Using ACT To Treat Addiction

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”  — Viktor E. Frankl

Acceptance and Commitment Therapy (ACT…pronounced “Act”) offers principles and techniques that can enable people to move beyond the addictive cycle…into their future. ACT arose in the ‘third wave’ of cognitive behaviour therapies and shares some fundamental principles with Dialectical Behaviour Therapy (DBT) and Mindfulness Based Cognitive Therapy (MBCT). The advantage of ACT for practitioners is the flexibility both in how it is delivered and the population it can serve. Unlike the prescriptive, manualized nature of DBT and MBCT, ACT has been shown to be effective for both groups and individuals, for a wide range of clinical issues, and it allows the clinician to adapt core techniques as needed.

Addiction, from an ACT perspective, is a result of experiential avoidance — the avoidance of uncomfortable and unwanted thoughts or feelings. Having a few drinks to ease social anxiety, using heroin to ease the pain of failure or trauma, or using methamphetamine to avoid boredom or loneliness are examples of experiential avoidance. Addiction adds an insidious layer of complexity because shame, guilt, self-contempt, and physiological withdrawal become feelings people also try to avoid — sometimes desperately.

ACT is based on 6 core principles:

Acceptance – Uncomfortable thoughts and feelings happen. The goal is not to avoid them, block them out, or pretend they aren’t there, but to accept them, make space for them, and then continue on. When confronting addiction there are plenty of unwanted thoughts and feelings, but one of the most challenging is CRAVING.

Cognitive Defusion [sic] – Have you ever repeated a word so often that it begins to sound funny or it completely loses its meaning? This is one way to promote cognitive defusion — to remove the (fused-together) meaning or context from thoughts, words, and feelings. Defusion creates space to regard thoughts and feelings from the perspective of a dispassionate observer, making it easier to let them go and allow more beneficial thoughts and feelings to take their place.

Being Present – Staying present in the face of uncomfortable internal or external stimuli, without judgement, can be difficult when coming out of an addiction. Painful thoughts and feelings can return without warning and overwhelm the individual.

The Observing Self – This is perhaps where Frankl’s space becomes the most literal, as it requires individuals to distance themselves from their thoughts and feelings and observe them as if they were a separate entity. Having these thoughts and feelings is normal, but this doesn’t make them valid or true.

Values – It is not uncommon for an addiction to become the central unifying purpose of an individual’s life. This tends to obscure what is of real importance.

Committed Action – Once a space has been created and values identified we can begin to allow ourselves to be pulled by our future instead of pushed by our past.

A silver bullet to “solve” addiction is something I have been searching for throughout my career. But there are likely as many silver bullets as there are individuals. What I have found in ACT is a framework that allows people to regain control, not over their addiction but over their thoughts, feelings, and actions. This control allows them to move in value-led directions — and their addiction can dissipate as a by-product. The work to get there is not easy — but it is certainly worth it.

Helpful Links:

Training/books by Russell Harris, an ACT-based practitioner/trainer.

Detailed outline of ACT, principles and practice, also by Russ Harris, from Psychotherapy.net.

Summary and links, Association for Contextual Behavioral Science.

Urge surfing…wrt addiction. From “Mindfulness with Dr. Walsh,” 2016.

Great interview (video) with Steven Hayes, by “Dr. Dave — The Science of Psychotherapy,” 2019.