The Heart of Addiction

How psychology drives addictive behavior.

Don’t Judge People for Not Trying

It’s more complicated than that

"You could stop if you really tried!" We have all heard this idea. It contains two assumptions: that making an effort - trying - can stop addiction, and that trying is a matter of conscious choice, a decision to exert willpower. Both these assumptions are dead wrong.

Addiction is a psychological compulsion to perform certain acts. Like other compulsive behaviors, addiction is driven by deeper emotional factors. These involve feelings of overwhelming helplessness, for which the addictive behavior is an attempted solution. With such a powerful internal mechanism, it should be obvious that you can have all the willpower in the world and be putting out all the effort in the world and still find yourself unable to stop addictive behavior.

But what are we to make of people with addictions who don't seem to be even trying to stop?

Some of these folks don't try because they see no reason to do so ("My drinking isn't a problem, so get off my back."). Here the issue is not a failure of effort, but minimization or denial. Such denial has its own origins and meanings, however, which can be addressed in treatment. For example, I've found that what is commonly called denial is often little more than an understandable defensiveness about being labeled an "addict" with all the denigrating connotations that have been associated with that word. This denial tends to dissolve when people understand that addiction, while often disastrous, is at heart driven by a healthy need - to reassert power against helplessness. It is far easier for folks to acknowledge this problem than have to accept that they are weak or powerless, or that they suffer with some character deficiency.

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Other individuals have an apparent lack of effort because they have given up on ever managing their addictive behavior. Since addiction is so badly misunderstood in this country, addiction treatment is often unsuccessful. After repeated failures in traditional treatment approaches many people just throw up their hands. Who could blame them? The solution here is not to attack them for lack of effort, but to find a therapist who understands the psychological basis for addictive behavior and isn't wedded to old ways of seeing addiction that have failed them before.

Still others recognize their problem, haven't given up, and say they want to stop - yet don't seem to work at it. Surely the issue must be laziness or lack of willpower here, right? No, because for many people, their apparent lack of willpower is simply the result of the greater power that drives their behavior. Their deeper need to reverse intolerably helpless feelings simply crushes more conscious wishes, such as the desire to quit. Outwardly, these folks may appear to be indifferent. But as I describe in many cases in my books, "The Heart of Addiction" and "Breaking Addiction," these same people often prove to be quite able and willing to end their addictive behavior once they work out the powerful factors behind it. Awareness of the deeper emotional precipitants for their addictive urges enables them to separate these powerful issues from their addictive behavior. When that happens, any issues of willpower vanish: it's like unplugging the power cord to the addiction.

There is one more group who appear to lack effort: those who have, over time, just adapted to a lesser life. They live in a stable compromise where they tolerate the costs of their addiction in exchange for its immediate feelings of relief. One man I saw, for example, lived for decades with chronic alcoholism and the resulting endless tension in his marriage. Growing up, he had never expected more from life, so he viewed his unhappy existence as inevitable. After a significant time in therapy, and as a consequence of resolving these lifelong issues, his "willpower" to stop drinking miraculously returned.

The appearance of putting forth effort is a misleading and harmful way to gauge the desire of someone to get better. We would all be better off if we tried to understand the factors that lead people to be passive or opposed to controlling their addictive actions - and support them in seeking good psychological help to work out these factors.

 

Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.

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