The Wisdom To Know The Difference Part 1

The wisdom to know the difference.

An acceptance and commitment therapy workbook for overcoming substance abuse.

Kelly G. Wilson, Troy DuFrene.

I dedicate this book to my brother David Gary Wilson, who we lost to a ma.s.sive stroke in the last days of writing.

In my early childhood, my family always had more kids than bedrooms. We never missed a meal, but we lived working-cla.s.s close. My brother Dave and I shared a bed for a long time when we were little. These were those old-timey mattresses with hills and valleys and the occasional broken spring that would poke up and get you if you didn't find the best spot to lie on. Before we went to sleep, Dave would roll over on his side, and I would give his back a good scratch: no, a little higher, a little higher...yes, right there. And then I would roll over and he would scratch mine.

And then those two little boys would slip off to sleep.

I remember those times with great fondness. There was a closeness, an intimacy, that I find so precious. I close my eyes now and they fill with tears. I can feel the pillow cradling my head, the warmth of the blankets all around me, laying right there next to my brother Dave. We were safe and life was good.

In this moment, I am overwhelmed with the sweetness of it-two little boys, brothers, all tucked in for the night.

Remember, Dave? One brother with another. I will miss you so.

-KGW.

To tomorrows, which may sometimes be in short supply.

-TD.

Acknowledgments.

It takes a whole lot of people to make a book like this, and there's little chance we'll remember them all. Much grat.i.tude goes out to our mentors, teachers, students, confreres, comrades, and friends, all of whom materially contributed to the work.

Special thanks to folks at New Harbinger whose commitment to our work has been unflagging: Matt McKay, Catharine Meyers, Michele Waters, and all the rest. And to our peerless editor, Heather Garnos, whose literary deftness and wicked backhand quite literally beat the book into completion, much love and fathomless grat.i.tude.

We gratefully acknowledge Mick Carnett's careful read, huge encouragement, exotic coffee contributions, and careful suggestions. Deep bow. Also to Maureen Flynn, who has worked very, very hard with me on some of the ideas found in this book.

Prologue.

A Personal Story.

G.o.d, grant me the serenity to accept the things I can't change, the courage to change the things I can, and the wisdom to know the difference.

You are not alone. I know the depths to which addiction can take a person, and I know something about recovery. I know it personally, and I know it as a scientist, therapist, and researcher. Woven into this book will be sensibilities science has to offer to the recovering person, but also some small bits and pieces of my own path in recovery and, finally, stories I've heard along the way.

The recovery process has been slow at times, even slower than baby steps. The best I've done some days was to sit on my hands. I've learned to appreciate even those days. If I'm sitting on my hands, it's very hard to make much mess to clean up later.

I started down this road something like twenty-five years ago. There was a time, in the winter of 1985, when I would be up in the night, lying on the bathroom floor, heartsick, alone, the house quiet all around me. Lying on that floor, between bouts of retching, I found myself in a dreadful spot-impossibly trapped between an absolute inability to drink anymore and an absolute inability to stop. Lying on that floor, I could feel the cool of the linoleum on my cheek and it was good. There in the bathroom, in the middle of the night, tortured, I found a moment's rest, my cheek pressed to the cool floor. My whole world was reduced to six square inches of cool linoleum. I could not leave that room without the terrors welling up around me. Even trying to rise from the floor filled me with awareness of all that I had done and regretted-and not done, and regretted more.

It was a starting point. From there, people began to teach me about acceptance and about holding my story in the world a little more gently, about letting go of limitations and opening up to possibility. By inches, I made my way up off the floor and out of that bathroom. I became engaged in the world in new ways. When I look where acceptance, openness, and engagement have taken me over the years, I have to pinch myself. I've fallen in love with people all over the world. I've become intimate with people and places and ideas that I could not have imagined. I've found souls all along the way who saw possibilities in me that I could not see in myself. And I've in turn had the privilege of seeing in others strength and beauty and possibility that they could not see in themselves.

