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It is much easier to stifle a first desire than to gratify all those that follow it. — La Rochefoucauld
In her recent book, Unbroken Brain, the journalist Maia Szalavitz writes, “Addiction doesn’t just appear; it unfolds, with many influences.”
No one would choose to be an addict. You don’t wake up one morning and decide to become an alcoholic. One day of drug use does not mean addiction. As the days accumulate, the characteristics of addiction emerge. Consequently, a person who never chose to be an addict ends up an addict. Similarly, someone who has a second helping of dessert every night ends up 20 pounds heavier than he or she had planned.
The Primrose Path theory of addiction, pioneered by the behavioral psychologist Howard Rachlin, suggests that addiction results from people’s lack of awareness of the impacts of current drug use on future preference (i.e., habit formation). Small steps on Monday make you more likely to commit a similar behavior on Tuesday. Behavior feeds on itself.
The Primrose Path theory focuses on the initial stage of addiction through a series of incremental decisions with consequences that are not perceived by the individual until it is too late. The theory assumes that the addicts are completely present focused in the cognitive sense. The individuals make decisions in the moment from the strict perspective of momentary pleasure, and oblivious to the long-term consequences. For example, when a person decides whether to have a drink, he typically does not take into account that he can get addicted. Rather, he simply compares the value of a drink now with the value of abstaining now.
This short-term thinking can lead to impulsive choices. For instance, when planning for the long-term, most people intend to eat healthy foods, exercise regularly, quit smoking, and spend less time on the internet. But these plans require gratification to be delayed. Since on any given day, the value of the present indulgence is always higher than the value of any distant reward (health benefit), people tend to go for instant gratification.
It is just our perverse tendency to favor the short-term over the long-term. Our brain always prefers the bird in hand to venturing into the bush. However, when we regret our past choices, we are taking a long-term perspective; for example, going to the bar and getting drunk and then regretting it. From an immediate perspective, the choice is quite sensible, but from a long-range point of view, the act seems to be a mistake.
Drugs are also used to cope with painful feelings like anxiety and depression. Drugs are more appealing for those who have suffered major traumatic experiences. The self-medication theory of addiction suggests that individuals with deficits in emotion-regulation skills (i.e., skills relevant for modifying emotional reactions and tolerating negative emotions) use drugs in an attempt to manage negative or distressing affective states. For instance, individuals with histories of exposure to adverse childhood environments (e.g., physical and sexual abuse) tend to have a diminished capacity to regulate negative emotions and cope effectively with stress. This coping style becomes a learned and nearly automatic behavior.
All in all, choices that create an undesirable way of life are made one day at a time. They are not made at the level of a long-term lifestyle consideration. These choices are shortsighted and initially inconsequential decisions, but in the end, they pave the path for a big decision. On any occasion, using drugs (or overeating) produces limited harm. The damage occurs after repeated indulgences.
Consequently, treatment progress requires slow and steady daily effort to make each day slightly better than the last. There is a limit to how much we can change other people or how quickly we can change ourselves. Indeed, research suggests that having an intention to do something only predicts actually doing the desired behavior about 33% of the time, even for non-addict people. No matter how strong the goal intentions, there is no guarantee that the goal will be achieved, because of the automatic and compulsive nature of the behavior.
