Changing Addictive Behavior

"Things do not change: We change." - Henry David Thoreau

"If you want deeply rooted change, you need to apply deep rooted methods"
- J. Goldstein

There is no shortage of material written about how people change addictive behavior. Today the number of methods, models, techniques, and programs advertised to work can easily  overwhelm any person struggling with an addiction. But what do we really know about what works? It turns out that researchers have spent a significant amount of time, money and energy trying to answer this question and after many, many studies, the bottom line is this:

1) In spite of there being a great range and diversity of techniques, we know that different treatments tend to produce similar results. Probably the most well known and costly study supporting this finding is Project MATCH. Over 1700 people with alcohol problems were randomized to one of three treatment conditions. The idea behind the study was that certain people would tend to have better outcomes with specific kinds of treatments. In the end, only one hypothesized match was statistically significant, but even those results were questionable after some time. Overall, we learned that people involved in treatment did better, and it did not matter which treatment group they were in. Many other studies have confirmed that the search for the one magic bullet has failed. We have many credible approaches that work equally well  (although a bit technical, this link is incredibly insightful in regards to changing addictive behavior).

2) The market on how to successfully change addictive behavior is not the sole property of treatment professionals. In fact, most people change on their own - we call this self-help. It's true. Many studies have confirmed that most people who struggle with addiction get to a point where they realize the costs of their behavior are too great. They decide they must change and find methods that work. But when self-help is not helping, then seeking professional assistance is the right thing to do.   

3) Whether someone uses professional treatment or not, managing addictive behavior is the result of utilizing the same processes of change. These processes include things like: helping relationships (pastor, friends, teachers, and yes, treatment professionals), giving ourselves a reward when we reach a predetermined goal, education (reading, taking classes, internet searchers), removing the objects of addiction from our homes, and substituting a healthy behavior in place of an addiction (exercise instead of smoking to deal with stress). As you can see, the processes are not a big mystery, they are things most of us have utilized time and again throughout our lives - and when we do them on our own you could say this is "self-help". When change works it is because we utilize the processes that make sense to us at the time. 

4) There is not one good recipe for how to successfully change addictive behavior. There are many good ingredients that a person can uniquely combine in their own way to produce successful outcomes. These days, those "ingredients" are often referred to as "evidence-based practices" (or EBPs). They include cognitive-behavioral strategies, medications, and community-based interventions. Unfortunately, many scientific reviews have suggested that the interventions that have the most empirical support are the same interventions least utilized in professional treatment programs. If one method does not seem to be working, try something else. When a person gets to the point where they say "nothing works for me" then it is time to seek professional help. Sometimes, the reason change is not working is because all too often what we need to do sits just outside of our conscious awareness - it is a leverage point that tips successful change in the right direction. But if we can't see it, we need to find someone who can. This is directly related to obtaining an accurate and comprehensive evaluation. 

5) One final point. If addiction is defined by the relationship that exists between a person and one or more objects of their additive behavior, then the goal of change is to replace (addictive) relationships with objects, with healthy relationships with people. Unfortunately, many change programs/strategies focus almost exclusively on stopping excessive behavior, when in fact it is equally - if not more important - to also focus change efforts on the desired goals. Any successful plan to manage addiction must include a plan on how to gain the necessary developmental skills to successfully initiate, form, develop, and maintain intimate relationships. Otherwise, staying away from objects of addiction for very long is doomed to fail.