The Smart Coach for Addiction and Behavior Therapy

Research is currently underway into which technical aids can help recover from addiction or unwanted behavior. The focus is on behavioral change before and during the moment of a relapse in substance use or behavior. These moments can be important learning moments during therapy.

Starting point

The Smart Coach Addiction and Behavior Therapy (SCAB) is based on immediately converting strong negative thoughts and feelings into a positive activity. This can prevent unwanted behavior. A sports watch is used as a supporting instrument in therapy . An example of this is to convert the negative spiral of craving in addiction into a positive one. Craving, also called ‘pull moment’, ‘yearning’ or ‘sigh’, is the crucial moment when a user makes the decision to use alcohol or drugs, or to gamble. If the user experiences craving and does not obsessively focus on the craving but trains himself to undertake another (sports) activity, recovery can be better achieved.

Goal

The purpose of the therapy is twofold. Firstly, the young person can gain insight into his negative lifestyle and learn how to change it. Second, the therapy is a diagnostic tool. If the young person is ultimately unable to change his lifestyle during therapy, he can be motivated to realize that other specialist assistance is needed to help him.

Collaboration agreement with parents and caregivers

Before starting therapy, it is important to enter into a collaboration. The therapy is primarily a work therapy in which parents/caregivers and the young person work together. It cannot and should not come from one side. Parents/guardians and the young person make agreements about what is expected of them. Agreements are also made here if the therapy is not sufficient and he or she wants to use other specialist help.

What is craving?

The moment an addicted person sees or smells the substance on which he is dependent, all kinds of physical and mental processes are activated. The body prepares to process the alcohol, cocaine or other substance. The senses play an important role in craving. The body predicts that the drug will be taken because it always happens that way. Pavlov’s conditioning theory plays a major role in this. It is important to know how the body will react. This varies per drug and person. For example, alcohol consumption lowers the internal body temperature and increases the heart rate. Alcohol therefore disrupts the balance in the body and the body will respond with a compensatory reaction to counteract the effect of alcohol. When you smell alcohol, the body will naturally become warmer and the heart will beat slower. This adjusts the body to the expected temperature drop and heart rate acceleration that will be caused by the alcohol. This preparatory compensatory reaction is experienced by the client as a strong and irresistible urge to drink.

Watch as a tool

It is not easy to detect craving. In addition, users normally do not pay attention to heart rate or blood pressure. Let alone that they pay attention to their health at all. As an addict you usually want to suppress two things; the cause of your addiction and the consequences of your addiction. A heart rate monitor from sports will be used as an important tool in this treatment.

Emergency plan

When the client signals craving or negative behavior in himself, he or she warns himself, as it were, by pressing the ‘alarm button’ on the watch. The program motivates you to take action. The action consists of making choices. With the help of a built-in training plan, the client is advised to follow a preset program. This can consist of a short or long walk, a bike ride or a moment of rest. During this moment, the client completes an ‘action list’ with actions to control the craving or negative behavior. If the action does not have the desired result, the client can contact his counselor or buddy. You understand that the client has to work hard to master these skills, but they will yield results in the long run.

Important functions for mapping pulling moments

We are not there yet with the watch alone. The watch that can be used during the treatment offers useful functions that are important to prevent a strong craving in the first place. For example, we use a sports watch with a GPS function. This application not only records (optionally) the abnormal heart rate that occurs during craving, it records the time of day, the number of times the person has a craving or unwanted behavior, and also the location where they are during the ‘action’. This is important information because cravings can arise at unexpected times. It happens to the client in predictable or unpredictable locations, for example in an entertainment center or shopping street when walking past the pub. Or just at home in the familiar place by the window or behind the TV, during an argument, stress or disappointment. Using the GPS function, the client will map the moments. It is not the case that the practitioner is constantly monitoring the client from behind his computer. That is not possible because the client has control and responsibility over his own data. The counselor or therapist discusses the results during a conversation with the client.

Color of the Smartcoach

The color of the Smartcoach is preferably orange. The reason for this is that orange symbolizes a choice. Just like at a traffic light, you have the choice to stop or continue driving. This gives the person the opportunity to make a well-considered choice. An appeal is made to personal responsibility and self-reliance. The coach’s respect for the person’s autonomy is also important here. This theme can be discussed in conversations using Socratic motivation to learn and promote the motivation for a good choice.

