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Learning to Steer
In George Bernard Shaw's Man and Superman, the Devil asks Don Juan why he bothers learning about himself and his core motivation. Don Juan replies: "Why, to be able to choose the line of greatest advantage instead of yielding in the direction of the least resistance. And there you have our difference: to be in hell is to drift, to be in heaven is to steer."
If you do not steer, your actions will be dependent upon the cause-and-effect principles that define the path of least resistance, rather than by your interests and principles. For example, the Problem of Immediate Gratification [the PIG] refers to the principle that a small but immediate payoff has a much greater influence on motivation, and behavior, than a larger but delayed payoff. The PIG tricks people — even those who know better — to trade what is dear to them [health, wealth, relationships] for the trivial but immediate payoff of using an addictive incentive.
While escaping an addictive trap is much more difficult than most people realize it is not impossible. Individuals with good cognitive abilities and a practical, self-directed mindset can develop the ability to act as intended despite the influence of great stress and temptation. This course is about learning to steer so that your actions are consistent with your values and sincerest desires. It is designed to help cognitively intact individuals develop the skills and faculties to enable them to act as intended despite the influence of local stressors and temptations that would provoke relapse.
Animals and young children generally do not consciously steer; they react to local conditions. What determines the behavior of the mouse is not its long-term best interests, but the cheese that baits the trap. Humans who appreciate how the mousetrap works are not taken in by it.
The idea that humans have willpower is a controversial topic. Most everyone caught in an addictive trap has tried what they call willpower — "white knuckling it" — without success. As a result of their repeated failures, they conclude that they have no willpower. The 12-Step model of addiction and its treatment rings true to them, because despite their best efforts and sincerest vows, they relapse again and again.
Addictive Disorders are notoriously difficult to treat because of the high relapse rate. While in treatment, patients typically comply with the treatment regime and are able to resist the pull of the incentive. The limitations of this treatment strategy show up after treatment is complete and the external supports provided by the program are no longer available: Most patients relapse.
Disease Model Vs Bio-Psycho-Social Model
In North America, the vast majority of treatment programs for addictive disorders are based on the 12-Steps of Alcoholics Anonymous. According to this view, incentive use disorders are diseases. Treatment emphasizes admitting powerlessness over the illness, complying with a plan developed by treatment providers, and adopting the norms and values of a new social group—the support or self-help group—in order to achieve total abstinence, which is the only acceptable outcome goal. The victim of the disease is responsible for neither the cause nor the resolution of the problem.
An alternative view, The bio-psycho-social model: You are not responsible for falling into your addictive trap—you had no control of your genes, early conditioning, and social history. However, now that you are an adult you are responsible to develop the skills and faculties that enable you to exercise your will. Rather than encourage you to accept powerlessness over a disease, this approach encourages you to develop the skills and faculties that enable you to act as intended despite the pull of nearby stressors and temptations.
Two types of matching errors
The Treatment Matching Self-Test. is certainly not infallible. As is the case whenever you have to l choose between two hypotheses and one is in fact, more helpful to you than the other, there are two types of errors you can make. Consider the hypothesis, "My Incentive Use Disorder is best conceptualized as a disease over which I am powerless."
Type I Error: Rejecting a true hypothesis . Some individuals who have developed a pathological relationship with an incentive have lost, or never possessed, the capability to over-ride their impulses. They will always require an external source of control to protect them from relapse. For these individuals to believe they can exercise their will during crises of stress and temptation is an error that will almost certainly lead to relapse.
Type II Error: Accepting a false hypothesis . Individuals who have developed a pathological relationship with an incentive, yet have retained good cognitive abilities are best served by developing the procedural skills to act mindfully during high-risk situations. In such cases, accepting the disease model when it does not apply may exacerbate that individual's dependence on an external source of control and interfere with developing the skills required to exercise will.
The reason that: It is better to learn to fish on your own than to be fed by an external agent: If you are fed, you will not be prepared to respond adaptively the next time you are hungry. However, when you learn how to achieve the desired outcome on your own, the change is irreversible. Likewise, if you depend on an external agent to prevent relapse, the next time you are in a high-risk situation you may not be prepared to handle it.
Treatment Matching Considerations
- Individuals who are cognitively impaired due to chronic substance abuse, head injury, or psychiatric disorder required substantial external supervision and are best matched with a treatment program based on the disease model.
- Some cognitively intact individuals, especially those who are religiously oriented and outer-directed, are best matched with a 12-Step treatment program
- Some cognitively intact individuals are best served by a treatment approach such as the one presented here, which focuses on strengthening the skills and faculties required to act as intended during times of great stress and temptation.
- To shed some light on which approach may be best for you, take the Treatment Matching Self-Test.
© Copyright 2014 by Bill Dubin, therapist in Austin, Texas. All rights reserved.