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Keeping Recovery On Track: How Psychology Can Help
Giving up smoking is the easiest thing in the world. I know because I have done it thousands of times. -Mark Twain
In his typically astute and cynically humorous fashion, Mark Twain captured the challenge anyone attempting to overcome substance use disorders faces: it is not the quitting that is hard (every user of substances, for example, quits while they are asleep—perhaps the thousands of times referred to by Mr. Twain!), it is the maintenance of non-using or reduced use over time that is hard.
Although substance use is not the defining characteristic of substance use disorders (negative consequences attributable to substance use form the core of our thinking about substance use problems), it is a necessary behavior for a substance use disorder to develop and persist. Recovery rests, at bottom, on the individual’s ability to exercise control over their substance use, whether that control be maintaining abstinence, or whether it be over the quantity and frequency of substance use such that no negative consequences result.
There are many formulas that have been proposed for helping patients prevent relapse to substance use. In most treatment programs here in the United States, a single formula is central—affiliate with and attend 12-step support groups. Unfortunately, as the high relapse rates we see across treated substance users attest, that formula is, to paraphrase another great American writer, H.L. Mencken, an answer that is clear, simple, and often wrong.
The Role of Psychology in Recovery
Scientists like Roy Baumeister, Gerd Gollwitzer, John Bargh and their students and colleagues have developed a fine-grained understanding of self-control processes that can be very helpful for people attempting to regain control of their substance use.-Frederick Rotgers
So what IS the formula for maintaining control over substance use? In this series of articles I will write about some fascinating research coming, not from the substance abuse treatment research community (although there are researchers currently studying the application of these ideas to substance use disorders), but from cognitive and social psychology. For decades, cognitive and social psychologists have been studying the fascinating phenomenon of self-control and exploring what makes it possible and how it works. Scientists like Roy Baumeister, Gerd Gollwitzer, John Bargh and their students and colleagues have developed a fine-grained understanding of self-control processes that can be very helpful for people attempting to regain control of their substance use.
Understanding Human Psychological and Behavioral Processes
One of the basic ideas emerging from this research is that there are two types of human psychological and behavioral processes. Some of our behavior and thinking is directly under our conscious control. We can intentionally do or think a vast range of behaviors and thoughts. In fact, these Controlled Processes are what we use consciously to shape our lives and decisions every day. Examples of controlled processes are the carrying out of plans to accomplish some task—cooking breakfast, for example. We think about what is needed, gather the required ingredients, intentionally operate the stove, toaster, coffee maker, and, “voila,” breakfast!
The other type of processes are what are called Automatic Processes. These behaviors, thoughts and emotions occur without our conscious intention. They are akin to what most of us call “habits”—behaviors, thought patterns, feelings that occur in response to situations (which may also include other of our own behaviors, thoughts and feelings) automatically, without any need for our conscious mind to implement them.
A nice example of automatic processes that we have all experienced is the driving of a car or riding a bicycle. When we first learned to drive, we had to think about and consciously attend to a plethora of factors necessary to insure that the car moved in the direction we intended, at the speed we wanted, and that we were aware of potential hazards in all directions. We had to think about (especially if we learned on a standard shift car) how to engage the clutch so the car wouldn’t stall or jerk, we had to worry about how to steer effectively, etc. However, once we had practiced driving enough times (perhaps trying the patience of a helpful parent, friend or driving instructor in the process!) these behaviors became automatic to the point where we no longer need to think about each and every one when we drive, we just do them.
These behaviors and thoughts have become what is called “functionally autonomous”—that is they unfold in the correct way whenever we are in the situation for which they are appropriate without our having to consciously attend to each and every detail. In fact, behaviors like driving can become so functionally autonomous and automatic that we may engage in them without even being aware of doing so! How many of us have had the experience of driving a well-known route only to arrive at our destination without recalling the drive, yet having driven safely and without incident?
So, what does all this automatic and controlled stuff have to do with not being Mark Twain?
Whenever humans engage repeatedly in a behavior (such as substance use), over time much or all of that behavior can become automatic or functionally autonomous. Think about the chain smoker, back in the days when employees were allowed to smoke at their desks, who at the end of the day looks down at the ashtray to find many cigarette butts there, but has no recollection of having actually lit up that many cigarettes. The behavior of smoking, for that person, has become automatic.
Whenever humans engage repeatedly in a behavior (such as substance use), over time much or all of that behavior can become automatic or functionally autonomous.-Frederick Rotgers
The challenge in changing that behavior is to re-institute, at least initially, conscious control over it. In order to maintain abstinence from cigarettes, that smoker must be consciously aware of each cigarette and take action to avoid actually lighting up! It is this process that makes recovery difficult—bringing what has become an automatic or habitual response to situations (often called “triggers” in the treatment world) that are associated with substance use back under conscious control, and then substituting a different behavior, leading to a different outcome.
In the articles to come over the next few weeks on Pro Talk, I will discuss several approaches and ideas that have grown out of the work of the researchers I named above that can be useful to people attempting to regain conscious control over substance use and over their own responses to situational triggers. Some of these approaches are actually quite simple on the surface, but can be extremely powerful! All of them have great utility for anyone attempting to re-establish control over substance use. Stay tuned!
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