The Karma of Practice

People generally seek the clinical services I offer when they have relapsed - gone back to drinking, regained the weight they lost, etc. During the first session, I almost always ask the obvious questions: "What led up to the first lapse?" Generally, they cannot remember the details of the sequence of events that led to the critical first violation of their rules. This is in striking contrast to the detail I receive when the same client describes some political conflict at work.

This surprising observation provides a key clue to unraveling the riddle of addictive disorders. Consider that in order to recall a sequence of events from memory, the sequence must have been noticed so that it could be encoded into long-term memory --a process that requires attention. When my client, the clever attorney Hasselbring, can only give me a superficial analysis of the sequence of events that led to his relapse, which suggests that his consciousness was not fully engaged at the critical time: He was on autopilot following the path of least resistance. During his most recent relapse, Hasselbring observed himself following a path he had previously recognized as harmful and vowed to never follow again. He reports that he remembered the vow of abstinence, yet he simply did not exert the effort required to perform mindfully, and passively followed the familiar sequence of events to its predictable destination –damage [occasionally irreversible] and demoralization.

Put yourself in my position [the clinician], every week I am spectator to different versions of the same theme: The client appears sincere and highly motivated when vowing to follow the intended path, but when actually faced with a crisis he or she tends to invest surprisingly little energy to perform as intended. Perhaps Hasselbring is fooling himself and me, and doesn’t really want to quit drinking. It cannot be denied that he voluntarily follows a sequence of actions that he, and everyone else, knows will end up badly. But he is not intending to screw up – even though he knows full well where the path from the first drink leads. From the clinician’s perspective it seems as if the sequence of events that lead to the first lapse unfolds all by itself - without Hasselbring’s conscious initiation or guidance.

The Karma of Substance Use

Performance becomes easier with practice. In fact, with enough practice performance can become so effortless that it requires no conscious attention at all; at which point the behavioral sequence has become autonomous. Consider activities such as driving or using a computer or musical keyboard. When first attempted, performance is slow, hesitant, and filled with error, but with practice speed increases, variability decreases, and execution becomes increasingly effortless. What once demanded considerable attention can now be performed rapidly and accurately with little or no awareness of the component actions.

Conscious attention is not required to initiate an autonomous sequence. Mere exposure to the triggering stimulus is sufficient, and once initiated the action has a ballistic quality - tending to run on to completion all by itself. For example, when driving, a red light is sufficient to elicit a sequence of events that I control, but the control is outside of my awareness. I do not have to consciously initiate and then guide the complex sequence of behaviors that brings the vehicle safely and smoothly to a stop. Rapid, accurate, effortless performance that makes no demands on valuable conscious resources has obvious advantages. The problem occurs when you want to change a behavior that has become autonomous. For example, an experienced driver would take longer to learn to reliably stop at a green light than he originally took to learn to stop at a red light. Until the new habit is acquired, the driver must pay attention in order to over-ride the well practiced behavior of driving through a green light.

Stephen Tiffany1, whose views have been paraphrased in the preceding paragraphs, suggests that after considerable practice, addictive behavior becomes autonomous. Autonomous behavior can be over-ridden, but it requires conscious attention to do so. The karma of repeatedly following the path to substance use is that using the substance becomes autonomous. As a result, whenever conscious resources are occupied by a demanding social situation, powerful emotional state, or diminished due to fatigue or intoxication, one tends to follow this default path.

An absent-minded relapse occurs when mindful processing, which is necessary to interrupt the autonomous sequence, is not invoked when needed. This may occur when a person was simply not conscious of the original commitment until the relapse sequence was already well under way. Less dramatic, but more common is Hasselbring’s favored path, in which he is more or less aware of the unfolding sequence of events leading to the first lapse, and is also fully aware of his previous intention to remain abstinent, yet he simply fails to dedicate the conscious effort required to interrupt the autonomous behavior chain. The decision to quit using the rewarding substance sets up a conflict. On one side there is the autonomous behavior that leads to immediate gratification. Against this is pitted your rational decision to move in a different direction – one that the rational mind concludes is more advantageous for yourself. The conflict plays out in real time, and resolves in either success or failure [success is better].

The purpose of these PIGs is to promote success in escaping the addictive trap by providing a summary of biological, psychological and social factors that pertain to addiction and its resolution. Bear in mind that addiction is such a potent and deceptive foe that intellectual appreciation is not sufficient. The procedural knowledge required to intentionally guide your actions during real time crises cannot be acquired by reading alone. You must develop this competence through personal experience in your own lifetime.

Footnote:
1. Tiffany, Stephen T. A cognitive model of drug urges and drug-use behavior: Role of automatic and nonautomatic processes. Psychological Review. 1990 Apr Vol 97(2) 147-168