Motivation in Addiction Treatment

Motivation in addiction recoveryThere are basically three types of motivation in addiction treatment. One is to avoid unpleasant consequences through compliance. These clients are usually pushed hard to get into treatment, and they’re the most likely to return to their drug of choice. Another form of motivation is calculation — a person has calculated the costs and benefits of drinking and using drugs and has concluded that stopping will be a better choice. The third form of motivation is existential — the person has committed to addiction treatment because life in addiction has become miserable, hopeless and precarious. These last two forms of motivation are stronger than the first with the last being the strongest.

Although addicts who’re forced into treatment by the courts, family, spouse, etc., can and do recover, they usually have to go through more trouble before the desire to change is deep and meaningful. I’ve seen clients who’re forced kicking and screaming into treatment turn around and realize they have a problem. Most of us working in the field for a lengthy period of time have come to realize that it’s almost impossible to tell who’ll recover and who won’t, but the odds are not favorable for the person who’s in treatment just because someone holds leverage over the person. You’ll often hear people say about addiction treatment and recovery that the person has to want to stop drinking or using some other drug in order to recover. A desire to stop is not necessary in the beginning. I’ve seen people forced into treatment with no intentions of stopping have an epiphany and recover long term, and I’ve seen people who desperately wanted to recover never stop for any long length of time and eventually die from their addiction. Nothing has hurt the addict more than for people to tell him/her that they aren’t trying hard enough, and that if they just put their mind to it, they could stop drinking alcohol or using cocaine or shooting up heroin.

The person who rationally looks at their addiction and decides the costs of using drugs outweigh any benefits are at least motivated, but if addiction recovery were as simple as calculation, most people would stop long before the late stages of addiction. Calculation can be strong enough to get a person into recovery, but there usually has to be something stronger keeping a person in recovery or they go back to the drug of choice after the bad memories fade and the calculation changes. Perhaps the person has bad fortune in recovery and loses their job in a bad economy — the person who’s only calculating the costs and benefits might say that recovery is not “paying off”.

The point is that a desire to stop is a good motivator, but not necessary to start the treatment process. Having a desire to stop, though, doesn’t guarantee recovery, especially if the person is quitting with the expectations that life will be trouble free without addiction. Addicts forced into treatment can and do recover, and addicts who initially decide to deal with addiction and recover can and do die from their addiction. What usually determines if a person recovers or not is their level of ongoing commitment to the long term process of recovery. The main form of motivation in addiction treatment that enhances long term recovery is internal commitment. When a person has truthfully admitted that addiction is a life-threatening problem and has committed to taking steps to achieve and maintain recovery, regardless of external circumstances or obstacles, then the motivation is real enough to sustain long term change and growth.

Virtuous Cycle in Addiction Recovery

recovery management

Upward and onward

In his book The Fifth Discipline, Peter Senge wrote about a virtuous cycle. Senge was writing about learning organizations, but the same principles apply to individuals and a virtuous cycle in addiction recovery. We’ve all heard about the vicious cycle — addiction is a prime example of a vicious cycle. A person becomes addicted to a drug, things get bad, the person tries to quit, the withdrawals are painful and life is just too hard without the drug, so the person says just one to take the edge off, then the cycle begins, over and over, with no apparent escape. This type of cycle is a downward spiral that ends in institutionalization, jail or death.

So, what is a virtuous cycle? A virtuous cycle would be when the addict actually breaks out of the cycle to create a new cycle that generates personal growth. The virtuous cycle is upward — it’s a good, reinforcing loop. The virtuous cycle is when a person applies recovery principles, things improve, the person reaches a plateau, then the person finds a new challenge, a new opportunity for personal growth which creates another cycle, over and over, upward and upward.

The path to the virtuous cycle is not easy, but it’s infinitely rewarding. In treatment, we attempt to guide clients to this virtuous cycle, to identify the old ideas that keep them trapped in the vicious cycle, to inspire actions necessary to get out of the vicious cycle and to teach recovery management tools necessary to start a virtuous cycle. The online Macmillan Dictionary defines a virtuous cycle this way:

a process in which a good action or event produces a good result that also causes the process to continue so that more good results happen

When the addicted person first tries to quit drinking alcohol or doing some other drug, they’re spending a lot of energy just staying away from the drug – if this is all the person does, no treatment, no counseling, no support, just white-knuckling it, then this will wear a person down mentally and emotionally, so that the person will most likely return to drug use. The virtuous cycle creates positive results — these improvements in the person’s life are inspirational. After improvement happens, the person’s drawn toward recovery rather than just trying to stay away from the drug(s) of choice. This makes all the difference in recovery.

