The Shrink’s Links: Surviving Infidelity

Bringing you the best of mental health every week.

There are few experiences as painful and as confusing as learning your partner has been unfaithful. Was it him, her, or you? Do you stay together or split? What do you tell your children? Can anyone understand?

survivinginfedelity.com conducts forums staffed by experienced moderators. There’s a healing library and they can help you find a counselor. Check it out. Click here.

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The Shrink’s Links: Advance Psychiatric Directives

Bringing you the best of mental health every week.

You know what an advance directive is, right? Advance Directives are the legal documents that enable you to state your preferences regarding medical care beforehand and empower someone to make decisions on your behalf when you are unable to do so yourself. They’ll come in handy when you’re in a coma and don’t want to be hooked up to a machine for years. The psychiatric version of an advance directive can also come in handy if you are sometimes hospitalized for mental illness and want to be treated in a certain way.

Let’s just say there’s a hospital you prefer, a medication you can’t tolerate, a doctor who should be involved, or a procedure that should be avoided. You can document this on your psychiatric advance directive. Unless you say so, the hospital will not tell your loved ones where you are, involve them in your care, or even allow them to visit. You might be OK with experimental studies or drug trials, but no one would know it if you didn’t say so in advance. You might want to make provisions for your children or see to it your plants get watered or your cat fed. If you have someone in your life who just drives you nuts, you may not want them around when you’re in the hospital. An advance directive can see to it that they will not visit.

Anyone who has bipolar disorder, schizophrenia, or is prone to being suicidal should prepare an advance psychiatric directive sometime when they are feeling well. I know, you don’t ever want to go to the hospital again, but it’s worthwhile to be ready in case it happens again.

Click here to get the forms you need.

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Some Things You May Not Know About Substance Abuse, Part 18: While you’ve been collecting key chains at your NA meeting, your addiction has been doing pushups in the dark

So, you’ve stopped drinking or drugging. The addiction seems to have gone away.

Has it, really?

Addiction takes cover sometimes when it feels threatened. It’ll hide in the bushes and come roaring out when you least suspect it. Make no mistake, addiction is cunning, baffling, and very, very patient. While you’ve been collecting key rings at your NA meeting, the addiction has been doing pushups in the dark.

Addiction prefers the dark. It likes to perform its dirty deeds in secret. The night belongs to Michelob. However, addiction is rarely ever a real secret. It’s kidding you when you believe it leaves no trace. You can tell when addiction is still afoot if you are willing to read the signs.

These are the signs:

You haven’t done the things promised for your recovery

If the problem behavior is gone, but you still haven’t been to see a therapist, attended meetings, written that letter of apology, changed associates, or done any of the things you promised, then the addiction is just hoping you won’t notice.

The behavioral changes have been minor

The more serious the addiction has been, the more excited you’ll be when there’s been a slight improvement.

You were drinking every day, now you’re thrilled that you cut down to once a week. You used to put your whole your paycheck into your arm, now you’re just chipping a little. The underlying attitudes towards drinking and drugging have not changed; the only thing changed is the frequency and severity.

When gardeners trim bushes back a little, they call it pruning; it doesn’t destroy the bush, it makes it grow more. The same thing happens when only minor changes are accomplished. You wouldn’t be satisfied with your surgeon if you had a mastectomy and he left some cancer behind, so don’t fool yourself by minor behavioral changes.

Other problems have arisen

Sometimes addiction plays whack-a-mole by extinguishing one problem behavior, only to transfer it to another. We see this frequently with addicts who will use one drug until the heat is on, and then switch to a different drug. Instead of scoring heroin on the street and using dirty needles, they get their narcotics from a doctor. You’ll think that’s an improvement, until you start to abuse those pills, too. The underlying issue remains.

Your thinking has not changed

If the rationalizations that have justified the addiction are still in evidence, then nothing has not gone away. You used to say you needed to drink, so you drank. Now, you don’t drink, but you still say you need to. Guess what? You’ll drink again. If the madness was truly gone, you’d no longer believe you needed it.

No fence has been built

It is not enough just to change the problem behavior to recover from addiction. You also have to know the route that it takes before it arrives. You need to put up a gate and shut out behavior that, in itself, is not problematic, but leads up to the problem.

