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The Wisdom to Know the Difference: An Acceptance and Commitment Therapy Workbook for Overcoming Substance Abuse

“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” This healing prayer has been adopted by Alcoholics Anonymous and other twelve-step programs and, with the advent of acceptance and commitment therapy (ACT), has found its way into modern behavioral science. The Wisdom to Know the Difference offers readers a unique path to treating alcoholism and drug addiction through ACT, which has been proven to be clinically effective for the treatment of alcoholism and substance abuse.

This workbook unifies the most widely practiced method of substance abuse treatment, the twelve-step program, with an empirically supported psychotherapeutic model, acceptance and commitment therapy (ACT). Each component of this ACT treatment plan has an explanation rooted in basic behavioral science, and readers will learn how these components fit into the twelve steps in Alcoholics Anonymous and similar programs. Written by Kelly Wilson, cofounder of the ACT treatment model, and Troy DuFrene, this workbook is accessible for all reading levels and can be used by those suffering from all forms of substance abuse.

Prologue
A Personal Story

God, grant me the serenity to accept the things I can’t change,

the courage to change the things I can,

and the wisdom to know the difference.

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You are not alone. I know the depths to which addiction can take a person, and I know something about recovery. I know it personally, and I know it as a scientist, therapist, and researcher. Woven into this book will be sensibilities science has to offer to the recovering person, but also some small bits and pieces of my own path in recovery and, finally, stories I’ve heard along the way.

The recovery process has been slow at times, even slower than baby steps. The best I’ve done some days was to sit on my hands. I’ve learned to appreciate even those days. If I’m sitting on my hands, it’s very hard to make much mess to clean up later.

I started down this road something like twenty-five years ago. There was a time, in the winter of 1985, when I would be up in the night, lying on the bathroom floor, heartsick, alone, the house quiet all around me. Lying on that floor, between bouts of retching, I found myself in a dreadful spot—impossibly trapped between an absolute inability to drink anymore and an absolute inability to stop. Lying on that floor, I could feel the cool of the linoleum on my cheek and it was good. There in the bathroom, in the middle of the night, tortured, I found a moment’s rest, my cheek pressed to the cool floor. My whole world was reduced to six square inches of cool linoleum. I could not leave that room without the terrors welling up around me. Even trying to rise from the floor filled me with awareness of all that I had done and regretted—and not done, and regretted more.

It was a starting point. From there, people began to teach me about acceptance and about holding my story in the world a little more gently, about letting go of limitations and opening up to possibility. By inches, I made my way up off the floor and out of that bathroom. I became engaged in the world in new ways. When I look where acceptance, openness, and engagement have taken me over the years, I have to pinch myself. I’ve fallen in love with people all over the world. I’ve become intimate with people and places and ideas that I could not have imagined. I’ve found souls all along the way who saw possibilities in me that I could not see in myself. And I’ve in turn had the privilege of seeing in others strength and beauty and possibility that they could not see in themselves.

And I can count a lot of days, a lot, between that barren winter of ’85 and this day, this morning, this moment—a lot of days when the best I could do was sit on my hands. And, today, I count those days sitting on my hands as good days. All in a row they brought me right here together with you.

Rest a while. There will be time. Perhaps we can sit together on our hands today. And tomorrow, there won’t be much mess to clean up. And we’ll rise together and sweep up and go about our day as best we’re able.

So if today is a day of hand-sitting, think of it as practice. The day will surely come when someone in need calls out. We’re not likely to be able to reach out and reverse time in their world—bring parents back from the dead, retrieve a lost opportunity or a lost love—any more than we can turn back the clock in our own world. But perhaps if we have practiced, we can sit with them, on our hands if it’s that kind of day, but together. And perhaps we’ll find a way in this world, just as it is, to fall in love, and see beauty and strength and possibility together.

