Do People with Opiate Addiction Have No Control?

It is commonly believed that willpower or self-control is most important when battling drug addiction, but new evidence indicates that the use of specific strategies for recovery may well be more important than and unrelated to self-control during opioid addiction recovery.

The newest paper reports that researchers studied how individuals, particularly those addicted to opioids or alcohol, judge their willpower and its status over time.  The paper also provides a theory that may lead to better understanding of what tactics to apply addiction recovery.

In the study, 69 patients addicted to one of three substances, opioids, meth, or alcohol, were followed and polled over a 3-year timeline.

The lead on the project, Anke Snoek a Ph.D. student in Australia, stated that self-control is often believed to be the most important factor to recovery because, in non-addiction based situations, willpower and self-control are relied on and are enough to help us make good choices.  Willpower and self-control fail from time to time, and we make choices that don't match up with our goals or beliefs. Most people, then, understand willpower from their experiences around the failure of willpower and believe that their non-addicted choices are the same as those of an addict and that the addict must lack self-control.

Snoke expanded, saying that the expectation would be that people with high levels of self-control would be the most successful recovering from addiction.

In any self-reported study, there is the possibility that respondents misidentify their status intentionally or unintentionally, and self-control can be difficult to measure, however, Snoek is confident as the subjects also provided very detailed information on their histories and daily lives. Most subjects were interviewed several times over the three year period. And Snoek came away with the belief that most individuals interviewed had high levels of self-control and willpower. As many of the respondents were living on the streets, they had cultivated high levels of willpower and strength to survive their day-to-day lives.

The study contained examples of subjects who used skills over the strength of will. From these data points, the scientists believed that some subjects claimed to be more strong-willed than they were. One confounding factor may be that these subjects were strong-willed people, but that their self-control and will was focused on surviving their lifestyle and was not deep enough to also impact their addiction.

The evidence from the article indicates that addicts generally do have self-control and a strong will. That they cannot change their drug use patterns isn't due to lack of self-control, but because self-control is not enough. Unfortunately, many people including medical professionals believe that addicts have no self-control or lack willpower. If these patients are taught how to use their will and self-control in smart and effective ways, they could significantly improve their outcomes.

Snoek further explained that there was a specific finding that was not published in the article. Comparing subjects who achieved recovery goals with those who didn't, two very interesting data points became clear.   One was that changing the patient's environment was critical to success. The other was that a patient who could control their emotion and feelings better had a better chance of achieving recovery goals. There is quite a lot of published evidence that indicates that the emotional state a person is in impacts their willpower. Being miserable leads to a very singular focus on one thing: not being miserable.

The study concludes that while most subjects indicated that they were had high or very high levels of self-control, no evidence linked that high self-control with successful recovery. Rather, the total number of tactics used by the subjects closely matched with recovery status. The patients in recovery were also much more interested in new tactics than those who relapsed. In essence, self-control and willpower were only important when used to power the strategies and tactics, not simply to avoid drug use.

There isn't a magic bullet for beating addiction. Addicts need different tactics and strategies at different points in their recovery. Those skills don't come quickly and knowing how to apply them and when is not always a quick process either. Hopefully, this information will lead to a deeper understanding of the critical role that recovery strategies play in recovery status and help to destigmatize those who are addicted.