There are strong behavioral and psychological concepts that need more attention and application in addiction care
The reason we need to incorporate more psychology and behavioral science into our care models is simple …
The time to recover from addiction is unnecessarily long and difficult.
Why is that?
1) Is it due to the length and severity of the addiction? This is a big factor.
2) Is it due to how systems of care are designed? Yes, it’s a structure largely built to align with number 1 above.
3) Is it due to certain narratives of society and the recovery process – i.e., once an addict, always an addict? So much going on here.
4) Is it due to a fear of taking new risks? This plus the above creates a massive headwind.
A large majority of those who find themselves in the addiction treatment system, have been to treatment 3+ times and lived in their addiction for 9+ years before their first treatment episode.
Triggers, cravings, dependencies, and habits are strong and very difficult to overcome. So yes, time is important. You will not and cannot reverse a 10 year addiction overnight or in 30 days. It takes work and time.
Of course, systems of care are set up around the work and time needed. 30-60-90 day rehab is less about the science of the care and more built around a general sense of time and work on oneself. Oh, and what insurance will pay for.
This is one part “standard of care” and another part social narrative. Have addiction? Go away for 30 days and come back when you’re ready to live.
Society — not medicine — says that once you’ve crossed the rubicon into addiction, you’ve got this thing for the rest of your life.
We kind of know this not to be true. Many people cease their addiction and go on to live healthy and thriving lives — even incorporating alcohol or some drugs back into their life. Still an addict?
Similarly, many people develop type-2 diabetes and fully reverse the condition. Addiction can be and is most often reversed.
That gets us to number 4 … fear. Fear sustains a person’s addiction and it restricts a person’s recovery.
And the science behind this is loss aversion.
“Loss aversion is a cognitive bias that describes why, for individuals, the pain of losing is psychologically twice as powerful as the pleasure of gaining. The loss felt from money, or any other valuable object, can feel worse than gaining that same thing.1 Loss aversion refers to an individual’s tendency to prefer avoiding losses to acquiring equivalent gains. Simply put, it’s better not to lose $20, than to find $20.”
Reframed in the addiction scenario … we would rather have another mediocre day in addiction than gain a great day without that addiction.
Applied to the recovery scenario … we would rather err on the side of sobriety than make a big, risky life decision.
In the 12-step world and the prevailing treatment system, it is common for sponsors and counselors to tell people to not make any big decisions in the first year of recovery.
Sadly, it’s the first year when great change occurs and we are presented with new opportunities. Too many forgo the path of new opportunity to stay on the safe road of sobriety.
An understandable decision given the horrors of life in addiction.
But we can do a better job of understanding this cognitive bias for people navigating the recovery path.
Instead of applying a broad belief about addicts or addiction to everyone that comes through the treatment or recovery door, we need to assess the person’s fear of loss.
Is the person’s fear based on how they were raised, their socio-economic status, or culture?
Then based on that assessment, a presentation of options that are both risk-adjusted and re-framed around the win or loss can be made. This will undoubtedly move the needle toward more wins instead of avoiding losses.
It’s difficult to make good decisions in the early months and even years of recovery. Our brains are literally recovering. Our decision-making capacity is, for many, diminished. Too often, counselors, sponsors, and coaches err on the side of autonomy, offering up options for the individual to chose.
Maybe, however, care teams need to be trained in how to frame any given option in a loss-gain context. Autonomy can be respected while simultaneously curbing the cognitive bias of loss aversion.
This should, according to the psychological science, improve decision-making and thus accelerate the recovery process.
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