If you are concerned about your drug or alcohol use, the Positive Change Pathway, created by Dr. Andrew Tatarsky, can help you to create your optimal relationship to substances—whether that means reduced, safer, more controlled use, or none at all.

Start your journey…

Setting Your Stage for Positive Change Improving Your Skills Self-Assessing Your Substance Use Embracing Your Ambivalence About Change Setting Your Positive Change Goals Making Your Plan for Positive Change
Step 1 - Setting Your Stage for Positive Change

To give yourself the best chance of making positive changes in your life, try to view the place where you are now with acceptance, compassion and curiosity. This will create a solid, safe foundation for the rest of your work and clear the path to learning.

Beginning a process of positive change does not require that we know the outcome of our journey—we just begin.

Spend some time reflecting on what you think and feel about your use of substances, your reasons for using and why you might be experiencing difficulties with your use. What is true for you?

Examine how you are feeling about yourself for having these difficulties. Are you feeling any negative emotions? Can you identify any stigmatizing ideas, or tendencies to be overly self-critical, self-hating or harsh? Have you unwittingly assumed that you are powerless to do anything about your substance issues, short of stopping altogether?

The tendency to take on others’ points of view can interfere with the discovery of our own truth. Try to identify and separate your own desires and perspectives from others’ judgments and wishes for you—take these into consideration as important but don’t simply accept them.

You might do this work in self-reflection, journal about it or find a trusted person to talk with about it.

Get in the driver’s seat

You might counter any assumption that you are powerless by thinking of getting in the driver’s seat of your own process of change.

Pursuing any learning or change requires you to take charge of the process. As with driving, you will need good skills (capacities for change); you may need a teacher or coach (a trusted friend or an appropriate professional); you will need to know where you want to go (goals); and you will need to know a route that will get you there (techniques and strategies).

Spend some time thinking, journaling or talking on the subject of how you feel about getting in the driver’s seat of your change process.

Step 2 - Improving Your Skills

To be a good driver of your own process of change, you must use certain mental skills or capacities. The ones we have found particularly useful are self-acceptance, curiosity, self-reflective awareness and the ability to “sit with” feelings.

All of these will come together in “urge-surfing”—a valuable technique that promotes reflection and consideration of change.

Self-acceptance

You didn’t plan to have difficulties. You didn’t choose to have the problems that you now suffer from. The choice to accept that you are here now is not giving yourself an excuse; it simply puts you in the best position to honestly assess what is happening and summon the self-support necessary to make positive change.

Problems associated with substance use present opportunities to learn something about yourself. Try to challenge judgmental moralizing, self-blaming and self-shaming: These reactions close down exploration.

Compassionate, pragmatic self-acceptance of where you are, the essence of harm reduction philosophy, is a powerful alternative. Recognize that your desire for change reflects positive motivation and awareness—two vital ingredients of the change process.

Curiosity

Curiosity brings openness to your learning. Being curious about how your substance use interacts with other aspects of yourself and your life—and whether there are self-defeating aspects of it—will provide a positive motive for reflecting on your use.

Self-reflective awareness

This is the ability to observe your thoughts, feelings, perceptions and behaviors keenly and without judgment. Noticing your moment-to-moment flow of experience enables you to discover the Event —> Thought —> Feeling —> Urge —> Decision —> Action sequences around your substance use.

Self-reflection enables clarification of the meanings and functions that substances have for you. Simply describing your experience —rather than judging it as good or bad, useful or not useful, stupid or smart—is optimal here.

Sitting with your feelings

Sitting with your feelings—simply taking time to experience them without reacting— supports self-reflection. The greater your capacity to sit with your feelings, the more still you can be with yourself and the greater your ability to look inwards and become more self-aware. This is central to stopping impulsive or compulsive behaviors, which are reactions to intense feelings that are hard to tolerate.

Our capacity to sit with our feelings improves as we practice, just like strengthening a muscle, increasing the intensity of feeling that we can tolerate in small increments.