Relapse comes masquerading as something harmless so that you will not see it coming. There’s nothing wrong with having a glass of wine at dinner or a pain medication that was prescribed by your doctor, right? No, not at all, except for where that leads, for you.

Authentic recovery means that you see through all the disguises.

You minimize your history

If the story you tell about your addiction differs significantly from your partner’s, then it’s still lurking about. If you talk about it only in terms of your suffering and leave out how it affected others, then you’ve not incorporated other points of view into your own. Your limited perspective is still all you have. You have an incomplete appreciation of the costs of your choices. You should be able to tell your partner’s side of the story as well as your own.

You’re withdrawn

If your partner complains that you’re virtually unreachable, emotionally inaccessible, or sexually uninterested, then relapse is waiting for its chance to strike. It doesn’t want people to ask too many questions, know too much, or get too close.

You’re always angry

You may be blaming other people for calling out your addiction and challenging it. you may be using anger as a way to keep others away, off balance, and uninformed. You may still be taking sides with it, against anyone who cares.

Your partner is working harder at recovery than you are

Your partner has been on you like white on rice. Ever since you had that relapse, she’s been monitoring your phone for drug dealers, checking your whereabouts, scanning your emails, opening your letters. She doesn’t let you go anywhere without her. She scrutinizes your eyes whenever you come home at night. She’s gone to more Al-Anon meetings than you’ve attended AA. She found a therapist for you, set up the appointment, went to every session, paid, and did the homework assignments. Your partner is working harder than you are.

If you have not taken responsibility for change, then you will not make the right choices the moment your partner’s back is turned.

You say everything is changed

You’re not the one to judge whether anything has changed. When your addiction fools people, it fools you first.

You want to move on and not get stuck in the past

That’s the addiction talking, trying to convince you to not learn from the past. Truly recovering people remind themselves of the past regularly, so that they’ll not repeat it.

You want credit for improvements

An adult straightens the house every day. He scrubs the toilets when they need it and mops the floor when it’s dirty. He doesn’t expect a medal for it. He just does it because it needs doing.

A toddler tickles the furniture with a feather duster once in a while and everyone will fall all over him, saying he was very helpful. That’s what they do for a child. Are you a child?

When madness takes over: the less you do, the more credit you think you deserve.

In a healthy world: you don’t earn special points for doing what you should have been doing all along.

It’s still all about you

Not only have you stopped the problematic behavior, but you’ve been going to therapy, attending AA, writing in your journal, and getting in touch with your feelings. These are all good things, but you’re still as self-involved as ever.

Real change means taking action towards becoming more loving, generous, caring, and empathetic towards others.

There are no signs

You looked over this list and you did not find a single thing that indicates relapse may be lurking. There seem to be no signs. Well, that’s your sign. If you aren’t seeing signs, then you’re fooling yourself. There are always signs.

The road to recovery is the same road as the road to ruin; you’re just traveling in a different direction. You pass by the same markers as when you were heading to ruin. You should be seeing them now and recognizing them for what they are. You should also be seeing some signs that indicate you are heading in the right direction. You should be seeing meaningful change.

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The Shrink’s Links: The Advent Conspiracy

Bringing you the best of mental health every week.

There are only twenty-four more shopping days until Christmas.

What’s the matter? Not feeling very merry? Maybe it’s time to change the way you celebrate Christmas.

Click here to join a conspiracy to make Christmas simpler and more meaningful.

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Some Things You May Not Know About Substance Abuse, Part 17: Recovery is easier than you think

All this reading about substance abuse and recovery may have given you the wrong impression. You may think that it’s hard to stop using drugs. Maybe it is, but nearly everyone who has experienced both addiction and recovery say the same thing: recovery is far easier than addiction.

You’re accustomed to all the work it takes to keep up an addiction, so you might not notice it anymore. You’re not accustomed to the work it takes to recover. It seems hard to decline your first impulse, to be honest with yourself, to go to meetings, and to open yourself up to healthy influences; but, in almost every case, you will wonder why you put it off so long. It’s not hard, it’s just different.

Let’s look at all the work involved in keeping up an addiction. You’ve got to get the drug. It’s rarely cheap and often involves going to a bad neighborhood and dealing with unsavory characters. You often get ripped off, run legal risks, and have to act secretly.
Then, you’ve got to use the drug. It sometimes involves the fuss of cooking and the pain of needles. It tastes bad, makes you cough, or gets you dizzy. You’ve got to stand out in the weather or hide yourself in the bathroom. You sometimes have to use it, even when you don’t crave it; like when you pull out your cigarettes before going into a movie theater because you won’t be able to smoke till the end.

