The four R's for addictions

We've all heard of the three R's but what do we know about the four R's? Well, it's a technique developed by Dr Jeffrey Schwartz of UCLA (The University of Los Angeles) which he wrote about in his book "BrainLock" in 1999.

He invented it for use with OCD but it's applicable to addiction sufferers too because it addresses compulsive 'needs' that feel urgent, compelling and irresistible.

The thinking is CBT. It challenges, exposes and desensitises through a series of four steps:

1. Re-labelling - where the client re-labels the urges as coming from the addiction not from themselves.

2. Re-attributing - where the client assigns the origin of this urge to the faulty brain patterns developed over his/her lifetime and usually relating to adverse experiences.

3. Re-focusing - where the client turns to other activities they enjoy doing to buy time to allow the urge to come into awareness.

4. Re-valuing - where the client reminds themselves of all the times the irresistible urge has been answered and the repercussions of answering it. What has it given the client? What has it taken away? Was it worth it? Is it worth it now?

The key to this approach is the focus on allowing the urge to rise in the clients mind so it can moved into full awareness and consequently be seen for what it actually is rather than for what the client has habitually mistaken it for; an irresistible force. A thought that wants to hoodwink the holder into thinking it is an urgent need that must be satisfied, or else!

The idea is that if the client realises it is not his/her own voice, or urge, but the voice and urge of the addiction he/she will not be fighting him/herself, or denying him/herself if he/she resists and ignores it. In fact, don't fight it, there is no need because it is just a thought held by an addiction that doesn't need to be heeded.

Eckhart Tolle in his book "A New Earth" expands on this. He advises us to take three conscious breaths when we feel the compulsive urge (the addiction) rising in us because this generates awareness. He then advocates noticing the urge as an energy field within us that is urging us to ingest or consume a particular substance or to act out a particular compulsive behaviour, and then to take a few more conscious breaths. In other words, pay it attention. By so doing we are moving it into our consciousness by making it a conscious noticing. By taking three deep conscious breaths we are further reinforcing the urge, or energy field within us, as being present, and in effect, and this is when the acting upon the urge usually happens. However, he says, after consciously turning towards the noticing of the energy field or urge within, and present inside us, we may well find instead of triggering an instinctive and impulsive acting out or ingestion of a particular substance, the urge disappears - for the time being. But, he says, it will return, that is the nature of addiction. You will hear it's voice again. And further more he says you may find it doesn't disappear at all but is actually too powerful to resist and you give in to it. And then he advocates something I found surprising:

"Don't make it into a problem. Make the addiction part of your awareness practice in the way described above. As awareness grows, addictive patterns will weaken and eventually dissolve." 

Both approaches are advocating a conscious awareness of the process that is going on in the client. The part I find intriguing is the voice belonging to the addiction not the client. At first I found this quite demonic, like a possession. Then I realised that, of course, all resistance comes from a place of fear.

The addicts fear, or terror, is triggered by the threat of losing what he/she has always considered to be an indispensable coping mechanism; a thing that alleviates pain and suffering by anaesthetising it. And my fear came from the threat of devils and demonic possession. My father was a minister in the C of E and as a child I heard him talking about exorcism, and it terrified me because he wasn't pooh-poohing it!

In both cases resistance showed itself and as all good therapists know, we have to learn to roll with resistance. In other words not fight it but acknowledge it, accept it, and work through it. Fighting it makes it stronger and the same principle applies to compulsive seemingly irresistible urges and impulses of addiction.

And what better way to demonstrate to our clients that acknowledgement of compulsive and addictive urges presence will weaken it as surely as fighting it will strengthen it than by using these approaches to underpin our work with them?

It seems oddly paradoxical, but then again, isn't that exactly what addiction is all about at its core?