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Salience and Suggestion

9:12 am in Excessive Appetites, Intentional Trance Formation by bill_dubin

We are all condemned to the limitations of subjective reality and so our perceptions and appraisals are creations of the Psyche and not unbiased representations of objective reality. Our understanding of reality is always distorted in one way or another, as different stimuli capture attention, elicit emotional reactions, and thereby bias state-dependent phenomena. When you become angry your perceptions and response tendencies change. The anger that produced these changes does not exist in the objective world; it is a subjective experience that was created by and exists solely within you. The truth when you are angry is different than the truth when you are contrite.

One client, who was working on an anger problem, reported that during a chaotic situation at an airport ticket counter someone kicked him in the back of the leg. When he turned around to “confront the asshole” he confronted a handicapped girl in a wheelchair, which had rolled, out of control, down a ramp and hit him. He reports that she was terrified by the rage on his face when he turned around. His subjective reality changed instantaneously as a result of the new information, although objective reality now included an apologetic adult and a terrified little girl.

Your motivational state is, to a large extent, determined by the stimulus that captures your attention. Some stimuli are more attention grabbing than others. Stimuli that are particularly salient can elicit a state change without your conscious intention. Stimulus Salience refers to how bright or attention grabbing a stimulus is, not necessarily how meaningful it is. The picture of one child suffering as a result of an earth quake may be more salient and elicit a greater emotional reaction than statistics of thousands killed

If there were a rattlesnake by your feet, you would be in a different emotional state (fight-or-flight) than you are in now, and it would be hard to pay attention to this text. This adaptive response results from our descent from organisms that noticed threatening stimuli; those who did not react quickly and powerfully are not our ancestors. A rattlesnake in the room with you is both salient and meaningful. But for an individual with snake phobia, even the idea of a snake—which is not objectively dangerous—can elicit a state change that is not adaptive.

Reward refers to the pleasurable effects of using an incentive. Reinforcement refers to the effect using the incentive has on future behavior. Reinforcement not only strengthens the behavioral sequence that lead to the incentive, but also enhances the salience of stimuli associated with it. The Karma of repeatedly experiencing powerful reinforcement is not only the creation of autonomous paths to relapse, but that stimuli associated with getting or using the incentive become increasingly capable of capturing your attention and eliciting unintended state changes—or trance formations. As a result of their association with the incentive, certain stimuli—persons, places or things—become salient. If you allow them to capture your attention they can elicit trances that will distort your perception, motivation and other state-dependent phenomena in ways that are counter to your interests.

Your biology, past reinforcement history, and current social environment determines what is salient. Your rational processing system gets to determine what is meaningful. To follow your path of greatest advantage you will have to know what it is, and develop the competence to resist the pull of highly salient stimuli and willfully select the target of your attention.

Doing Mode & Being Mode

5:00 pm in Excessive Appetites by bill_dubin

Doing Mode refers to interacting with the world in a goal directed way. The OPEN Path exemplifies Doing Mode. You notice a discrepancy between the way things are and the way you want them to be so you develop a plan to achieve your goal, execute it, and observe how it worked so you can modify your actions accordingly. In contrast, Being Mode refers to experiencing the here and now without trying to accomplish anything.

Suffering naturally evokes Doing Mode to solve the problem and end the suffering. When you attempt to solve a personal problem, your attention will often focus on the difference between the way you are and the way you want to be. If you are not careful, this perspective can be a seductive trigger for ruminative self-focus. Ironically, intending not to fall into this trap can set up a self-critical reaction when you catch yourself ruminating, “I’m ruminating again, after I told myself not to.”

Pathogenic rumination can be evoked by almost anything, and overcoming it requires that you recognize that you are doing it, so that you can disengage from it. But this, of course, implies Doing Mode, which is likely to trigger self-evaluation and ruminative self-focus, and the recognition that you have fallen back into it again.

This is an extraordinarily destructive trap, but it is so compelling. One approach to escaping it is to develop the meta-cognitive ability to intentionally switch from Doing Mode to Being Mode, and thereby awaken yourself from autonomous problem-solving and the state-dependent phenomena it engenders, and instead experience the here and now without interpretation.