Finally, you have to recover from it. There’s the hangovers, of course, the withdrawal, the delirium tremors. You’ve got to deal with the fallout from your spouse, the disappointment from your children, the criticism from your parents. There are lies and excuses you have to think up, and then remember what you said to whom. There are health issues. You’ve got piss tests at work and teachers looking closely at your eyes at school. Judges and probation officers don’t take kindly to chemical use and neither do old friends who know how you used to be.

Oh, there’s also the phenomena of increased tolerance. The more you use the drug, the less effective it’s going to be. You chase that first high and never experience that delight and wonder again. It gets to be that you can’t even get high anymore, but you use only to feel normal again.

People in the beginning and middle of addiction seldom think of all the costs involved. All those kids, smoking in front of the school are not saying to one another, Look at me, I’m starting a habit that going to cost me thousands of dollars a year, will make me stink, cause me to be socially ostracized, discriminated when I apply for insurance, give me cancer and heart disease, and bring me to an early grave. You think that’s what they’re saying to one another? No, they’re talking about how cool they look, how grown up they feel, and how no one else understands.

Let’s take a look at the decisions involved when you make the choice whether to use drugs or not. You probably use in response to a distress of some kind. It may only be the distress of the craving, itself; or you may use drugs as a way of coping with some anxiety or depression. Either way, you experience distress and assume you’re going to continue to experience distress unless you do something about it. The situation is depicted in this graph.

Image001

The vertical axis represents the level of distress, the horizontal axis, the passage of time. Your distress grows over time, until it gets to the point where you are now. You imagine that it’ll just get worse. You feel you have to do something fast.

What do you do? If you’re an addict, you use your drug.

Image002

Your distress level plummets pretty fast. You think, it’s a good idea you drank, shot up, or smoked, then.

But, there’s one problem, you don’t know what would have happened if you didn’t use your substance.

I’ll tell you what would have happened. What would have happened is what always happens. Things regress to the mean, people get used to anything, thoughts end, feelings go away, you get distracted. If you don’t do anything, it looks like this:

Image004
If you knew this, you’d feel like a fool, using drugs. All that cost, all that risk, all those consequences, all to get exactly where you would have gotten if you did nothing.
Well, if you feel like a fool looking at that graph, then look at what happens when more time goes by and all the costs, risks, and consequences of using drugs play out.

Image005

How do you like them apples?

This same graph works just as well with almost all kinds of distress and other things we do to intervene: shopping, getting in a fight, avoiding issues, hurting yourself, or killing yourself. We rarely know what the consequence of doing nothing is because there seems to be an imperative to always do something to relieve distress.

I used to advise people to learn to sit with feelings. If you feel angry, sad, nervous, or scared, see what happens if you do nothing. Study the feeling, contemplate it, and experience it before you act on it. You’ll find that, whatever feeling you had just went away and didn’t stick around long enough for you to study anything. So, I don’t say sit with your feelings because your feelings don’t sit. They travel. Watch them go by.

It’s easier than you might believe.

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Some Things You May Not Know About Substance Abuse, Part 16: You don’t have to use drugs to use drugs

A recovering alcoholic goes to a party in which there’s alcohol being poured. He’s determined to stay sober, but he doesn’t want to stop going to parties. All his friends are going to be there. They’ll be watching the big game on the big screen. It’s bound to be a great time.

He does all the things to ensure that he’ll stay sober at that party. He has good reasons to stay sober. They’re all written down on a laminated index card he keeps in his pocket. He brings someone who will support his sobriety. He has an alternative beverage. He has some lines worked out in his head to say if someone offers him a drink and some more lines if they persist. He parks his car so he can make a quick getaway if he has to.

Chances are, that person is going be successful at staying sober at that party. But, chances are, two days later, he’ll relapse when the pressure is off and he has no reason whatsoever to drink. I’ve seen it happen a hundred times.

What is going on?

Drinking alcohol got in his head. Not the alcohol, itself, but the idea of it. A lot of times, that’s all you need.

