Overcoming Addictions

Diane Potvin has been sober for 23 years, but is still acutely aware that she could fall off the wagon.

 

Mike Di Ioia lost more than 100 pounds by sticking to a rigid diet, but is haunted by memories of being sick, overweight, and afraid of dying. Diane Webber-Thrush tries to stop a modest wine-drinking habit, but a rough day at the office sends her back to the liquor store.

The dirty little secret about addictions is that relapsing is the rule, not the exception. Up to 80 percent of alcoholics treated for a drinking problem will hit the bottle again at least once. Between 60 and 90 percent of smokers light up within a year of stopping, and more than 90 percent of the gamblers who quit on their own will eventually place another bet. Even minor bad habits are hard to break: People make the same New Year's resolution for an average of five years running before they maintain the change for even six months.

When it comes to major behavioral changes—anything from losing weight to quitting hard drugs—few people do it perfectly the first time. For most, it's a long and winding road.

Yet many people do eventually overcome their bad habits. There are more ex-smokers (48 million) than current smokers (46 million) in the United States. In the biggest American survey of alcohol use, only one-quarter of the people dependent on alcohol were still drinking heavily the following year. Another long-term study revealed that for cocaine addicts who had gone through treatment, more than half were clean five years later.

Such statistics have inspired a new psychology of addiction that puts the problem of relapse front and center. It recognizes that relapse is distressingly common—but also that it can be just a stumble on the road to recovery. In fact, if handled the right way, a relapse can actually open the door to lasting success.

The abstinence-only doctrines that once dominated the thinking about addiction have given way to a more flexible—and more forgiving—approach. Overcoming a habit is understood to be a slow and halting process that is often plagued with slipups and setbacks. This understanding is motivated in part by evidence from neuroscience that addictions change the brain in ways that can take a long time to undo. "The last 10 years have given us a picture from a lot of different areas of science that once addiction sets in, it takes on the character of a chronic illness," says Jon Morgenstern, director of substance abuse services at Columbia University Medical Center in New York City. "It's very difficult for people to maintain behavioral change. Relapse is considered a part of the condition."

By the same token, relapse is no longer seen as a catastrophe. A fall off the wagon may feel like a failure that cancels out all the hard work of quitting, but that all-or-nothing perspective doesn't square with the facts, says G. Alan Marlatt, a professor of psychology and director of the Addictive Behaviors Research Center at the University of Washington. "It's like learning to ride a bicycle. Almost everybody falls at least once." A relapse can provide useful information. The trick is to view an episode of backsliding as a chance to learn, an opportunity to develop better techniques for anticipating and avoiding or overcoming urges. This insight applies to a range of problems, from life-threatening drug addictions to compulsions like overeating.

 

Out with Black-and-White Thinking

When marlatt started working in an alcoholism ward in the 1960s, roughly 70 percent of the clients he saw bounced in and out of hospital-based treatment programs. But addiction counselors weren't supposed to acknowledge the high rate of relapse: The thinking then was talking about that would "just give people permission to do it," Marlatt recalls. Frustrated, he began studying how successful quitters maintained their sobriety over time. "We found that many had slips or lapses, and were able to get back on the wagon again," says Marlatt. "They were learning from their mistakes, and figuring out what to do next time." He developed a recovery model that addressed the reality of relapse, identifying common triggers and concrete psychological skills that helped people get back on the straight and narrow.

One of his early insights was that black-and-white thinking can turn a minor lapse into a major one. After a small slip, many people throw in the towel. A new ex-smoker has a couple of drags of a friend's cigarette, bums another, and then buys a pack, figuring she's already negated all her progress. This "abstinence-violation effect," as Marlatt named it, is the belief that anything less than perfection is total failure. It leads the quitter to conclude he just doesn't have the willpower to succeed.

But having just one slipup does not inevitably lead to a full-blown relapse. The slide back into addiction can be reversed. Addiction psychologist Stanton Peele describes it as multiple stations of a journey. The first "stop" for a drinker might be seeing an old drinking buddy at a bar. The drinker could "get off" at that point by leaving. If he stays, he could order ginger ale. If he does have a beer, he can "get off" at the next stop by going home rather than drinking more. The idea is that there are many opportunities to avert a total relapse.

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