Mindfulness
Mindfulness is a mental discipline that promotes awakening and may be defined as: Sensitivity to present experience with non-judgmental acceptance.

Much of our behavior occurs autonomously in the service of one goal or another. As we go about our daily lives, we are typically preoccupied with the past or future while our actions in the present are generally mindless sequences of behavior in the service of some local goal, such as driving to the store. In contrast, mindfulness involves keeping attention in the present moment without judging it as good or bad—calmly and consciously observing and accepting whatever is happening in the here and now.

Thought Experiment: Mindfulness Meditation. Focus your attention on the sensation of the air as it passes in and out of your nostrils with each breath. Each time a thought or feeling arises, notice it, but don’t analyze it or judge it, and return your attention to the breathing. Don’t approach this exercise with the expectation that anything special will happen (that is the very trap we seek to escape through this exercise). As you follow your breath you will notice that a range of thoughts, images and sensations arise in your consciousness and elicit reactions. Your task is to intentionally suspend the impulse to characterize or evaluate what you are experiencing, and instead to experience the here and now directly without filtering it in any way.

Meta-Cognitive Awareness—the appreciation that subjective reality is the state-dependent creation of a biological creature at a particular moment (not necessarily an accurate reflection of the objective truth) can free you from the Soul Illusion. The understanding that thoughts and emotions are not necessarily valid and may be distorted in perverse ways when local conditions elicit pathogenic trances, makes it possible for you to exercise your will. When local conditions influence your appraisals and response tendencies in ways that promote relapse, your task is to recognize this and to re-capture your attention so that you operate the vehicle in accord with your core motivation.

Awakening
The exercise of will often involves a meta-cognitive shift from the perspective of the creature to the perspective of the operator of the creature. For example, when the spouse abuser recognizes that he is in one of his angry Mr. Hyde trances, he has learned to consult the reminder card [described in the next section] that says: “I am probably reading this because I want to act out my anger, but that would be a mistake. Instead I will practice reducing my anger and acting in accord with my interests and principles.”

Developing the ability to awaken from the Mr. Hyde trance and act according to his core motivation—stay out of jail and re-establish a rewarding lifetime partnership—is a non-trivial challenge. This same challenge of awakening from a pathogenic trance faces the individual with an incentive use disorder. In both cases, good outcome requires a meta-cognitive shift from the state-dependent perspective that would motivate destructive behavior to the detached perspective of an interested but uninvolved spectator.

Thought Experiment: Meta-cognitive perspective of a conflict. During a high-risk situation see if you can detach from Doing Mode so that you can observe your sensations and thoughts with acceptance. Use language to describe, the two conflicting forces: Cravings or urges that pull you toward the incentive, and the forces which pull you in a different direction. After you finish, it is recommended that you write about your experiences, describing as best as you can the details of these motivations—your experience of them, their priority now, their priority then, and any conclusions you may have about your core, or true, motivation.

The critical component of the exercise of will is the meta-cognitive shift.

The Serenity Prayer

6:51 pm in Excessive Appetites by bill_dubin

“God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference,” is an eloquent statement of the Enlightened Path.

Here is the way to know the difference: The only things you can change are your thoughts and actions; everything else is outside of your control. Consider how the Serenity Prayer applies to ruminative self-focus. “The things I cannot change” include outcomes, the past, what people think of me. I must have the serenity to accept these realities.

Given your awareness of situations or personal characteristics that diminish the quality of your life, it is natural to apply your problem-solving skills to improve things. The goal is clear enough: Maximize pleasure and desirable outcomes and minimize pain and miserable outcomes. Unfortunately, problem-solving methods applied to the self tend to trigger self-evaluation and hence ruminative self-focus, which in turn increases the likelihood of suffering and bad outcomes.

Ironically, problem solving in the service of escaping suffering, or achieving gratification, drives the recursive mechanism. The irony shows up in many neurotic and addictive disorders. For example, individuals with social phobia are often successful at minimizing social contact, which prevents the exposure to social situations, which is the cure for social phobia. Substance abusers are notorious for coming up with ingenious methods to access their chemical of choice despite the heroic efforts of families or treatment programs to protect them—the relapse, of course, exacerbates their suffering.

