Acceptance and Commitment
Therapy for Substance Abuse
Treatment
Fern Richie, DSN, APRN-BC
fernrichie@gmail.com
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.”
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
on
than attempts to avoid pain, ACT focuses
 Helping us make room for pain
 Reduce its impact
 Create a life worth living despite pain
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
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
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

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

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
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
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

Mantra of ACT
A Accept one’s thoughts and feelings; be
present
 C Choose a valued direction
 T Take action

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
Mindfulness
Paying attention in a particular way: on
purpose, in the present moment, nonjudgmentally
 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”

Six Core Processes of ACT
Defusion
 Acceptance
 Contact with the present moment
 Self-as-Context
 Values
 Committed Action

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
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?”
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.”
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
Values

Statements about:
◦ 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?

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

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

From Suffering (Active Addiction) to
Vitality (Recovery)
Fusion with thoughts
 Experiential
avoidance
 Unworkable actions

Being present
 Opening up
 Doing what matters

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”

‘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
Helpful Websites
http://www.thehappinesstrap.com/
 http://contextualscience.org/act

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.
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Thanks for your participation!
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