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Solving a challenge to 'one day at a time'

April 11, 2014
by Jamie Marich, PhD, LPCC-S, LICDC-CS
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Jamie Marich, PhD

“One day at a time” is a slogan of recovery synonymous with the 12-Step path. Those who enter 12-Step treatment or meeting culture are likely to hear it at their first exposure, and even people outside the 12-Step sphere are familiar with the term. Movies such as “28 Days,” where Sandra Bullock’s recovering character Gwen protests, “What, like two or three days at a time is an option!”, and other pop culture references have made “one day at a time” more than just a 12-Step phenomenon. As a counselor and a recovering woman, I do not challenge the relevance of now-centered living and staying in today. My concern involves the irresponsibility of throwing this slogan at newly recovering people as an instant solution without helping them learn how to live one day at a time.

In this article, I will briefly explore why living one day at a time poses a particular challenge for newly sober people, especially those who are also struggling with unhealed trauma. Then I will explain how another buzzword in the helping professions, “mindfulness,” offers an elegant solution for helping people learn how to live in today, and more specifically in each moment.

Understanding the brain

For survivors of trauma, what happened 10, 20 or 50 years ago can quite literally seem like today. When newly recovering individuals allude to being stuck in their past, experiencing it like it’s still happening, it is not just a matter of “the disease talking” or such people “making excuses.” A simple understanding of how unprocessed traumatic memories affect the brain shows us how a wounded person’s past can still very much be his present.

Trauma, which comes from the Greek word meaning “wound,” is not just diagnosable post-traumatic stress disorder (PTSD); rather, it is any physically, spiritually, sexually or emotionally wounding experience that requires processing at the level of the brain. When traumas are not processed, it is like depriving a physical wound of the proper care it needs to heal fully. Yes, some wounds might clear up on their own, but many will leave lasting complications.

The limbic brain, also known as the mammalian brain or midbrain, is the central processing unit for mammalian learning and emotional response. Paul MacLean, originator of the triune brain model, explains that the limbic brain developed very early in mammalian evolution to regulate the motivations and emotions we now associate with feeding, reproduction and attachment behaviors. MacLean explains that everything in the limbic system is either agreeable (pleasure) or disagreeable (pain/distress), and survival is based on the avoidance of pain and the recurrence of pleasure.

The limbic brain contains the amygdala, the instinctive flight-fight response we associate with trauma, and the hypothalamus, associated with survival. The limbic brain, as this regulatory center, is also responsible for the dopaminergic responses of pleasure that we associate with being stuck in the addiction cycle.

Most important to recognize for this discussion, the limbic brain does not operate on the same rational sense of time we know as human beings. Quite literally, the limbic brain has no clock. Rational time management is a function of the cerebral cortex, unique to primates. When trauma goes unprocessed, it stays stuck in the limbic brain, which essentially keeps it stuck in the time that it happened. Once again, a trauma survivor’s felt sense of today might chronologically be many years in the past. Thus, adopting “one day at a time” living becomes easier said than done.

Twelve-Step traditionalists might argue that adopting another slogan, such as “fake it 'til you make it,” offers the solution for getting a person to shift into a “one day at a time” mindset, and that the person needs just to “keep coming back” to the support of meetings in order for it to click. While I’m not opposed to the logic in either of these slogans, I’ve consistently posited that this conventional 12-Step wisdom is not sufficient, especially when we are working with survivors of trauma.1

It is not enough just to barrage newly sober people with slogans and platitudes, either in treatment or in meetings. As professionals, our charge is to teach clients action-oriented skills for learning to be in the present moment without having to self-medicate or react to stress in an unhealthy manner. From a trauma-informed perspective, skills that are action-oriented and not just cognitive or verbal are optimal at working with the limbic brain.2 By learning, adopting and then practicing such skills with greater consistency, living one day at a time becomes more possible because we are helping clients to reorganize their neurological storage.

Introducing mindfulness

Mindfulness is a practice that, by its very meaning, can teach newly recovering individuals how to navigate the ups and downs of learning to live in the now. Mindfulness has attracted a great deal of attention in the helping professions in recent decades. In 2012 alone, there were approximately 500 peer-reviewed articles published that demonstrated the clinical benefits of mindfulness in a variety of populations, including those with addiction.3 However, there are still people out there who make the stereotypical assumption that mindfulness only means sitting in a perfectly postured lotus pose under a tree somewhere, while you rest in total silence with your hands fashioned in a pristine meditation gesture.

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Jamie

Thank you for this educational and insightful piece. We know so much more about the brain these days than we used to ah?

I think both of these are useful at different times for varying reasons. I like mindfulness as it can be really good at returning one to reality (not always welcome) but almost-always essential! And I like Day at a time because it somehow assists when you need to know that drug craving will be over at some point as long as we just don't insist it stops right now and then get the needle, when it doesn't (no pun intended)

Great to read that you a dr..

Andria

!

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