Preventing unwanted behavior. Is it really within our powers?

                 PREVENTING UNWANTED BEHAVIOR. IS IT WITHIN OUR  POWER ?


          Just as it is hard to start a new habit, it is hard to stop an old one. In fact, some behaviors are thought to be unpreventable, i.e. beyond our ability to control with "willpower" or self-help techniques. Many feel this way about drinking alcohol; some do about eating, smoking, and even procrastination. When we add an awareness that genetic, metabolic, physiological, unconscious, and environmental factors as well as underlying emotions affect our reaction to drinking, food, smoking, coffee, soft drinks, sugar, etc., it shakes our faith (rightly so) in self-control. There is evidence, for instance, that alcoholics chemically process alcohol differently from nonalcoholics (Heilman, film). Alcoholism is called a "disease," implying that it is an unstoppable physical disorder, treatable only by physicians or a Higher Power? For an extensive discussion and references, see the Addiction section and Stanton Peele's books (Peele & Brodsky, 1991). For the specific steps to take when preventing relapse, go to Relapse Prevention.

          Experienced people in Alcoholics Anonymous (AA), Overeaters Anonymous (OA), and Emotions Anonymous (EA) say the first step towards recovery is to admit you are powerless over alcohol, food, emotions, or whatever. Then, their 12-step program basically says, (l) abstain (totally in the case of alcohol) by asking for help from friends (in AA or OA or EA who have been in the same situation) and from a Higher Power, (2) admit your "defects of character" and the wrongs you've done, and (3) make amends. AA is often considered the best available treatment for alcoholism, so use it if you need it. Interestingly, AA has a reputation for being successful in spite of little or no outcome research. Unfortunately, AA opposes research (members aren't supposed to disclose what happens at AA meetings) and doesn't directly teach self-control methods. It is known that many people go to AA only a few times and others backslide after hundreds of AA sessions. One study of 90 addicts found that they had, on average, attended 586 AA sessions before relapsing (Chiauzzi, 1989). That is an amazing amount of "treatment" to be followed by failure. So, AA is not a perfect miracle cure. If AA added more self-control beliefs and procedures, especially relapse prevention, to its program, it might be more effective. Only research can tell us. See more references concerning alcoholism at the end of the chapter.

          There is also evidence that overweight people adjust their metabolism as they reduce their intake of food so that they tend to stay about the same weight, called their "biological destiny" (Bennett & Gurin, l98?). If that is the case, losing weight may be very hard to do if you have a genetic tendency to be heavy or to crave sweets, etc. It is believed that weight loss efforts work best the first time you try to diet; thereafter, the body loses weight more slowly but gains it back much more rapidly. Also, over-weight people produce more insulin than thin people when they see food and that increases hunger pangs. Heavy people respond more to external cues--smells, sight of dessert, etc. All this (plus the emotions pushing us to eat) makes it hard to lose weight. As most people know, our metabolism is a function of our activity level, so losing weight without exercise is especially hard to do.

          No matter what the physiological and emotional processes are and how difficult it is to reduce drinking or overeating, the addict still has the problem of how to stop a harmful habit. Should he/she get professional medical help, psychological help, give up trying to do the impossible alone and turn to God, join a self-help group, take antabuse or diet pills, go to a Mental Health Center or an addiction treatment center, talk to friends, read and try to help him/herself or what? My answer again is, "Try all kinds of treatment until something works."

          Is it harder for some people to overcome bad habits than others? Since this is like the question "Do I see blue the same as you do?" we will never know but old habits are hard for everybody to stop. How hard? There is very contradictory evidence. Some treatment programs claim a 90% success rate (during the treatment phase). In general, relapse after treatment of addictive behavior is very high, 50% to 90% (Brownell, Marlatt, Lichtenstein & Wilson, 1986). Two thirds to 3/4's of drug and alcohol abusers relapse within three months after treatment (Chiazzi, 1989). In one study, less than 10% of treated alcoholics abstained for two years (Armor, Polich, & Stambul, 1978). Researchers of weight loss projects also report disappointing results: few stay in treatment, and 80% of those that do, gain any weight loss back within a year. Smokers frequently quit, then relapse. Clients who stay in these treatment programs for various problems are successful (why else would they stay?), but thus far no program enables a high percentage of clients to maintain their gains. So, it is hopeful (we can change) but the final long-term results of today's "programs," even the expensive ones, are not good enough. On the other hand, note that about half of all former problem-drinkers have quit drinking "on their own" (no help from a MD or AA or any treatment). You are not powerless! But I'd recommend getting all the outside help you can, as well as self-helping.

          Similarly, Stanley Schachter (1982) reported some interesting but controversial findings: almost 2/3's (63%) of people who tried to lose weight or stop smoking on their own (without professional help) were successful! And they kept it off for years! This implied that self-help was better than professionally run treatment programs. Subsequent studies (Cohen, et al, 1989) showed this was not true; self-quitters (smokers) did no better or no worse than clients in a stop smoking clinic. But over the years, we try to help ourselves a lot more often than we use professional programs. Thus, 85% of those trying to stop are on their own and only 15% join a stop-smoking program. About 1/3 of all smokers have tried to stop within the last year; most failed. Of those trying to stop sometime (or many times) between 1976 and 1986, 48% of the self-helpers and 24% of the treatment clients were successful. Altogether 40 million Americans have stopped smoking, so it is possible. 90% of the successful ones were on their own and most of them had tried again and again. 70-75 million are still smoking. There is no evidence that successful quitters used different behaviorchange methods than the relapsers; they just motivated themselves more and kept on trying (maybe until they found an approach that worked for them). There is hope. Again, I'll remind you: self administered programs (listening to a tape, reading a manual, watching a videotape) have been just as effective as the rapist administered programs (Scogin, Bynum, Stephens, & Calhoon, 1990). The keys seems to be learning to be motivated and maintaining your gains.