If you’re reading this book, you know something about suffering. You know something about being stuck. Maybe you’ve sunk to the depths I had sunk to that dreadful winter of 1985. Perhaps farther, perhaps not so far. Still I will assume that you know something: something about despair, something about struggle, something about feeling trapped. You know that one’s own personal hell is always the one that burns hottest.

So, I offer this little book as a way of extending my hand to you. Twenty-five years ago a fellow named Tom extended his hand to me in my darkest hour. At the time, I wondered what his angle was, what advantage he hoped to gain. I had nothing really to offer in return. I lost track of Tom and it took a few years to sort out what he had wanted from me. Here is what he wanted: if that hand up helped me to find my feet in this world and helped to set me on a path, if that hand up moved my life to an inexplicably and unexpectedly better place, someone would eventually reach out to me for help. Tom knew that. When that day came, life would ask me a question: will you reach back? Tom’s hand was offered to me twenty-five-odd years ago in a locked psychiatric hospital in Seattle. It’s in the spirit of the kindness of that offered hand that I offer mine to you in the form of this book. Welcome. Welcome.

1
Many Paths to Recovery, but Only One for You

There are certainly many paths to recovery. But you’ll only take one. What’s the best choice for you? We don’t know. And you can never really know. You only get to live life once. However you live it, you won’t know how it would have gone had you lived it differently. Time runs in one direction. Scientific studies often tell us what happened on average to the people who got this or that treatment. We’ll cite some statistics in this book. But at the end of the day you won’t have something happen to you on average. Something very particular will happen to you. The best measure—and we’ll emphasize this over and over again—is how your path to recovery is working in your own life. We’ll hold onto this practical theme throughout.
What Lies Ahead

Our initial drafts of this book began without much in the way of introduction. Our intention was to not waste words talking about theories and principles. We wanted to get immediately to sharing things that would be of use to you as you move toward recovery. And in the end we remain committed to this approach. Kind friends, however, prevailed upon us during the writing process to offer a few words of introduction.

The substance of this book is grounded in a model of psychotherapy called acceptance and commitment therapy (ACT from here on, which should be pronounced as a word rather than separate letters.) ACT is an application of a discipline in psychology called behavior analysis. Unless you have an interest in the study of psychology, the only thing we want you to take away from this fact is that we’re concerned here with your behavior, with what you do, far more than we are with what you think or who you “are” in some abstract sense. Rather than explain too much about how ACT works as a model of psychotherapy, we’d rather keep writing to you about the issue of addiction and recovery and let the details of the approach come out in the process, in a commonsense, storytelling way rather than a deliberately professional or scholarly-seeming way. We will offer that the principles of ACT are being evaluated on an ongoing basis in research facilities all over the world, and that, from its earliest days, ACT has been applied to substance-abuse issues with good results. While what follows isn’t science, it is of science. This is important to us, and we hope it’s of some reassurance to you.

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Blending ACT and 12-Step

While this book is grounded in ACT, we’ve chosen to devote space in this book to discussing how an ACT approach to recovery can be woven into a 12-step recovery process, the kind of approach you would encounter at Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). ACT and 12-step are not a perfect fit for each other, but we think that they touch at enough points to make the two approaches work together well. In fact, we think there is an opportunity for the two models to support and inform each other.

We deliberately use the words “support and inform” with some care. This isn’t an AA book, and we are not proposing to speak authoritatively about AA or its methods. We believe, though, that AA’s basic writings suggest no one is in a position to speak or write this way. We recognize wisdom in the AA steps and traditions, and we acknowledge that many, many people have found their way out of addiction and to richer, more meaningful lives with the help of AA. We also note that AA comes from a storytelling tradition, a tradition that is grounded in the stories of its members and in the insight of their collective experience, rather than from a tradition of empirical observation, of science. We base this book on our assumption that the science-based principles of ACT and the narrative-evolved principles of AA, even if not a perfect match for one another, do overlap and interact in interesting ways. We believe that ACT can blend with and support AA recovery and, at the same time, lend the AA tradition the rigor of the laboratory.

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