The Mentality of Childhood

12:01 pm in Excessive Appetites by bill_dubin

“Accept the truth, even if it is not what you expected or wanted” is the kind of advice one might give a child. In domains of low self-efficacy, even otherwise competent adults revert to the mentality of childhood. Children are attached to outcomes, react emotionally when their efforts are frustrated, and tend to focus on themselves, how they feel, and how valuable they are.

At the theoretical level, the scientific method is flexible in its openness to new facts and ideas. At the procedural level, it is rigid; a good scientist adheres, without exception, to good scientific process. You can be confident that (s)he followed the procedures exactly as described in the publication’s method section. The Enlightened Path requires adherence to good process: Honor your commitments exactly as described and without exception! Be aware of this responsibility when you compose your plan. Do not look for or accept loopholes!

On the Enlightened Path, whatever happens is nature’s way of teaching you the principles of cause-and-effect. Performance errors that in the past would have triggered ruminative self-focus, are instead used in the service of personal growth by increasing your understanding of cause-and-effect relationships. Following the Enlightened Path requires that you perform as intended without exception . . . except when there are exceptions.

Rather than react to unexpected and unpleasant data with self-focused rumination, you are to use the information to develop a more accurate appreciation of the relevant cause-and-effect principles that influence your subjective experience. The truth wants to set you free!

An Exquisite Irony
As you follow the Enlightened Path, you will discover the truth about how you actually respond during real-time crisis. The truth is what it is, and it can be cruel. However, the truth can only set you free if you can accept it. Your challenge is to prevent your reaction to learning the truth from provoking ruminative self-focus and other drains on your motivation and cognitive resources.

Planning itself involves attachment. The very attempt to achieve a goal implies that reaching this goal is desirable. When I feel bad, I am motivated to figure out what to do so I will feel better. But this requires that I check whether or not my tactics are working. If I detect, failure, that means my tactics are not working and I should change them. Sadly, most people interpret negative feedback as evidence of their intrinsic defects or worthlessness, which begins the self-focused ruminative sequence that is never helpful.

Individuals who take on a task as demanding as this one must be open to the truth, yet avoid the judgmental reactions that would trigger neurotic rumination and the impaired performance it brings about. Preventing ruminative self-focus from hijacking your cognitive resources is a critical challenge. Discovering the truth about cause-and-effect, rather than avoiding looking at it, is what enables you to benefit from the lessons that nature is trying to teach you. The Enlightened Path requires that you be awake and open to the truth, no matter how ugly or cruel.

Please click here for implications of the enlightened path on recovery from dependence on an incentive to cope with the experiences of life.

The Enlightened Path

10:09 am in Excessive Appetites by bill_dubin

  • Is light a particle or a wave?
  • Is the electron here or not here?
  • Am I the most important thing in the universe or am I merely dust and ashes?
  • Should I follow a rigid or a flexible path?

Oddly, the best answer to each of these questions is: Yes! Both of the incompatible alternatives are valid at the same time.

Because we do not have direct access to objective truth, our understanding of reality is riddled with paradox. The enlightened path refers to the ability to cope with such paradoxes. This path is not available to the young, for it requires the maturity to accept ambiguity and the limitations of one’s understandings and influence.

The Watercourse Way

The Tao is a metaphor for the natural order of things. Water follows the path of least resistance. Appreciating and working with the cause-and-effect principles of hydrodynamics enables the construction and maintenance of irrigation and plumbing systems that work. Just as the flow of water is influenced by lawful principles such as gravity, the course of your biography is influenced by lawful principles such as the PIG [a small immediate payoff is more influential than a much larger but delayed payoff]. Appreciating and working with the natural laws of the Psyche is the way of the will.

It is not the water’s fault that it is influenced by gravity, nor is it yours that you are influenced by the PIG. You are, however, responsible for taking factors such as the PIG—the hyperbolic relationship between the immediacy of a payoff and its influence on state-dependent phenomena—into account when you develop a plan to escape an addictive trap.

You are not responsible for having fallen into an addictive trap; there are a range of biological, psychological, and social cause-and-effect principles that combined to produce your current predicament. However, now that you are an adult and have recognized that you have a problem, you are responsible for overcoming it so you can act in accord with your interests and principles.

