Kishline’s relapse, it is a mark of ideological intransigence and intellectual dishonesty that critics such as the NCADD do not note that she was regularly attending A.A. at the time of the crash.

    Kishline’s story is not just a tale of personal despair and failure. It embodies centuries of American conflict over alcohol in which teetotalers have repeatedly clashed with advocates of moderation. Having failed to impose their vision on the rest of the nation through Prohibition, the forces of abstinence nowadays focus mainly on problem drinkers, insisting that they renounce alcohol rather than try to use it more responsibly. This stubborn position overlooks substantial evidence that the sort of moderation training once advocated by Kishline can succeed where abstinence fails.

    The A.A.-style abstinence approach dominates American treatment programs. A 1997 survey of private treatment centers found that 93 percent followed A.A.’s 12 steps (which include admitting that one is “powerless over alcohol”) and 99 percent insisted upon abstinence. The belief that alcoholics must abstain is so ensconced in American folklore that contrary research findings tend to produce angry responses. // [end of excerpt


    • Marc August 4, 2013 at 9:21 am #

      Thanks, NN. I just read the whole article that you linked. Stanton Peele is not only articulate and logical, he also has an impressive command of the relevant research, and I think he presents the findings fairly, despite his personal beliefs. (For example, he acknowledges sampling differences that contribute to the finding that “treated” alcoholics have worse outcomes than nontreated ones. To my mind, that’s the research equivalent of “being a gentleman.”) Like you, he draws a sharp line between testimonials or anecdotes (which are essentially worthless when it comes to evaluating treatment options) and facts derived from well-run studies.

      I have nothing to add, except to underline the irony that “poor Audrey Kishline, the founder of Moderation Management” was actively involved with AA, not MM, when she drank herself into a serious accident.

      Why are ex-addicts, reporters, and mental health professionals so EXTREME in their feelings and beliefs that they are willing to seriously distort facts in order to clinch their arguments? I just don’t get it.

  6. Nicolas Ruf August 4, 2013 at 12:34 pm #

    Well, I seem to have stepped in it! When I spoke of wreckage creation I was not referring to Margot, but to criteria for diagnosing addiction. I suppose there is some distinction between harm reduction and wreckage reduction, but I don’t see it. I’m also baffled by the distinction between shooting heroin twice a week and drinking on weekends.
    I absolutely stand by my statement that the issue is control. It’s not that every time one uses wreckage ensues either, but when there’s wreckage one has been using. If one’s use of whatever is predictable as to amount, timing, and outcome, all well and good.
    Isn’t the issue to help people find out where they stand? There are clearly some people who need to abstain or their lives will be ruined. There are others who can use safely, for lack of a better word.
    My cautionary note comes from seeing, and please don’t discount this because it’s anecdotal, people defend, rationalize, excuse, and justify their right to use and try to reinstate control in spite of the wreckage and end up in prison, institutionalized, or dead.
    I’m not saying that it’s impossible to mature out of harmful using; far from it; we see it all the time in people growing up and starting careers or getting into committed relationships or whatever and their partying drops to a nonharmful level.
    And whether Audrey Kishline was a member of MM or AA or both or neither is irrelevant as are her life circumstances. The point is and was that she needed to abstain and had gone to considerable lengths to protect and control her drinking.

  7. Marc August 5, 2013 at 7:16 am #

    Well this is a more nuanced and conscientious argument, and I see some truth in it. Maybe the term “harm reduction” is unfortunate because, as you say, it’s hard to distinguish it semantically from “wreckage reduction.”

    Nevertheless, if you really can’t see a difference between drinking on the weekend and shooting heroin on the weekend, there’s a wide gulf between our world views. The difference is based on the simple fact that shooting heroin is always dangerous whereas drinking moderately is very often not. Yes, it is dangerous — hazardous — for some people. We all acknowledge that. So let’s move beyond that point.

    The difference — and I agree with you here as well — has to do with control. And as you imply, it’s about the reliability or predictability of control. How sure are we about being in control? Yes, this is crucial. But you skip over another important factor: how serious are the consequences of being wrong? If I drink alcohol one night — perhaps more than I should — is the consequence a mild hangover or the collapse of everything I hold dear?

    But I’ve blabbed enough about this. What do others have to say about harm reduction as exemplified by controlled drinking — for someone like, say, Margot?

