This isn’t about addiction, but self-harm is not unusual in the addicts we serve.
A common motivation teenagers give is that non-suicidal self-harm provides a way to escape unpleasant thoughts and emotions. Another motive, little explored before now, is that self-harm is a way to deliberately provoke a particular desired feeling or sensation. A new paper from US researchers has explored this aspect of self-harm, known as “automatic positive reinforcement” (APR).
Edward Selby and his colleagues gave 30 teenagers who self-harm (average age 17; 87 per cent were female) a digital device to carry around for two weeks. Twice a day, the device beeped and the teens were asked to record their recent thoughts of self-harm, any episodes of self-harm, their motives, their actual experiences of what it felt like, as well as answering other questions.
Just over half the sample reported engaging in at least one instance of self-harm that was motivated by wanting to experience a particular sensation (and 35 per cent of all self-harm behaviours had this motive). The most common sensation the teenagers sought was “satisfaction” (45 per cent of them), followed by “stimulation” (31 per cent) and “pain” (24 per cent). Those were the hoped for sensations. In fact, pain was experienced more often than it was sought; stimulation was experienced as often as it was sought; and satisfaction was experienced less often than the teenagers wanted.
There were differences between the teenagers who self-harmed in order to produce a particular feeling and those who didn’t have this motive. The former group self-harmed more often during the study (and in the past) and they thought about self-harm more often and for longer. Those seeking a particular feeling from self-harm also engaged in more other risky behaviours including using alcohol, binge eating and impulsive spending. Zooming in on the different sensation motives, those teens seeking pain and stimulation tended to self harm more than those who sought satisfaction.
By way of quick review, “enabling” actually means doing positive things that will end up supporting continued negative behavior, such as providing your child with money so they won’t “go hungry” during the day, knowing they use it to buy pot. Another example is going to talk to your child’s teacher to make sure she doesn’t get a bad grade, even though her bad test score was due to drinking. Or calling your husband’s work to explain he’s sick today, when he’s actually hung over.
These are examples of doing something “nice” for your loved one that actually (from a behavioral reinforcement standpoint) might increase the frequency of the negative behavior, not decrease it. The logic: if they act badly and nothing happens, or something good happens, this behavior is encouraged, even if what you are doing is “nice”. This IS enabling, and this is not helpful in changing behavior in a positive direction.
But everything nice is not enabling! And that’s the quicksand we have developed in our culture. Staying connected, rewarding positive behaviors with positivity, being caring and loving; these things are critical to positive change.
So what’s the difference? Positive reinforcement is doing “nice” things in response to positive behavior. Simple as that. When your loved one wakes up on time in the morning, when he takes his sister to school, when she texts you tell you she’ll be late, when he doesn’t smoke pot on Friday night, when he helps you make dinner instead of going for a quick drink with the boys on the way home. These are positive actions, and acknowledging them, rewarding them, being happy about them, is a GOOD thing, not enabling.
Another study brings good news about adolescents and 12 step recovery:
The proportion attending 12-step meetings was relatively low across follow-up (24 to 29%), but more frequent attendance was independently associated with greater abstinence in concurrent and, to a lesser extent, lagged models. An 8-item composite measure of 12-step involvement did not enhance outcomes over and above attendance, but separate components did; specifically, greater contact with a 12-step sponsor outside of meetings and more verbal participation during meetings.
The benefits of 12-step participation observed among adult samples extend to adolescent outpatients. Community 12-step fellowships appear to provide a useful sobriety-supportive social context for youths seeking recovery, but evidence-based youth-specific 12-step facilitation strategies are needed to enhance outpatient attendance rates.
More evidence for the benefits of 12 step facilitation for adolescents:
Results of multivariate logistic GEE models indicated that adolescents with continued 12-Step attendance had better outcomes over time, whereas those in the early but not continued group had no different long-term outcomes compared to those in the low/no attendance group.
A problem, of course, is relatively low participation rates:
The majority (60%) had no or low attendance throughout 7 years. About one-fourth had high probability of attendance in the first year post-treatment entry but discontinued afterwards. Fewer than 15% continued 12-Step attendance throughout the 7 years
Among adolescents with substance use disorders, overall 12-Step attendance was low post-treatment, but robust connection with 12-Step groups was associated with better long-term outcomes. Findings highlight the importance of 12-Step attendance in supporting long-term recovery among adolescents, and suggest that strategies are needed to facilitate 12-Step attendance. Additional research is needed on how the frequency, intensity and duration of 12-Step meeting attendance, as well as the type of activity, is associated with beneficial effects, and whether the relationships vary for different subgroups. Policies to address specific adolescent subgroups, based on severity, age or other characteristics could then be developed for targeting 12-Step facilitation efforts.