THE FOUR STEPS, PLUS ONE STRATEGY

Adapted from Chapter 33 of In The Realm of Hungry Ghosts: Close Encounters with Addiction, by Gabor Maté M.D.

These steps are an adaptation to the healing of addiction of the Four Step method developed by Dr. Jeffrey Schwartz at UCLA for the treatment of OCD. They may be used not just for OCD or addiction, but for any compulsive, repetitive and self- deprecating, self-harming thought pattern.

The four steps should be practiced daily at least once, but also whenever an addictive impulse or self-undermining belief pulls you so strongly that you are tempted to act it out—or if you are just mentally stuck in such a pattern. Find a place to sit and write: preferably a quiet place, however even a bus stop will do if that’s where you happen to be when the addictive urge arises. You’ll want to keep a journal of this process, so carrying a small note book with you is an excellent aid.

Step 1: Relabel

In Step 1 you label the addictive/self-deprecating thought or urge exactly for what it is, and not mistake it for reality.

When we relabel, we give up the language of need. I say to myself: “I don’t need to purchase anything now or to eat anything now; I’m only having an obsessive thought that I have such a need. It’s not a real, objective need but a false belief. I may have a feeling of urgency, but there is actually nothing urgent going on.” Or, “it’s not true that I’m a weak person,” or “it’s not true that I can never succeed, it’s just a belief,” or, “it’s not true I am responsible for everything, it’s only an idea in my mind.” Or, “it’s not true that I’m unworthy...” etc.

Essential to the first step, as to all the steps, is conscious awareness. It is conscious intention and attention, not just rote repetition that will result in beneficial changes to brain patterns, thoughts and behaviours. Be fully aware of the sense of urgency that attends the impulse and keep labeling it as a manifestation of addiction rather than any reality that you must act upon. “In Relabeling,” writes Dr. Schwartz, “you bring into play the Impartial Spectator, a concept that Adam Smith used as the central feature of his book, The Theory of Moral Sentiments. He defined the Impartial Spectator as the capacity to stand outside yourself and watch yourself in action, which is essentially the same mental action as the ancient Buddhist concept of mindful awareness.”

The point of Relabeling is not to make the addictive urge or compulsive thought disappear—it’s not going to, at least not for a long time, since it was wired into the brain long ago. It is strengthened every time a person gives in to it—and also every time one tries forcibly to suppress it. The point is to observe it with conscious attention without assigning the habitual meaning to it. It is no longer a “need,” only a dysfunctional thought. Rest assured, the urge will come back—and again you relabel it

with dogged determination and with mindful awareness. “Conscious attention must be paid”, Jeffrey Schwartz suggests. “Therein lies the key. Physical changes in the brain depend for their creation on a mental state in the mind—the state called attention. Paying attention matters.”

Step 2: Reattribute

“In Reattribute you learn to place the blame squarely on your brain. This is my brain sending me a false message.” This step is designed to assign the relabeled compulsion to act or think in a certain way to its proper source.

In Step 1 you recognized that the compulsion to engage in the addictive behaviour or self-damaging thought pattern does not express a real need or anything that “must” happen, only a false belief. In Step 2 you state very clearly where that urge originated: in neurological circuits that were programmed into your brain long ago, when you were a child. It represents a dopamine or endorphin “hunger” on the part of brain systems that, early in your life, lacked the necessary conditions for their full development. It also represents emotional needs that went unsatisfied.

Reattribution is directly linked with compassionate curiosity towards the self. Instead of blaming yourself for having addictive thoughts or desires, you calmly ask why these desires have exercised such a powerful hold over you. “Because they are deeply ingrained in my brain and because they are easily triggered whenever I’m stressed or fatigued or unhappy or bored.” The compulsion says nothing about you as a person; it is not a moral failure or a character weakness, just the effect of circumstances over which you had no control. What you do have some control over is how you respond to the compulsion or negative belief in the present. You were not responsible for the stressful circumstances that shaped your brain and worldview, but you can take responsibility now.

Step 3: Refocus
In the Refocus step you buy yourself time.

Although the compulsion to open the bag of cookies or to turn on the TV or to drive to the store or the casino is powerful, its shelf life is not permanent. Being a mind- phantom, it will pass and you have to give it time to pass. The key principle here, Dr. Schwartz points out, is this: “It’s not how you feel; it’s what you do that counts.”

Rather than engage in the addictive activity or indulge in the negative self-talk, find something else to do. Your initial goal is modest: buy yourself just fifteen minutes. Choose something that you enjoy and that will keep you active: preferably something healthy and creative, but anything that will please you without causing greater harm. Instead of giving in to the siren call of the addiction or sinking into the familiar despair of negative self-belief, go for a walk. if you “need” to drive to the casino, turn on the TV. If you “need” to watch television, put on some music. If you “need” to buy music, get on your exercise bike. Whatever gets you through the night—or at least through the

next fifteen minutes. “Early in therapy,” advises Jeffrey Schwartz, “physical activity seems to be especially helpful. But the important thing is that whatever activity you choose, it must be something you enjoy doing.”

