Controversies in the Addiction Field: Change Versus Acceptance
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.Individuals in recovery encounter a conflict that is evident throughout life: changing things versus accepting them. Each person must find a way to resolve these conflicting agendas. We must be able to change things. We also must not change things (to accept things as they are). Some things need to be changed. Some things need to be accepted. There is no single "right" way. There is only the right way for each person, in each particular set of circumstances. Moreover, the "right" way may change throughout the course of someone's life. People clash with each other over this. Each person mistakenly believing their way is THE right way. Instead, both ways could be right. Or, both ways could be wrong. There are many healing paths to recovery. As long as the path results in healing, it is the "right way" for that person.
Let's examine this change vs. acceptance dialectic a bit further. Obviously, people in recovery must make some changes or the addiction problem will remain the same. Similarly, a person in recovery must be willing to accept some things. Perhaps they need to accept the obvious fact there is a problem. Perhaps they need to accept suggestions from other people about how to solve the problem. Each of the four models of personal responsibility varies in terms of this tension between acceptance and change.
For people with an external locus of control, recovery is strongly oriented toward acceptance. Nonetheless, change is still required. For instance, for the person who likes the enlightenment model (responsible for causing the problem but not for solving it), attending AA meetings to achieve recovery makes sense. In meetings, one can learn about the true nature of alcoholism. One becomes enlightened as they learn, taking the first drink caused the problem. Therefore, the solution is to abstain from taking that first drink. But, since this is not easy to do, the solution rests upon a higher power to provide this ability. One also learns about character defects that contributed to the establishment of drinking problems. Acceptance and change are both required to gain recovery. One's responsibility is to attend the meetings, and follow other aspects of the AA program.
Another model that reflects an external locus of control is the medical model. If you gravitate toward the medical model (not responsible for causing or solving the problem), you accept you have an addiction problem and recognize you must find suitable experts to help you solve your addiction. You will need to accept the advice and suggestions of the experts if you wish to recover. You must also change your behavior in the manner they suggest. Once again, change and acceptance are both required. However, each model suggests a different balance between change and acceptance.
For people with an internal locus of control, recovery is strongly oriented toward change. Nonetheless, acceptance is still required. For example, the compensatory model proposes you are not responsible for causing the problem but you are responsible for solving it. Although you are trying to make the needed changes in your life, you still need to accept there are some things you cannot change. If there is a history of drinking problems in your family, you might need to accept your genetics place you at risk. In short, alcohol is very appealing and tempting. You need to accept this reality while changing your response to this appealing and tempting substance.
The moral model is another model with an internal locus of control. You are responsible for creating and solving the problem. This requires you to make significant change. You will learn from your mistakes and take corrective action. You may experience substantial guilt about having allowed the problem to develop. Although the guilt might become excessive, a small amount of guilt can serve to motivate people to change their behavior.
The Serenity Prayer, written by Reinhold Niebuhr, provides an excellent way to summarize the issues of change versus acceptance. 12-step groups, such as Alcoholics Anonymous, nearly always recite this prayer:
God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.
For individuals leaning toward an internal locus of control, recovery will be more about "courage to change the things I can." Conversely, for individuals leaning toward an external locus of control, recovery will be more about "serenity to accept the things I cannot change." Whether we have an addiction or not we must all find a balance between active growth (courage to change) and passive rest (serenity to accept).
Some people find the Serenity Prayer does not reflect their religious and spiritual beliefs. An alternative wording might be the following affirmation:
I possess the courage to change the things I can, the serenity to accept the things I cannot, and the wisdom to know the difference.
Our wisdom constantly evolves as we gain life experience. This experience helps us to find the right balance of change and acceptance. It's quite natural to notice the similarities between our own problems and the problems of others. However, we must also recognize even when situations seem similar they may not be. No two situations are identical. No two people are the same. Each person must find their own balance serenity (acceptance) and courage (change). Perhaps the most important part of the serenity prayer is the part that implores God to impart the wisdom needed to achieve this balance. Whether or not God imparts this wisdom, we all must find it. The wisdom to find a balance between change and acceptance seems crucial.
The different approaches people use to solve complex and troubling problems, such as addiction, do not need to become a source of conflict or debate. We understand these differences as each person's unique way of balancing change and acceptance to bring about the solution they desire.
Resources
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Articles
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What is Addiction?
- Introduction to What is An Addiction
- Definition of Addiction
- Definiton of Addiction Continued
- The Addiction Definition Compared to Other Addiction Terms
- How Do I Know if I Have An Addiction?
- Why Don't They Just Stop? Addiction and the Loss of Control
- Is Alcoholism a Disease?
- Addiction Statistics: How Big of a Problem Is It?