A recovering drug addict drives to meet a prospective customer on the far side of the city. On the way, he passes by the abandoned building where he used to score dope. He’s not going there to get dope, he’s just driving by. He has no interest in getting high. He’s been there before and doesn’t want it again. Things have gotten much better for him since he began his recovery. He has this job, for one. He’s back with his old lady. His kids are talking to him. Using drugs again would be just crazy.

But then, as he drives by the old drug house, he gets this funny feeling. Something tightens up in his chest. His stomach goes queasy. You know what? He gets a little high. He hasn’t done anything more than drive by the old drug house, but that’s all he needs to do. He doesn’t get as high as in the old days. It’s not like that; but the excitement is still there.

You know what he does? He goes on to his meeting. If he tells anyone about his drive past the old drug house, he tells them about how he was able to pass by, without relapsing. His old lady congratulates him on his success. He’s feeling pretty good about himself.

A week later, he drives by again. This time, it’s not really on his way. The same thing happens. He gets a little high; and, just like before, that’s enough.

A week after that, he drives by again. This time, he pulls over and has that feeling a little longer. You guessed what happens eventually. As they say in the meetings, if you keep going to the barbershop, one of these days you’ll get a haircut.

This is what’s known as a contact high: the high you get when you’re in the vicinity of your drug. The term is sometimes mistakenly used for the high you get when you imbibe second hand smoke or handle a drug with your hands so that it passes through your skin. You can get high by imbibing secondhand smoke and handling drugs with your bare hands, but that’s not properly called a contact high. A contact high occurs psychologically, not physiologically. It’s all in your mind.

We shouldn’t be surprised by this. It’s related to the placebo effect. When scientists are researching a new medication and want to test it, they will give the new medication to a group of people and study the effects. They’ll take a second group of people and give them a pill that looks just like the new medication. They will tell them it is the new medication, but it’s really just a sugar pill. The sugar pill is called a placebo. Then they’ll study the effect of the placebo.

Placebos always are effective to some degree. For instance, when they conducted the trials for Prozac, a popular and important anti-depressant, the placebo was effective in about half the cases. Prozac was effective in about two thirds of the cases. That’s not a huge difference, but I guess it was enough to say that Prozac works. Still, when Prozac works, it’s a pretty good chance that it works because the patient believes it will work, rather than because of some physiological effect.

People who believe that everything comes down to cells and chemicals are mystified by the placebo effect, but the phenomenon has been used and abused by both healers and charlatans, for good and ill, for centuries.

Words are the most powerful drugs used by mankind. Kipling

I once had a client who was very anxious. Nothing seemed to help her and the medicine she was taking for it was actually harming her. Her doctor hatched a scheme. He told her they had discovered a new, very powerful medicine. He would put it on her and discontinue her old medicine. The new medicine was a placebo, but he went through the usual song and dance doctors go through, describing all the side effects. He was making them up, but he needed to make it believable. She took the new medicine.

A couple weeks later, she saw her doctor again. All her symptoms of anxiety had disappeared, just like he said they would, but she was also getting all the side effects. She couldn’t tolerate the side effects, in fact. She refused to take any more of the medicine.
Here’s another story. I once worked nights selling drinks at a teenager’s nightclub. We had no alcohol there, of course; it was all just sodas and juice; but, one week the owner had gotten a couple cases of non-alcoholic beer.

A few of the kids were pretty excited to see the beer. They either didn’t hear or didn’t understand that it was non-alcoholic. It looked like beer. It tasted like beer. They started drinking it, pounding it, really; just as hard as their big brothers might at a frat party. You know what? They got just as drunk as if they had been drinking real alcohol. They would have passed a breathalyzer test, but wouldn’t be able to drive real well. We actually talked them into surrendering their keys and calling their parents. Boy were the parents mad when they thought we had been giving beer to their children.

So, you see, it is not necessary to actually use a drug to be effected by a drug, and it’s possible to relapse without ever actually touching the stuff.

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The Shrink’s Links: 7 Cups of Tea

Bringing you the best of mental health every week.

If you’re a good listener or need a good listener, then 7 Cups of Tea might be just your cup of tea.

7 Cups of Tea is an on-demand service that connects you anonymously & securely for a one-on-one chat.

Whether you want to discuss the meaning of life or question whether it’s worthwhile to live it, got a burning desire to complain about the bad call that caused the Bills to lose the game or want to tell someone, anyone about that shameful thing you did, have a cup of tea with 7 Cups of Tea. Their listeners won’t judge or solve problems or tell you what to do; they’ll just listen. They give you the space you need to help you clear your head.

