Develop Skills for Coping With Automatic Thoughts

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The counselor helps the client identify automatic thoughts and reviews some of the techniques used in previous sessions:

C: Everyone trying to stop marijuana use has thoughts about using. It's not the thought that creates the problem but how people cope with it. If you learn to recognize these thoughts and counter them with contrary thoughts, they need not lead to a lapse.

The three general principles for coping effectively with thoughts about using are

1. It's easier to choose to remain abstinent and not to give in to persistent thoughts if you are committed firmly to quitting.

2. It's easier to challenge drug-related thoughts and change them if you are aware of them.

3. This coping skill takes a long time to master; these thoughts can return months and years after you stop using.

The counselor reviews strategies for managing thoughts about using marijuana and shows the client Managing Thoughts About Marijuana (form 6A):

C: Challenge them. Use other thoughts to challenge the resumption thoughts. For example, "I cannot get a little high without increasing my risk of using more" or "I don't have to use marijuana to unwind after work; I can use relaxation exercises" or "I can have good times without marijuana; it may feel strange at first, but in time I'll feel more comfortable."

An important aspect of challenging thoughts about using (as well as forms of thought distraction and substituting behaviors incompatible with using) is to avoid visualizing what you are not going to do and instead picture a behavior that you will do. You might try developing a mental picture of the new behavior when the old habit pops into mind.

List and recall benefits of not using. Thoughts about the personal benefits of abstinence can weaken excuses for using. Benefits to think about include better physical health, improved family life, job stability, more money for recreation and paying bills, increased self-esteem, and self-control. It is important to pay attention to these positive aspects and the progress you're making; don't focus on what you're giving up. Carry a card with you listing the benefits, add items as you think of them, and review them regularly.

Recall and list unpleasant using experiences. Recall the pain, fear, embarrassment, and negative feelings associated with using marijuana. Make a list of unpleasant experiences, such as memory problems, lack of motivation, procrastination, arrests, withdrawal, paranoia, and sleep disturbances on the back of the card that lists the benefits of abstinence. Read the card regularly. Counteract the positive thoughts you have about using with the negative aspects of using and the benefits of abstinence. Visualize the possible using episode to the end and include all the detrimental consequences that occur with using marijuana.

Find distractions. Think about something pleasant, like holiday plans, vacation spots, loved ones, relaxation, or hobbies. Focus on a task you want to get done.

Promote self-reinforcement. Remind yourself of your success—for example, 2 weeks of abstinence, involvement in treatment, staying in the treatment program.

Leave or change the situation. Try a different activity, such as a hobby or physical exercise.

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