  8. Nicolas Ruf August 5, 2013 at 2:06 pm #

    Help! A little credit here, please. I can tell the difference between shooting H and drinking moderately. Using whatever moderately is neither risky nor hazardous. The risk is the unpredictability of immoderation. For those who have had issues with control in the past, use is risky because of the unpredictability: slight hangover or loss of everything one holds dear?
    MM and other similar groups can be useful as steppingstones to abstinence; otherwise who needs them? If use is under control it’s under control and who needs a group. If one is fighting for control, one is probably already out of it. Think about it: who is going to be most attracted to a group that promises reinstatement of control (reinstatement because if there was no loss of control why would you need to manage your moderation?)? Who is going to be most committed to preserving and protecting their use? Those addicted. Just please do away with all these jackpots. And now we’re going to call on and trust the self or future self or leader self who got us here in the first place? “Trust me; this time I really mean it. This time will be different.”
    Stanton Peele may be articulate, logical, and up on the relevant research; problem is, he’s dead wrong.

    • Marc August 6, 2013 at 7:17 pm #

      You say: `’If use is under control it’s under control and who needs a group. If one is fighting for control, one is probably already out of it.”

      That’s a good argument. I mean it. But I’m not done with you. If addiction was a simple switch, and control was either ON or OFF, permanently, statically, for life, then I would have no comeback.

      But you know all about the stages of recovery. And you know about diversity (though you’ve yet to admit it). Ironically, maybe, for some people the effort to be completely abstinent is what kills them, because they fail time and time again. Bad strategy, huh? So, ok, maybe you’re right that harm reduction serves as a stepping stone for these people. But that’s a subset of a very large population.

      Do you really believe there’s only one positive outcome possible? Can’t control be regained by some people along whatever path they’re on? After 25+ years studying personality development, I see it as a branching tree, not a teeter totter.

      And Margot didn’t belong to any group. She fixed herself….as a majority of alcohol-dependent individuals do, according to every statistical analysis I’ve ever seen.

      When you end your argument — which is so logical in some places — by proclaiming that some other expert on addiction, someone who doesn’t share your views, is simply “dead wrong” — methinks you arrived at the conclusion before building the argument.

      If anyone else is following this, quit lurking and JUMP IN!!!

    • Margot Tesch August 7, 2013 at 7:33 am #

      Hi Nicolas
      I need more information here. I read Peele’s full article and I could not see that he took a position. It seemed to me (and maybe this is my lack of experience in analysing technical papers) not to take a position, but to report on the outcomes of research. It seemed to me that he didn’t discount either approach (abstinence or moderation) but pointed out that neither always work yet both have the potential to. In what way do you perceive he is “wrong”? Are you advocating that moderation is not possible?
      We bump continuously into the grey areas of language – what is addiction, what is harmful, what is wreckage? There are all measures on a spectrum and subjective to each person’s experience. So for me this makes the debate more difficult.
      My recovery over a previous addiction was to food. I was a rampant bulimic food addict. It had taken over my life and I wasted a lot of $$$$ feeding my addiction. My recovery was not instantaneous and was protracted over probably a decade. I joined self help groups which served to help me “see” and admit I had a problem. How I overcame it was to “corner” my behaviour. I would only give myself permission to binge and purge within more and more restricted social circumstances (i.e. being alone). This became more difficult once I was married and had children. At some point I stopped (I don’t actually remember when). I guess this is an example of successful moderation that resulted in abstinence. It worked and I see no reason not to believe that it can work with my drinking habits. I simply give myself permission to drink certain social circumstances and not others. Not that my goal is abstinence, just to change the boundaries.
      Do you think this is not possible?

      • Marc August 13, 2013 at 7:00 am #

        Very interesting, Margot. Of course there are some addictions, and food addictions are the most obvious, that can only be treated by reduction rather than abstinence. But it is particularly interesting that your reduction of the frequency of the binge/purge cycle eventually crossed a line where it just stopped. I think that addiction very often is beaten by that very pattern. Heyman’s research ( shows that recovery follows trajectories that look a lot like growth curves. This implies that recovery is a developmental process.

  9. Nicolas Ruf August 6, 2013 at 11:43 am #

    While I’m on my soap box, how likely is it that all the journals and research, NIDA, NIAAA, and ASAM are wrong and Peele is right? It’s a conspiracy of the ‘treatment industry’ and the ‘diseasing of America.’ It’s like listening to Ted Nugent on the Second Amendment or Fox News for the news.
    I have said before and I repeat, I’m all for harm reduction. I’m a firm believer in the Stages of Change and of incremental progress. I’m also agreed on meeting people where they are and having them find out for themselves where they need to be. It’s their recovery and they’re responsible for it.
    Unfortunately, nobody knows success rates or failure rates or relapse rates or what works best. It gets complicated. Audrey Kishline allegedly had seven years of successful controlled drinking and look at what happened. But any study conducted during those seven years would have said that she was an example of successful controlled drinking. So we’re all relying on anecdote or we’re invested in a particular belief. Many in AA believe that they got plucked from the wreckage by something outside of themselves, that left to their own devices they’d have drunk/drugged themselves to death. They further believe that the ‘disease’ is dormant inside them and if they waken it the insanity will return and they will drink again. They further believe that they have to clean up their act and straighten up and fly right. There’s no way to prove this.
    Addiction treatment grew out of AA because nothing else worked as well. As far as we know this still holds true. The ‘Control your Use’ movements and groups come and go, and their evaporation rates say something.