Slowing down the breath can help you to relax with what you are feeling, making it less uncomfortable. You can then name your feelings, or describe them in terms of the thoughts and sensations associated with them, which can help to demystify them and make them less frightening or overwhelming.

Learning the skills

You can cultivate these skills simply by reminding yourself to be curious, self-reflective and tuned in to what you are feeling as you move through your day.

Some people also find it useful to have a time set aside each day to practice tuning in. Yoga, meditation and exercise are activities that support the strengthening of these capacities, and classes can provide a great deal of support for some.

Exercise: Awareness and relaxation training

Set aside 5-30 minutes. Pick a comfortable, quiet place where you will not be disturbed. Sit comfortably on a chair or cushion. Put on some quiet, relaxing music if you like.

You can also partner with a friend, taking turns to read the instructions to each other. You can try this exercise with your eyes open or closed; many people find it easier to focus inward with their eyes closed.

Step 1: Scan your body.

Like a scientist or reporter, gathering information without judgment or interpretation, observe is what is happening in each part of your body in each moment. “Scan” your body mentally, focusing on the sensations you feel. Notice the sensations in your toes, then slowly work your way up, all the way to the top of your head.

Can you feel tightness? Coolness on your skin? Can you feel your heart beating? The pulse throughout your body?

Now shift your awareness to what you hear, see, smell and taste. Become aware of memories, thoughts and images that pass through your mind’s eye. Notice all of these experiences without judgment. If you find yourself moving away from this moment, getting hung up on a thought, gently move your awareness back to the present experience of sensation and perception.

Step 2: Slow down the breath.

Notice the sensations of your breath going in and out of your mouth and nose. Notice the rising and falling of chest and stomach. Exhale slowly, counting to four or six. Inhale a little more deeply than before, counting to four or six. Hold the breath for a moment when you get to the top. Then exhale once again, slowly and deeply.

Continue breathing like this for three minutes.

Step 3: Breath out the tension.

As you inhale, focus on any tensions or discomforts that you feel. Imagine you can breathe them away as you exhale. Inhale healing, cleansing breath to the tension spots and exhale what you don’t want to carry with you. Imagine you can feel gravity pulling you down into the cushions under you.

Give your muscles permission to stop working. Do this systematically from the bottom of your toes to the top of your head.

Step 4: Feeling-recollection.

Think of a word or phrase that describes a feeling that you would like to recall. Peaceful. Calm. Clear. Powerful. Grounded. Can you remember feeling this way and how it felt in your body and mind? Imagine you can inhale this feeling, carried by the breath. Inhale the feeling that you want and exhale what you want to let go.

Urge-surfing

Urge surfing brings all these skills together in a technique that can help you to explore urges to engage in substance use and other behaviors that you may be considering changing. It enables sitting with and reflecting on urges, without acting from impulse. This puts space around the urge, interrupting any habitual behavior, and makes it possible to consider alternative choices.

Turn your awareness within and notice the urge. Take five seconds, three minutes or as long as you like to do this. Remember, you can always choose to do the habitual thing if you wish. But surfing the urge puts a little space between the urge and whatever you choose to do.

“Hang out” with your urge and describe it in terms of the feelings and body sensations it causes, and the wishes and fantasies it brings about what you want from using. What needs might be expressed or communicated through the urge? Is there another way that you might be able to respond? Be aware that for as long as you choose to “surf the urge,” you are not acting from impulse or habit –you are in charge, in the driver’s seat.

Step 3 - Self-Assessing Your Substance Use

Your motivation to make specific changes in your relationship with substances should ideally be based on your own assessment of the place substance use has in your life.

Before you can decide how to change this relationship, you must be clear about how your current use is problematic, if indeed it is. You may ultimately decide that stopping is the best choice for you. But a commitment to stop is not necessary for you to begin making positive changes in your use.

As you identify negative aspects of your use, you can make small changes to reduce the harmful consequences. Self-assessment will help you become aware of negative consequences, of how your pattern of use is causing them and of other aspects of yourself or your life that may be contributing to them. Your substance use may be intertwined with all other aspects of your life, so understanding your relationship with substances will provide clues to positive changes that you might make in other life areas, which in return may positively impact your substance use.