And I can count a lot of days, a lot, between that barren winter of '85 and this day, this morning, this moment-a lot of days when the best I could do was sit on my hands. And, today, I count those days sitting on my hands as good days. All in a row they brought me right here together with you.

Rest a while. There will be time. Perhaps we can sit together on our hands today. And tomorrow, there won't be much mess to clean up. And we'll rise together and sweep up and go about our day as best we're able.

So if today is a day of hand-sitting, think of it as practice. The day will surely come when someone in need calls out. We're not likely to be able to reach out and reverse time in their world-bring parents back from the dead, retrieve a lost opportunity or a lost love-any more than we can turn back the clock in our own world. But perhaps if we have practiced, we can sit with them, on our hands if it's that kind of day, but together. And perhaps we'll find a way in this world, just as it is, to fall in love, and see beauty and strength and possibility together.

If you're reading this book, you know something about suffering. You know something about being stuck. Maybe you've sunk to the depths I had sunk to that dreadful winter of 1985. Perhaps farther, perhaps not so far. Still I will a.s.sume that you know something: something about despair, something about struggle, something about feeling trapped. You know that one's own personal h.e.l.l is always the one that burns hottest.

So, I offer this little book as a way of extending my hand to you. Twenty-five years ago a fellow named Tom extended his hand to me in my darkest hour. At the time, I wondered what his angle was, what advantage he hoped to gain. I had nothing really to offer in return. I lost track of Tom and it took a few years to sort out what he had wanted from me. Here is what he wanted: if that hand up helped me to find my feet in this world and helped to set me on a path, if that hand up moved my life to an inexplicably and unexpectedly better place, someone would eventually reach out to me for help. Tom knew that. When that day came, life would ask me a question: will you reach back? Tom's hand was offered to me twenty-five-odd years ago in a locked psychiatric hospital in Seattle. It's in the spirit of the kindness of that offered hand that I offer mine to you in the form of this book. Welcome. Welcome.

1.

Many Paths to Recovery, but Only One for You.

There are certainly many paths to recovery. But you'll only take one. What's the best choice for you? We don't know. And you can never really know. You only get to live life once. However you live it, you won't know how it would have gone had you lived it differently. Time runs in one direction. Scientific studies often tell us what happened on average to the people who got this or that treatment. We'll cite some statistics in this book. But at the end of the day you won't have something happen to you on average. Something very particular will happen to you. The best measure-and we'll emphasize this over and over again-is how your path to recovery is working in your own life. We'll hold onto this practical theme throughout.

What Lies Ahead Our initial drafts of this book began without much in the way of introduction. Our intention was to not waste words talking about theories and principles. We wanted to get immediately to sharing things that would be of use to you as you move toward recovery. And in the end we remain committed to this approach. Kind friends, however, prevailed upon us during the writing process to offer a few words of introduction.

The substance of this book is grounded in a model of psychotherapy called acceptance and commitment therapy (ACT from here on, which should be p.r.o.nounced as a word rather than separate letters.) ACT is an application of a discipline in psychology called behavior a.n.a.lysis. Unless you have an interest in the study of psychology, the only thing we want you to take away from this fact is that we're concerned here with your behavior, with what you do, far more than we are with what you think or who you "are" in some abstract sense. Rather than explain too much about how ACT works as a model of psychotherapy, we'd rather keep writing to you about the issue of addiction and recovery and let the details of the approach come out in the process, in a commonsense, storytelling way rather than a deliberately professional or scholarly-seeming way. We will offer that the principles of ACT are being evaluated on an ongoing basis in research facilities all over the world, and that, from its earliest days, ACT has been applied to substance-abuse issues with good results. While what follows isn't science, it is of science. This is important to us, and we hope it's of some rea.s.surance to you.

Blending ACT and 12-Step.

While this book is grounded in ACT, we've chosen to devote s.p.a.ce in this book to discussing how an ACT approach to recovery can be woven into a 12-step recovery process, the kind of approach you would encounter at Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). ACT and 12-step are not a perfect fit for each other, but we think that they touch at enough points to make the two approaches work together well. In fact, we think there is an opportunity for the two models to support and inform each other.