App and Smartphone

The therapy can also be applied via an App on a smartphone. However, this is not preferred because the target group following the therapy does not always show ‘stable’ telephone use. People regularly change phones, the phone is broken, stolen, sold, or confiscated, etc. Even though they carry the phone in their pocket, they may still find a certain action with an App too cumbersome. The Smartwatch is more durable and provides more stability. People wear it continuously, the watch is strikingly visible due to its color, requires a short action, can measure more functions, and offers additional benefits to motivate the person to exercise.

Self-sustainability

The method teaches the young person to become self-reliant during difficult moments. Young people do not often take the initiative to reach out when they are having a hard time. This may have to do with the fact that that skill has simply not been developed yet. With the sports watch he has an instrument at his disposal to learn this. He learns to convert negative thoughts into positive activities. This teaches him, for example, that craving is only a snapshot. By following the actions, the young person discovers that he can control the craving. Through this ‘smart coach’ he learns not to be dependent on others but discovers the strength within himself.

Diagnostics

The SCAB can function as a tool to make a ‘diagnosis’ of the current lifestyle of the young person. For example, if a young person has difficulty getting to school on time, the SCAB can be used. If the young person uses the Smartcoach correctly, his behavior can be mapped out after a few weeks and the coach can discuss this with him. In situations where the young person encounters difficult situations involving use, this can also be mapped out. Even if he has used the Smartcoach in the agreed period, the coach can discuss this with him.

Preventive

The SCAB method can be used to prevent serious addiction problems or psychological complaints by breaking a negative spiral. After all, exercise helps to become and stay physically and mentally healthy. It has been scientifically proven that exercise can reduce or prevent psychological complaints.
Young people who start using addictive substances at a young age learn a certain behavior as a result. The brains of adolescents, which are still developing, are, as it were, negatively ‘programmed’. If the use or behavior is repeated over a longer period of time, the person develops a ‘habit’ on which he becomes dependent. The brain comes to recognize use as a ‘pleasant function’ that it cannot function without. You can compare it with learning to read, write, cycle, recognize objects, etc. If the SCAB can be used early, there is a good chance of recovery from the influence on the reward system and the dopamine ‘household’. This can prevent addiction or negative behavior in the longer term.

Motivation

To use the therapy you must be motivated to stop your use or negative behavior. It is not the case that the sports watch itself facilitates recovery. No therapy has yet succeeded in this. However, that wouldn’t be good either. For example, if you have been addicted for ten years and use cannabis daily, it is not wise to stop overnight. It is wise to always do this under the care of a therapist.

Support

The therapy will always be accompanied by support from the GP and counselors who are trained for the therapy. However, the latter is not yet an issue as long as the therapy is still in the test phase. The GP provides important support when, for example, the client is taking medication for high or low blood pressure or other health disorders. The SCAB therapy can be combined with the Twelve Step program.

Running therapy

The SCAB has similarities with Running Therapy. The idea behind it is roughly the same. However, the most important difference is that the SCAB is primarily intended to break the negative patterns of addictive behavior. An additional advantage is the action of exercise and the positive effect this has on a physical and mental level.

Course of treatment

Before therapy can start, an intake interview takes place. The client is then referred to his or her own GP. It is fundamental that the GP is aware of the method of therapy. The client receives instructions on how to use the watch. In some cases he will also not stop using immediately. It is important that the client first maps out his heart rate and craving. This is an important part of the treatment because the user must unlearn his old behavior and then have to counter it with new behavior. Then, after he has learned new behavior, he will be able to confront himself with his old lifestyle. If the client has a partner, it is advisable to involve him or her in the treatment. After all, it is often the case that those around us have little or no understanding or insight into the ‘disease’ of addiction. Finally, the environment also benefits from the client’s recovery. With the help of the heart rate monitor and the various associated functions, it can be demonstrated that recovery is not an isolated process. Support and motivation from the partner can be very important here.