Substances play many roles and carry multiple meanings in people’s lives; these need to be clarified if we’re to understand what anchors a current pattern of using.

Substances may help people relax, introspect, or feel more connected to their bodies. They may provide a sense of connection to a community or a sense of identity; represent a rebellion against parental control; help people to access creativity; provide a bridge or bond between people; provide a sense of self-reliance; soothe emotional distress, such as anxiety; enhance sex and intensify pleasurable experiences; aid work and more. Substances can help and hurt at the same time.

How does your use positively and negatively impact your health, emotions, self-esteem, relationships, work or school, finances, social life and identity? What roles and meanings does your use have for you?

Identifying the multiple meanings of your use can make it possible to consider other solutions that may relieve some of the pressure to use.

These two strategies can help with this process:

Strategy 1: Tracking, charting or journaling

Simply keeping a record of your substance use has been found to promote positive changes with no other intervention. Over the course of a week, you might simply write down the day, time, amount and method of using for each instance of substance use.

If you feel up to it, you can also note the feelings, thoughts, expectations and circumstances preceding use and the immediate consequences of using (how did it work out?).

Strategy 2: Microanalysis

This strategy is designed to clarify how you typically use substances and how they fit into your life, both in terms of which factors affect your desire to use and how substances affect other aspects of your life, positively or negatively.

Using the information you gathered through tracking/charting/journaling, write a detailed description of your pattern of use. Address the following:

  • Describe the pattern: When, where and how much do you tend to use?
  • Identify triggers and motives: What contributes to your desire to use in terms of what you were feeling? During the week you tracked, what did you want from using? What were your justifications or reasons for using? And what was the context, in terms of who you were with and what was happening around you?
  • Evaluate the results and consequences of your use: Describe the qualities of the effects/high; did it deliver what you wanted? How did it positively and negatively affect other aspects of your life, such as health, freedom, finances, relationships, intimacy, school or work, emotional life, self-esteem, social life, recreation and ambition?
  • Evaluate the quality and severity of your use: How often does it come from conscious choice? How often does it come from impulse and habit? Do you find yourself using when you think and feel you shouldn’t because of the potential harms? Is this related to some clearly identifiable triggering feeling or event? Does using typically enhance a social situation for you? Is it an occasional problem in some way? Do you feel cravings, or that you are “out of control”?
  • What might you like to change about your use?
Step 4 - Embracing Your Ambivalence About Change

When substance use becomes problematic we always feel some ambivalence about it. It is important to embrace this ambivalence as a basis for considering alternative solutions.

Despite some awareness of the potential risks associated with certain substances, people still want to use them. Habits are comforting and easy, and they may serve important conscious and unconscious functions for us. Like old shoes that we have loved, shoes that took us to so many wonderful places and evoke so many meaningful memories, our habits are hard to discard—even if they come into conflict with our current lives and interests.

The investments we have in our old ways of being contribute to an ambivalence about changing that we need to embrace and address if we’re to move on. The parts of you that are threatened by your substance use will naturally feel at odds with the parts of you that are positively invested in it. But if both parts can be present in your experience at the same time, it will be possible to consider new solutions to the impasse.

Bringing curiosity and awareness to both sides of your ambivalence

Spend some time reflecting on and writing about the two sides of your ambivalence listed below. Describe each part of yourself in terms of its place in your life, its interests, energy, feeling, tone and aspirations. Discuss why that part of you wants to stay the same, or change.

  • The part of you that wants to stay the same and continue to use substances as you currently do
  • The part of you that wants to change the way you use substances
Decisional balance

This is another exercise designed to help you clarify your ambivalence about changing your relationship to substances. It also has been found to help people find their motivations to make positive changes to their substance use.

