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Sober Nation

Putting Recovery On The Map

10-15-19 | By

Why Is It so Hard to Quit Pain Pills?

Why is it so hard to quit pain pills? Or quit smoking? Or drinking cola? Or any other habit or addiction?

Most people want to change. They just don’t know how.

Most people actually want to stop habits and addictions that are hurting them or their loved ones. Habits like:

  • Quitting pain pills
  • Overspending
  • Smoking
  • Drinking too much alcohol or soft drinks
  • Eating too much sugary foods
  • Gossiping
  • Isolating
  • Ruminating
  • Yelling at their kids
  • Pornography

Everyone has something that they want to quit, but are putting it off. Everyone.

What’s Wrong with Us? Why Is It So Hard to Quit Pain Pills?

We hear the voices in our head that say, 

  • If you really wanted to quit, you would. You must not want it.
  • You’re too weak.
  • You’re too stressed to stop now.
  • You’re too lazy.
  • You’re too far gone. You’ll never quit.
  • You need help, but it would be too embarrassing to admit it to someone.

Is Willpower and Motivation the Answer?

Before I was certified in addiction medicine, I would spend meaningless hours as an internist, doing the thing I thought I was supposed to do: tell people to quit whatever the thing was that they were doing that was causing them problems. I told people, “quit smoking.” “Lose weight.” “Stop the pain pills.” “Blah blah blah blah.” There are not enough blahs to describe the ridiculous waste of time this was. And I just became frustrated, as did all the patients who wanted to make the change, but just didn’t know how. They all knew WHAT they needed to do. They just did not know HOW to get there. 

As Dr. and Dr. Prochaska describe in their phenomenal book, Changing to Thrive. Using the Stages of Change to Overcome the Top Threats to Your Health and Happiness, doctors and patients alike become discouraged by trying to get people to do the thing they need to do. Beefing up willpower is not the end all, be all answer. A much more helpful approach is asking the right questions! In fact, the answer might be asking the appropriate questions.

Why is Asking The Right Question the Answer?

Glad you asked.

The Transtheoretical Model of Behavior Change, developed by James Prochaska and Carlo DiClemente over 35 years ago, describes the “Stages of Change” people go through on their journey to getting free of captivating behaviors. There is no less desire to be free of the behavior, but there are different concerns in each stage. Each stage of change necessitates a different set of questions to be addressed in order to move the person to the next stage. The very first question to ask is, what stage are you in right now?

How Do You Know What “Stage You’re In?”

  1. Precontemplation: You do not want to change the behavior in the next 6 months.
  2. Contemplation – You do want to change the behavior in the next 6 months.
  3. Preparation – You want to change the behavior this month!
  4. Action – You changed the behavior and for the fewer than 6 months, you have been doing the new behavior
  5. Maintenance – You have been doing the new behavior for over 6 months.
  6. Termination – The change is done and there is no fear of relapse.

We are in different stages of change for different behaviors. Let me give you a few examples:

Sally wants to start exercising, but she thinks she has no willpower. She went to the gym as a young woman, but when her kids were born, she stopped. She has been stuck in a demoralized place for the last few years, thinking she just doesn’t have enough willpower. However, she stopped eating dessert 5 months ago. She wonders how she did that, but can’t make herself go to the gym. She is in the pre-contemplation stage of change for exercise and the action stage for avoiding dessert.

Here’s another example:

Bob quit pain pills because of his addiction to them one year ago and has been taking buprenorphine (Suboxone) in a maintenance program. He still smokes cigarettes. His lung doctor told him to quit, but he just does not want to. However, he has reunited with his wife and baby daughter. His wife also wants him to quit smoking, but he just gets defensive when she brings up the topic. Secretly, he wants to, but does not want to be nagged and has no desire to stop any time soon. He does wonder why he could quit pain pills, but not quit cigarettes. He is in maintenance stage of change with his opioid use disorder and is in pre-contemplation stage for his cigarettes.  

So the first question to ask when you are having a desire to change a behavior is this: how soon do you want to make the change?

If you are in the precontemplation stage of change, your answer will be, 6 months or longer.

If you are in contemplation stage, your answer is, thinking about making the change in fewer than 6 months.

If you are in preparation stage, your answer will be, this month! I’m almost there.

Once you know what stage of change you are in, you can move to the next stage by addressing the questions and new understandings in each stage. It will have required less willpower, but more understanding of where you truly are. 

To quote Victor Hugo: “Nothing is more powerful than an idea whose time has come.”

___

Leslie Cole, M.D.

Prochaska, James O., Ph.D., Prochaska, Janice M., Ph.D. Changing to Thrive. Using the Stages of Change to Overcome the Top Threats to Your Health and Happiness. Hazelden Publishing, 2016.

Disclaimer: This article is for information and educational purposes only and is not medical or psychological advice, diagnosis, or treatment. It’s solely intended for your own self-improvement and does not replace the advice and services of health care professionals. You are advised to seek professional advice as appropriate before making any health decision.

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