Score list

The therapy consists of six sessions of six weeks. A score sheet is completed during each session. This list is a measuring instrument to measure the results of the therapy. The score list consists of ten questions for which a maximum of ten points can be scored. The questions are designed in such a way that the client gets as positive a feeling as possible. After all, the target group that follows the therapy in most cases has a negative self-image. This method is aimed at approaching the young person positively. The young person completes the score sheet themselves, with the help of the coach or counselor. The Smartcoach is aimed at allowing the young person to do as much as possible themselves to improve self-reliance. When completing the score sheet, new goals are formulated for the next session.
So after six weeks, six score lists have been completed. The young person can therefore score a maximum of 60 points. In that case, the therapy has been positive and will be terminated. If the young person achieves a negative score, the therapy can be extended for another six weeks. All score lists together can be used as a diagnosis.

Duration of treatment

It is still difficult to say how long the treatment should last to provide ‘results’. This may differ per client. During therapy we will look at when a person regains control over his or her life.

Preventive therapy for young people with addiction

The method is primarily intended to be a tool to help young people stop their use or behavior. In practice, it is difficult to motivate young people for treatment for substance abuse or addiction. People often do not want to be admitted to a clinic at all. Above all, do not spend too long or too often in the consultation room. However, there are exceptions to this, for example when there is a serious addiction or GHB use. This method is, as it were, a ‘Smart Coach’ that provides instructions at the most difficult moments. Young people are usually open to using technical gadgets. However, one must understand that it is certainly not a toy but a serious matter to change your lifestyle. The heart rate monitor that is used has various ‘smart’ functions that are actually intended for sports. However, the functions have many similarities with cognitive therapy in addiction care to cope with cravings. A training program can also be set up to relearn and monitor structure and daily rhythm. The data can be conveniently displayed in an online Excel file. These are practical instruments to visually show the young person the advantages and disadvantages of use.

Compensation

There is currently no reimbursement for the therapy. It will be investigated which health insurers are willing to reimburse the therapy and/or the watch as an aid. If there is no reimbursement (yet), it should not be an obstacle to following the therapy. For example, the costs of purchasing a smartwatch can be borne by the client himself or his parents and family. Sometimes there is a ‘pot’ available at the institution. Practical experience shows that a solution can always be offered.

Mental health lifestyle training

However, the therapy can simply be applied in addition to regular care. After all, it is an additional instrument that can be used, for example, in addition to lifestyle training within mental health care. The SCAB is a valuable concrete tool to reinforce the Lifestyle Training. It gives the young person insight into his use and behavior.

Costs of the therapy

The costs of the therapy differ per institution that offers the therapy. There is no clarity about this at the moment. In any case, one can assume the own contribution of the sports watch. This can vary from 100.00 to 200.00 euros.

Costs of the training

The therapy can only be given by certified and trained therapists or counselors who have had the training. The scope of the training consists of one day. The costs of the training can be determined in consultation. Refresher training is necessary every year.
The training program includes:

  • knowledge of how the sports watch works
  • conversation technique that can be applied during therapy

How does it work in practice?

In practice, the coach always uses the website www.polarpersonaltrainer.com together with the client.
Below are a number of example conversations from practice, the ‘J’ stands for young person and the ‘C’ for coach or counselor:

C: ‘We will then take your registration. I see you didn’t register last month. Why is that?J: Well, it’s going really well. I haven’t had a craving once. I’m not bothered or anything.C: Okay. That is beautiful. So you think things are going well? J: Yes, actually. C: The watch is your property as you know. Do you think you can do without conversations from now on?J: Well, I don’t know. I think I need a chat every now and then and I don’t know if I’ll get a craving in the near future. C: Do I understand that you want to try it for a while longer?

C: You registered three times in the past two weeks. Were those really craving moments?J: Yes, I had a really hard time those three times.C: What did you do to control the craving?J: Well, just as we agreed.C: Okay, I’d like to go out discuss all three times with you step by step.J: Yes, that’s good. The first time I was with friends who were going to smoke a joint. They also asked me and I was almost going to say yes but then I saw my orange watch and quickly pressed the red registration button.C: Okay and then?J: I clearly said that I had stopped and was leaving now. One responded negatively and the other positively. I felt really bad. I looked at how long I had lasted and felt myself getting stronger. I cycled for half an hour without getting tired. When I got home the craving was gone and I stopped recording. C: You did very well. How did you feel about saying no?J: Yes, strong and no more feelings of guilt. It was the first time I really said no.

