The Heart of Addiction

How psychology drives addictive behavior.

Don't Stay Sober "One Day at a Time"

Folks with addictions can do much better.

We have all heard the “One day at a time” AA slogan. Its purpose is to keep people from feeling overwhelmed by the prospect of never drinking again. It may be useful when folks are teetering on the brink of having a drink: “Tough it out, you just have to get through today.” But aside from those moments, it is terrible advice.

In fact, it is exactly backwards. If people hope to break an addiction, the best thing they can do is think ahead to the next time they’re likely to want to drink (or gamble or overeat). Compulsions, or addictions, aren’t isolated events that must be managed only when they arise. Like every other emotional symptom, they are just a way we repeatedly deal with the central concerns within each of us. So, when people understand how addictions work psychologically in themselves, addictive urges become highly predictable. Instead of having to live with addictions one day at a time, they can master them forever.

Readers of this blog or my books know that addictions are neither more nor less than psychological compulsions that arise in circumstances when people feel overwhelmingly helpless. This feeling emerges because something in the situation touches on an area deeply important to them. Addictive actions are a way to reassert power against this helplessness; the addictive act is a “displacement,” or substitute, for taking a more direct action to reverse helplessness. Ways to break an addiction, therefore, range from working out the underlying issues that make people feel helpless, to just understanding how, why, and when these feelings arise, even without fully working out their causes. Fully resolving important emotional issues usually requires psychotherapy. But learning how to manage an addiction, and even turning addictive urges into useful tools for understanding one’s own emotional life, can be done on your own. I described how to do this in the book Breaking Addiction. One critical part of mastering addictive behavior is learning how to predict it far in advance. That means thinking ahead.

By thinking, or even just imagining, future circumstances that are likely to produce addictive urges, folks often feel the early twinges of those urges. Now they are in position to think about and understand why the urges arise in that setting. Once they have gone this far, they can figure out just what actions to take to prevent these urges. This might mean changing future plans, or dealing with a problematic relationship ahead of time, or figuring out how to manage the same situation in a completely different way from usual, or even just developing a new perspective about what is coming up. The point is that all these things are fairly easy to do in advance of that teetering-on-the-edge moment.

There should be nothing surprising about this. Looking ahead is how we all deal with most of our lives. But to make this actually work, you have to know what to look for. It’s not only the specific situations, but the reasons for feeling overwhelmingly helpless in those situations. As I’ve described elsewhere, people can get very good at this. Some have been able to know why and when they will feel like drinking or gambling months in advance. With this self-awareness, they have been not only able to arrange their lives differently, but also to work on the issues within themselves which make them vulnerable.

It makes sense for people to know what is overwhelming for them, then to look ahead to when that feeling will return. The last thing people with addictions should do is think about them one day at a time.

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

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