Utilization sobriety: Brief, individualized substance abuse treatment employing ideomotor questioning

American Journal of Clinical Hypnosis,  Jan 2003  by Walsh, Bart J

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This article presents a substance abuse treatment method that acknowledges and accommodates the personal needs that are being addressed by substance. This method, Utilization Sobriety, bypasses perceived resistances and employs idiosyncratic psychobiological learning to achieve a body-mind gestalt that is complementary to the client's sobriety. It develops a safe framework for addressing any subsequent mental health themes directly or indirectly related to substance misuse. A treatment protocol for the use of Utilization Sobriety as well as relevant clinical material illustrating its application and a discussion of its implications are offered.

Key words: Alcohol, benefit state tool, drugs, gestalt, hypnosis, ideomotor, sobriety, utilization, substance abuse

The efficacy of hypnotic approaches to substance abuse treatment is both supported and challenged in the literature. Stoil (1989) notes the many confounding factors involved in accurately evaluating the usefulness of hypnosis in treating alcoholism and the difficulty distinguishing hypnosis from the therapies to which it is applied. Some position hypnotic methods for substance abuse treatment as uneventful, poorly defined, or ill advised because there is a lack of conclusive evidence to justify its application (Nash, 2001; Wadden & Penrod, 1981; Edwards, 1966). Those with successful outcomes, however, cite both the use of hypnosis as the sole treatment (Page & Handley, 1993) and also that of hypnosis used in conjunction with other treatment methods (Orman, 1991; Vandamme, 1986).

The approach this author calls Utilization Sobriety poses a commonsense way to work with people to change their substance use habits. By acknowledging, respecting and utilizing the gestalt an individual brings to treatment, the process is kept simple and very idiosyncratic. Treatment can then be responsive to a myriad of possible causal factors. Utilization Sobriety is a substance abuse treatment approach that employs conscious and unconscious communication which utilizes the individual's psychobiological learning about a particular substance for the achievement and maintenance of sobriety.

The hypnotic method known as ideomotor (idea/thought + movement) questioning is employed in the Utilization Sobriety approach. It is usually thought of as a way of communicating with deeper levels of mind that are commonly referred to as "unconscious". Development of "yes" and "no" finger signals, independent of conscious volition, can occur quickly and allows for the elicitation of deeper, less conscious responses. Ideomotor signaling occurs as a commonly observed phenomenon known as body language. During treatment questioning, naturally occurring responses such as a head nod may take place simultaneous with developed finger signals. Erickson (Erickson, Rossi, & Rossi, 1976) commonly worked with a client's ideomotor expressions and solicited responses via physical movements. Others have elaborated on the development of specific ideomotor signals and approaches to questioning unconscious process (Cheek & LeCron, 1968; Cheek, 1994; Rossi & Cheek, 1988; Rossi, 1986).

No formal trance induction is needed in the Utilization Sobriety procedure. Although the development of ideomotor finger signals may produce various levels of trance, it is only the establishment of the signals that is necessary for the treatment to be engaged. Questions are posed in a way that allows the subject's idiosyncratic needs to determine the development and depth of trance. The following treatment protocol outlines the initial phase of Utilization Sobriety treatment.

The Utilization Sobriety Protocol

The Utilization Sobriety protocol calls for ample client preparation for hypnotic work and the establishment of good rapport. This may involve providing information about unconscious process and functioning, referencing enhanced client control as inner resources are accessed, eliciting the client's picture of a goal achieved, and discussing possible awkwardness adjusting to the change. Once adequate preparation has taken place, subsequent steps can follow. They are:

1. Obtain a substance use history. Solicit information about client's current life circumstances.

2. Elicit and note words that describe any perceived benefit (emotional, intellectual, sensory, perceptual, behavioral, social etc.) of substance use for the client. This provides information about needs and coping strategies without inducing shame.

3. Ask the client "If it were possible, would you like to be able to experience the same benefits you derive from using X (the substance[s] in question) without actually using X?" If the response is affirmative, then provide more information about the unconscious access to stored memory of experience (behavioral, emotional, physiological etc.). Explain how the physiological system learned all about X after its first usage and encoded that information in the central nervous system as well as how learning can be retrieved and employed.