C: Looks like you’ve had craving moments over the past two weeks. J: Yes, that’s right. Twice if all goes well.C: Yes indeed, but if you look closely, do you notice anything?J: Well no, what then?C: You have registered well. But it’s strange that no distance has been recorded.J: Why not? I pressed the button, right? C: Yes, that’s right. Look here you can see that everything went well. So the GPS connection was good. Could you perhaps tell us something about that first craving? J: Well, what was that again? I was at a friend’s house and they started using cocaine.C: Did you say you wanted to stop?J: No, I didn’t dare.C: Okay, I understand. Do you still find it difficult?J: Yes, very difficult, but I didn’t use.C: I think it’s great that you said no and then didn’t use.J: Yes, I thought so too.C: But it is good to go a step further next time. As you just indicated, you still find it difficult. You don’t have to make it more difficult for yourself than it already is. That’s what you’re here for, right? J: Yes, that’s right. C: As you know, in this training you learn to control cravings. Remember the three ‘A’s? Step 1 Alert, step 2 Action, step 3 Distance.J: Yes, I remember that.C: Okay. You say that you find it difficult to take action and then you do not create any distance from the unsafe situation. Am I expressing that correctly? J: Yes, you got that right. C: Then we will work on step two in this session. .J: Okay is good.

C: Have you used the smartwatch yet? J: No, I took it off and put it in my room. C: Why? J: Well, I didn’t think I needed it. C: Okay, and how did that go without the smartwatch?J: Well good. But I had a hard time last weekend.C: What do you mean? Tell me.J: I had a few beers and then I felt like doing cocaine. I then thought about that watch, but I wasn’t wearing it. I thought that was a shame.C: Did you use?J: No, not.C: Did that thought help you?J: Yes, I think so. But I don’t need it anymore.C: Okay, but how do you want to proceed?J: I don’t know. I don’t think the watch helps.C: Why not? You said you’ll be fine without it. What do you need then? Could admission to the clinic help? J: Maybe I need that, yes. I think that’s good for me.

C: How did you get to school on time last week? J: Well good. C: Okay, have you used the Smartcoach yet? J: Yes, but not every day. C: Shall we see how that went? J: Yes, that’s fine. C: Look here you can see all the times you have used the Smartcoach. You did a good job.J: Yes, but I don’t think I used it last Tuesday.C: Yes, that’s right, that state is not listed here either. Why didn’t you use it?J: Well, I woke up on time and got out of bed and forgot to start the Smartcoach.C: That’s very good. So you can do it. I see that you have used the Smartcoach every day before. You can see exactly which route you take to school and how long it takes you to get to school. Maybe you can break a record.J: Yes, I see.C: Hey, here’s a day when you used the Smartcoach but no route was completed. Did you also get out of bed yourself but forgot about the Smartcoach? J: Let me think. Well, not actually. Then I actually didn’t feel like it anymore. But my mother didn’t call me either.C: Okay, I hear you saying two things. You weren’t in the mood and your mother didn’t wake you. Shall we look into that?J: yes, that’s fineC: You didn’t feel like going to school. What do you think of the lessons? J: Well, that’s fine. C: Is it the teachers? J: Some yes. I think that’s really worthless.C: Okay, I’m thinking of two things. Either you just don’t go to the right school with the right teachers or you’re just lazy.J: Yes, something like that.C: What also strikes me is that if your mother doesn’t call you, you just stay in bed.J: Yes, that Correct. Usually my father calls me and if I don’t get up he gets angry.C: And is there an argument again?J: Yes.C: You know, I’m starting to understand it a little bit.J: What then?C: You think school is boring, okay, that bothers more people. But I think you just need structure and self-discipline.J: Hmmm,,,yes that could be because I can actually do what I want and that’s not good either.C: Shall we see what we can do about that?J: Yes that’s OK.