John Gottman and Nan Silver are the authors of The Seven Principles for Making Marriage Work. Their approach for couples wanting to improve relationships is based on a seven-week program focusing on the positive aspects of their partners and their current situation. They emphasize how easy it is to fall into negative patterns of behavior with loved ones.

At the Coleman Institute for Addiction Medicine, we work with people who are committed to making behavioral changes. Usually these clients are attempting to stop using alcohol (beer, wine, and/or spirits) or opioids such as morphine, heroin, Dilaudid® (hydromorphone), fentanyl, Percocet® (and other flavors of oxycondone), Vicodin® (and other flavors of hydrocodone).

Both good and bad behaviors are born from beliefs. Sometimes beliefs surrounding substance use and abuse are so old and so deep that our patients can’t quite remember how they influenced what has now become a very soul-sucking, hamster-wheeling addiction.

I like to emphasize how a thought repeated becomes a belief; how a belief repeated becomes one’s ‘personal religion’. As the reinforced thought is repeated over and over and over again, it begins to take up more and more ‘real estate’ in the brain, actually creating a neural default pathway. We then live our lives by the structures we’ve created—oftentimes when they are no working for us.


After a successful alcohol detox or ambulatory opioid detox at one of our many outpatient facilities, we recommend some type of therapy.

Cognitive behavioral therapy (CBT) is an effective therapy for people with Substance Use Disorder (SUD). And research indicates that the skills individuals learn through cognitive-behavioral approaches remain after the completion of treatment.

A tenet of cognitive behavioral therapy (CBT) is to notice or ‘catch’ the thoughts that don’t serve us, then challenge them. This can be difficult because once a neural pathway has been established our brains don’t always distinguish if this thought is good or bad, right or wrong, true or false; it simply becomes compelled to gather evidence to support whatever ‘fact’ we’ve created.

When people learn to bring awareness to this process, they recognize the freedom to choose and intentionally ‘gather evidence’ to support any one of these thoughts. Then they can escape the prisons they’ve created in the forms of crippling thoughts leading to destructive behavior patterns.

But establishing a new neural pathway takes practice.

Find a person who has made a significant behavioral change for the better. If you query them carefully, you will find this is exactly what they did, even if they weren’t aware this was going on at the time.

Just as Gottman and Silver have created an exercise to reinforce positive daily thoughts about one’s partner, this approach can be applied to any kind of behavior one is attempting to change.

There is great power in journaling. What if, after a detox, patients created their own list of replacement thoughts, supporting their efforts to be sober? What a great addition to a new morning routine!

I have created a suggested example here for a week, but this is clearly a personal exercise. Alcohol and opioids wreak havoc in infinite patterns for everyone seduced by their power.


Thought: I sleep better when I don’t drink alcohol.

Task: Describe a good night’s sleep you had when alcohol-free (AF).


Thought: My mind is sharper when I don’t drink alcohol.

Task: Name a situation where you were alcohol-free and your mind was clearer.


Thought: I eat more intentionally when I am alcohol-free.

Task: Describe a specific eating situation that was intentionally better because you chose not to drink.


Thought: I communicate more effectively with my partner (spouse, significant other…when I am alcohol-free.

Task: Describe such an incident.


Thought: I adhere to my exercise regimen more consistently when I am alcohol-free.

Task: Name a time you stuck to your exercise regimen because you weren’t drinking.

As our patients begin the journey towards long-term recovery, keeping track of the positive aspects on paper (or computer) can be a marvelous tool, especially when coupled with therapy and/or recovery meetings.

If you or a loved one are ready to begin the journey of recovery with a safe and comfortable detox, please call us at the Coleman Institute for Addiction Medicine. You may have some long held negative beliefs about what it means to detox off alcohol or opioids, and we may be able to offer you some alternative facts.

Joan R. Shepherd, FNP