In the case of self-deprecating thought patterns, you may wish to refocus on what is loving and alive in your life, on possibilities you have fulfilled or have glimpsed, on what you have contributed to yourself or to others, on people you have loved or have offered you love.

The purpose of Refocus is to teach your brain that it doesn’t have to obey the addictive call. It can exercise the “free won’t.” It can choose something else. Perhaps in the beginning you can’t even hold out for fifteen minutes—fine. Make it five, and record it in a journal as a success. Next time, try for six minutes, or sixteen. This is not a hundred-meter dash you have to win, but a marathon you are training for. The successes will come in increments.

Once again, with self-negating thought patterns, refocus by recalling (and writing down) aspects of your life where you have honoured yourself, times when you have stood authentically in your true power, when you have spoken your truth, when you have acted out of genuine regard for yourself and/others.

Step 4: Revalue

This step should really be called Devalue. Its purpose is to help you drive into your own thick skull just what has been the real impact of the addictive urge or self-demeaning thought in your life: disaster.

The addicted mind has been fooled into making the object of your addiction the highest priority. Addiction has taken over your attachment/reward and incentive/ motivation circuits. Where love and vitality should be, addiction roosts. The distorted brain circuitshave you believe that experiences that can authentically only come from genuine intimacy or creativity or honest endeavour will be yours for the taking through addiction. In the Revalue step you devalue the false gold. You assign to it its proper worth: worse than nothing.

What has this addictive urge done for me, you ask. It has caused me to spend money heedlessly, or to stuff myself when I wasn’t hungry, or to be absent from the ones that I love, to take on tasks that have stressed me, or to expend my energies on activities I later regretted. It has wasted my time. It has led me to lie and to cheat and to pretend —first to myself, and then to everyone close to me. It has left me feeling ashamed and isolated. It promised joy and delivered bitterness. The real “value” of my addictive compulsion has been that it has caused me to betray my true values.

Be conscious as you write this out—and do write it out, several times a day if necessary. Be specific: what has been the value of the urge in your relationship

with your wife? Your husband? Your partner, your best friend, your children, your boss, your employees, your co-workers? What happened yesterday when you allowed the urge to rule you? What happened last week? What will happen today? Pay close attention to what you feel when you recall these events and when you foresee what’s ahead if you persist in permitting the compulsion to overpower you. Be aware. That awareness will be your guardian.

Do all this without judging yourself. You are gathering information, not conducting a criminal trial against yourself. Jesus said: “If you bring forth what is within you, what you have will save you.”1 That is true in so many ways. Within you is knowledge of the real value of the impulses you have up until now obeyed. To quote and paraphrase Dr. Schwartz, the more consciously and actively you come to revalue the addictive drive in light of its pernicious influence on your life, “the more quickly and smoothly you can perform the Relabel, Reattribute and Refocus steps and the more steadily your brain’s ‘automatic transmission’ function returns. Revaluing helps you shift the behavioral gears!”

Dr. Schwartz advises what he calls the two A’s: Anticipate and Accept. Anticipate that the compulsive drive to engage in addictive behaviour will return. There is no final victory—every moment that the urge is turned away is a triumph. Anticipate relapse, and accept that the addiction/recurrent thought form exists “not because of yourself, but despite yourself.” You never came into life asking to be programmed in this way. It’s not personal to you—millions of others with similar experiences have developed the same mechanisms. What is personal to you is how you respond to

it in the present. Keep close to your impartial observer. 

Step 5: Re-create

Life, up until now, has created you. You’ve been acting out of ingrained mechanisms wired into your brain before you had choice in the matter, and its out of those automatic mechanisms and long-ago programmed beliefs that you have created the life you now have. It is time to re-create: to choose a different life.

You have values. You have passions. You have intention, talent, capability. In your heart there is love and you want to connect that with the love in the world, in the universe. As you relabel, reattribute, refocus and revalue you are releasing patterns that have held you and which you have held onto. In place of a life blighted by your addictive need for acquisition, self-soothing, admiration, oblivion, meaningless activity: what is the life you really want? What do you choose to create?

Write down your values and intentions and, one more time, do so with conscious awareness. Envision yourself living with integrity, being able to look people in the eye with compassion for them--and for yourself. The road to hell is not paved with good intentions. It is paved with lack of intention. Re-create. Are you afraid you will stumble? Of course you will: that’s called being a human being. And then you will take the four steps--plus one--again.