    • Marc August 6, 2013 at 7:35 pm #

      I can’t argue with everything you say, because a lot of it is pure rhetoric. But a lot of it is sensible and persuasive. Could you maybe highlight which is which in future posts?

      For now, I’ll just end where you end. If you want to convince others that AA got so big because nothing else worked as well, then you’re going to have to back that up with data. And it’s just not there. AA works for a subgroup that ends up being very effective at spreading the word. AA produces a lot of failures, but its successes stand in high relief. These folks have worked damned hard to beat an intractable problem, and therefore a lot of them end up saying “it’s the only way.” While I respect AA, I don’t respect that party line. In Psych 101 it was covered under cognitive dissonance theory.

      But that debate is all over the web, so let’s not go there. You’re right that it doesn’t matter what group Audrey Kishline belonged to when she had the accident. And you’re right that “harm reduction” did not work for her. But no, we’re not all relying on anecdotes. Some of us want the kind of picture that only research can provide. As you say, anecdotes are simply ways to reify what we already believe. What’s the point in that?

  10. Nicolas Ruf August 7, 2013 at 10:15 am #

    Of course AA did not ‘produce’ failures. I apologize for the rant. I don’t pretend to know what works for everybody, but I do know (in spite of my rhetoric) that AA is not the answer for everybody. As far as data for AA working best, I inferred it from its longevity and sheer number of groups, even if there are only two people per group with sustained recovery.
    Here’s the nub as I see it. We’re all operating on our prejudices or on anecdote as far as success and failure of control efforts go. We know that some people drink/drug themselves to death and some people abstain for long periods of time and they get better. We don’t know for sure, but we suspect, that there’s a point of no return; cross it and you can’t use safely. Not only that, but we suspect that being addicted to one thing makes it easier to get addicted to other things.
    When I tried to control my cigarette smoking, I’d say, “Okay, Nick, 5 cigarettes a day.” Then I’d start obsessing: “If I have a cigarette after breakfast and half of one during morning break, should I have a half or a whole after lunch?” “If I bum a hit off a friend’s cig does that count?” “How about if I smoke that butt left in the ashtray? Isn’ that a freebie?” It was making me nuts. It was simply easier to quit (“easier!”) than to try to control.
    People’s failure to control is not their fault. I wish we could help people who do need to abstain have that wake-up call, moment of clarity, gift of desperation, epiphany, whatever it is, but it seems to have to come from inside. Any method that helps people gain or regain control or which acts as a facilitator of that moment of clarity has my full support.

  11. Marc August 13, 2013 at 6:53 am #

    We end up agreeing on a lot of things, not surprisingly. But there’s one thing that we’re still a million miles apart on:

    Why do you dismiss the value of outcome research? The phrase “evidence-based treatment” is ubiquitous in clinical psychology these days. For good reason. Treatment approaches that are not evidence based may have zero effect (in which case you’re just wasting time and/or money) but they may also have a negative effect….for all kinds of reasons. One of which is that you were led to believe in the efficacy of something when something else could have actually helped you when you needed it most.

    So it is with AA. There ARE outcome studies, but AA does not conduct them in any formal, normative manner, as far as I can tell. Why not? Well-conducted studies would inform us as to who would benefit more from AA and who would benefit more from alternative treatments. Surely that’s a big advantage over “operating on our prejudices or on anecdote” as you put it.

    As you say, we suspect this and that. Sometimes we’re right. But the purpose of research is to test what we suspect so that we can confirm it or deny it. Note that 100 years ago, we (as a culture) suspected that blacks were inferior to whites and women were inferior to men.. I’m glad we didn’t just hold onto our “suspicions” — instead, we (at least partly) let facts intervene in our beliefs!

  12. Margot Tesch August 18, 2013 at 7:54 pm #

    Just thought I’d check in to report that my alcohol free days are having an interesting impact. For one, they alleviate the “how much” or “when to stop” internal debate which is refreshingly peaceful. I find I look forward to them after the weekend. I can also see that I’m being able to “see” the negative affects of drinking. I remember a similar thing happened when i gave up smoking (went cold turkey). After a period of abstinence you start to realise how much smoking smells bad, how gross the dirty ashtrays are, how you can smell better and you aren’t coughing up phlegm etc. etc.
    With no drinking I’m more cognitively aware and have a clearer head in the morning. I feel better.
    It is going to be an interesting journey of change.