We deliberately use the words "support and inform" with some care. This isn't an AA book, and we are not proposing to speak authoritatively about AA or its methods. We believe, though, that AA's basic writings suggest no one is in a position to speak or write this way. We recognize wisdom in the AA steps and traditions, and we acknowledge that many, many people have found their way out of addiction and to richer, more meaningful lives with the help of AA. We also note that AA comes from a storytelling tradition, a tradition that is grounded in the stories of its members and in the insight of their collective experience, rather than from a tradition of empirical observation, of science. We base this book on our a.s.sumption that the science-based principles of ACT and the narrative-evolved principles of AA, even if not a perfect match for one another, do overlap and interact in interesting ways. We believe that ACT can blend with and support AA recovery and, at the same time, lend the AA tradition the rigor of the laboratory.

How will this work? In the chapters that follow, we'll break from time to time to relate the ACT material in the chapter to a touch point of the 12-step approach. We'll pull this material out of the normal flow of the text. If it interests you, read it. If not, feel free to disregard it. In an afterword to this book, we've included some thoughts on 12-step. If you're involved in 12-step or considering becoming involved, you can take a look. The majority of the book doesn't depend on the 12-step model or your partic.i.p.ation in it.

We include this material in the book in the full knowledge that many people in both the AA and the behavior science communities might disagree with us about this compatibility. Our hope is that you, reader, will enjoy the freedom to decide whether this book is useful to you without the distraction of any discussions of ideology or what is "right."

By way of introduction, we are collectively Kelly Wilson and Troy DuFrene. Kelly is a professor of psychology at the University of Mississippi in Oxford, Mississippi. He was one of three authors of the book Acceptance and Commitment Therapy, the book that laid the foundation for the evolving ACT research, study, and treatment communities. Kelly has been actively involved in substance-abuse treatment for more than twenty years and has personal experience with addiction and recovery. When the narrative of this book is expressed in the first person singular, you are reading Kelly's voice alone. Troy is a writer who happened, in one of those strange ways things sometimes turn out, to stumble into the ACT research community in 2006. Moved by the ideas he discovered there, he lingered and teamed up with Kelly to write Mindfulness for Two (2008) and Things Might Go Terribly, Horribly Wrong (2010).

We offer this book to you in service, fellows.h.i.+p, and friends.h.i.+p. Our sincere hope is that the book is of service to you-that it helps you get where you want to go.

To Abstain or Not to Abstain.

Some people claim that there's a single inevitable course for untreated substance dependence: an inevitable downward spiral. Research studies don't support this claim (Vaillant 1995). Some people drink or use heavily and then stop and don't use at all. Some drink and use heavily and then go back to nonharmful patterns of use. Some drink and use heavily and then go through periods of nonharmful use followed by periods of harmful drug and alcohol use. We won't mince words: we firmly believe that the decision whether to abstain is yours and yours alone. Our purpose in this book isn't to convince you to quit. There's nothing in ACT that says that people should abstain entirely from addictive substances. What we've written here we offer as help and support for the decisions you have made or may make with regard to your own recovery. (We also acknowledge here that abstinence is at least popularly linked to 12-step recovery approaches such as Alcoholics Anonymous. We have more to say about this in the afterword to this book, Some Thoughts on the 12-Step Approach.) Reasons to Abstain.

That said, we're not telling you not to quit, either. The decision about whether to abstain or control your use of alcohol or drugs, while ultimately personal, is not one to be taken lightly. If you haven't given significant time to that question, we recommend you do so now. As you think it over, we recommend careful consideration of the alternatives.

The outcome you want from addiction treatment is centrally important to the treatment itself. Without a doubt, some people succeed, through treatment, at moderating their drinking. But there are undeniable risks that come with an attempt at moderation. If you're considering moderation as an approach to dealing with your substance abuse problem, we'd ask you to consider what would have to happen for you to p.r.o.nounce your efforts a failure. And by consider we mean seriously consider. Below are a few things to think about that weigh on the side of abstinence.

