Monday, 14 December 2015

The Science of Habit Change

Part 4/14 (to see other parts of the article, click on the pages at the bottom)

Click here to listen and/or download this article as a professionally recorded AUDIO BOOK (45 minutes).

An estimated 2.1 million people seek help from AA each year, and as many as 10 million alcoholics may have achieved sobriety through the group. AA doesn't work for everyone-success rates are difficult to measure, because of participants' anonymity-but millions credit the program with saving their lives. AA's foundational credo, the famous twelve steps, have become cultural lodestones incorporated into treatment programs for overeating, gambling, debt, sex, drugs, hoarding, self-mutilation, smoking, video game addictions, emotional dependency, and dozens of other destructive behaviors.

The group's techniques offer, in many respects, one of the most powerful formulas for change. All of which is somewhat unexpected, because AA has almost no grounding in science or most accepted therapeutic methods. Alcoholism, of course, is more than a habit. It's a physical addiction with psychological and perhaps genetic roots. What’s interesting about AA, however, is that the program doesn’t directly attack many of the psychiatric or biochemical issues that researches say are often at the core of why alcoholics drink. In fact, AA’s methods seem to sidestep scientific and medical findings altogether, as well as the type of intervention many psychiatrists say alcoholics really need.

What AA provides instead is a method for attacking the habits that surround alcohol use. AA, in essence, is a giant machine for changing habit loops. And though the habits associated with alcoholism are extreme, the lessons AA provides demonstrate how almost any habit - even the most obstinate - can be changed.

Bill Wilson didn’t read academic journals or consult many doctors before founding AA. A few years after he achieved sobriety, he wrote the now-famous twelve steps in a rush one night while sitting in bed. He chose the number twelve because there were twelve apostles. And some aspects of the program are not just unscientific, they can seem downright strange.

Take, for instance, AA's insistence that alcoholics attend "ninety meetings in ninety days"-a stretch of time, it appears, chosen at random. Or the programs intense focus on spirituality, as articulated in step three, which says that alcoholics can achieve sobriety by making "a decision to turn our will and our lives over to the care of God as we understand him." Seven of the twelve steps mention God or spirituality, which seems odd for a program founded by a onetime agnostic who, throughout his life, was openly hostile toward organized religion. AA meetings don't have a prescribed schedule or curriculum. Rather, they usually begin with a member telling his or her story, after which other people can chime in. There are no professionals who guide conversations and few rules about how meetings are supposed to function. In the past five decades, as almost every aspect of psychiatry and addiction research, has been revolutionized by discoveries in behavioral sciences, pharmacology and our understanding of the brain, AA has remained frozen in time.

Because of the program's lack of rigor, academics and researchers have often criticized it. AA's emphasis on spirituality, some claimed, made it more like a cult than a treatment. In the past fifteen years, however, a reevaluation has begun. Researchers now say the program's methods offer valuable lessons. Faculty at Harvard, Yale, the University of Chicago, the University of New Mexico, and dozens of other research centers have found a kind of science within. Their findings endorse the Golden Rule of habit change: AA succeeds because it helps alcoholics use the same cues, and get the same reward, but it shifts the routine. Researchers say that AA works because the program forces people to identify the cues and rewards that encourage their alcoholic habits, and then helps them find new behaviors.

Take steps four (to make "a searching and fearless inventory of ourselves") and five (to admit "to God, to ourselves, and to another human being the exact nature of our wrongs").

"It's not obvious from the way they're written, but to complete those steps, someone has to create a list of all the triggers for their alcoholic urges," said J. Scott Tonigan, a researcher at the University of New Mexico who has studied AA for more than a decade. "When you make a self-inventory, you're figuring out all the things that make you drink. And admitting to someone else all the bad things you've done is a pretty good way of figuring out the moments where everything spiraled out of control."

Then, AA asks alcoholics to search for the rewards they get from alcohol. What cravings, the program asks, are driving your habit loop? Often, intoxication itself doesn't make the list. Alcoholics crave a drink because it offers escape, relaxation, companionship, the blunting of anxieties, and an opportunity for emotional release. They might crave a cocktail to forget their worries. But they don't necessarily crave feeling drunk. The physical effects of alcohol are often one of the least rewarding parts of drinking for addicts.

"There is a hedonistic element to alcohol," said Ulf Mueller, a German neurologist who has studied brain activity among alcoholics. "But people also use alcohol because they want to forget something or to satisfy other cravings, and these relief cravings occur in totally different parts of the brain than the craving for physical pleasure."

In order to offer alcoholics the same rewards they get at a bar, AA has built a system of meetings and companionship - the "sponsor" each member works with - that strives to offer as much escape, distraction and catharsis as a Friday night bender. If someone needs relief they can get it from talking to their sponsor or attending a group gathering, rather than toasting a drinking buddy.

"AA forces you to create new routines for what to do each night instead of drinking," said Tonigan. "You can relax and talk through your anxieties at the meetings. The triggers and payoffs stay the same, it's just the behavior that changes."

habitloop