Taking an “Opposite Action” to Prevent Relapse

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When intense emotions lead to strong urges, taking an opposite action can help you make choices that preserve your sobriety.¹ Addiction and substance use disorders can cause urges to use alcohol or drugs, even after you have completed a recovery program.^{2, 3} The concept of the opposite action is a form of emotional regulation that can help you manage these urges.

In this article:

• Dialectical Behavior Therapy and Opposite Action
• Opposite Action in Theory
• Opposite Action in Practice
• DBT in Alcohol Addiction Treatment

Dialectical Behavior Therapy and Opposite Action

In the past, when treating addiction to drugs or alcohol, relapse prevention was the focus of recovery after successful completion of a rehabilitation program.³ Today, many addiction treatment professionals prefer to teach skills that help people maintain changes they made in rehab after leaving treatment.

Therapists use behavioral therapies and skills training to support your ability to safely respond to symptoms of substance use disorders, like urges to use substances. These behavioral therapies also improve your ability to care for your own mental health and wellness.

Therapists who use dialectical behavior therapy (DBT) work to foster a mindful “here-and-now” approach to overcoming personal challenges, mental health disorders, and addiction. DBT introduces mindfulness-based skills, like the concept of the opposite action, that you can use to stay focused on your recovery. Researchers suggest that DBT, which was developed in the 1970s, and other behavioral therapies that use mindfulness “have breathed new life into” addiction treatment.⁴

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Mindfulness skills teach you how to notice emotions, thought patterns, and experiences you have in yourself and the world around you.^{3, 4} These skills help you become aware in a non-judgmental, non-reactive way.^{3, 4}

Awareness allows you to identify triggers that lead into other emotions, thought, patterns or experiences. For example, you may be able to pinpoint which emotions lead increased cravings alcohol, which thought patterns lead to romanticizing past substance misuse, and which experiences intensify your urges to use substances.⁴ Noticing these experiences can help you practice understanding and acceptance instead of avoiding unpleasant realities.

With the DBT skill of opposite action, you can use this information to preserve your efforts to recover from addiction, manage intense or unpleasant feelings, and make choices that align with your personal values.^{4, 5}

Opposite Action in Theory

As its name suggests, the opposite action technique encourages you to engage in actions that represent the opposite of what your emotions urge you to do.⁶ Emotions, even the painful ones, constitute both real and valid experiences. Research suggests that it even make sense to experience strong emotions that are potentially triggering as a reaction to certain circumstances.¹ Strong emotional reactions can be part of a learned response pattern or even part of processing invalidating or traumatic experiences without the “buffer” of alcohol to numb the intensity of those experiences. Taking an opposite action entails acknowledging what you feel and working to reduce the intensity of the emotion or foster a different emotion.⁶

Learning to self-regulate emotions is an important skill for many individuals in addiction recovery. Many individuals self-report that their substance misuse formed as a coping mechanism for avoiding difficult experiences or emotions like stress, managing mental and emotional symptoms of underlying conditions like anxiety, or distracting from or decreasing the intensity of emotional pain. DBT and other behavioral therapies prioritize the recognition of these patterns and the mindful response to them that can create new patterns, including long-term addiction recovery. ³

Opposite action brings attention to changing how you respond to unhelpful thoughts and feelings.⁵ Take the term “avoiding relapse,” for example. Those words may trigger obsessive thoughts about how much you need to stay sober, which can lead to you actually spending more time thinking about drinking alcohol. By placing a strong emphasis on “relapse prevention,” therapy may trigger the exact thoughts and memories that you would like to avoid. For someone who does not want to alcohol or other substances, these thoughts might create anxiety, fear, or self-doubt.

Instead of focusing on “avoiding relapse,” opposite action can prompt you to consider something different, like “maintaining recovery-focused changes.”^{3, 6} Focusing on the opposite actions in these situations means acknowledging the way you feel and focusing your attention on choices that can help you maintain your addiction recovery goals.^{3, 6}

In this example, when you feel you are “white knuckling” alcohol relapse prevention, the emotion that comes up—such as anxiety—may make you feel like you should do things like:

• Exert a hyper-level of control over your behavior
• Avoid going out in order to avoid potential triggers
• Stop consuming media just in case you encounter a depiction of alcohol

But strict control and isolation like these example instinctive responses may come at the sacrifice of personal care tasks, social interaction, and personal interest activities.

To practice taking an opposite action, you decide what the opposite of what your emotions are “telling you to do” would be. You can decide on your opposite action with the help of your DBT therapist.

In this example, when you feel intense anxiety about the possibility of relapse, you can sit with the feeling for as long as you need to, but your goal is to avoid doing what you instinctually want to as a result of the emotion. Your opposite action could be:

• Doing you enjoy to remind yourself that doing so doesn’t jeopardize your sobriety, such as watching a familiar movie
• Reaching out to a friend to talk about something you both love
• Doing a sober, but not explicitly recovery-focused activity to remind yourself that you have many facets in addition to your recovery journey and that you can maintain your sobriety without that being the only thing in your life
• Going out with a sober friend or loved one to a place where you feel safe or holding a sober activity with them at home, such as a game night

Opposite Action in Practice

Taking a step-by-step approach to opposite action can help you apply this technique in a structured, mindful manner.⁶

Emotional Check-In

You can begin to use this technique by acknowledging the emotions that you feel. Feelings differ from thoughts and include experiences like:

• Happy
• Sad
• Afraid
• Resentful
• Angry

Doing opposite action work with your therapist can help you pin down the exact nature of feelings you are having a hard time identifying. For example, if expressing your emotions was discouraged in childhood, you may have a difficult time recognizing emotions such as anger. Anger may feel like another emotion or no emotion at all.

