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ACCEPTANCE AND COMMITMENT
THERAPY
, known as ACT, is the first
evidence-based treatment for
addiction that shares the same
philosophy as the recovery model. It
is also perfectly compatible with the
12 steps. ACT is founded on the idea
that treatment is about building a life
of meaning and purpose.
ACT is a modern form of CBT
(cognitive behavioural therapy) that has
been around for just over a decade
(Hayes et al, 1999). It is part of the new
wave of treatments based on accept-
ance and mindfulness that have been
growing in popularity over the last 25
years, and is a principle-based therapy
rather than being driven by treatment
protocols. This means that it is suitable
for more complex conditions such as
addiction, where the client needs to
learn only six basic principles: accept-
ance, defusion, mindfulness, taking
perspective, values, and commitment.
ACCEPTANCE
When repeating a behaviour leads to
increased problems over the long
term then the best solution is to let
go of it. Addiction is one example, but
also more normal behaviours like
avoidance can become problematic,
for instance social anxiety.
Acceptance means letting go of
behaviours that do not work.
DEFUSION
All people get caught up in thoughts
that are not necessarily true, for
instance thoughts about the world – ‘if
I go to the meeting nobody will talk to
me’ – or thoughts about ourselves,
such as ‘I am stupid.’ When people
buy into their thoughts, ACT calls that
being fused and it often produces
behaviour that leads away from values.
Defusion is about learning to stand
back from these thoughts, and choose
behaviour that is towards your values.
MINDFULNESS
In ACT the mindfulness component is
about learning to be present in the
here and now. By noticing the reality of
the situation people are better able to
choose the behaviours that will work in
the current context.
TAKING PERSPECTIVE
All people get caught up in their lives
and lose perspective. Taking
perspective is about learning to stand
back and see the bigger picture. From
this ‘observer’ perspective it is usually
easier to see the right moves and
make the right decisions.
VALUES
This describes what is important and
meaningful to you as an individual. It is
the direction you want your life to go in
so that it has purpose and feels
satisfying. This is not the same as
trying to be happy, rather describing
the types of activities that feel right at
a deeper level – for example family,
work, recreation.
COMMITMENT
Committed action is at the heart of
ACT. Instead of trying to feel better, ACT
emphasises carrying on with your
values even when it feels
uncomfortable. For example if you feel
anxious about going to a meeting then
go, and take the anxiety with you so
long as this is important to your values.
The six components are fluid and
summed up in a metaphor called the
passengers on the bus:
Imagine that your life is like a bus
and you are the driver. On the front of
the bus is the route you want to take
(valued direction). As you start the bus
up a bunch of unruly passengers get on
board and start making a noise (your
thoughts and feelings). As you set off
some of them come down and start
harassing you, so you start telling them
to sit down. But they don’t, so you stop
the bus and try to make them.
ACT uses lots of metaphors like
this to help people understand that it
can be futile to struggle with unwanted
thoughts and feelings, and that when
you do it can bring your life to a halt.
The alternative is to live with them and
learn to drive the bus.
There is an extensive evidence
base for ACT across many conditions,
as well as a specific evidence base in
addiction. More than 50 randomised
control trials (RCT) have been
published and six of these are in
addiction. The overall evidence base
has been independently reviewed and
compares favourably to CBT (Öst,
2008). In the United States the model
has been evaluated by the Substance
Abuse and Mental Health Services
Administration (SAMHSA) and approved
as a recognised treatment for
addiction. There is evidence for use in
residential rehabilitation, with
methadone maintenance and for
recovery across alcohol, opiate,
stimulant and cannabis use.
For groups, a very simplified version
called the ACT Matrix has been
developed by myself and Dr Kevin Polk
and used throughout the addiction
services in Portsmouth. Over the last
five years groups have been run across
multiple agencies – the hospital, family
centre, probation, community drug team
and beyond. In that period attendance
and outcomes have improved more
than 100 per cent year on year. The
matrix is also being used as a model
for rehab at the Addiction Recovery
Centre (ARC), and has been developed
into a model of peer recovery.
ACT is compatible with the 12 steps
and a perfect fit for the recovery model.
It is easy to use through the matrix
format, yet highly evidence based. While
relatively new, it is now established in
the UK within the mainstream treatment
agencies, in rehab and in peer recovery.
It is a simple model, which can join up
the treatment journey for the client and
deliver reliable results.
Mark Webster is a registered
psychotherapist. Fully referenced
version available at
www.drinkanddrugsnews.com
Acceptance and
Commitment Therapy
(ACT) is a perfect
match for the
recovery model,
says
Mark Webster
10 |
drinkanddrugsnews
| May 2014
Recovery |
Acceptance and commitment therapy
www.drinkanddrugsnews.com
PURPOSE
A sense of
‘There is an
extensive
evidence base for
ACT across many
conditions, and
also a specific
evidence base
in addiction.’