I’ve been thinking a lot about the idea of motivation and willpower as it pertains to substance use disorder. BJ Fogg, author of Tiny Habits, says:
“. . . motivation and willpower get a lot of airtime. People are always looking for ways to ramp them up and sustain them over time. The problem is that both motivation and willpower are shape-shifters by nature, which makes them unreliable.“
Fogg says for people to change a behavior, there must be the perfect storm of three elements happening simultaneously:
A Framework for Behavior Change
Fogg explains that you can visualize this model in two dimensions.
Along this vertical axis is the level of motivation for a behavior and it can range anywhere from high to low.
Along the horizontal axis is the ability to do a behavior. It’s also a continuum. On the right is high ability, and he labels that side as “easy to do”. On the left side of this axis are behaviors that are “hard to do”.
Motivation, Ability, and Prompt in Action
Here’s an example: Let’s say I’ve decided I need to cut down on trans fats. My motivation may be high because I’ve gained a few pounds.
If a prompt comes along in the form of pizza delivered to the break room, with the aroma stirring my dopamine to new heights, my mere visit to the break room makes the behavior of eating the pizza much easier. In contrast, if my motivation is still high, but I avoid the break room, the ability to avoid eating the pizza is easier. The pizza is the prompt, the motivation is the desire to cut down on trans fats, and the behavior is eating or avoiding the pizza.
Fogg points us to the action line, which shows the relationship between motivation and ability. If someone is anywhere above the action line when prompted, they will do the behavior. Eat the pizza or avoid the pizza, depending on the scenario. If they are below the action line, they won’t do the behavior.
Using Behavior Change in Substance Use Disorders
Substance use disorder is complex. Addiction is a bio-psycho-social condition and requires interventions at all these junctures. However, I do think it is helpful to utilize this science of behavioral change and find ways to intentionally incorporate these concepts to enhance a recovery program.
Patients who come to Coleman Addiction Medicine are generally quite high on the motivation scale. Our patients are no longer having fun with their drugs (if they ever did — many of our patients were simply overmedicated by doctors for pain conditions). These people want to stop using opioids such as hydrocodone, oxycodone, hydromorphone, oxymorphone, heroin, and fentanyl.
The Coleman Addiction Medicine Difference
Using Fogg’s model, our Accelerated Opioid Detox can skew the horizontal axis to the right, making the act of detoxing easier to do. Our program differs from many approaches in several distinct ways:
- We treat our patients in an outpatient setting. The first and last days of what is usually a 5-day detox will require a stay of several hours. The intermediate days are about 20 minutes. This also means no hospital expenses.
- We utilize a safe combination of multiple comfort drugs. I have heard tough stories from my patients who have gone to ‘detox’ programs, having been promised way more than was ever delivered.
- Families or other chosen support members are integrally involved in our process from the beginning through the end.
- Our treatment utilizes long-acting naltrexone to ensure that physical cravings are no longer a prompt for sabotaging success.
If you would like more information for yourself or a loved one, consider taking advantage of this effective treatment that can launch recovery and freedom from opioid dependence. True, long-lasting, recovery will require a lifetime of self-knowledge and daily attention and intention, but getting off the opioids must happen first.
If you are motivated, let us help you.
Joan R. Shepherd, FNP