Even when the patient has concluded that continued substance use is no longer the best option, he or she still harbors a number of important doubts about the ability to change.

The electric switch on a white background. 3D image.Motivation vs. Unmotivation, Part Two

There are three barriers to real motivation. I’m not talking about the motivation to go to detox, or placate the judge, boss or family. I’m talking about the sort of motivation that can carry people into recovery. For that goal, seems to me three conditions must be met.

First, the addict must reach the conclusion that the consequences of continued substance use outweigh the benefits. This isn’t easy.

If you read through the stories in AA’s Big Book — there are a hundred– you find a recurring theme of betrayal: First, alcohol was my friend, and then, over time, became my adversary. In practice, this means every alcoholic can tap into a fund of positive memories of the good old days when drinking didn’t seem like much of a problem. It’s sometimes called euphoric recall— the pain of addiction fades into the background while fond recollections come to the fore. If you’ve ever sat around a detox lounge, you realize they’re not talking about the awful events that preceded admission to the hospital; more likely they’re sharing stories of the best binge, the finest dope. One advantage of attending all those 12 Step meetings is you can’t help being reminded of the bad parts. Someone else always seems to bring them up.

Now for the second requirement: Even when the patient has concluded that continued substance use is no longer the best option, he or she still harbors a number of important doubts about the ability to change. Those doubts aren’t just based in low self-esteem; they spring from prior unsuccessful attempts to control or stop substance use. The vast majority of addicts and alcoholics arrive in treatment with such doubts, and the tendency is to willfully set them aside in a quest for hope. That’s not always the best approach. Often we need to unearth and address them directly.

The third and final requirement is to come up with a plan for change that is acceptable to the addict or alcoholic. It’s a subjective judgment and therefore varies widely between individuals. A big part of counseling is to assist in the development of this plan, and in helping the patient come to terms with the need to implement it. Because change is not all that much fun, and a disorganized, unsuccessful attempt at change can sap motivation.

So from my view, real motivation arrives when those three conditions have been met. There are still plenty of challenges to overcome. But now the patient is trying. And when you try, you’re likely to succeed.

More info coming up in Part Three: A Simple Test

Motivation vs. Unmotivation -More from this series:


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