You won't die from quitting. One consideration is that no one ever died from letting go of addictive substances. Some things with which people have problems, like eating, are necessary. You've got to eat. But many of these things are not necessary for survival. It's simply not a biological imperative that you drink or use drugs. You needn't ride a motorcycle at excessive speeds without a helmet, gamble beyond your means, or engage in daily anonymous s.e.xual encounters, yet all of these carry significant personal risks. And if you feel compelled to engage in these activities when doing so comes at the expense of other areas of your life that matter to you, we would argue that the prospect of not engaging in these activities deserves very long and careful consideration. We're absolutely not going to tell you to quit. The choice to engage in any and all activities-including drinking or using drugs-in your life is absolutely yours and yours alone. (And, yes, we realize that this absolute freedom is scary and can, itself, be a source of considerable anxiety for you. We'll have more to say about that later.) Habitual behavior is hard to control, especially when you're on autopilot. A lot of our behaviors are sort of automatic. Perhaps you've noticed this in your own life in areas outside addiction. For example, Kelly was always taught to clean his plate at dinnertime. He grew up working cla.s.s, and wasting food was a serious no-no. It has been a huge effort for him, as an adult, to decide when to quit eating based on how his stomach feels rather than by whether his plate is empty or not. He's gradually learning that he doesn't have to fill his plate. And, even if he does fill it, he doesn't have to empty it. And he doesn't typically go to buffets. Why? Although he no longer piles his plate high, he also seldom, very seldom, eats a minimal portion when he goes to a buffet. Some circ.u.mstances make some behaviors more likely (and, often, make them happen automatically). If you're having problems with addiction, you don't want to be spending time on autopilot, especially when addictive substances are involved.

Some substances make it easier to use other substances or more of the same substance. Some substances-and alcohol is a great example-lower your inhibitions when you use them. You know when you want to do something and that little voice in the back of your head tells you not to for some reason? Some substances incline you to pay less attention to that little voice. So, for example, if you're at the bar and the band starts playing, you might be a little reluctant to step out on the dance floor. You want to, but you feel a little inhibited. If you have a couple of drinks, the inhibition melts away. This isn't in and of itself a bad thing, particularly if what you feel inhibited about is asking someone to dance. But what if the thing you feel like doing but feel inhibited about is having another drink or using some cocaine? Alcohol has the same effect on those inhibitions. In AA, they sometimes say, "One drink. One drunk." This isn't strictly true, but there's some basis for concern. Being able to accurately estimate one's blood alcohol does not make a person immune from decreased inhibition or lapses in judgment. There are good reasons that there are laws against driving while under the influence of even a small amount of alcohol. A lack of inhibition and poor judgment when you're piloting a ton of steel at high speed toward trees and cliff edges and other people can have disastrous consequences.

One of the most favorable circ.u.mstances for using substances is using substances. This probably sounds like word play, but it's not. When you go to the supermarket, they have people in the aisles to give you little bites of food. If you eat a little, it sometimes cues eating a lot. Free samples are not really free. Like an old potato chip commercial used to say, "Bet you can't eat just one." This isn't necessarily anything specific to addictive substances; it's also true of a lot of other things in our lives. The difference is that those other things have likely not caused you the same level of problems as drugs and alcohol. You've probably never lost a job from eating too many potato chips or crashed your car after too much chocolate or had your spouse file for divorce after buying a gallon-size jar of artichoke hearts. And we're not suggesting that one chip inevitably leads to another. It simply increases the chances that you'll keep indulging until the bag is empty (or you run out of dip.) Likewise, taking one drink increases your odds for taking another, and this will ever be the case. Given this truism, it's well worth your time to consider very, very carefully if you want to put yourself in that position. You must ask yourself, Is the increase in likelihood worth it to me at this point in my life?

