1. Acceptance and Commitment Therapy for Substance Abuse Treatment
Fern Richie, DSN, APRN-BC

2. 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.”

3. Acceptance & Commitment Therapy
“I just want to be happy” – a psychological trap of needing to “feel good” all of the time
Psychological flexibility - a better goal?
Being in the present moment with full awareness and openness to our experience, and taking action guided by our values
Living a full, rich, and meaningful life
Both pleasurable and uncomfortable feelings will be experienced
Rather than attempts to avoid pain, ACT focuses on
Helping us make room for pain
Reduce its impact
Create a life worth living despite pain

4. More on ACT
Based on assumption that many unwanted internal experiences cannot be eliminated, so they must be accepted
Is a behavioral therapy, with an existential component
By using mindfulness and acceptance strategies, we can step back from instantaneous emotional reactions rather than use over them
By accepting, rather than fighting/struggling with aspects of our inner worlds over which we have no control, we can invest time and effort in what we can control – practice recovery strategies
Persist when persistence is useful
Desist when what we are doing isn’t working

5. The Importance of Values
Values are the fuel; the danger of running on empty
Values get lost in the shuffle of living
Values and adjustment disorder
If not “living” our values, we will begin to feel uncomfortable
If feeling uncomfortable
May incorrectly appraise a stressor
May try to “fight the feeling”
End up feeling worse, not better

6. What About Symptom Reduction?
Emphasis of most Western psychotherapeutic approaches is symptom reduction
ACT assumes the position that quality of life is primarily dependent upon mindful, values-guided action
This is possible regardless of how many symptoms you have
Through ACT we try to change our relationship with our symptoms
Thus values-congruent living is desired outcome
Usually ACT will result in symptom reduction

7. We All Suffer… “Life is spelt H.A.S.S.L.E.” – Albert Ellis
“Life is difficult.” – M. Scott Peck
“Life is suffering.” – Buddha
“Shit happens! - Anonymous

8. ACT and Suffering
ACT aims to help people learn and grow as a result from their suffering
Use pain as a springboard into creating a more meaningful life
“Our clients are not broken, they are just stuck.”
What gets people stuck?
Fusion
Experiential avoidance

9. Fusion Our thoughts dominate our behavior
In ACT, we might say “you’re being pushed around by your thoughts” or, “the thoughts are telling you what to do”
How workable are the thoughts?
Does the thought help client move toward a better life?
No attempt in ACT to change one’s thoughts

10. Experiential Avoidance
Trying to get rid of or escape from unwanted experiences
Higher experiential avoidance is associated with higher levels of substance abuse (Hayes et al, 2004)
Must help the client get in touch with the cost and futility of experiential avoidance

11. Mantra of ACT A Accept one’s thoughts and feelings; be present
C Choose a valued direction
T Take action

12. ACT for Substance Abuse Treatment?
Sit in kindness with the uncertainty of recovery
Accept your life as it is – but also how it may become
Find strength in the things that really matter to you
Commit to act in the present moment
Learn how a change of perspective can help you see yourself with fresh eyes
Wilson, 2012

13. Mindfulness
Paying attention in a particular way: on purpose, in the present moment, non- judgmentally
Curiosity and openness, even to a difficult moment (better than running from it or fighting it or using over it)
Helps to develop a detached relationship to thoughts and feelings
Shift from “impulsive reacting” to “skillful responding”

14. Six Core Processes of ACT
Defusion
Acceptance
Contact with the present moment
Self-as-Context
Values
Committed Action

15. Defusion
Fusion means getting caught up in our thoughts and allowing them to dominate our behavior
Rules
Reasons
Judgments
Defusion means separating or distancing from our thoughts, letting them come and go, rather than being caught up in them
Noticing thoughts rather than being caught up in thoughts
Letting thoughts come and go rather than holding on to them

16. Getting to Defusion Begin to notice your thoughts
“So, what’s your mind telling you now?”
“And what does your ‘thinking self’ have to say about that?”
Next, look at workability of your thoughts
“So, is that a helpful thought? If you hold on tightly to it, does it help you deal with the situation differently?”
“If you let that thought tell you what to do, will it take you in the direction of a rich, full, and meaningful life, or in the direction of being stuck and suffering?”
Notice when you are fused or defused with your thoughts
“So, right now, how caught up are you in that thought?”

17. Acceptance
Not the same as approval, tolerance, or even liking something
Accept if and when doing so enables us to act on our values
Is a process, not a technique
Expand, make space
Letting go of any urge to resist or avoid what is in front of you at the present moment
This may mean “sitting with” a craving to use
Recognize that a craving is just that – a craving
Show self-compassion
“I’m not a bad person because I am craving the dope right now.”

18. Contact with Present Moment
Being in the here and now, fully conscious of our experience (rather than being lost in our thoughts and missing out on life)
Helps us perceive more accurately what is happening
Whether to change or persist in current behavior
This is hard for those of our clients who have experienced trauma

19. Values Statements about: Leading principles that guide and motivate us
What we want to be doing with our life
What we stand for
How we want to act on an ongoing basis
Leading principles that guide and motivate us
Our hearts deepest desires for the way we want to be and act in the world
Is success measured by achievement of goals?
Is success measured by living out our values?

20. Committed Action
Taking larger and larger steps of effective action, guided and motivated by values
Being flexible and adaptable
Persist with or change behavior to better coincide with one’s values

21. Steps to Committed Action
Choose a domain of life that is high priority for change
Identify the values to pursue this domain
Develop goals, guided by these values
Take action mindfully

22. From Suffering (Active Addiction) to Vitality (Recovery)
Fusion with thoughts
Experiential avoidance
Unworkable actions
Being present
Opening up
Doing what matters

23. ACT and AA/NA A perfect match? No, but a great fit.
Both are into-action programs
We must create the life worth living
Non-acceptance blocks us from doing this
Both focus on practice
Both are traditions that are a means to an end: the end is a better life
Both focus on commitment in the “here and now,” not the future
“In this very moment, am I engaged in right action?”
“Do the next right thing”

24. ‘Having spent the better part of my life trying to either relive the past or experiencing the future before it arrives, I have come to believe that in between these two extremes is peace.
Author unknown

25. Helpful Websites http://www.thehappinesstrap.com/

26. Books
Wilson, K. G. (2012). The Wisdom to Know the Difference: An Acceptance and Commitment Therapy Workbook for Overcoming Substance Abuse. Oakland, CA: New Harbinger Publications.
Harris, R. (2009). ACT Made Simple. Oakland, CA: New Harbinger Publications.
Harris, R. (2008). The Happiness Trap. Boston: Trumpeter.

27. Thanks for your participation!