Fill in the boxes below to assess the pros and cons of maintaining your current substance use and of changing it:

Step 5 - Setting Your Positive Change Goals

As your self-assessment deepens and you embrace your ambivalence, your unique set of positive change goals can emerge and be considered. Goals may be quantum leaps, or they may be tiny forays into new territory. You might think of goals as experiments with new ways of being.

Remember that every positive change, large or small, is a success. Small positive changes add up to larger changes. Small changes can also give us feedback about ourselves that may contribute to a growing sense of confidence in our ability to change.

Once you have identified goals that you are curious about exploring, you will feel motivated from the inside to work on this rather than pressured to do it by someone else, a condition for change that does not seem to be very helpful in the long run. Choosing the goals for yourself dramatically increases the likelihood that you will stay with the process and achieve positive change.

The ideal use plan

This is an exercise for clarifying what your ideal, healthiest, most self-affirming relationship with substances might be.

  • Based on your assessment of the risks and negative impact of your current pattern of using, which changes might minimize the risks and reduce the harm? Describe, as specifically as you can guess at this point, how this new pattern of use might look in terms of substances, ways of using, frequency, amount and circumstances of use.
  • Consider which other changes might you make in your life that would support your desired changes to your substance use.
  • If you make an initial attempt to implement your new plan, bring a scientific, “hypothesis-testing” attitude to your experiment. Does your plan achieve the results you desire? Is it realistic? Are there challenges or obstacles that need to be considered with a view to revising your plan?
Step 6 - Making Your Personal Plan for Positive Change

The final step in our Positive Change Pathway is to create a personal plan that will help you get from where you are to achieving your new goals. Rather than deprivation and simply trying to control yourself, this approach focuses on strategizing to implement your new goals and care for yourself most effectively.

Points to consider include: how you think and plan; what you will do differently; how you enlist support from others for your new goals; who you spend time with and who you avoid; how you care for yourself in new ways; and how you address issues related to your use in other, more effective ways.

Some useful strategies for your plan
  • Play with your habit: Doing this, rather than enforcing change, can make the process easier and less of a set-up for frustration. See what happens if you wait five or 30 seconds before you engage in it. Take a breath and urge-surf when you feel like doing it; stop the action, see what you feel and then decide whether or not to do it.
  • Self-monitor: Identify triggering Event —> Thought —> Feeling —> Urge —> Decision —> Action sequences.
  • Dialogue with the urge: Consider both sides of your ambivalence about giving into the urge and see whether a decision to use now seems to be the best choice, given all of your interests.
  • Identify your triggers: Turn your attention away from the urge and consider what triggered it. Consider whether using is the best or only response to that feeling, thought or event and what else you might do to express yourself, care for yourself or otherwise respond to the trigger.
  • Eighteen alternatives: Brainstorm a list of 18 or more alternative responses you might have to the things that typically trigger your desire to use. (A patient of ours came up with that number 18 for himself.) Practicing alternatives reduces the risk of coming to depend on using, helping you to develop a range of ways of caring for yourself.
  • Have a game plan: Get ready in advance for each situation in which you will be using. What are your goals for this occasion? How much? How often? What are safe limits? What is a safe pace? What do you do between? When do you stop? Plan a strategy, as you did with your ideal use plan, for successfully achieving your goals. Eat beforehand. Be a good “defensive driver” by anticipating challenges to your plans and preparing to meet them. For example,what will you say when a friend questions you about your limited use? How will you respond when you know you have had enough and you feel the desire for more? Do you have a safety buddy?
  • Who is in your support system? Making positives changes may be hard work and may take time. Many forces pull us toward the repetition of old habits. To counteract them, you may need a team around you to support your decisions. This may include friends, family, self-help groups and professionals—consider who you may find it useful to invite on to your team.
 

If at any point in working the process issues or problems arise that are frightening, dangerous or emotionally difficult, a professional consultation with the appropriate professional may be necessary or important to consider.

You might consider a one-time consultation with me to clarify the nature of what you are struggling with and to firm up your positive change plan. I can be consulted to support you at any point in this process and help you clarify the right approach to take. In the collaborative spirit of my work, I am available to people in flexible ways that meet their needs and interests.