Moderate drinkers often don't stay moderate for long. While we don't know of any strong evidence that suggest that drinking always leads to more drinking, there's considerable evidence that drinking predicts drinking and that more drinking predicts more drinking. Although the use of a little bit of a substance may or may not send you into a spiral of intoxication, it certainly increases the risk of more use. For example, in a very large clinical trial for alcoholism treatment called Project Match, patients were divided into three groups based on their drinking patterns during the year following treatment: one group abstained, a second drank moderately, and a third group drank heavily. If we look at the number of people in the abstaining, moderate, and heavy drinking groups, we find that at year three, the majority of the abstainers (71 percent) were still abstainers. The majority of the heavy drinkers (78 percent) were still heavy drinkers. The majority of the moderate drinkers, however, were no longer cla.s.sifiable as moderate drinkers. Twenty-seven percent had become abstainers and 50 percent relapsed to heavy drinking (Maisto et al. 2006).

These data suggest a few things. First, they suggest that some individuals, though diagnosed with alcohol dependence, do moderate their drinking and continue to stay moderate over time. However, many don't. Another thing suggested by these data is that a substantial number of individuals may ultimately find their way to abstinence, for whatever reason, even though they don't start out planning to abstain.

Reasons to Keep Drinking and Using.

Different drugs, and alcohol especially, are a big part of our culture. Depending on your social network, many events in your life may have drinking or drug use as a social component. If you make the decision to abstain, it's likely, especially in the initial stages of recovery, that you'll feel awkward in these settings. Many people will have opinions on whether you should drink or use. Some will actively offer you something to drink, a toke, or a line. A few will actively attempt to undermine your resolve. Social discomfort isn't insignificant.

Kelly has had some personal experience in this regard that you may find interesting. As a psychologist, academic, and scientist, he goes to many conferences every year. The c.o.c.ktail lounges at big convention hotels are a sort of social magnet. A lot of papers, research projects, and collaborations have been started in those lounges. Kelly has reported to his station in c.o.c.ktail lounges all over the world for more than twenty-five years. He loves hanging out and talking shop.

From time to time in these situations, a newer colleague will offer to buy him a drink. He politely refuses. The colleague insists. Kelly refuses again. The colleague persists: just a sip. Kelly tells the colleague that he doesn't drink alcohol. Kelly has had a number of individuals over the years ask him when he stopped drinking. Without exception, Kelly stopped drinking long before he ever met the individual asking the question. Some have refused to believe it. He's had people who have sat in c.o.c.ktail lounges with him for more than a decade who never noticed that he wasn't drinking. They just never picked up on the fact that the drink in front of him was always, always a mineral water. When they note his boisterousness, he typically jokes, "Imagine what I was like drunk!" In twenty-five years of conversations like that, he has almost never had anyone inquire in any depth about why he doesn't drink. Mostly, he doesn't offer and they don't ask.

The conviviality of the c.o.c.ktail lounge is one factor. There's camaraderie in the cups. To be among your fellows, slightly sloshed, can be a lovely thing. There's also the flavor of a good stout, the elegance of a complex Bordeaux, or the nuance of a fine single malt scotch. There's the warm glow that comes like magic from just the right dose of alcohol.

Some will accuse us here of romanticizing alcohol and drugs. But it wouldn't be true to say that we were making these things up. Alcohol and, indeed, even drugs have played an enduring role in the unfolding drama of history. Champagne launched s.h.i.+ps, cold beer has been a signal that the workday is done, and drinking wine, smoking marijuana, and eating hallucinogenic cactus have all been part of religious sacraments. None of these things are, in themselves, "bad." The alcoholic's problem is not that he drinks. It's that he must drink. Neither alcohol nor drugs need be deplored or demonized before you can choose to let them go. The decision to do so may be for you, as Shakespeare put it, sweet sorrow. Or you may make that choice simply because you feel it's time to leave the party. You don't have to make an enemy of drugs and alcohol to decide that it's time for you to stop using them for good-and we've already discussed some, we think, fairly compelling reasons you might want to do just that. Again, the choice rests with you. (We'll have more to say about this later on. The Two Paths Meditation from chapter 2 can be helpful in finding the s.p.a.ce you need to make this kind of decision.) Choosing Your Path.

