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Section 6
Decision-Making

Question 6 | Answer Booklet | Table of Contents

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In the last section, we talked about five common myths that addicts believe about expressing feelings.  These myths were they will be unable to stop crying; that acknowledging grief and disappointment will damage them; that they will become impulsive or violent if they express anger; that expressing feelings will increase their pain; and that positive feelings will get them hurt.

In this section, we will be discussing the six steps in making an effective choice.

For clients with addictive personalities, as you know, often they have difficulty in making decisions and choices. Recall Amanda’s case from section 3 on the Internal War. Amanda age 35 was going through a divorce. Her history of addictions with both alcohol and cocaine left her in a dilemma regarding custody of her children.

Amanda stated, "I couldn’t think. Every time I tried to decide what to do, my mind would jump around. After a while, I would get tired of trying to think about what was best for custody with my kids." Ultimately, Amanda was making no decision, and put off thinking about the situation for another day, then another day, and another day and so on.  Does this putting off of decisions sound familiar?

Clearly, addicts like Amanda need guidelines regarding how to make decisions.

♦ Amanda's 6 Steps of Decision-Making
-- 1. Paying attention to internal and external clues,
-- 2. Using both intuition and practical reasoning,
-- 3. Evaluating options and their short- and long-term results,
-- 4. Making a choice,
-- 5. Committing to the choice, and
-- 6. Adapting to the unexpected. 

As I outline these 6 steps, you might evaluate whether playing this section during a session with a client who is needing to make a decision might be beneficial.

Step #1 - In the first step, Amanda needed to pay attention to both internal and external clues regarding custody. She needed to deliberately and consciously choose to focus her awareness on all information that may have aided her in making the necessary choice. As you may realize, paying attention to these clues itself is both a choice and a commitment to find a new, more effective way to think about decisions.

I asked Amanda to pay attention not only to what she wanted from this situation but also what others wanted.  She stated, "I knew I wanted to keep my kids just to myself, but sometimes I could tell that staying with me was not what they wanted. I knew my ex-husband was concerned about it, too, because I had said some pretty damn bad things to the kids in the past."

Step #2 - Second, Amanda needed to be creative. I told her that she should use a combination of intuition and practical reasoning. As you know creativity leads to new ideas and risk-taking by trying new ideas and rejecting old ways. I asked Amanda to use her intuition to consider other options or possibilities instead of simple black-and-white sole custody for either her or her ex-husband.

She stated hesitantly, "I guess we could try joint custody. I hadn’t thought of that before."

Step #3 - Third, I told Amanda to try to evaluate the options, considering both short- and long-term results of each choice. In some cases, clients with addictive personalities will have difficulty evaluating options. Amanda had difficulty understanding how to evaluate options. For clients encountering this barrier, a checklist for each option might be beneficial. 

Here is the check list:
1. Is this choice practical?
2. If not, are aspects of it practical, or can you make it practical?
3. What are the benefits?
4. What are the drawbacks?
5. Do you know the steps to follow to bring this choice about?
6. Do you feel good about this choice?
7. Does it make sense? Can you explain it clearly to someone else or on paper?
8. Would you advise a friend to make this choice?

Amanda wrote "I would have trouble advising a friend in my situation to pursue sole custody."

Step #4 - Fourth, I asked Amanda to make a choice. Usually, once an addict has completed the first three steps, making the choice is much easier than he or she anticipated. Amanda decided not to pursue sole custody. She stated, "I think it might be best for my kids if they have time with both of us. I can’t have them all the time."

Step #5 - I told Amanda that now that she had made a decision, the fifth step was to commit to acting regarding that choice. As you know the choice is not really made until a commitment to action is made.

In some of Amanda’s attempts to think about a solution, she would make a choice, but her lack of a commitment allowed her to second guess and doubt her decision and forced her back into limbo regarding the decision. To commit to the decision this time, Amanda said, "I will call my ex tomorrow to discuss joint custody as an option."

Step #6 - Finally, I told Amanda that she may need to be able to adapt to the unexpected. As you are well aware, addicts need to be able to adapt to the situation, or be willing to handle the changes and make choices again in the future. I told her that in this case regarding custody, just because she made a decision did not mean that her decision was set in stone.

A judge will have the ultimate decision regarding custody. Amanda looked hesitant, then stated, "I know sometimes I’ll need to adapt or be prepared for the unexptected. If my husband does not want joint custody and wants to try for sole custody for himself, my plans might have to change."

Do you have a client with an addictive personality who, like Amanda, has trouble making effective choices? Would he or she benefit from knowing the six steps to making an effective choice, 1. paying attention to internal and external clues, 2. using intuition and practical reasoning, 3. evaluating options and their short- and long-term results, 4. making a choice, 5. committing to the choice, and 6. adapting to the unexpected?

In this section, we have talked about the six steps of making an effective choice. The six steps of making an effective choice are 1. paying attention to internal and external clues, 2. using intuition and practical reasoning, 3. evaluating options and short- and long-term results, 4. making a choice, 5. committing to the choice, and 6. adapting to the unexpected.
Reviewed 2023

Peer-Reviewed Journal Article References:
Dijkstra, A., Jaspers, M., & van Zwieten, M. (2008). Psychiatric and psychological factors in patient decision making concerning antidepressant use. Journal of Consulting and Clinical Psychology, 76(1), 149–157. 

Field, M., Heather, N., Murphy, J. G., Stafford, T., Tucker, J. A., & Witkiewitz, K. (2020). Recovery from addiction: Behavioral economics and value-based decision making. Psychology of Addictive Behaviors, 34(1), 182–193.

Hallinan, S., Gaddy, M., Ghosh, A., & Burgen, E. (2021). Factor structure and measurement invariance of the Revised Brief Addiction Monitor. Psychological Assessment, 33(3), 273–278.

Kang, D., Fairbairn, C. E., & Ariss, T. A. (2019). A meta-analysis of the effect of substance use interventions on emotion outcomes. Journal of Consulting and Clinical Psychology, 87(12), 1106–1123. 

Piehler, T. F., & Winters, K. C. (2017). Decision-making style and response to parental involvement in brief interventions for adolescent substance use. Journal of Family Psychology, 31(3), 336–346.

QUESTION 6
What are the steps of effective choice that an addict might use? To select and enter your answer go to Answer Booklet.

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