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The Author of Your Fate

William Dubin, Ph.D.

Among the first discoveries of a person seeking to escape an Addictive Disorder is that the challenge is different than they thought. The will to refrain from incentive use is certainly necessary, but most people are good at heroics and can resist temptation. . . for a while. In fact, problem drinkers often use their ability to stop drinking as proof they are not problem drinkers. The problem is not an inability to withstand temptation; the problem is relapse.

sad womanThe fact that so many Americans are obese is not because weight loss is difficult or rare (most overweight individuals have lost large amounts of weight, more than once) it is because they almost always regain all they lost and more. Incentive use disorders are so destructive to individuals and relationships primarily because of their high relapse rates.

Because relapse is so common, only a fool believes that weight loss is the cure for obesity, or that the decision to quit drinking is sufficient to overcome chemical dependency. To achieve good long-term outcome you will have to develop the ability to act as intended despite the influence of local conditions that would motivate relapse.

Incentives and Excessive Appetites

You would think that once you realized that using the incentive was causing more harm than good, quitting would be easy. Sadly, this is not the case. In fact, I have dedicated my 35-year career as a psychologist to solving this riddle: What causes people to trade what is dear to them-health, wealth, relationships-for a short-lived and usually trivial payoff?

Overeaters, cigarette smokers, problem drinkers, and drug abusers knowingly sacrifice their health and relationships for gratifications that are not that great. Compulsive gamblers, shoppers, sex/pornography users, and computer gamers, may sacrifice their principles or relationships for the relatively small payoff they receive from their incentive use.

An incentive that corrupts one individual may be of little interest to another. However, the details of the relationship between the individual and the incentive are often quite similar across the many disorders of appetite. A particular incentive is corruptive to the extent that it can influence the Psyche to trade something of greater value for something of lesser value, as when a politician trades integrity for cash.

Incentives that promise immediate pleasure or relief from pain are particularly corruptive, because they offer the Psyche some control over experience. How much an individual sacrifices for the incentive is the measure of damage.

Relapse and Loss of Control

Once a pathogenic relationship with an incentive develops, individuals tend to follow a predictable path to loss of control. A typical pattern:

 

As the relationship between the individual and the incentive matures, its costs become more noticeable. At some point it becomes obvious that the costs dramatically outweigh the benefits and the individual decides to change. In many cases, the initial motivation produces short-term success, but with the passage of time, the motivation to resist the pull of the incentive fades until at some point a local stressor or temptation has more influence on the individual's actions than does the now distant commitment. If the individual fails to override the pull of the incentive, a first lapse occurs. The demoralization that results from violating the vow to not lapse weakens their resolve, which may, ironically, motivate further incentive use to cope with demoralization. Total relapse occurs when the individual abandons the effort and returns to uncontrolled incentive use. As time goes on, the negative consequences of incentive use accumulate and become more salient, which causes the individual to once again decide to change his or her ways. . . As this pathogenic pattern is repeated, the individual progressively loses control of incentive use and becomes dependent.

Relapse may motivate the individual [or the individual's family] to seek outside help to show the way to good outcome. Treatment providers, programs, books, and support groups can be helpful in the beginning to provide support and structure to get the change process started. These behavior change strategies cast the individual in the passive "patient" role, which demands compliance with an active, effective agent of change (therapist, guru, program, support group). The weakness of this approach shows up later.

Outcome research has been particularly unkind to weight loss and substance abuse treatment programs, and most published studies report that the vast majority of program participants relapse. The seeds of failure are included in the tacit demand that the participant comply with an external source of control. The participant is then vulnerable to relapse when the external source of control is not available. Some treatment strategies are clearly iatrogenic-that is, they do more harm than good. For example dieting, the obvious solution strategy to obesity, increases the morbidity of the problem by decreasing participants' control over eating.

Willpower and the PIG

Why do people repeatedly use the incentive when they say it gives them more pain than pleasure? The Problem of Immediate Gratification (the PIG) describes the cause-and-effect principle that immediacy of a payoff is more important than its magnitude: A small payoff now is more influential than a much larger payoff later. Naturally, we want immediate gratification of the desire to be free of this problem.

The desperation to escape a problem that is jeopardizing one's health, wealth, or relationships is understandable. However, good long-term outcome requires an irreversible change analogous to the change from childhood to adulthood. This kind of change results from completing a passage that no one can take for you nor spare you. Conventional treatment based on the medical model in which the patient passively receives treatment from the competent treatment provider encourages the very dependence we seek to escape.

Willpower (your ability to behave as intended despite the influence of local conditions) like muscle power, is enhanced through exercise. Most clients are suspicious of the concept of "willpower" because they have discovered that "white knuckling" never seems to work.

When someone uses the term, "willpower" as in: "I tried to quit smoking by using willpower, but relapsed anyway" it implies they failed because they did not have enough of this willpower to follow their plan. Most people who use the term that way don't have a plan, other than to try real hard to not drink. Typically, the person realizes there is a problem and decides to change, but fails to do anything beyond making the decision to change. The resulting failure is taken as proof of their lack of willpower, which may then be attributed to a disease, defect, or to the general hopelessness of their situation. An alternative interpretation is that relapses demonstrate how formidable, and hence how worthy of your respect, this task is. If you have sufficient respect for this challenge, you will go to any lengths to develop the ability to influence the course of your life intentionally. Escaping an addictive trap requires nothing less.

You are not responsible for creating this problem. You had no control over your genes or early childhood experiences. However, now that you are an adult with good problem solving skills, you are responsible to get yourself to act in accord with your principles and interests. Waiting for an external agent to free you is a defining attribute of dependence. The price of freedom from dependence is accepting the responsibility to make you free.

The Addictive Traps Metaphor

The key to good long-term outcome is learning how to prevent relapse. People relapse in different ways and for different reasons. Each individual has a particular set of vulnerabilities which, when exposed to high risk situations, produces a predictable outcome. An addictive trap shows up when a particular pattern repeatedly undermines an individual's attempt to follow a more advantageous path. There are several common traps. An example is reactance: Forbidding anything-especially something that is rewarding-has the unintended consequence of producing the motivation to rebel against the restriction. Reactance is a major problem for some individuals and trivial for others.

To achieve good outcome you will have to appreciate the traps into which you tend to fall and develop the skills to escape or avoid them. Your biography is the story of the many challenges that you encountered and mastered. You can now read, drive, and do many other things that seemed difficult before you learned how. Acquiring each of these procedural skills changed you irreversibly.

Most people remain dependent because they misperceive the true nature of their problem. They seek short-term behavioral suppression rather than the skill to cope with the crises they are bound to encounter. Developing the skills to cope with stress and temptation without relying on the incentive or other external agent is the irreversible change that will free you from dependence.