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The Surprising Truth
About Addiction

By Stanton Peele

Change is natural. You no doubt act very differently in many areas of your life now compared with how you did when you were a teenager. Likewise, over time you will probably overcome or ameliorate certain behaviors: a short temper, crippling insecurity, smoking, overeating.

For some reason, we exempt addiction form our beliefs about change. In both popular and scientific models, addiction is seen as locking you into an inescapable pattern of behavior. Both folk wisdom and modern neuroscience regard addiction as a virtually permanent brain disease. No matter how many years ago your uncle Joe had his last drink, he is still considered an alcoholic. The very word addict confers an identity that admits no other possibilities. It incorporates the assumption that you can’t, or won’t, change.

But this fatalistic thinking about addiction doesn’t jibe with the facts. More people overcome addictions than do not. The vast majority do so without therapy. Quitting may take several tries, and people may not stop smoking, drinking or overeating altogether. But eventually they succeed in shaking dependence.

Kicking these habits constitutes a dramatic change, but the change need not occur in a dramatic way. So when it comes to addiction treatment, the most effective approaches rely on the counterintuitive principle that less is often more. Successful treatment places the responsibility for change squarely on the individual and acknowledges that positive events in other realm may jump-start change.

Smoking is at the top of the list in terms of difficulty of quitting. But the majority of ex-smokers quit without any aid – no nicotine patches, gum, Smokenders groups or hypnotism. At your next outing, ask how many people have quit smoking on their own. You’ll be surprised!

People change when they want it badly enough and when they feel strong enough to face the challenge. Educational programs and incentives will only go so far. You can give them the tools, but until they decide to take action, they can’t break down the bad habits and build the new.
Even when people are ready to make a change, it often doesn’t happen all at once. The following are six principles of change that patients go through on their way to success.

Six Principles of Change

One: The belief that you can change is the key to change. This is not the powerlessness message of the 12 steps but rather the message of self-efficacy. Addictions are really no different from other behaviors – believing you can change encourages commitment to the process and enhances the likelihood of success.

Two: The type of treatment is less critical than the individual’s commitment to change. People can select how they want to pursue change in line with their own values and preferences. They don’t need to be told how to change.

Three: Brief treatments can change longstanding habits. It is not the duration of the treatment that allows people to change but rather its ability to inspire continued efforts in that direction.

Four: Life skills can be the key to licking addiction. All addictions may not be equal. The community-reinforced approach, with its emphasis on developing life skills, might be needed for those more severely debilitated by drugs and alcohol.

Five: Repeated efforts are critical to changing. People do not often get better instantly – it usually takes multiple efforts. Providing follow-up care allows people to maintain focus on their change goals. Eventually, they stand a good chance of achieving them.

Six: Improvement, without abstinence, counts. People do not usually succeed all at once. But they can show significant improvements; and all improvement should be accepted and rewarded. It is counter-productive to kick people out of therapy for failing to abstain. The therapeutic approach of recognizing improvement in the absence of abstinence is called harm reduction.

Taken from: Annual Editions: Health 05-06
The Surprising Truth About Addiction, Psychology Today, May/June 2004.