- A Brief History of Alcoholism
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- Introduction to Causes of Addiction
- The Many Causes of Addiction and Bio-Psych-Social-Spiritual Model
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- Sociocultural Model of Addiction and Recovery Implications
- Public Health Model of Addiction and Recovery Implications
- Moral and Spiritual Causes of Addiction
- Addiction and Personal Responsibility: A Fundamental Conflict
- Personal Responsibility and Locus of Control
- Controversies in the Addiction Field: Change Versus Acceptance
- Conflict between 12-Step Anonymous Groups and Science: A Historical Perspective
- Conflict between 12-Step Anonymous Groups and Science Continued
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- Introduction to How Do You Get Addicted?
- The Biology of Addiction and Recovery
- How Does Addiction Affect the Brain?
- Addiction Changes the Brain's Chemistry
- Addiction Changes the Brain's Communication Pathways
- Addiction Changes Brain Structures and Their Functioning
- Impaired Decision-making, Impulsivity, and Compulsivity: Addictions' Effect on the Cerebral Cortex
- Drug Seeking and Cravings: Addictions' Effect on the Brain's Reward System
- Habit Formation, Craving, Withdrawal, and Relapse Triggers: Addictions' Effect on the Amygdala
- Stress Regulation and Withdrawal: Addictions' Effect on the Hypothalamus
- The Good News: The Brain Also Helps to Reverse Addiction
- The Psychology of Addiction and Recovery
- Learning Theory and Addiction
- Classical Conditioning and Addiction
- Operant Conditioning and Addiction
- Social Learning Theory and Addiction
- Cognitive Theory and Addiction (Thoughts, Beliefs, Expectations)
- Cognitive Theory and Addiction Continued
- Cognitive-Behavioral Therapy: Improving Coping Skills
- Addiction and Other Psychological Disorders
- Developmental Theory and Addiction
- Recovery from Addiction: The Psychology of Motivation and Change
- Addiction: Social and Cultural Influences
- Addiction and Sociological Influences: Culture and Ethnicity
- Recovery from Addiction: Becoming Aware of Cultural Influences
- Recovery from Addiction: The Powerful Influence of Families
- Recovery from Addiction: Social Support
- The Spirituality of Addiction & Recovery
- The Spirituality of Addiction & Recovery Continued
- Incorporating Spirituality into Recovery from Addiction
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Signs and Symptoms of Addiction
- How Do You Know If You Have An Addiction?
- The Diagnostic Criteria for Substance Use Disorders (Addiction)
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- Alcohol-Related Disorders
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Treatment for Addiction
- Treatment for Addiction
- Natural Recovery: Recovery from Addiction Without Treatment
- Natural Recovery Continued
- Choosing An Effective Treatment Approach: Evidenced-Based Practices
- What Makes An Addictions Treatment Effective?
- Biological Approaches to Addiction Treatment: Medications
- The Role of Medication in Addictions Treatment
- Pharmacologic Medications for Addictions Treatment
- Pharmacologic Medications for Addictions Treatment: Part II
- Psychological Approaches to Addiction Treatment
- Motivation for Change: The Stages of Change Model
- Motivation for Change Continued
- Types of Evidenced-Based (Effective) Treatments for Addiction: Motivational Interviewing
- Relapse Prevention Therapy
- Contingency Management
- Cognitive-Behavioral Therapy
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- What The Pros Know: The Practical Recovery Model
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- The Social Support Approach to Addictions Recovery: Recovery Support Groups
- Self-Empowering Support Groups for Addiction Recovery: Smart Recovery
- Moderation Management
- Women for Sobriety
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- Summary of Self-Empowering Support Groups
- Spiritual Approaches to Addiction Recovery
- 12-Step Support Groups: Groups That End With "Anonymous"
- 12-Step Support Groups: Part II
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- Expanding Addiction Treatment Choices in the United States
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- Addiction: Learning to Forget
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- Addiction: Treat It Like a Disease
- Addiction: What Is It?
- One in 4 People Prescribed Opioids Progresses to Longer-Term Prescriptions
- NIDA’s Dr. Phil Skolnick discusses intranasal naloxone
- "Eyes On" Research in Drugged Driving
- How Will Anti-Drug Vaccines Be Used? An Interview With Dr. Thomas Kosten
- Opioid Use in Pregnancy: A Community’s Approach
- Naloxone Rescue Kits
- Living Without Fear
- What You Need to Know About Internet Addiction
- Hooked, Hacked, Hijacked: Reclaim Your Brain from Addictive Living
- The Neuroscience of Internet Addiction
- Internet Addiction: Signs You Need to Shut Down
- What the Internet is Doing to Our Brains
- Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
- The Reward Circuit: How the Brain Responds to Cocaine
- The Reward Circuit: How the Brain Responds to Methamphetamine
- The Reward Circuit: How the Brain Responds to Marijuana
- The Reward Circuit: How the Brain Responds to Natural Rewards and Drugs
- Mindfulness-Based Relapse Prevention (MBRP) for Addictions Video (vol. 1)
- Mindfulness-Based Relapse Prevention for Addictions (vol. 2)
- Prescription Opioid Misuse
- Substance Use Disorders/Addictions - Clinical Overview
- Addiction in the Elderly
- Teenagers, ADHD, and Substance Abuse
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