You have now examined two defining strategies for coping with addictive traps. Soon you will design a plan to guide yourself through the heroic challenges you are bound to encounter. You will then have to follow the plan through a real world full of predictable and unpredictable circumstances that would motivate you to abandon it. How flexible should you be? At one extreme is the Impeccable Path in which you rigidly adhere to your plan with no exceptions, at the other extreme is an OPEN Path where errors are opportunities for growth.

The Enlightened Path is a middle way and contains elements of both. You must honor all commitments without exception, but you must only commit to what you can control.  You control your behavior and attitudes, but not outcomes! You can accept responsibility for what you do, but it would be imprudent to accept responsibility for the outcomes of what you do; forces other than you have an influence on how events play out in the objective world. So be careful about committing to improving your life or to repairing relationships; you may have less control over such things than you think.

This middle way is an opportunity to apply the scientific method, in a gentle and forgiving manner. The Enlightened Path presupposes that your understanding of reality will always be imperfect, so you must be open to disconfirming information and use it to nurture your understanding of cause-and-effect.  Please click here for exercises that can enhance your ability to follow this path.

The OPEN Path

4:00 pm in Excessive Appetites by bill_dubin

Relapse is common because we are all vulnerable to the Soul Illusion: During high-risk situations we will not be as motivated to avoid lapsing as we are now. This is not a problem for followers of the Impeccable Path, because they do not have to make plans. They have no choices other than rigid adherence to their commitment. The OPEN Path is more complicated.

To follow the OPEN Path you would develop an Implementation Intention such as, “When I encounter high-risk situation X, I will execute tactic Y.” You have to exercise your will to carry out your plan, and then, like a scientist, you would observe what happens. If you get the expected outcome, you are on the right track. Congratulations! However, if things did not work out as you expected, nature is telling you that cause-and-effect play out differently than you thought, and you must modify your plan to account for this new knowledge. Then, you would execute the new plan and be open to the feedback nature gives you, and so forth. Over time you will develop a more sophisticated understanding of cause-and-effect in your universe and a progressively more realistic and effective set of coping tactics.

The OPEN Path refers to: Outcome, Plan, Execute, Nurture:

1. Choose an Outcome you want.

2. Develop a Plan to achieve it.

3. Execute the plan.

4. Nurture your understanding through observation and modify the plan accordingly. Go back to step #3.

Example of H’s plan: “At the wedding reception, whenever I think of drinking alcohol, I will take a sip of club soda and focus on my family.” Later, he will review his observations, asking himself: “What can I learn from this experience?” “What helped and what did not?”
The Truth Will Set You Free!
The objective of the OPEN Path is to improve your understanding of cause-and-effect through observation. If your predictions were good enough for you to create a plan that worked well, congratulate yourself, and note what you did that was effective. Success has a lot of information value: There are many ways to fail, but few ways to succeed.

However, if things did not go as predicted, nature has taught you something you did not know before. The task now is to appreciate that you received something of value, rather than a rebuke, and use this new information to improve your understanding so you can modify your plan accordingly. You might make some adjustments or abandon the tactic completely in favor of a different approach. As you continue to accept natural feedback and use it to improve your coping abilities, you will become progressively more effective.
Self-Forgiveness
The follower of the OPEN Path seeks truth as revealed by observation. Personal experiments are conducted primarily to ask a question of nature and receive an answer. These experiments are risky. Unexpected results are common; if we knew what would work we would not have to do the experiment.

Performing these experiments requires courage. Unfortunately, many people with addictive disorders are relentless promoters of self-hate. The inevitable setbacks and hard times are taken as proof of their intrinsic worthlessness or of the hopelessness of their situation.  The solution to this problem is presented in the next Blog Entry.

The Impeccable Path

11:00 am in Excessive Appetites by bill_dubin

Despite their repeated relapses most people never develop sufficient respect for the challenge they face. Instead they believe their previous failures reflect their own defectiveness. If they appreciated what they were up against, they would not make shallow commitments.

Once you make up your mind to control your appetites, the only thing preventing you from giving in to a temptation is your commitment not to. Failing to honor a commitment sets the precedent that you can make a commitment and then violate it. This precedent weakens the ability of future commitments to influence your behavior. The critical error of making and then breaking a commitment can transform an excessive appetite into dependence. The transition is gradual and the individual is generally not aware of the process while it is happening.

