New Year’s resolutions fail for many people because of incomplete understanding of the process that needs to take place. We take a look at approaching our resolutions by relating them to the addiction recovery process. Our expert, Dr Inaba gives us a clear perspective, including the sequence of change: pre-contemplation, contemplation, preparation, action, maintenance, and planning for relapse.
Transcript (edited):
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. Its 2012 and one of the things that happens routinely at the beginning of a new year is people make New Years resolutions and I thought it would be interesting to talk a little bit about that because resolutions usually involve a lot of change – which is directly related to the idea of relapse and recovery. One resolution people make – and it is often on my mind as well – is controlling the tobacco dragon, which I have been grappling with for a number of years … most of my adult life actually. As weve talked about before, the addiction to nicotine is perhaps one of the strongest addictions out there and one that is difficult shake – the statistics show that it takes most people 7 or 8 tries before theyre successful, if they are successful. So, Darryl, what are your thoughts on New Years resolutions and how they relate to relapse and recovery?
DARRYL: Happy New Year, Howard and youre quite right. This is resolution time and people are fond of making very strong commitments to changing some of the things they do or changing some of the things about themselves that theyre unhappy with and that is healthy – wanting to change things that youre uncomfortable with. But very few resolutions actually are successful – thats been my history and the history of many people who make resolutions. Its difficult, first of all, to make any change. People underestimate how difficult it is to change even those things you are very, very uncomfortable with. Look at problem marriages – people are very unhappy in their marriage and they want to change a lot, but the longer theyre unhappy, the more they cling to the relationship because its reliable. At least they know where theyre at!
HOWARD: Exactly! The devil known as opposed to the devil unknown.
DARRYL: And then there is ambivalence among other things. One of the cornerstones of treatment in addiction, of course, is grappling with change – moving from being addicted to a place of sobriety and recovery. Making that change requires a lot of work because it is difficult to make changes and to keep constant the changes or maintain the changes that a person decided to make. Dr. Prochaska and Dr. DiClemente developed the Stages of Change in the late 70’s – pre-contemplation moving onto contemplation, then preparation, then action and then maintenance and relapse. Those stages are addressed with plans or interventions that move a person through the process. A person trying to do this on their own – saying, Oh, Im going to quit smoking on New Years Day has very little chance of success unless they are well versed in these levels of change. And most of this speaks to the need for some sort of intervention with friends or a therapist or a counselor or somebody who can help walk a person through the whole process.
Making a New Year’s resolution shows that a person has moved from pre-contemplation into contemplation. They know they want to change. They are looking at what they want to change. Unfortunately, a lot of people just get stuck there, Howard. They never move into the action phase of change because there is no one to help them through that process and they havent prepared themselves for the next step that will help them get unstuck.
I know a lot of people have told me they want to quit alcohol, which happens to be about number 7 on the list of top 10 resolutions every year. Your problem, nicotine, is always number 1 or 2 people all over the United States want to quit smoking. Weight loss is right up there as well. So we have a pretty consistent list of things people want to change. But what happens is people say – “oh, Im going to quit smoking” but they have no plan. Theres no action timeframe. Theres no fact finding. Theres not a lot of work done and oftentimes the thinking is .yeah, I want to change and quit smoking, but Im not going to change right now. It will be some time during this year. Maybe some time during the next century, but it does take a lot of work to deal with making it through.
When a person is in the contemplative state and they say they are wanting to make a change like quitting smoking I think it is important for them or somebody working with them to first validate their decision and to ask “are you ready to make that change? Have you thought about the skills, the tools necessary to enact that change? And do you understand that you cant just make it happen overnight?” It is a difficult process and requires moving in to the preparative level of change the planning stage of change to get some sort of action. But during contemplation, it is important to clarify what a person’s desire is, why they have that desire and to evaluate the pros and cons of maintaining what they want to change versus the benefits of change.
Wanting to quit smoking – which is the largest health killer in the United States – is absolutely a wonderful thing. Validation is important, encouraging someone to move forward and get the information, develop the skills, get the tools and prepare and plan how this change is going to take place before they actually enter the action phase of change. As part of the preparation stage, the person must identify the obstacles. What prevented them from making this change before? What undermined their change? Once the list of obstacles is identified they must be addressed – by themselves or with a friend or in a 12-step program or whatever identify how these obstacles can be overcome in order to move past the things that caused the person to become stuck before. A person has to identify what I call their recovery environment. What is their support system? Who is in their social network, in their environment? Who can help them with the practices that they have decided are important to initiate this change and to succeed.
An important thing, I think, that we do in addiction counseling is to validate the capability of human beings. They have tremendous self efficacy. They have abilities, they have intelligence, they have a lot of resilience and a lot of skills to actualize what they want to do what they can do and where they want to be. That validation keeps them motivated, reinforces the notion that their change is good and that they can indeed succeed. What are the first steps? Maybe the first step is for you it would be to get rid of all the cigarettes in your house but thats kind of difficult for a lot of people. Were doing that now at the Addiction Recovery Center – the agency initiated a policy of no smoking as of January 1st, although the Oregon state law allows a grace period of 6 months, so the smoking ban in drug abuse treatment programs in the state of Oregon must be in place by July 1st and many programs are looking at that as a respite and are continuing to allow clients to smoke in their programs. But hats off to the agency and staff who says, “this is really the biggest addiction and biggest killer so we dont care if the state says the law becomes effective July 1st, were starting January 1st” and so we rolled it out January 1st and were getting a lot of grief. We had different alternatives available for clients to deal with their withdrawal symptoms and their craving. We knew that everybody was going to try to violate this one way or another, and you know, human beings are resilient too and its amazing to see the different ways our clients try to get around the ban and sneak a cigarette. They go to meetings off site and smoke or they have visitors smuggle them cigarettes. Its just amazing to see it. Were catching on to these tactics slowly, but surely, but were never going to solve this 100 percent.