    • Marc August 19, 2013 at 5:37 am #

      Bravo!!! I stand by my argument that your approach exemplifies a home-spun version of harm reduction, bolstered by a focus on self-trust. But it also turns “harm reduction” into a three-dimensional map of multiple possibilities, rather than a simplistic, 2-D “policy” that too easily gets dismissed as a lazy alternative to other well-defined approaches. The nub is this: you show that changing one’s patterns of use can be a segue to all kinds of new perspectives, new opportunities, new pathways. There’s an old saying: “a change is as good as a rest.”

      Nick may be right that “addiction” is rarely defined in terms of frequency of use. But the developmental process of “recovery” may very well be defined on the basis of changes in frequency, which can lead to a host of other changes.

      Thanks again for sharing your experience with us, Margot. I hope that others have learned as much as I have by looking at what you’ve accomplished.

  13. Victoria - January 15, 2014 at 6:06 am #

    Having a positive mind will make us do positive things. It’s really proven by several experts that positive thinking will stimulate the brain to only accept and do positive things. We actually have an inside power to heal ourselves without anyone help. Just try to think positive everyday. It can help you away from your addiction and you will see the results later.

  14. Bill September 2, 2014 at 11:38 am #

    Amazing information on here, self-trust is an essential step in overcoming Addiction. Thank you for taking the time to write this and inspiring people everywhere to continue to fight for their sobriety. Personally, Awakenings for Women in Boca Raton, FL has helped me to remain sober for the past 2 years now. It is important to find what works for you and your addiction.
    Continue to search and fight for your sobriety.

    Good luck,
    Laura Judge

    • Marc September 5, 2014 at 2:13 pm #

      Thanks, Laura. I’m glad you find the concepts useful and also that they blend with your own experience of recovery. Good luck to you!

  15. Daryl Scott March 17, 2015 at 11:16 pm #

    Hi! I’m new here. Thanks for sharing this harm reduction program. I’m happy for you Margot for achieving your goals in life! A lot of people continue to improve reduction programs like in Center Care Alcohol Rehab, where I have been before. It was very inspiring and giving more strength to all people reading this which truly awesome! Because I am one of the successful recovered from alcohol dependence, now I am encouraging other patient to make an image of their future. Although some of you still believe that addiction is not an illness or disease. Maybe in some way you are right and in another way you are not. Still the expert on this field will be the one who can say what is true about it. Again, I want to say Thank you to all people here. I’ll get more important information which is truly helpful.

    • Marc March 19, 2015 at 6:38 am #

      Welcome to the blog, Daryl. Now you’ll have to catch up with us…Look at some recent postings for an ongoing dialogue about approaches to recovery, treatment, and so forth. And then your comments will become part of the discussion.

  16. Lynda March 23, 2015 at 8:30 am #

    Hi, I’m new here – only found your first book a few days ago and couldn’t put it down. Thank you for such a fine and informative piece of writing. I’m wondering if you might be able to comment on the addiction of skin picking (now officially known as dermatillomania). I have been plaqued by this habit for most of the past 35 years (I’m 54), a long story….. Many therapists have treated it as OCD but recent research shows it to be more like addiction. From what I see on the net many people “suffer” with this more silent type of addiction, which has all the usual hallmarks of shame and childhood trauma etc. And the “drug” is always with us, no need to go anywhere to get it. Would the same type of chemical processes be taking place in the brain when one is indulging in a “picking session”. It’s no small thing with people ending up in hospital needing blood transfusions. I haven’t read many of the blog comments, but plan to – I trust that the ways to stop will be the same as with any addiction. Any comment would be much appreciated. Am looking forward to reading your new book. Thanks again…

    • Marc Lewis March 24, 2015 at 10:27 am #

      Hi Lynda, and welcome to our blog. From the research and theory that I’ve digested, I see OCD as the grandparent of late-stage addiction. So you don’t have to bother about discriminating them. Both involve activation of the dorsal striatum in response to cues…that’s the part of the brain in charge of stimulus-response learning — learning that doesn’t require a “reinforcer”…in other words, the response is nearly automatic. There can be lots of underlying personal history to get us to that place, but once we’re there, it’s really hard to shake the habit.

      I truly don’t have good ideas about treatment for this and other compulsive behaviours that aren’t substance related. In my book I do come up with some general ideas for treatment, and they have to do with reconnecting the urge or desire with a different outcome, to switch the feeling to another goal. But exactly how to do that with skin picking….I’m really not sure.

      I’m sorry not to be more helpful. But it is possible that further insight therapy isn’t the best route, Something more immediate and behaviour-oriented might work better. Also, shame is a big deal in all kinds of addiction. If you can work to reduce or eliminate the shame, then the habit might lose a lot of its momentum. Mindfulness/meditation could be very valuable.

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