Out of the Habit Trap: Five Stages to Freedom

The Steps to Self-Cure

How does anyone manage to kick a habit after years of living with it? To find out, San Francisco sociologists Dan Waldorf and Patrick Biernacki interviewed heroin addicts who quit on their own, and sociologist Barry Tuchfeld at Texas Christian University talked with some 50 alcoholics who recovered without therapy or AA. And in conducting our own field research with addicts of all types, my associate Archie Brodsky and I have outlined the critical steps in self-cure.

The key word is self: taking charge of your own problem. Some psychologists call this self-mastery; others, self-efficacy; others, the belief in free will. It translates into three components necessary for change: an urge to quit, the belief that you can quit and the realization that you must quit—no one can do it for you. Once you have quit, the rewards of living without the addiction must be great enough to keep you free of it.

The stages of successful self-cure are remarkably similar, regardless of the addiction:

1. Accumulated unhappiness about the addiction. Before a change can take place, unhappiness with the addiction has to build to a point where it can't be denied or rationalized away. This phase of the process of self-cure, to use Vaillant's analogy, is like the incubation of a chick. Just because the chick hatches, rather abruptly at that, doesn't mean it happened spontaneously. A lot of changes go on first beneath the outer shell.
   To break an addiction, you must believe the rewards you'll get (from not smoking, from exercising and losing weight, from cutting down on or giving up alcohol or drugs) will surpass what you got from the habit. Heroin addicts who "mature out" typically explain to interviewers that a life of hustling, prison and the underworld was no longer worth it.
2. A moment of truth. An alcoholic pregnant woman told Tuchfeld: "I was drinking beer one morning and felt the baby quiver. I poured the rest of the beer out and I said, 'God forgive me, I'll never drink another drop.' " Another woman who had quit (and resumed) smoking several times found herself sorting through the butts in an ashtray late one night, desperate for a smoke: "I saw a snapshot of myself in my mind's eye," she told me, "and I was disgusted." She has not been a smoker for 15 years now.
   Most ex-addicts can pinpoint a moment at which they "hatched" from the addiction and left it behind. It is impossible to distinguish the real moment of truth from the addict's previous vows to quit, except in retrospect. But it is just as foolish to disregard these reports altogether. Because they are part of such a high percentage of successful cures, they seem to have an important meaning to the ex-addict.
   Epiphanies that work can be brought on by dramatic, catastrophic events: an alcoholic becomes falling-down-drunk in front of someone he admires, or a cigarette smoker watches a friend die of lung cancer. But most moments of truth seem to be inspired by trivial remarks or chance occurrences. Either way, they work because they crystallize the discrepancy between the addict's self-image and the reality.
3. Changing patterns. People successful at self-cure usually make active changes in their environment—they may move away from a drug culture, become more involved in work, make new friends. But some people break a habit without changing their usual patterns. The man whose story began this article—the heavy drinker and smoker—was a musician who continued to spend nearly all his nights in bars. He wrapped himself in a new identity—"I'm a nondrinking, nonsmoking musician"—that protected him from his familiar vices.
4. Changing theidentity of addict. Once former addicts gain more from their new lives than from the old ways—feeling better, getting along with people better, working better, having more fun—the lure of the addiction pales. One longtime heroin addict quoted in the book High on Life quit the drug in his thirties, went to school and got a good job. Later, during a hospital stay, he was given an unlimited prescription for Percodan, a synthetic narcotic. He marveled at how he had no desire to continue the drugs when his pain stopped: "I had a different relationship with people, with work, with the things that had become important to me. I would have had to work at relapsing."
5. Dealing with relapses. One of the problems with biologica theories of addiction is the image of imminent relapse it creates for the addict—the idea that one slip is a return to permanent addiction. Many of Schachter's ex-smokers admit having a puff at a party. Half of those ex-addicts who had been in Vietnam did try heroin at home, Lee Robins found, but few returned to a full-fledged addiction. The addict who has successfully modified his or her life catches the slip, and controls it.

The steps out of addiction, therefore, are: to find a superior alternative to the habit you want to break; find people who can help you puncture your complacent defenses; change whatever you need to in your life to accommodate your new, healthier habits; celebrate your new, nonaddicted image whenever you can.

The common feature in all these steps is your action, your beliefs. Self-curers often use many of the same techniques for breaking out of an addiction that formal treatment programs do. But motivated people who have arrived at these techniques on their own are more successful than those in therapy.

Why should this be? One possibility, of course, is that the people who go for professional help are the hard cases those who have tried to change on their own and found it impossible. People may try to quit smoking a dozen times, or lose and regain a few hundred pounds, before deciding they need help. Therapy often represents only one attempt at cure, whereas people usually come to grips with a problem over a period of years.

But I also think that therapy itself may inadvertently impede cure, by lowering the addict's sense of self-mastery and self-control. In turning to therapy, addicts unwittingly acknowledge that they are powerless to break the addiction. Thus medical supervision of drug withdrawal, for example, can actually inflate the difficulty of doing something that drug addicts accomplish repeatedly on their own.

Therapy can be especially demoralizing when it's based on the notion that addiction stems from an unchangeable biological weakness. Such a philosophy can make quitting even more difficult. Sociologist Charles Winick observed two decades ago that adolescents who failed to mature out of heroin addiction were those who "decide they are 'hooked,' make no effort to abandon addiction and give in to what they regard as inevitable."

We now see why that discovery applies to the general problem of breaking self-destructive habits. Only death and taxes, it now appears, are truly inevitable. Everything else is negotiable—and open for improvement.