An Alternative to Powerlessness

[David Baxter PhD]

An Alternative to Powerlessness
by William Dubin, Ph.D.
June 16, 2010

The Problem of Immediate Gratification [The PIG] is a defining feature of Incentive Use Disorders. So, naturally, those suffering the negative consequences of their excessive appetites want immediate gratification of the desire to be free of their problem. Overeaters want quick weight loss, but weight loss is not a cure for obesity! The vast majority of the participants of diets and weight loss programs will weigh more a year later than they did when they began their program. One- and two-year outcome research for substance abuse, gambling, and other addictive disorders shows similar patterns of short-term behavior change (while the individual is under the influence of the program) followed by an increasing likelihood of relapse with time from program completion, typically reaching around 80% within the first year after treatment.

There is no external salvation from dependence on an external agent. To the extent an external agent-a treatment provider, program, support group-was responsible for the behavioral control, relapse is likely when the salience of the external source of control diminishes with time.

The Nature of Your Challenge
An alternative to admitting powerlessness over a disease and turning responsibility for outcome over to an external agent is to admit you have freewill and accept the responsibility to develop the faculties required to act as you intend despite the influence of local conditions.

Volition is a controversial topic and many people believe that willpower is a destructive illusion. Most everyone with an excessive appetite has tried what they call willpower-"white knuckling it"-without success. [The "brute force" method may, perversely, provoke counter-regulatory motivation.] However, if willpower is defined as acting as intended despite the influence of local conditions, then the term describes a faculty worth developing. Simply stated, you have a two-phase challenge: First, you must decide how you intend to act when you encounter high-risk situations. Second, you must get yourself to act in accord with that decision, despite the influence of the local stressors and temptations.

You learn to exercise will1 during your encounters with a wide range of high-risk situations. At these critical moments, you have the opportunity to observe the cause-and-effect principles that govern your actions when exposed to stress and temptation. An important component of exercising will is to shift from an emotional trance to a dispassionate trance. This shift in perspective can enable you to become aware of your core motivation and act accordingly.

Addictive traps are easy to fall into and hard to escape. No escape plan works for everyone, because each trap is unique. An external source, such as a book or generic program, cannot show you the way to good long-term outcome, or even tell you what good long-term outcome means in your particular case. To act in accord with your interests and principles, you have to first define what they are. No external agent can do this for you; the path to self-determination is for your steps alone. Experiential invitations designed to encourage contemplation will enable you to focus your cognitive resources on how you want to use the remainder of your lease on life-your core motivation.

Appreciating what you want and doing what it takes to get it are different challenges. Acting as intended despite the influence of local conditions that would motivate you to lapse defines the "exercise of will." This kit has the ambitious goal of enhancing your power to intentionally influence the course of events.

An Efficacy Enhancing Treatment Strategy
The strategy of this kit is strikingly different from that used by programs based on the 12-Step model of Alcoholics Anonymous. According to the latter view, incentive use disorders are diseases. Treatment emphasizes getting the patient to admit powerlessness over the illness and to comply with the plan developed by a treatment provider. Rather than encourage you to accept powerlessness, or recommend that you turn your problem over to a higher power or treatment provider, here are tools and methods to enhance the power of your will.

Preventing relapse requires that you are able to make good choices in real time, which turns out to be much more difficult than it sounds. In your fantasy, you will respond heroically during your future encounters with stress and temptation. When you are in the midst of a crisis, performing mindfully will not be as easy as it now seems. To follow your path of greatest advantage rather than yield in the direction of least resistance requires the exercise of will.

The challenge ahead is among the most important and the most demanding of your life. It takes more than wanting it to achieve the benefits of good long-term outcome. Preventing relapse demands that you act as intended during the critical moments of crisis when your energies and cognitive resources are depleted or otherwise occupied.
Exercising will is a heroic undertaking. The text and other media contained in this kit provide conceptual models, concrete tools, and experiential invitations that will strengthen your ability to act in accord with your interests and principles, rather than yield in the direction of least resistance.

A major advantage of a self-directed approach is that it encourages the development of the faculties required to exercise will.

Consider Mr. Hasslebring who has been clean and sober during his stay at a 30-day rehab program. Sadly, the content discussed in the psycho-educational groups was of little value during the critical moments of the actual crisis he encountered in his home environment, and the program staff and structure were not available to help him.
​

The vast majority of the graduates of inpatient and intensive outpatient chemical dependence and weight loss programs relapse soon after the influence of the external agent disappears. Evidently, their treatment left them insufficiently prepared to cope with the high-risk situations they actually encountered. Good long-term outcome is the byproduct of good performance during high-risk situations.

