Familiarity Breeds Hopelessness
When we are following these bad habits for a long period of time, we begin to label ourselves as "having a weight problem" or "a smoker" or "someone who does this". We treat our familiarity and long-established habits as evidence that this is the kind of person that we are and this "label" becomes "proof" that we can't change. "I'm an overeater" becomes evidence that "I can't lose weight".
However, this labeling does not stand up to critical evaluation of the evidence. At one time you were not a smoker, not overweight, not overspending and not engaging in risky behavior. You might have said at that earlier time, "I'm someone who doesn't do risky things". But, of course, that label was only true for a particular period of time. Then things changed-you began taking more risks. So, if it changed once, then maybe it can change again. All ex-smokers were once "smokers" and all recovered alcoholics were once active alcoholics. People who are no longer obese were once obese.
The consequence of labeling yourself is that you feel hopeless and helpless about changing yourself -and you stop thinking about ways by which you can change. With prolonged familiarity of your habit you may begin to believe that there are no choices involved. You begin to think that this behavior-for example, smoking or drinking-has nothing to do with the situations that trigger the behavior, your conscious thinking and your ability to make a choice.
I once treated a 75 year-old man who had been an alcoholic for 45 years---he could not recall a period as an adult when he did not drink to excess. As we examined the costs and benefits of drinking, he commented, "I have been a drinker all my life-so it's hopeless-I can't change". I asked him if he knew any other elderly people who have stopped drinking in recent years and he commented that he did. The question, then, was, "How was it possible that they were able to stop doing something that they did for fifty years?" Much to everyone's surprise, he stopped drinking completely and remained sober for another ten years.
You Normalize Your Mistakes
We often believe that behaviors that are frequently engaged in by other people are safer than they really are. If so many other people are drinking, driving beyond the speed limit, or smoking-then we think it must be fairly safe. This "popularity" of risky behavior helps us "normalize" our own behavior, providing a justification for us to continue to do what we are doing.
Almost every alcoholic that I have treated would normalize his behavior by pointing out that all his friends drink as much if not more than he does. Ironically, this is because many of his friends are alcoholics in the bar. People who overspend often justify their behavior by saying that all their friends are maxed-out on their credit cards. We tend to socialize with people with similar habits. If you are abusing alcohol or drugs, you are very likely socializing with other people who engage in the same behavior. Alcoholics and drug abusers tell me that they do not like socializing with people who do not engage in these behaviors because they will feel "judged". This is probably true-since non-alcoholics are judgmental of people who are drunk.
Although it's doubtful that everyone is just like you, pointing to others as examples of your own problematic behavior does not solve your problem or reduce your risk. It may make you feel better to think that you are just like your friends, but it also may be true that your friends will face some dire consequences at some point.
Vincent was an alcoholic who justified his drinking by pointing out how many of his friends-at the bar---drank to excess. He also believed that if he stopped drinking he would lose some of his friends. (This turned out to be partly true.) However, as he pointed to his friends who drank as the "norm", I asked him if he knew any people who had developed a problem from drinking. He indicated that one of his friends had developed a liver problem and was in the hospital-his friend was 41. The problem with normalizing your behavior this way is that you may be selectively sampling people similar to you, you may underestimate the longer-term effects on your "friends", and you may ignore the benefits of not having the problem that you have.
You Avoid Doing What Is Unpleasant
Underlying changing all of the risk behaviors is the fear of facing the negative emotions of making these changes. If you are an alcohol abuser-and you stop drinking-you will experience some anxiety. If you stop smoking, you will become irritated and upset for a short period of time. If you are an over-spender, you will feel anxious or resentful if you keep a budget. Similar to many people who worry or who are anxious, you are using avoidance to handle problems that may occur.
When I asked Wendy to consider keeping a budget to find out how she was spending her money, she initially resisted doing this. Even though she was increasing her debt on her credit cards-and even though her job was not secure-Wendy said, "If I start writing down how I am spending my money, I'm going to realize how poor I really am. I will feel deprived not getting what I want to get". In fact, Wendy felt that buying new shoes-that she did not need-would give her immediate pleasure. Similarly, when Dan considered trying to abstain from drinking, he was flooded with thoughts about how negative this experience would be for him: "I'll feel tense all the time, I won't be able to sleep, I won't have any fun with my friends".
In fact, deciding to do some of these things-like not smoking, eliminating or reducing drinking, or living within your means---will initially cost you some discomfort. I have found it helpful to ask people the costs and benefits "immediately" after changing and the costs and benefits "of having changed this one year after you have changed". Wendy was able to realize that the benefits of living within her budget for one year would far out-weigh the discomforts of keeping a budget. However, she also realized that the initial experience of keeping a budget would be frustrating.
The same trade-offs hold for the other problematic habits-overeating, smoking, avoiding seeing a doctor, etc. For example, Paul was a sixty year-old man who never had a colonoscopy - a rather simple (but unpleasant-sounding) evaluation. When he thought of having this done, he felt anxious-and then avoided thinking about it. I asked him to identify the specific things that he thought were unpleasant. He indicated that having to experience the procedure might be painful, the preparation (using laxatives) would be very distasteful and-most importantly-he was afraid that he would find out that he had cancer. This factor in procrastination and avoidance is very common for medical non-compliance---the fear of finding out that you have gone too long without an exam and now you have a dreaded disease. Paul did have the procedure and he was surprised that everything was not only fine-but that the procedure was relatively non-eventful.
Underestimating risk often reflects the same kinds of biases and processes underlying worry-where you overestimate risk. In both cases, you want to avoid anxiety or discomfort and you selectively focus on information consistent with your bias. Worry won't kill you, but failing to worry-and do something about it-can kill you if you are avoiding preventable risk.
References:
1Brownell, K. D., & Horgen, K. B. (2003). Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, and What We Can Do About It. New York: McGraw-Hill.
2Wadden, T. S., & Stunkard, A. J. (2002). Handbook of Obesity Treatment. New York: Guilford Press.
3American Lung Association. (n.d.). Data and Statistics. Retrieved February, 2003, from http://www.lungusa.org/data/.
4National Highway Traffic Safety Administration. (2002). Traffic Safety Facts 2001: Alcohol. Retrieved December, 12, 2002, from http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSF2001/2001alcohol.pdf
