Avoiding is a primary defense that many people suffering from substance abuse use to not face the realities of their addiction. This is actually a source of suffering. Acceptance is the process of coming to terms truthfully with their situation. It focuses neither on the past, nor the future, but rather, the present moment. Read on to learn more about the role of acceptance in recovery from substance abuse.
The Role of Acceptance in Addiction Recovery
Acceptance is a central part of many approaches to recovery from addictions. Chen has nicely summarized this as “Self-acceptance is an underlying mechanism that addresses the cyclical nature of shame, guilt and Substance Use Disorders (SUDs). It improves emotional dysregulation, psychological well-being, and activates a change process of recovery from SUD” [1].
Acceptance is a key element of several main therapy approaches to working with SUD. They include:
In AA and NA
In the current Alcoholics Anonymous (AA) and Narcotics anonymous (NA) 12-steps model of recovery, acceptance is featured in Step 6 as “acceptance—accepting character defects exactly as they are and becoming entirely willing to let them go” [2]. “By showing ourselves acceptance and then submitting to a higher power, we can work toward letting go of the behaviors that are holding us back from truly achieving our goals.” [3]
Now AA has a long history of success, but for many the submission to a higher power does not sit comfortably. There are alternative agnostic approaches such as SMART Recovery and Secular Organizations for Sobriety (S.O.S) which do not require this belief but still feature the role of acceptance.
In Mindfulness Meditation
The concept of acceptance is a powerful one which resonates with many and ties into similar concepts such as the Buddhist, Indian and Indigenous American teachings of mindfulness and contemporary practices of mindfulness meditation. Mindfulness centers around the use of attention to monitor your present moment experiences and a mental attitude of acceptance toward momentary experience. Paying attention to your behaviors and taking responsibility for them in each moment is similar to the practice of mindfulness.
In Dialectical Behavioral Therapy
“It is what it is” is the mantra of Radical Acceptance which is one of the key tenets of learning Distress Skills in the Dialectical Behavioral Therapy (DBT) psychotherapeutic approach. Radical Acceptance means complete and total acceptance of all facets of the situation you find yourself in, without judgment of yourself, the situation or others. Radically accepting a situation whether little or big, like trauma, does not mean you agree with it or approve of what happened. It is simply letting go so you can move on with your life [4].
In Acceptance and Commitment Therapy
A relatively new evidence-based approach to psychotherapy is Acceptance and Commitment Therapy (ACT). ACT has been very successful when used with people who have SUDs. In simple terms it teaches people to accept rather than avoid life’s realities.
ACT “rests on the fundamental principle that pain, grief, disappointment, illness and anxiety are inevitable features of human life.” Its therapeutic goal is to help “individuals productively adapt to these types of challenges by developing greater psychological flexibility rather than engaging in counterproductive attempts to eliminate or suppress undesirable experiences. [5]”
How Can Acceptance Help You Recover?
Acceptance unlocks the door to:
- Truly recognize your addiction and its impact on you and others.
- Recognize your inability to control your addiction without help.
- Develop skills to manage emotional and psychological distress.
In the case of ACT, it places the process of acceptance at the core and combines this with aspects drawn from both CBT and Mindfulness. ACT’s main focus is on psychological flexibility. That is your ability to confront the present moment and alter your actions to achieve a desired effect. The core with SUDs is for you to accept the urge and symptoms related to substance misuse (acceptance) and then use psychological flexibility and other techniques to reduce the urge and symptoms (commitment) [6].
In contrast to Cognitive Behavioral Therapy (CBT), in which people try to avoid or replace the urge and symptoms of SUD with more positive things, with ACT the person confronts and accepts that they exist and then looks for ways to improve or overcome challenges.
How to Practice Acceptance in Addiction Recovery
In AA or NA, acceptance is one of the central tenets of recovery, yet one of the most difficult to understand and achieve. Continued shame, anger, self-pity and fear show that you haven’t fully accepted your disease. Acceptance means learning to release control, realize your limitations and face reality. It requires allowing ourselves to live in the moment and perceive what is happening without judgment. It requires both rational and emotional acceptance.
Mindfulness Meditation centers around paying attention on purpose to the current moment, with acceptance. It involves a focused practice of developing the awareness of all aspects of your experience—physical sensations, feelings and thoughts—in a non-judgmental manner and without being reactive. This allows you to deliberately choose where to focus your attention at any time and how to respond appropriately to unpleasant or stressful situations or symptoms.
In DBT, Turning the Mind is an important practice to facilitate radical acceptance which requires accepting your situation over and over again. If you start to stray from that practice, Turning the Mind is the skill you use to come back to your path of acceptance.
In ACT, six processes of adaptation are used: acceptance, diffusion, flexible attention to the present moment, self-as-context, values and committed action. ACT can have the following benefits [A]:
- Acceptance allows you to think about your problems without developing anxiety or feeling guilty.
- Cognitive diffusion enables you to have negative thoughts and emotions to challenge your behavior without fixating on them.
- Mindfulness helps you be aware of negative feelings without being judgmental towards yourself or trying to change the situation.
- Commitment helps you achieve your long-term goals by focusing on the values that will help you get better.
- ACT helps you become psychologically more flexible.
Path of Recovery
Depending on which approach is taken, there are a wide variety of paths to recovery. Acceptance is key to all of these.
12-Step programs have a clearly articulated set of steps, traditions and methods to follow that allows for little flexibility and requires belief in a higher power. SMART Recovery and Secular Organizations for Sobriety (S.O.S) have a similar program but on an agnostic basis.
DBT and ACT have their own well-thought-out therapeutic approaches which have proven effective. Acceptance is central to both.
Mindfulness is an approach that has been adapted and incorporated in all of these approaches. The recognition of acceptance, which largely derives from mindfulness meditation, has increased in the last forty years and research on the effectiveness of these methods is growing.
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Sources
[1] Chen, G. 2021. The Role of Acceptance and Change in Recovery from Substance Use Disorder. Journal of Psychoactive Drugs.
[2] Buddy T. 2024. What Are the 12 Steps of Recovery?. verywellmind.
[3] Buddy T. 2023. AA Step 6 of the 12-Step Program. verywellmind.
[4] Radical Acceptance & Turning The Mind. DbtSelfHelp.com
[5] Dindo, L. et al. 2017. Acceptance and Commitment Therapy: A Transdiagnostic
Behavioral Intervention for Mental Health and Medical Conditions. Neurotherapeutics (2017) 14:546–553.
[6] Osaji J, Ojimba C, Ahmed S. The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature. J Clin Med Res. 2020 Oct;12(10):629-633
Lacey graduated from Brand University with a MA in Psychology, Marriage & Family Therapy. Lacey is a skilled clinician, supervisor, and administrator with extensive therapy experience. She is responsible for providing clinical leadership and policy direction for our program and maintains accepted standards of medical practice throughout the facility.