Footnote
¹ Will is defined here as the capability to act as intended in real time, despite the influence of local stressors and temptations that would motivate a lapse.


William Dubin, Ph. D. is licensed by the state of Texas as a Psychologist, and is specialized in the treatment of addictions, having received the Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders from the American Psychological Association. Readers in the Austin, Texas area dealing with psychological issues (such as depression, anxiety or anger) or "incentive use" issues (otherwise known as addictions) may contact Dr. Dubin for face-to-face consultation and treatment through his practice, Psychological Assessment Referral and Treatment Services, online at www.psycharts.com. Dr. Dubin's PsychARTs office may be reached via telephone at 512-343-8307

 

[David Baxter PhD]

Problem of Immediate Gratification
by William Dubin, Ph.D.
April 7, 2010

The Problem of Immediate Gratification (the PIG) refers to the universal principle that immediacy is much more important than magnitude of a payoff when it comes to influencing overt behavior. This is especially true for animals, children and impulsive adults.
Impulsivity is defined as the tendency to choose a small reward now at the expense of a larger reward later (e.g., choosing $1 now over $10 tomorrow). Alternatively, impulsivity can mean avoiding a small punishment now in exchange for a big punishment later (e.g., avoiding dental treatment).

The relationship between immediacy of a payoff and the magnitude of its influence on behavior is hyperbolic. So when the incentive is nearby (in terms of time, space, or psychological distance) it can be awfully influential on real-time behavior.

Motivation is fluid and changes with local conditions. When the incentive is near, it has a greater influence on motivation than a commitment made some time ago. Experiential phenomena are state dependent. When you are close to the incentive, it will exert an influence on you in ways that you cannot now fully appreciate. Choices that may seem ridiculous now may seem like a good idea then.

Ultimately, the outcome of your efforts will be determined by how you perform during the high-risk situations that lie ahead. At these critical moments, you will be in conflict: Pulling in one direction is the motivation to follow the path of greatest advantage, and pulling in the other is the motivation to yield in the direction of least resistance and get the payoff of doing so.

Incentives that motivate both approach and avoidance evoke conflict within the individual. The PIG says, “Regardless of which payoff is biggest or most important, the one that comes first determines what you will do.”

Some outcomes such as physical health, professional success, or loving relationships may have large magnitude but are not produced immediately by a specific behavior. In contrast, the gratification produced by your incentive of choice is immediate, and for that reason exerts an influence on behavior that is disproportional to its magnitude or importance.

Impulsive individuals are particularly vulnerable to the PIG and some incentives are particularly corruptive. Even though they feel guilty about it, several women with whom I have worked have voluntarily given up their babies to use the drug. The PIG is worthy of your respect. Appreciating it intellectually is not the same as experiencing the change of motivation personally. Understand this: Your appraisals and response tendencies will be different when the incentive is nearby than it is now when the possibility of incentive use is not so immediate.

When you are far from the incentive, the motivation to avoid it is greater than the motivation to approach it. But when you are near the incentive, the PIG works its magic and the pull of the incentive can become very strong very quickly. Once the gradients cross and the motivation to approach is greater than the motivation to avoid, there is nothing to stop relapse—the loss of control can happen so fast that you won’t even notice it happening.

When the motivation to avoid the incentive is subtracted from the motivation to approach it, the resulting gradient of net motivation is also hyperbolic; the tendency to approach increases exponentially as the distance between you and the incentive decreases. Note that the motivation to lapse is relatively flat until it crosses the “X” axis. But as soon as it does, the increase in net attraction is so rapid that you may lapse before you know it—there may be no internal debate, no attempt to override the urge; you may simply have gone from intending not to lapse to intending to lapse before you knew what hit you.

When you are far from the incentive, the gradient of net attraction is below zero indicating motivation to avoid the incentive. Under such circumstances the prospect of long-term success appears certain. But when you are near the incentive—in terms of time, space, or psychological distance—net attraction will be greater than zero and you will be motivated to approach the incentive. As the distance between you and the incentive continues to shrink, its influence on state-dependent phenomena insidiously increases exponentially. It is important to be vigilant for the changes in subjective reality that can tip you off that you are getting too close to the incentive. It is important to be vigilant for these warning signals early and, once you do, urgently put distance between you and the incentive.