Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

486 V. TREATMENTS FOR ADDICTIONSAdvantages of Abstinence1. Feel better aboutmyself.2. Feel more in control.3. Get to work on time.4. More likely to keep my job.5. Save money.6. Better for my health.7. Not get so criticized by my sister.8. Not hang around other “druggies” so much.9. Spend my time better.Disadvantages of Abstinence (with reframe)1. I may feel bored and anxious (BUT it’sonly temporary and it’s good to learn tostand bad feelings).2. I don’t know what to do with my time (BUTI can learn in therapy how to spend timebetter).3. I won’t be able to hang out with my“friends” (BUT I do want to meet new“nondruggie” friends).Advantages of Taking Drugs (with reframe)1. Escape from feeling bad (BUT it’s only atemporary escape and I don’t really solvemy problems).2. Have people to hang out with (BUT they’redruggies and I don’t really like them).3. It’s hard work to quit (BUT I’ll do it step-bystepwith my therapist).Disadvantages of Taking Drugs1. Seems to make me depressed.2. Costs money.3. Bad for my health.4. Makes me feel like I’m not in control of mylife.5. Makes me feel unmotivated.6. Hard to solve my real problems.7. May make me lose my job.8. Makes relationship with my sister worse.9. Stops me from going out and making newfriends.10. Makes me feel like I’m wasting time.11. Makes me feel stuck, like I’m not gettinganywhere.FIGURE 22.6. Advantages–disadvantages analysis.Principle 4: The Initial Focus of Therapy Is on the PresentTherapists initially emphasize current and specific problems that are distressingto the patient. When the patient has a comorbid diagnosis, it is important toaddress problems related to both. For example, Kim needed help in problemsolving about a critical supervisor at work and in learning alternate copingstrategies (instead of using substances) when she was distressed about a workproblem. She and her therapist discussed how to respond to the hurt she feltwhen the supervisor rebuked her for lateness, how to decrease her anger byrehearsing a coping statement addressing her activated core belief, how to useanger management techniques such as controlled breathing and time-out, andhow to talk to the supervisor in a reasonable manner.The therapist also helped Kim respond to automatic thoughts. Through acombination of Socratic questioning and modeling, Kim learned to change thethought, “I should tell my supervisor off,” with “He’s just trying to do his job; Iwant to keep this job; I can just say OK for now and stay calm.” Toward themiddle of therapy, the therapist and Kim began discussing her past as well—tosee how she developed her ideas about relationships, and how they related toher current difficulties.