There are many paths to recovery from substance dependence. Some may tell you that there's only one way out of the trap of addiction. You must be saved in the ___________ church (fill in your favorite religious tradition)! You must go to AA! You must knuckle down! You must go to treatment! And on and on. But if we could rewrite the universe of treatment, we would take pains to make it one with many alternatives.

There are many paths into and out of substance dependence. It's simply the case that many people have recovered without doing any of these things. And still many more people have failed to recover even while doing all of them. History is unquestionably filled with people who recovered with just a bit of friendly advice and no treatment at all. There are certainly people who just got up one morning and decided to let it go. But, if you were one of them, the chances are pretty low that you would have found your way to this book.

And while there are as many paths to recovery as there are people struggling with addiction who seek some other way of living, observation over time has suggested that some paths probably work better than others. We do know some things that predict whether people will have long-term substance problems. People with stable jobs and families and good strong social support have an easier time recovering, on average, than those who don't. People who start drinking or using later in life are more likely to recover, on average, than people who start earlier. People with fewer other psychological problems are more likely to recover and avoid relapse, on average, than people with more and more severe mental health issues. But even here, we need to point out that these things are true about groups of people on average. Some people keep drinking or using even though the cards are stacked in their favor, and some people recover with all the cards stacked against them.

And what about you? Which are you? Do you fit neatly into any of these categories? Or are you the exception to the averages? We don't know. At the risk of sounding like a broken record, we're not here to tell you whether you should abstain from drugs and alcohol. We have no particular opinion on that matter. We're libertarian enough to say that this is a matter for you-and only you-to decide. If, however, you've decided for yourself that it's time to let go of drugs and alcohol, if you find that drug and alcohol use is getting between you and a life that you could love, then we offer this book as a support in that task.

ACT as an Approach to Recovery.

ACT is a behavioral treatment that has been shown to be useful with a wide variety of problems in living. There are clinical tests where ACT has been used with people who have problems with anxiety, depression, hallucinations, delusions, and chronic stress. ACT has been used with a lot of people struggling with different health problems like diabetes, chronic pain, obesity, and cancer. And, perhaps most important to you, ACT has been used successfully with a variety of addictions, including serious problems with multiple substances such as heroin, cocaine, and alcohol, with marijuana dependence, and with tobacco dependence. What's more, ACT self-help books have shown very good results in scientific tests.

Does this matter to you? It might, but we doubt it. And honestly, we don't think it should matter very much. Maybe you could be attracted to ACT's roots in science. Maybe it's appealing that the therapy has an expanding information base and practice community. Or maybe you're drawn to the fact that ACT has been applied to problems in many areas of life, not just a few. In the end, we believe that what really matters is whether what ACT has to offer resonates with you. And rather than go on and on about what ACT does have to offer, we'll put it all to you in one simple question:

In this very moment, will you accept the sad and the sweet, hold lightly stories about what is possible, and be the author of a life that has meaning and purpose for you, turning in kindness back to that life when you find yourself moving away from it?

From where we sit, this question, honestly and diligently answered, is the very heart of what ACT has to offer. It speaks to this very moment, to what is happening to you in your life, right here and right now. It asks you to accept that your life-everyone's life-is inevitably colored by things that are lovely and things that are painful. It reminds you that how you see the world right now might not necessarily be how things actually are and certainly doesn't determine how things might eventually become. It asks you what it is that you really want your life to be about and what you're willing to do to make it be so. And, finally, it asks if you are willing to commit, moment after moment after moment, to turn back to those things you value and care about, even when you've strayed-as we all do more often than we would like.

We'll have more to say about the particulars of ACT as we go along. For now, we invite you to sit for a moment with this question before reading on. It will matter a lot to the rest of the time you spend with us in this book.

So, now we begin our task. We invite you to give what we offer here a try. We'll be asking you to do some kind of crazy stuff: odd exercises, activities, meditations, writing a.s.signments, and other sorts of things. It's our sincerest hope that you find things here that move you toward a life you can love.

