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Discuss Automatic Thoughts and Strategies for Coping

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The counselor describes situations that may trigger automatic thoughts or thoughts that could lead to a lapse:

Counselor: Nostalgia.Some people who formerly used marijuana remember using nostalgically, as if marijuana were an old friend. For example, “I remember the good old days when I’d go out dancing and smoke a few joints.”

Testing control. After a period of abstinence, people in recovery may become overconfident. For example, “I bet I can use tonight and go back on the wagon tomorrow morning.” Curiosity also can be a problem: “I wonder what it would be like to get high again?”

Crisis.A person may respond to stress by saying, “I can handle this only if I’m high” or “I went through so much, I deserve to get high” or “When this is over, I’ll stop using again.”

Feeling irritable when abstinent. Some people find new problems arise after they become abstinent and think using will solve these problems. For example, “I’m short-tempered and irritable around my family—maybe it’s more important for me to be a good-natured parent and spouse than it is to stop using right now” or “I’m no fun to be around when I’m not using; I don’t think I should stop because if I do, people won’t like me as much.”

Escape.Individuals want to avoid unpleasant situations, conflicts, or memories. Failure, rejection, disappointment, hurt, humiliation, embarrassment, and sadness tend to demand relief. People get tired of feeling hassled, upset, and lousy. They want to get away from it all and from themselves. They seek numbness and the perceived absence of problems.

Relaxation.Thoughts of wanting to unwind are normal, but sometimes people look for a shortcut, trying to unwind without doing something relaxing. The individual may choose the more immediate route through marijuana.

Socialization. This overlaps with relaxation but is confined to social situations. Individuals who are shy or uncomfortable in social settings may feel they need a social lubricant to decrease awkwardness and inhibitions.

Improved self-image.This situation involves a pervasive negative view of oneself and associated low self-esteem. When individuals become unhappy with themselves, feel inferior to others, regard themselves as lacking essential qualities, feel unattractive or deficient, or doubt their ability to succeed, they begin to think of using marijuana again because using previously may have provided immediate, but temporary, relief from these painful feelings.

To-hell-with-it thinking.During the weeks and months of trying to be abstinent, a person may become discouraged and think to hell with it. Thinking this way might result from a disappointing experience, feeling tired from coping with temptations, or other difficult situations.

No control.The attitude of being unable to control cravings ensures relapse. Individuals give upthe fight, conceding defeat before attempting to resist marijuana use; they may feel out of control in other aspects of their lives as well. Marijuana is considered a viable option. This attitude differs from the to-hell-with-it attitude in which individuals do not necessarily feel powerless; they just don’t want to continue abstaining.

Explore Conceptual Difficulties

A client may have difficulty understanding the concepts of cognitive analysis and restructuring. If a concept is not understood, then the benefits of cognitive coping skills are lost. The counselor probes for the client’s understanding before moving on to the next concept. Using illustrations and examples helps convey the basic principles.

Initially a client may be unaware of the thoughts and feelings that precede decisions to use marijuana. He or she may be unaware of triggers and state, I just start using, that’s all. The client may admit that usually some external force occurs immediately before use but cannot remember what it is. The client denies personal responsibility for actions and attributes behavior to forces beyond his or her control, making it difficult for the client to initiate appropriate coping skills.

To help the client grasp cognitive concepts, the idea of “slowing down the action” (as in an instant replay or a slow-motion film sequence) of the thought process is useful. The counselor assists the client in breaking down the sequence of thoughts and feelings that lead to particular actions. He or she learns to observe, for example, that a tense interaction with a colleague may lead to feelings of frustration and to thoughts about not being good enough (e.g., smart, competent, or skilled enough), which lead to thoughts about wanting to use marijuana. Once the client can analyze the series of thoughts that might have led to a previous relapse, the notions of selfmotivating (or self-awareness) and of modifying one’s thoughts (cognitive restructuring) can be introduced. The goal is to make the client aware of his or her thought processes and enable the client to replace using thoughts with coping thoughts that enhance abstinence:

Counselor: Try to identify your thoughts about resuming marijuana use and rationalizations for using. What thoughts preceded your last using episode after a period of abstinence? What thoughts about marijuana seem to be the most frequent or strongest? Under what circumstances do these resumption thoughts tend to occur? Although this activity may feel strange, like most skills, it becomes easier with time.