When you put these emotions into words, you can better acknowledge how you feel. Maybe you have more than one feeling at a time. That’s okay too! Just put those different emotions into words and recognize that they exist.⁶

Once you take some time to describe your feelings, consider how strong they feel.⁶ Intense feelings may offer important information and guidance on how to act.¹

Consider how well the feelings, and their intensity, fit the situation you face. The intensity of your emotions, strong or weak, can give you clues about how they impact your behavior. Disproportionate emotions may not be caused directly by the current situation, but by something the situation reminds you of. These extremely intense emotions may be particularly likely to become overwhelming and motivate you to act in ways that could interfere with recovery.

Actions and Opposite Action

At this point, you can start to connect your feelings to the actions you take.⁶ What do you notice in your body, your face, and how do you relate to others? Do your emotions match your behavior?¹ Does your behavior match the situation you are in? Notice how your emotions influence the way you act and begin to consider whether you need to take opposite action.

Now, consider your potential opposite actions.⁶ Imagine, as an example, that a situation at home or at work has become stressful and in response, you begin to feel angry or upset. Maybe you notice that your face has begun to tighten. In the past, you may have engaged in an argument, yelled, or had a drink when you became upset in similar situations. Opposite actions might include intentionally loosening your facial muscles, speaking calmly, taking a time out, or taking care of your body in a different way without the use of substances.

Get specific, both about what your emotion drives you to do and the opposite action of that behavior. Getting specific about the emotions you feel, behaviors you want to change, and the opposite, recovery-focused choices you want to make can help you commit to this new plan of action. Your therapist can help you work through issues you may encounter, like difficulty linking a behavior to a specific emotion or deciding on an appropriate opposite action for a certain urge.

Commitment and Self-Reflection

Commitment takes consistent practice and self-reflection. Remembering how emotion-driven behavior has affected you in the past can remind you of the importance of practicing opposite actions. When you set time aside to practice opposite actions, consider the impact that self-regulating your emotions can have on how you interact with others, progress in recovery, enjoy activities, and progress in other life areas. Think about the consequences of your past actions and what consequences you would like to see with your opposite actions.⁶

Continue to check in with how you feel. Your therapist may prompt official check-ins during sessions, but you can check-in with yourself as it feels useful. Take note of changes you observe in your emotions. Consider how well your opposite actions are working and whether there are other opposite actions that you want to take. You can use a journal, guided daily reflections, or other type of log to keep track of changes in your feelings and behavior that you observe over time.⁶ This log can be helpful for identifying aspects of the opposite action skill you would like to work on with your therapist.

DBT in Addiction Treatment

Opposite action, and other DBT interventions, are often used in combination with other addiction treatment approaches.³ Using multiple approaches to recovery can help you get the support you need to heal in several areas of your life.

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For example, many individual therapists use a combination of therapeutic modalities as they continue to assess your needs. Your therapist may use exercises from other modalities—like exposure therapies such as EMDR, grounding techniques based in somatic experiencing therapy, and exercises from cognitive-behavioral therapy (CBT)—to offer you holistic sessions based on your background and diagnoses.

If you participate in other types of therapy, the clinician may use DBT exercises to enhance the quality of the sessions. The dialectical thinking that gives DBT its name—essentially holding two opposing but true thoughts at the same time—may be used in family or group therapy, as well as in motivational interviewing sessions. For example, motivational interviewing can involve acknowledging both that using substances gave you some sense of pleasure that you may intensely miss on difficult days, while also acknowledging that sobriety gives you clarity, control, and safety that you cannot experience if you continue to use substances. Holding both these ideas simultaneously can help you find the motivation to accomplish recovery-focused tasks.

Substance use disorder treatment may also include:³

• Medication management
• 12-step, peer-led, or mutual support groups like Alcoholics Anonymous (AA)
• Case management
• Sober living accommodations
• Community supports

Addiction treatment does not have a “one-size-fits-all” approach. If you think that DBT or another mindfulness-based approach to treatment might match your needs, seek a program that can offer you those interventions. Ask the staff who coordinate care if the therapists at their program have credentials and experience in providing DBT services.⁷

For more information on treatment programs and how they can support your recovery, call 800-948-8417 Who Answers? to speak with a treatment specialist.

Resources

1. Musch, S. The Magic of Opposite Action. University of Oregon, University Health Services Counseling Services.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
3. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: A guide for professionals, 2nd ed. The Guilford Press.
4. Stotts, A. L., & Northrup, T. F. (2015). The promise of third-wave behavioral therapies in the treatment of substance use disorders. Current opinion in psychology, 2, 75–81.
5. Freedman, P. A. (2018). The Addiction Recovery Workbook: Powerful skills for Preventing Relapse Every Day. Althea Press.
6. Mckay, M., Wood, J. C., & Brantley, J. (2007). The Dialectical Behavior Therapy Skills Workbook.. New Harbinger.
7. National Institute on Alcohol Abuse and Alcoholism. (2020, November 23). Step 2 – Ask 10 recommended questions. U.S. National Institute of Health.