Should I Change Addictions One at a Time, or All at Once?
- By A. Tom Horvath, Ph.D.
- Published 17/02/2009
- Advice
- Unrated
A. Tom Horvath, Ph.D.
Adapted with permission from an article originally published in the SMART Recovery newsletter. A. Tom Horvath, Ph.D., ABPP, is a board certified clinical psychologist and president of Practical Recovery (addiction treatment), an addiction treatment facility in La Jolla (San Diego), CA, focusing on collaborative care and self-empowerment.
View all articles by A. Tom Horvath, Ph.D.
Most people have more than one significant addiction. Smokers tend to be drinkers. Gamblers tend to be drinkers and smokers. Coke or heroin users tend to use other drugs also. If I have more than one addiction, and am ready to change several (not necessarily all): how should it be done? Should I attempt to change all of them at once? One at a time? If one at a time, the biggest or smallest first?
There does not appear to be any scientific basis for answering these questions. This article will review some of the issues you might consider in making your decision.
It is ironic that these questions, which typically are of great interest to many who are changing addictions, have been addressed little by research. Clinical experience is clear, however, about what most individuals actually do. Most change is brought on by some form of "crisis." Consequently, initial change efforts are aimed at the addiction, or possibly the cluster of addictions, that have brought on the crisis. For instance, a drunk driving arrest might bring on interest in reducing drinking, but no initial interest in stopping smoking. A doctor's warning about needing to lose weight would probably not also lead to interest in reducing gambling. A relationship crisis might lead one to aim toward being less dependent on the relationship for organizing one's life, but not increase interest in reducing pot smoking.
So, if you want to be in the company of most people who change addictive behavior, you would probably just change the addiction or addictions that led to the crisis. Of course, dealing eventually with the others would prevent more crises later!
Even
if you want to focus only on the addiction that brought on the crisis, there is another factor to consider if you want to be effective. Are there other addictions that lead to the “crisis” addiction? Or are you using other addictions as a way to cope with not having the crisis addiction? For instance, does smoking lead to having a drink, or does it help you cope with not having a drink? If smoking is a way to cope, then it might not be crucial to address smoking and drinking at the same time. If smoking seems to set the stage for drinking, addressing both simultaneously is probably necessary to dealing effectively with drinking.
What about dealing with the smallest or largest addiction first? If you are not in crisis, starting with the smallest might help build your confidence. The process of changing an addiction (building motivation, coping with craving, identifying and resolving the problems the addiction helps you cope with, and building new satisfactions and better relationships into your life) is the same regardless of the specific addiction, or the degree of severity. Starting with a smaller addiction would help prepare you for changing a larger one.
You might also consider dealing with all your addictions at the same time, whether you are in crisis or not. A major advantage of this approach is that you can get through the transition period (generally the first few weeks, sometimes up to 3 months) all at once. Even though this method is less popular then one-addiction-at-a-time, it can work well. It would be particularly important in this approach to prepare for the difficulties you will likely face. For instance, if you expect to be irritable, arrange your life so that it will be as peaceful as possible for awhile (e.g., take time off work if possible).
There does not appear to be any scientific basis for answering these questions. This article will review some of the issues you might consider in making your decision.
It is ironic that these questions, which typically are of great interest to many who are changing addictions, have been addressed little by research. Clinical experience is clear, however, about what most individuals actually do. Most change is brought on by some form of "crisis." Consequently, initial change efforts are aimed at the addiction, or possibly the cluster of addictions, that have brought on the crisis. For instance, a drunk driving arrest might bring on interest in reducing drinking, but no initial interest in stopping smoking. A doctor's warning about needing to lose weight would probably not also lead to interest in reducing gambling. A relationship crisis might lead one to aim toward being less dependent on the relationship for organizing one's life, but not increase interest in reducing pot smoking.
So, if you want to be in the company of most people who change addictive behavior, you would probably just change the addiction or addictions that led to the crisis. Of course, dealing eventually with the others would prevent more crises later!
Even
What about dealing with the smallest or largest addiction first? If you are not in crisis, starting with the smallest might help build your confidence. The process of changing an addiction (building motivation, coping with craving, identifying and resolving the problems the addiction helps you cope with, and building new satisfactions and better relationships into your life) is the same regardless of the specific addiction, or the degree of severity. Starting with a smaller addiction would help prepare you for changing a larger one.
You might also consider dealing with all your addictions at the same time, whether you are in crisis or not. A major advantage of this approach is that you can get through the transition period (generally the first few weeks, sometimes up to 3 months) all at once. Even though this method is less popular then one-addiction-at-a-time, it can work well. It would be particularly important in this approach to prepare for the difficulties you will likely face. For instance, if you expect to be irritable, arrange your life so that it will be as peaceful as possible for awhile (e.g., take time off work if possible).