Beatrice came in for a follow up visit. She is in her early 50’s and has wrestled with her addiction to alcohol for more than half of her lifetime. Except for a (pretty bad) one night slip last Thanksgiving, she now has two years of recovery under her belt. She holds her recovery gingerly, like a butterfly in cupped palms. Her recovery means everything to her, and she doesn’t want to take it for granted ever again. She did that once and lost six years of her life, including her relationship with her beloved daughter and grand-daughter. They are in the process of carefully rebuilding this relationship.  

Dreaming of Long-Term Recovery

Although I don’t doubt Beatrice’s sincere aspiration for long-term recovery, I believe one of the most important messages I can reinforce with my patients is the notion that relying on the dream of long-term recovery as a motivator for staying sober can be a dangerous approach. As BJ Fogg, founder of Stanford University’s Behavioral Health Lab and author of Tiny Habitspoints out, “Big spikes of motivations are awesome for doing really hard things — once. Rescuing your child. Quitting your job. Throwing away all the junk food in your house. Sprinting through the airport to catch a flight. Attending your first AA meeting…”  

More Than Just Motivation is Needed

Achieving the outcome of being in long-term recovery and having a good relationship with those you love, like Beatrice wants with her daughter and grand-daughter, takes more than relying on mere motivation. Don’t get me wrong, the motivation is not bad; in fact, it’s absolutely integral to any behavioral changes. It is simply, according to Fogg’s research, the least reliable of the three necessary components needed to change your behavior: motivation, prompt, and ability. Any actions or behaviors are much more likely to happen when motivation is high and they are easy to do. And actions require a prompt.  



Putting the Behavior Change Framework into Action

In Fogg’s model, it is imperative to make doing behaviors which support the aspirations easy. Inherent in this approach also means creating relevant prompts. Using his model, behavior = motivation + ability + prompt, let’s look at some of the reasons contributing to Beatrice’s successful recovery. PROMPT: Beatrice’s sponsor, Sue, texts her a message each week that she will be picking her up for their Tuesday morning home-group meeting. ABILITY: Beatrice doesn’t have to find her keys, warm up (or cool down) her car, fill her tank with gas, or worry about parallel parking (which she says was a big reason she used to avoid going to her favorite meeting). MOTIVATION: Beatrice thoroughly enjoys her time with Sue and gets a lot of inspiration from the group. Breaking it down, we can see that the behavior (attending an AA meeting) happened due to the prompt, the high level of motivation, and the ease (or ability) of attending.  

Take Action to Support Recovery

While any substance use disorder is a complex bio-psycho-social issue, applying this kind of model to make a plan that supports long-term recovery can be incredibly helpful. I also like that it takes away some of the inevitable negative self-talk. If Beatrice didn’t go to an AA meeting because she was intimidated about parallel parking, it’s not because she doesn’t care about her recovery or sustaining a good relationship with her daughter…rather, it reveals an opportunity to focus on ways to make the desired behavior easier to accomplish. When Beatrice and I discussed how to break down and examine the components of her behavior to predict likely successes or failures, she immediately came up with other ways to remove obstacles getting in the way of desired outcomes. At our next appointment, she promises to bring me her plans for increasing vegetables in her diet! The Coleman Institute for Addiction Medicine has been working with people who desire long-term recovery for over twenty-five years. If you or a loved one is struggling to stop drinking alcohol or to get off opioid pain medication, heroin, methadone, fentanyl or buprenorphine products, let us help make it safe and streamlined for you. Joan R. Shepherd, FNP