Change is Natural

Writing to SMART Recovery counselors and group leaders, Stanton reminds them that recovery is a natural process, one assisted by counselors and support groups, or reinstated when a person goes in the wrong direction. When presenting this view, Stanton must always doff his cap to Harold Mulford.

SMART Recovery News & Views, Summer, 2001, pp. 7-8.

This is why therapists and helpers must embrace natural processes

How (or when) do people quit addictions? Let me explore four different answers to this question. Although these answers outwardly seem to contradict the tenets of the most popular addiction therapy in the U.S. (and the world), Alcoholics Anonymous and its 12 steps, in fact the answers subsume the operation of AA.

People change addictive behaviors when they want to. Motivation is central to change. As I first said in Love and Addiction, to a large extent, people quit addictions to the extent that they wish to do so. It is hard to say something more profound about the relationships and behaviors that make up addictions, and escaping their grasp, other than that people pull away on their own. This, of course, violates AA’s denigration of the idea of “will power.” But what, exactly, is it that makes some people finally come to and stay with AA itself? Motivational interviewing, a therapy that focuses on and heightens the person’s existing desires to change, builds on this process.

People change addictive behaviors when they feel they can. People won’t leave a habit — or can’t — until they feel they have the strength to live without it. As people mature, or feel more self reliant, or build up a more adequate life structure, they will then be more likely to have the strength to resist the allure of the addiction they have become aware is harmful for them, but which they rely on and find solace in. The therapeutic deductions from this process are that (a) people need to feel strong and to focus on their strengths in order to change, (b) people will change more to the extent that the rest of their life improves and is strengthened. The Community Reinforcement Approach attempts to strengthen each component of a person’s life (work, leisure, family).

People change addictive behaviors when they feel they should. Just as with self-control, AA simultaneously relies on values and disparages them. That is, AA and related 12-step groups say that the addiction is beyond the individual’s control. And, yet, they argue on a values basis that the addiction is bad for the person and that the person should want to change. At a secular level, we see that so many people have quit smoking because it has become such a disapproved activity. When people close to a person insist that he or she change, change is more likely to occur. Thus, any change in social milieu to place people in environments where the target behavior is not favored will produce a net change in the behavior.

People change addictive behaviors when they have support to do so. AA is one popular support (and not a self-help) group. But it is far from the only support people find for quitting addictions. Consider brief interventions, in which a health care worker questions or assesses a patient’s drinking habits, and then recommends that the person change these (usually by cutting back). The clinician then makes sure to check up on the individual during future visits. In this way, the clinician becomes implicated in the change process, encouraging, supporting, and checking that the person does indeed change. Even this minimal level of support, when consistent and reliable enough, is often sufficient to bring about the desired change.

There are several things to note about this list. In the first place, it is commonsensical. And this is the way it should be. There are not that many undiscovered elements to human behavior since Shakespeare or the Bible. The desire of Alan Leshner, Enoch Gordis, and others to find magical aspects of the human nervous system that will suddenly eradicate people’s addictions is a “whore’s dream” — the fantasy the someone will magically come along and give a prostitute enough money so she can afford to quit. Only, in this case, the fantasy is that the NIDA and NIAAA will throw enough money at addictions research that a new, heretofore unimagined cure will suddenly appear.

All of these change processes occur without help to a greater or lesser extent — they are “natural” processes. This is why so many people — the majority of those in remission — quit addictions on their own. Of course, change is often slow, halting, and painful, and people want assistance in their efforts to change. Thus, I have identified therapies designed to encourage such natural processes. Groups like SMART Recovery and many professionals involved with SMART encourage and support change. But they do so, not by imparting secret spells or employing newly discovered aspects of human motivation and reinforcement. They do so by building on truisms of human growth and change and crafting them more successfully to the counseling relationship and support groups.