When we planned for this we realized how difficult it would be – that we would have to help our clients go through these levels of change. Were going to make it a part of the service plan or the treatment plan of every one of our clients – addressing nicotine – whether they smoke or not. If they don’t smoke we want to continue to motivate them never to start. This also includes tobacco cessation, so its not just smoking, its chewing tobacco as well. We’re working with them so that they can enact these changes. Getting rid of cigarettes first, participating in tobacco anonymous, doing some background work on possible medical treatments for nicotine addiction or going through some sort of detox then slowly tapering off the nicotine. You know, all the plans for change that you make , well then, the process is not to take on the biggest, most difficult thing first – take a few baby step first. Do the easiest things first and do them effectively and completely so you can cross that task off the list and go to the next one. But take little small steps to work forward because ..”I’m quitting today” may not be the best New Years resolution .
HOWARD: Instant gratification.
DARRYL: Someone says “Im going to be instantly healthy instantly good. Im going to make it!” That never works. Once youve taken that first step youre actually in the action phase. And the action phase, especially for nicotine, can take several months. Nicotine is a pretty addictive substance and it causes withdrawal. Many people say withdrawal symptoms are gone within 3 or 4 weeks. I dont believe that. I had a nicotine addiction – I certainly smoked cigarettes, I smoked a pipe, I used chewing tobacco for many, many years. It was a difficult thing to deal with and I think many underestimate or under appreciate the withdrawal symptoms from nicotine and the phenomenal craving that occurs with nicotine. And its not that gnawing, grab at you, type of craving, its the craving thats more subtle, but deeper and heavy its its almost on a temporal basis. Its your association of times when nicotine has been your friend, in the movies it was always after sex. Usually for me it was after any meal.
HOWARD: Its coffee for me.
DARRYL: All those things are huge obstacles to change and you have to develop some sort of plan to deal with each and every one of those things and work with somebody to implement that plan. The action phase can take several months, maybe as long as a year before you move into the maintenance phase and implement a plan to maintain your abstinence. And the good thing about addiction to nicotine and addiction in general is that the brain is so resilient and continues to find networks .continues to grow networks continues to grow new memory protrusions and even continues I believe, to add mile and sheath to speed up the ability of brain cells to operate throughout a person’s life. And if you give up nicotine, many health benefits are realized almost immediately. With every passing day and every passing month, you continue to realize great health benefits and great personal benefits from not smoking, so you have to come up with a plan to maintain that recovery. I once read something by Stanton Glantz that listed all the benefits gained from quitting smoking – in the first 30 minutes, first week, first year if you remain abstinence from nicotine or tobacco exposure for 8 years if you were lucky enough not to have already developed emphysema, heart disease, cardiovascular problems or any of the major problems associated with nicotine or tobacco use – that you risk goes back to 0. Actually, your risk is the same as somebody whos never smoked before because your body cells have all turned over. You have total new body cells every 8 years. The only cells that aren’t new of course, are the ones in your brain. Theyre more permanent that the other cells of your body, so that means that youre addicted to nicotine but you aren’t activating that addiction and you’ve returned to good health. But, should you slip or should you pick-up smoking again, you activate the addictive pathways of the nicotine or of the tobacco and then you go right back to addiction.
So thats why not just with tobacco, but with alcohol and other drugs, recovery is a lifelong process and people have to remain abstinent from their drug of choice throughout their lifetime. Each day they gain more and more health benefits and more and more human benefits and social benefits from their abstinence. But, its working through these processes and change that the last stage of change that Prochaska and Dr. DiClemente talk about, the last level is not really a stage of change maybe it is called change because there seems to be relapse with any kind of chronic persistent disorder, or illness, or anomaly. So the potential of relapse must be addressed and planned for – plan the action that you are going to take if you have a slip or have a relapse how youre going to get back into a healthy situation so that you can start initiating the action phase of staying off again. It is important to remember that relapse is a part of every chronic condition.
It is great to hear that you want to change your smoking. Its a difficult thing. There are now a lot of medical resources that are helping people who, especially the chronic relapser. Nicotine especially, I think, as well as heroin, have more relapses associated with its addictive nature and than does alcohol, cocaine, methamphetamine or other drugs. In that regard, some new medical approaches are targeted to help deal with craving, help deal with withdrawal symptoms, help the person maintain their abstinence from nicotine.
HOWARD: Well, Darryl, thank you for that significant and detailed insight into the process that is recovery and how all of us might make a better effort or have a better success at achieving our New Years resolutions, whatever they might be. And I think its a good perspective and I hope those of you listening have enjoyed Darryls comments as much as I have and take them to heart. Good luck with your plans for change in this new year.
DARRYL: Howard, Happy New Year and congratulations on a great, great resolution! Anything we can do to help – I can come up with some steps for you!
HOWARD: Well see what we can do. Okay, that wraps our pod for today. Thanks for visiting the CNS Podcast, if you have questions, comments or suggestions drop us an email: info@cnaproductions.com . Please check back soon for the next in the series.