Click here to go to the site

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Some Things You May Not Know About Substance Abuse, Part 14: Help is Closer Than You Think

It is a whole lot easier to get substances that will addict you than it is to get into treatment for addiction. In many localities, there are drug dealers at every corner, but to get to a clinic, you have to take two buses. Intake coordinators will make you wait in a room with old magazines and ask you million questions; but bartenders will serve you right away and leave you alone if you don’t want to talk. Insurance companies will seek to deny you coverage, but you can buy as many packs of cigarettes as you want on your credit card. You can get narcotics from every doctor, but it’s tough to find one who prescribes Suboxone (AKA: Buprenorphine), a medication that can assist you in getting off narcotics. There’s even an act of Congress that limits your access.

Suffice it to say that it’s a lot easier to get substances that will addict you, than it is to get into treatment.

However, that’s not the same as saying that help is far away.

Practically every church basement hosts an Alcoholics or Narcotics Anonymous meeting. If your town is large enough, there will be one every day of the week. They don’t cost anything, but they will pass the hat to buy coffee. There are no forms, no appointments, no one to call for pre-approval, no side effects. You don’t have to take time off from your job. You don’t have to give them your whole name. You don’t have to speak. You don’t even have to stop using. You just have to have the desire to stop. They can’t make it any easier than that.

But it’s still not easy to go to AA or NA. I’ve found there are two big barriers that get in the way.

The first is that you will have to deal with people. There will be people there who are either not serious enough about recovery or too serious. There will be people there to pick up women and women there to get picked up. There will be judgmental ones and understanding ones. If you speak, they will answer you with simplistic slogans and facile quips. Some will smell. Many will smoke. They all will remind you of the worst moment of your life and forbid you from forgetting it.

They are much the same as the people you will find in a bar or a drug house. The people who meet in the church basement are little different than the ones who meet upstairs, in the church, although they don’t dress up and are less sanctimonious.

The second barrier that people have to attending AA or NA is the insistence those organizations have in using a higher power. The Higher Power is mentioned everywhere. You can’t even get past the second step without them bringing it up.

Step One is, We admitted we were powerless over [fill in the blank] – that our lives had become unmanageable.

The bars and drug houses are filled with people who admit they are powerless over their addictions. They may forget sometimes, but they know it. Having this knowledge is not enough. Hitting bottom is not enough. There has to be some hope.The hope is supposed to come in the form of Step Two.

Came to believe that a Power greater than ourselves could restore us to sanity.

It’s that second step that stops many people. They have too much baggage associated with the Higher Power.

Religious institutions have, over the centuries, done a pretty good job of marginalizing the very people that populate most self help meetings. For that matter, addicts have done a pretty good job at doing the things that piss church people off. Furthermore, the idea of God, for many addicts, never matured. Their idea of God is often a child’s idea of God, like with the beard and thunderbolts, smiting people from up in Heaven, and all that; or the adolescent idea of God, concerned about what group you belong in, who’s in and who’s out. There are all kinds of problems and hangups that hold people up in the second step.

If you have trouble with the Higher Power, let me introduce you to something you may be able to wrap your head around.

Every addict knows he or she is divided into two parts. There is the addicted part that sets you up, talks you into using, chooses associates from among those who use, chases away those who don’t, scores the dope, shoots the needle, heaps the guilt, and refuses the help.

Then there’s the other part. The part that wants to stop, that refuses to use, sometimes, that makes healthy connections, apologizes for the hundredth time to family, hates the dope, loathes the needle, knows he can do better than guilt, and looks for help.

Most addicts think the first part, the addicted part, is more real. They identify with the first part. That’s the self, they say. But the second part, the healthy part, is real, too; although it may be, as yet, unrealized. There are two parts to you, although you might only know the first.

Which of the two parts would be the higher?

The healthy part, I thought so. There’s your Higher Power.

If you cannot connect with the idea of the Higher Power many people have, or with your old idea of the Higher Power, connect with the healthy side of yourself as your Higher Power. Get to know it, listen to it, confess to it, rely on it, let it guide you.

Help is closer than you thought.

