Recovery from Addiction: The Psychology of Motivation and Change
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.
In this psychology of addiction section we've talked a great deal about how people become addicted. We also talked about the changes that people need to make in order to recover from addition. However, it should be rather obvious that if it were just a simple matter of wanting to change, we suspect most addicted persons would be no longer! Recent research in addictionology has revealed that a primary component of recovery from addiction is motivation. So where does the motivation for change ultimately come from? Perhaps the best answer we have so far comes from a study of individuals who recovered on their own, without any outside help (no re-hab, 12-step support groups, etc.). Studies of these folks suggest that self-change occurred when they decided the costs outweighed the benefits. Stated differently, they recognized they would lose something of great value if they continued (Toneatto, Sobell, Sobell & Rubel, 1999). In other words, "Enough was enough!" People also needed a second ingredient: The belief that change was possible.
To achieve satisfaction with our lives we must develop a sense of meaning and purpose. We must know what we want, and how to obtain it. Oftentimes there are competing and conflicting priorities. Nonetheless, we must make choices that optimize our life satisfaction. We give up some things in order to gain something else. Addiction recovery appears to be no different. Addiction and recovery are competing priorities. We cannot have both. Many times people feel conflicted about giving up their addiction. This is certainly understandable. People can strengthen their motivation to change. They do this by carefully evaluating the pros and cons of change (recovery) versus no change (addiction). As we will see in the treatment section, this is exactly what people do who recover on their own. They weigh out the costs and benefits of their addiction. They decide they will change because continuing simply isn't worth the price.
Having decided to change, we need to figure out how to make that change happen. Some people have no difficulty figuring out they need to change and how to do it. These people recover without any outside assistance. For others, the decision to change is difficult, while the "how to" part is quite simple. These individuals may benefit from some guidance that helps them to accurately weigh the costs and benefits of their addiction. As we mentioned in the biology section, addiction disrupts rational thought and judgment. Therefore, people sometimes have difficulty making an accurate appraisal. This does not mean they are "in denial." It simply means they might benefit from some outside guidance. Motivational interviewing may be a beneficial tool to help these folks. For other people both tasks are challenging. The decision to change is a hard one. So is the "how to" accomplish change. These individuals will greatly benefit from professional and/or non-professional help.
Our primary message is that no two people are alike. Some people need no help to change. Others need help in making the decision to change; but once decided, they need little further assistance. Still other people have difficulty with both the decision to change, and how to make that change occur. Addictions treatment should be fluid and flexible enough to match the specific needs of each person.