2.

In This Very Moment.

Having spent the better part of my life trying to either relive the past or experience the future before it arrives, I have come to believe that in between these two extremes is peace.

-author unknown.

What if there is as much living in a moment of pain as in a moment of joy? What if, right here in this very moment, peace is something you can enjoy? This chapter is about showing up in your own life and about the benefits of learning to practice the gift of stillness even in a storm, or maybe especially in a storm. The growing of such a practice can allow you to live with intention and purpose, even in the most trying moments that your life will surely deliver. If you're reading this book, we imagine such a resting place would be welcome.

Focusing on Yesterday and Tomorrow.

We humans spend a lot of time going over and over the wrongs done by us or to us. Like cows, we chew and chew, but instead of chewing gra.s.s, we chew our troubles-over and over and over (and over and...well, you get the idea). Sometimes we worry about the future and what might happen. Sometimes we worry about whether the past will repeat itself. After that, we go over the long list of terrible things that just might happen. We fritter away precious moments trying to redo the irredeemable past and trying to fix the unknowable future.

Worrying is like spending time fussing over the road map in order to figure out traffic conditions miles ahead. The map just doesn't have much to offer in that area. (Yes, mobile technology and network-powered maps have changed this somewhat, but run with us on this one.) You might pick a less busy route, but if you spend a lot of time on the side of the road staring at a paper map, traffic conditions won't become any clearer to you. And, in the meantime, your progress on your journey stops. Another alternative is looking at the map while driving, but this kind of distraction has its own consequences (Ahh! Screams are heard from the back seat). Stopping on your journey to look at a map, momentarily, is a fine idea. But there's only so much the map can tell you. In order to get anywhere, you need to spend most of your trip traveling with your eyes on the road, watching for what will happen next. Ruminating is like spending all your time looking in the rearview mirror. Worrying about the future is like trying always to get a peek past the horizon while remaining oblivious to what's happening to you right now, at ground level. Sure, glance back and look far ahead sometimes-but doing nothing else is a surefire way to put your life in a ditch.

Worry and rumination as we understand them have one very significant thing in common, and it probably is very easy for you to figure out what that is: they both focus actively on some time other than right now. There is a promise buried in worry and rumination. The promise is that if we go over our mistakes thoroughly enough, if we worry out all the details of our future, we will somehow avoid future problems. Planning is important and so is reviewing the mistakes we've already made. But when planning and reviewing become full-time jobs, we miss out on a lot of things that are happening-right now.

You'll have no trouble at all, we think, in linking these not-now problems to your experience with substance abuse and recovery. It's likely that you remember a time when substance abuse wasn't an issue in your life, even if that time might have been when you were a child. And you probably spend a fair amount of time pondering the direction your life will take as time goes by. Will you stay sober or stop using? No one knows. No one can know, at least not as long as you keep breathing. Drinking or drug use is something that you can do as long as you have the freedom and independence to make your own decisions. But we're not going to talk now about whether or not you'll kick the stuff now or ever. Rather, our purpose in this chapter is to talk about the alternative to worry and rumination, to focusing actively on the future or the past. And that alternative is-you guessed it-focusing actively and flexibly on the present moment.

Common Sorts of Worry and Rumination.

A very common source of worry in recovery is whether the recovery will last and whether the mess a person has made can ever be cleaned up. The biggest targets for rumination tend to be our past mistakes and, maybe to a lesser degree, the wrongs we perceive others have done to us.

"WILL IT LAST?"

We mentioned this above, but it's such a huge deal in recovery for people who have decided to quit that it's more than worth repeating. From the moment you put down your gla.s.s, stub out your joint, or toss out your needles, no one can possibly know whether you'll drink or use again. This uncertainty is something you'll carry with you always, even after many years of sobriety, and it can be one of the most painful aspects of recovery.

There are a couple of ways people manage this uncertainty. One is forcefully expressing their certainty, telling anyone who will listen that they will never drink or use drugs again.