The point of making a commitment is to freeze your motivation, so that your future behavior is determined by your commitment to follow your plan rather than by local temptations. A commitment is your guarantee that you will adhere to your plan even when it would be easier or more pleasurable to defect. If you fail to honor your guarantee you have made a liar of yourself, and future guarantees will be worth less.

Making a commitment is like making a bet. If you adhere to it you win and your willpower is enhanced; if you fail, you lose and the strength of your will diminishes.

Odysseus and the Sirens

In a different era Odysseus had to sail within earshot of the Sirens. No sailor could resist their seductive call. The penalty for giving in to this irresistible temptation was death by drowning—the fate experienced by all who had come before. Appreciating the danger, Odysseus filled his men’s ears with wax so they would not be able to hear the Sirens. Odysseus wanted to hear what the Sirens sounded like, but he knew that if he did he would be unable to resist their pull. The heroic solution: Odysseus pre-committed his future behavior by ordering his men to tie him to the mast of the ship.

The plan was successful—when the ship sailed past the island, the Sirens called, but the men could not hear them and kept rowing. Odysseus heard the Sirens, but did not (could not) give in to the temptation, because he was bound to the mast.

Four Lessons
1. Odysseus made his plans in advance. He knew that once he heard the Sirens it would be too late to influence his own behavior—their call would have transformed him from a potent warrior to a helpless victim. You would do well to use Odysseus’ humility as a model. Understand this: When you encounter a high-risk situation you will not have the strengths that are available to you now, and you are not likely to come up with an effective response during the crisis. To succeed you must have a well planned, well rehearsed coping tactic already in place.

2. Engineer your environment to minimize your exposure to temptation: avoid high-risk situations and people—at least until the healthy habits have strengthened.

3. Because no sailor had ever survived the temptation of the Sirens, some might take a defeatist attitude and passively accept the inevitable loss. But Odysseus was a hero (he had high self-efficacy) and so he approached the challenge as a problem to be solved. He devised a good plan and executed it well.

4. The most important lesson is, even though Odysseus experienced irresistible temptation, he did not give in to it. Before reading on, think back to the story . . . how did he do it?

Having respect for the irresistible power of the Sirens, he pre-committed his future behavior by having himself bound by strong rope. Likewise you can pre-commit your future behavior by being bound by your word. For example: “I am not experiencing temptation now, but I know that I will. So I give my word that no matter what the circumstance I will keep distance between me and the incentive.” Willpower refers to your ability to adhere to your commitment despite the influence of local factors that would pull you astray.

Willpower—the power of your intention to influence real world events—is a creation of the Psyche and can be gained or lost according to how you actually perform.

Thought Experiment: Earnest promises. You announce that you need to move some bulky furniture. Ernest, who owns a pickup, offers to help. You point out that he often makes such promises and has let you down many times. He replies, “But this time I really mean it.” He seems sincere, but he seemed sincere the other times too. The objective world demands that the furniture gets moved. Should you count on Ernest showing up or make your plans assuming he won’t? Events in the objective world have not happened yet so we don’t know for sure whether or not Ernest will show up. However, your expectations will be based upon what you have learned about how seriously Ernest has taken his previous commitment to you.

When you make commitments to yourself, are you earnest? Failing to honor your word weakens subsequent commitments—telling yourself: “But this time I really mean it” is not an effective rescue. On the other hand, each time you honor a commitment you enhance your willpower.

Understand this: Once you decide to change your ways, you must permit no exceptions to occur!

Note that the word “decide” is derived from the root “cide,” which means “to kill,” as in sui-cide, homi-cide, insecti-cide. When, for example, an alcoholic makes the decision to quit drinking, it is understood that (s)he means to kill, once and for all, the option to drink alcohol, and thereby lock out drinking in the future. (The requirement of absolute adherence to the commitment is equally important for those who choose moderation rather than abstinence as an outcome goal.)

Typically, one decides to control an impulsive behavior when its costs are more salient than its benefits. Your commitment is your promise to adhere to the plan in all circumstances. Willpower is the measure of your ability to deliver on that guarantee. Willpower is not static, and your capability of overriding the influence of the PIG can increase or decrease according to certain lawful principles. Local conditions such as negative emotional states or exhaustion can deplete this power. So, like an athlete, it is important to train hard to develop your strength and be vigilant for circumstances that would deplete it. Please click here for more about Will and Subjective Reality.

