Although there is some debate as to whether an illness such OCD or severe depression can be learned like any other habit such as driving a car competently, or addictions to alcohol and gambling are somehow different to habits such as overeating, what I hope to show you is that the similarities in the learning process are greater than the differences and this overlap is of practical use.
We know that the common pathways in the reward circuitry that affect normal learning and memory, control and decision making, are also involved in addictive behaviour.
So in effect this spectrum of learned behaviour has similar patterns of brain circuitry only separated on the one hand by the usefulness, and on the other by the impairment, of function which results.
At one end of the spectrum are skills such as cycling proficiently, walking confidently over any terrain or driving a car competently. We can learn to do these things unconsciously, automatically, and on demand, driven by bottom-up neurological circuits based in the basal ganglia and monitored at a distance by our Prefrontal Cortex (PFC).
The difference between these learned routines and addictive ‘pathological’ behaviours is that in the former we retain a sense of control over our thoughts, emotions and behaviours. At any given moment we can exercise that control by utilizing our top-down executive PFC function. In other words we can override the unconscious efficiency of that habitual pattern when it is appropriate to do so.
In fact this top-down PFC ‘cool control’ function is so important in making a ‘deliberate change’ to behaviour, there are even brain circuits devoted to this process. We will be exploring this particular aspect in the next few posts.
At the other end of that spectrum, whether this involves addiction to drugs, alcohol or other unhealthy repetitive behaviours, there is commonly a sense of loss of control. We become preoccupied by thinking about exercising the habit and its associated compulsive behaviours. This is often accompanied by increasing levels of anxiety and impairment of ‘normal’ functioning.
In between these we have what we might call ‘modern-day’ addictive patterns such as those associated with ‘workaholism’, ‘shopaholism’, and the compulsive attraction to TV, internet, gaming apps., social media, texting and even ‘negativism’. Most of us carry out these activities to an extent but in a balanced and controlled way which doesn’t intrude on or interfere with having a ‘normal’ life and relationships.
Why do some people develop unhealthy habits?
Some people are literally ‘creatures’ of habit and may be more likely to learn unhealthy habits including addiction. Other elements which may be important:
- Our level of intelligence may play a role in the susceptibility to becoming addicted to drugs and alcohol.
- In adolescence a susceptibility to addictive behaviour may exist because brain circuits dealing with emotion, judgement, and inhibitory control are relatively late to develop.
- A percentage of the population may have a bio-genetic disposition to chemicals and/or addictive behaviours.
- Early life traumas such as isolation or abuse can contribute to a predisposition to addiction.
How do some people cross the line from habit to addiction?
There is often a transitional process which begins with ‘normal’ repetitive behaviour (“But I’m still in control”), before we carry it out on impulse and then eventually compulsively. Both are often associated with a sense of loss of control.
When we feel ‘impelled’ to do something we may experience a sense of tension or arousal before carrying it out, and either pleasure, gratification or relief as we act on that impulse. Afterwards we may experience regret, sadness or ‘beat’ ourselves up.
A good example is hedonistic overeating of palatable food. David Lewis, in his book Impulse, describes mindless overeating, carried out habitually by a sizeable proportion of the population (pun intended), as “Digging our graves with our teeth”.
When we feel compelled to do something this is also often accompanied by feelings of anxiety and stress and sense of ‘relief’, or at least a reduction in stress, by completing the pattern. A good example is OCD.
As the habit passes from an impulsive to a compulsive pattern there may be a shift from positive to negative reinforcement. For example when drug or alcohol addiction first develops there may be a preoccupation with the substance and anticipation of its positive reinforcing mostly pleasurable affects. Later, often following binge intoxication, experiencing the negative effects of withdrawal leads to negative reinforcement. In other words avoiding the negative effects of withdrawal becomes an additional driver for compulsive drug use.
How can some people change habits, including addictions, and some find this “impossible”?
Addictive or other repetitive behaviours, whether drug or non-drug e.g. gambling, overeating, OCD, often persist despite negative consequences on health, well-being or relationships.
Yet we know that some people can stop compulsive use of tobacco, alcohol and illegal drugs on their own. For others addictive behaviour can be more difficult to change because the patterns are often associated with the sense of loss of control and cravings.
Physical or mental cravings often arise in anticipation of the associated rewards can reinforce the habit. This might explain why we continue to gamble when there is no hope of winning, or drink to a state of stupor, or continue to eat even though we are “Digging our graves with our teeth”. The anticipated reward itself is no longer achievable or of less importance than carrying out the routine.
Some of these elements may make it more difficult to control some behaviours rather than abstaining from them completely: for a habitual alcohol or drug abuser making a positive change is often an ‘all or nothing’ option. This is not an option for the ‘hedonistic’ overeater who will still need to eat after an intervention and/or a change in behaviour.
So even the physical or mental cravings are not as important as the habit, the behaviour or actions, which are part of the routine itself. This is why changing the behaviour in response to a given stimulus, and planning this in advance, is key.
We have mentioned before that our belief systems are extremely important. Beliefs may be reinforced by the actual or perceived difficulty in controlling or changing the behavioural patterns, so much so that the belief can become our identity. For example the person ‘becomes’ the behaviour: ‘the alcoholic’ or ‘the drug addict’; the obese overeater becomes a ‘chronic disease’ sufferer.
One of the starting points in changing a habit is to separate it from who the person really is. Jeffrey Schwartz, describing a four-step approach to OCD in his book Brain Lock, calls this ‘Assertive Relabelling’. Having an addictive behaviour may be a problem but it is not who you are; unless you want it to be.
Next: H4H. You may have more will power than you think. IF-Then and Smart Practice can help.
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