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The Shrink’s Links: Journal Therapy

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Has there ever been a shrink that does not suggest that her clients keep a journal? None that I ever knew of.

Journaling can help you clarify your thoughts and feelings, know yourself better, release the intensity of feelings, and unlock creative capabilities.

If you have a shrink that suggested that, then you may be at a lost of what to say in your journal. This site can help.

Click here to go to the site

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Some Things You May Not Know About Substance Abuse, Part 13: Even if you’re not ready to quit, you can get ready to quit

Even if you’re not ready to quit, you can get ready to quit

Get some paper and a pen. Put it by the substance you are thinking of quitting. Even if you are not ready to quit yet, do this one, little thing. Before you use the substance, mark on your paper the time and the date. Write a line or two about why you’re choosing to use the substance at this time. That’s all.

If you do this exercise, there may be some times that you realize you have no reason to use the substance. You’re just doing it out of habit, sheer mindless, automatic routine. OK, write that down. You might choose not to use the substance after all, since you don’t have a good reason. The spell is broken by the paper and pen. That’s why I had you put the paper and pen by the substance, so it can be there, ready when you are not thinking about what you are doing.

There may be other times when you have a reason to use the substance. Write that down, also. As you do that a few times, you may see a pattern emerge. You will identify your cues. It might be a time, a day of the week, a feeling, a circumstance, a person, or some other thing that triggers the thought of using. These are your reasons for using. They are problems you’re attempting to solve by using the substance.

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The Shrink’s Links: The Nap Wheel

Bringing you the best of mental health every week.

If you’d like to take a nap, but are not sure when, you’re probably a mother of young children or a wage slave who doesn’t have a place to hide from your boss.

If you have all the time in the world and can take a nap at any time, but are not sure what time would optimize the nap’s effect of rebooting your brain, then take the nap wheel for a spin.

Click here to go to the site

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Some Things You May Not Know About Substance Abuse, Part 12: It works best to change many things at once, rather than one thing at a time

It works best to change many things at once, rather than one thing at a time

Anyone attempting to break a habit can learn a lot from marketers. They’re the experts at getting you to change. They love it when you are at a transitional period of your life.

Advertisers love to target pregnant women. They have their ways of knowing when you’re pregnant. You surfed over to the Walgreens site and checked the prices of pregnancy tests. Next thing, you’re inundated by ads for prenatal vitamins, maternity clothing, and soft drinks.

Soft drinks? Why would pregnant women be targeted by ads for soft drinks?

Because people have high levels of brand loyalty for things like soft drinks. They very rarely switch brands, but are more likely to during times of life transition.

Advertisers look for people at transitional moments in their lives: going to college, getting married, having a baby, moving to a new home, retiring. Routines are suddenly in flux. Shopping patterns and brand loyalties are up for grabs. Their advertising dollar goes further that way.

Transitional moments are a great time to break a habit. They are so good, in fact, that you just might want to create a time of transition so that you can break a bunch of bad habits at once. This doesn’t mean you have to get pregnant so that you can stop shooting heroin. All you need to do is lump all the changes you need to make together and start them all at once.

People in recovery have known this for a long time. That’s the rationale for sending a person to inpatient rehab for 28 days. Yes, rehab gets you out of an environment of chemical use and, yes, there are helpers there 24/7, but rehab also breaks your old routines and forces you into a different pattern for your day.

Inpatient rehab is not used as much as it used to be and, when it is, it’s often not for 28 days, but that doesn’t mean you can’t create a transitional moment yourself. Consider all the bad habits you have and the good ones you want to develop. Put them together and work on them all at once.

A lot of people find that overwhelming. They say they can’t do everything at once. It’s too much. Science shows otherwise. People are more successful when they do. One change helps the other change. When you drink less coffee, you smoke fewer cigarettes. When you smoke fewer cigarettes, you are more comfortable when exercising. When you exercise more, you sleep better. When you sleep better, you drink less coffee.

The thing that makes a habit a habit, is that it’s done automatically. You don’t even think about it, and it’s done. You start it before you know it. When we change other habits, or when we are in a time of life transition, we are forced to rethink things; patterns are broken, and new possibilities emerge.

Therefore, if you want to break a habit, or start better ones, create a transitional period of your life. It’ll be easier that way, really.

Click here to see other posts I’ve written about addiction

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