Total Abstinence vs. Moderation

5:05 pm in Excessive Appetites by bill_dubin

The disease model and 12-Step programs assume that the individual is powerless to control incentive use, and so do not permit moderation as a treatment goal. The bio-psycho-social model does permit such a goal, which for many individuals is a weakness of this approach. In fact, even though the author does not know anything about you, he asserts that choosing moderation as a goal rather than complete abstinence is probably a mistake. Nevertheless, you are an adult and it is your call. Be aware that your relationship with the incentive can take three forms: 1) abstinence, 2) controlled use, or 3) uncontrolled use. (If you cannot control your incentive use, you only have two options.)  

The desire to maintain your relationship with the incentive is certainly understandable; incentive use does have its benefits. Ironically, the greater the payoff, the greater is the incentive’s corruptive power; incentives that can deliver immediate gratification have such an impact on the Psyche that attempting to be a “controlled user” may be a fool’s errand. However, if you still want to pursue moderation rather than abstinence as a goal, take the PIG’s wager: If you win you get to be a controlled user; if you lose you must admit that the PIG [the Problem of Immediate Gratification] is stronger than you had imagined (or are capable of imaging), and abstinence and uncontrolled use are your only options.

  • Establish whatever rules you think are appropriate regarding incentive use.
  • Whatever these rules are, the PIG bets that you can’t follow them.
  • Take the PIG’s bet—that is, you wager that you will adhere impeccably to your rules.
  • If you win the bet you get to continue to use the incentive under the terms of your rules.
  • But if you lose the bet you must admit that you cannot be a controlled user. You don’t get a second chance. Any violation of the rules means you lose, so bear this in mind when you make your rules.
  • Controlled use means that you are following your own rules, so there must always be rules pertaining to this aspect of your life. You may modify your rules according to some predefined schedule – never on the spur of the moment.

The Disease Model of Addiction

11:09 am in Excessive Appetites by bill_dubin

Many people with addictive disorders are impaired and require external structure or supervision to lead functional lives. There are, however, some individuals who remain cognitively intact and function quite well in most domains, save their relationship with a particular incentive. The model described by this kit is poorly matched with impaired individuals or those who seek external structure from groups, treatment providers, or programs.  As a rule of thumb, the more impaired the individual, the greater the external control required to maintain incentive-free periods. Some operational definitions of “impairment”: 

  • Cognitive impairment resulting from chronic substance abuse.
  • Cognitive impairment due to other factors such as head injury, other organic causes, low native intelligence.
  • Psychiatric impairment resulting from mood disorder, thought disorder, or personality disorder.

 In North America, the vast majority of treatment programs for addictive disorders are based on the 12-Steps of Alcoholics Anonymous.  According to this view, incentive use disorders are diseases. Treatment emphasizes admitting powerlessness over the illness, complying with a plan developed by treatment providers, and adopting the norms and values of a new social group—the support or self-help group—in order to achieve total abstinence, which is the only acceptable outcome goal. The victim of the disease is responsible for neither the cause nor the resolution of the problem.

This approach is available to all; there are no restrictions or limitations on who may follow this path, and many individuals have benefitted greatly from this approach. Those who are poorly matched cognitively or philosophically with the demands of the self-directed approach described in this kit have many excellent 12-Step programs from which to choose.

The bio-psycho-social Model  emerged from the principles of biological, psychological and social sciences. According to this view, you are not responsible for falling into your addictive trap—you had no control of your genes, early conditioning, and social history.  However, now that you are an adult you are responsible for extricating yourself from self-sabotaging traps so that you act in accord with your interests and principles.  Rather than encourage you to accept powerlessness over a disease, this approach encourages you to develop the power of your will so that you  act in accord with your interests and principles.

For more about this issue, and some practical steps you can take, please click here.

Dependence

3:35 pm in Excessive Appetites by bill_dubin

The PIG (the Problem of Immediate Gratification) is a defining feature of incentive use disorders.  Individuals 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. For strategies to enhance you willpower please click here

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 will 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.”