When a person is pulled toward recovery because they want more growth and improvement, then great things can happen.


realpse and lapse

relapse prevention

Why do so many who receive treatment for an addiction problem relapse? That’s a question I often hear. First, let’s distinguish between relapse and a continuation of the addiction after a short break. Most people who start drinking or using drugs shortly after treatment call this a relapse, but there was really no recovery. There has to be some significant level of recovery in order to say someone relapsed when they return to drinking or using drugs. Those who take a break from using drugs in order to receive treatment for a month or so, perhaps because they were forced by the court or a family member, then continue drinking and using shortly after treatment haven’t relapsed — they just stopped drinking alcohol or using their drug of choice for a short period to get out of trouble for a minute. Alcoholics and drug addicts stop using from time to time for short periods for one reason or another, but this doesn’t mean they’ve recovered from addiction.

So, relapse is when a person has had a significant period of recovery and is actively making changes to remain abstinent and put things back together. People sometimes relapse after a year of recovery, three years, 30 years, although if someone stays sober and clean for a year and is managing a recovery program, the chances of them maintaining long term, permanent recovery is very high. I also need to distinguish between a relapse and a lapse. A relapse is a full return to addiction, while a lapse might be a one time slip that the recovering person quickly does something about and returns to the recovery program.  Those who do relapse usually stop doing the things that got them into recovery to start with. They stop utilizing their support, like AA or NA or a church group if they are part of a church — the family thinks they are cured, and their friends see them as past all that unpleasantness for good. Most often the person takes being clean and sober for granted and thinks they have power over their addiction disorder. Once the recovering person believes they have power over alcohol or some other drug, they might start thinking they can take a drink or smoke a joint periodically without consequences. Their minds start playing tricks.

When the alcoholic or drug addict experiences a period of recovery, they are healthier, think more clearly, have better relationships, are able to hold down a good job, make more money, etc., so they might start thinking they are as capable as anyone else of drinking sociably or using drugs recreationally, especially if they remove themselves from their support structure which served as a reminder of how bad it was before. The pain they experienced years before fades in their memory — they start thinking problem with alcohol or some other drug might have been because they were immature, or it was just a wild period, but now that they’ve put their lives together and have become responsible, it’ll be different. When the recovering alcoholic or addict drifts away from their long term recovery program, they put themselves at risk for relapse, even if they never intended to when they first started drifting.

Relapse is not inevitable

relapse is not inevitable

Relapse Prevention

Addiction has been called a disease of relapse, mainly because relapse is common. First, though, we need to distinguish between the up and down process of addiction, in which a person might struggle for awhile after deciding to stop drinking or using drugs. Someone addicted to alcohol, opiates or other drugs might go through many experiences of trying to stop but never getting into recovery. When a person decides to do something about the problem, they might stay straight for a short while then drink or use drugs, and this can go on for months. This is just the process of addiction — recovery hasn’t happened yet. There is no recovery, so there is no relapse, just many attempts to deal with the problem. All the attempts can move someone closer and closer to recovery, but they can’t be considered to have recovered then relapsed during all these attempts.

Relapse is when a person has some significant time in recovery and has moved past the irrational compulsion to drink or use drugs, then starts drinking and using drugs again. It’s actually more complicated than that. If a person has been in recovery, utilizing support resources and relapse prevention tools, and has changed his/her thinking and behavior regarding alcohol and other drug use, then the person begins drifting away from the support and stops using the relapse prevention tools, it can be said that the person has relapsed in their mind before taking the first drink or using the first drug again.

It’s the mindset and behavioral changes that constitute the relapse — the actual return to active addiction is merely the end consequence of the mental, emotional and behavioral relapse. It’s like someone who’s lost 60 pounds and has a bright outlook on life and feels healthy again — then the person stops doing the things they did to lose weight and feel good about themselves — then they go on an eating binge, all after a long time of feeling good and keeping the weight off. This process can be called a relapse.

Relapse is not inevitable. Recovery management is about understanding that relapse is possible, thus, managing recovery for the long term. If a person in recovery has no plan for the times when it gets hard to continue in recovery, or has no plan to deal with the down times in life, then the person will put themselves at risk for relapse. If, however, a person in recovery has plans for those tough times, then, when they get to a cross roads in recovery, they’re more likely to know what steps to take to protect their recovery. There are many people in recovery who don’t relapse once they recover from what AA calls the “seemingly hopeless state of mind and body” that is addiction. Relapse is not inevitable.