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2015
Dr.Hays

Willpower & Addiction

Posted by Dr.Hays Jun 26, 2015

Last week, I wrote a blog highlighting the difficulty of trying to manage tobacco withdrawal through willpower alone and suggested a more effective use of this cognitive tool in recovery.  What followed was an engaging discussion in the comments that inspired me to expand on the concept of willpower. 

 

Willpower is viewed as one’s ability to exert control over their thoughts and behaviors through conscious decision-making.  Often, it includes resisting short-term desires to accomplish a long-term goal such as a student electing to study for an important exam instead of going to a party with friends.  Willpower is a positive character trait that uses our higher level brain functioning to delay a small reward today so we can achieve our dreams of tomorrow. 

 

However, why is it that there are people whom society would see as very successful, strong-willed, and disciplined who cannot seem to quit smoking?  Why was Sigmund Freud, the founding father of psychoanalysis a man who wrote numerous articles and books, treated hundreds of patients, and even stopped his cocaine use, unable to quit smoking and eventually die from his tobacco use?  With his theories of human behavior and self-discipline, shouldn’t he have been able to quit “cold turkey” with willpower alone?

 

Of course not, and the reasoning behind this lies in our understanding of addiction. 

 

Addiction is a chronic disease that changes the structure of the brain and affects many areas, particularly those that influence decision-making, behavior control, and learning.  It works on a very primitive, instinctual level that often bypasses or impairs our brain’s higher level functioning.  For example, if I were to throw you a ball and instructed you to not catch it, you would have to consciously resist the impulse to catch.  In the moment when a craving or withdrawal hits, our brain starts functioning on a powerful, unconscious level that often overrides our ability to think clearly and control our actions (like the impulse to catch the ball, but significantly more intense).

 

As I shared in my previous blog, willpower has a place in recovery as a tool to help us focus on and prepare our plans for quitting.  It is, however, not very effective as a means to control cravings to smoke because addiction simply functions on a different level.  If you are contemplating a quit attempt, consider spending time on BecomeAnEx.org and the Ex community.  You will find a collective wisdom in recovery, a great deal of empathy and acceptance, and helpful tools for living a smoke-free life!

Cigarettes deliver nicotine very quickly and powerfully to the brain.  This burst of nicotine becomes very strongly associated with a whole assortment of cues in one’s life.  These cues are the things that you run into every day that make you think of lighting up, because they actually “trip a switch” in your brain that is almost automatic.  For some people it can feel like their body is already reaching for a cigarette before their mind realizes it. 

It can be very tiring and difficult to only will-power one’s way through the cravings associated with activities, people, feelings, moods, places, and the many other smoking situations that occur through a day.  Willpower is better used to create plans in advance so that the cues to smoke are less intense and overwhelming. 

Use willpower to sit down, beforehand, and develop strategies to manage the many situations that are associated with smoking.  Identify cues.  They can be very personal, but some common ones are: seeing a cigarette or someone smoking, seeing an ashtray, hearing the flick of a lighter, smelling smoke, drinking coffee, seeing tobacco advertising, having an alcoholic drink, or just being in a room or a place where you normally smoke.

Imagine alternative activities or thoughts to use that can help to distract from these situations.  Make a firm decision to use medications that can reduce the intensity of cravings to smoke.  Write down the reasons for not smoking and keep it in place of the cigarette pack to review when cravings happen.  Change routines.  Plan to begin the day differently.  Relax in a different room.  Take a different route to work.  Take a break with non-smoking friends or colleagues.  Avoid your favorite places to smoke.  Get rid of cues that can be disposed like lighters and ashtrays. 

Developing plans to employ active alternatives to smoking, or plans to avoid cues altogether, is an effective and smart use of your willpower. 

 

  

People often feel they can stop smoking - they’ve done that beforeIt’s the staying stopped that is the difficult part.  Thus, many are concerned about having a lapse (smoking a cigarette or two), or even worse – a relapse (going back to a regular pattern of smoking).

                  

If you are able to “catch” yourself after a lapse, you can probably recover quickly if you follow these steps:

1.      Stop using tobacco right away, and throw away all tobacco products and paraphernalia (lighters, ashtrays, etc.)

2.      Call or contact your support people (family, friends, or co-workers who are supportive of your quitting).

3.      Call your healthcare professional and if you have seen a counselor or Tobacco Treatment Specialist, call that professional.

4.      If possible, change your environment and go to a smoke-free place, or one you do not associate with smoking.

5.      Get active – a brisk walk or a few minutes on a treadmill will activate the endorphins (those natural opiates in the brain).  This is similar to that “feeling good” response that many associate with smoking.

6.      Think about all the reasons you are trying to quit in the first place (health, family, children, grandchildren, money, etc.)

 

It’s also important to look at what led to the lapse:  what you were doing, who you were with, and how you were feeling.  Was tobacco helpful in coping with that situation/problem, or did it make it worse?  Did you try other ways to cope with this same situation/problem?

Finally, decide on how you will deal with this situation/problem the next time it arises, and then take this as learning opportunity for yourself, as you learn to live tobacco-free.

Tobacco has a sneaky way of infiltrating into many aspects of daily life.  Over many years, using tobacco gets associated with certain places, activities, or people.  Triggers become stronger over time through a process called conditioning.  Perhaps when you get into the car to drive to work you have an immediate urge to smoke – even if you just had a cigarette a few minutes ago!  This “conditioned response” is automatic, and may often seem almost impossible to ignore or suppress. In fact, it may almost cause a sense of panic because you think the urge may never pass…just get worse and worse.

Human nature is to be intolerant of discomfort, and unfulfilled urges to smoke can be very uncomfortable.  So in these trigger situations remaining tobacco-free can seem tough.  One way to approach triggers and the thoughts and emotions that come with them is to practice mindfulness.  Mindfulness is the exact opposite of trying to “ignore” or “suppress” an urge.  Mindfulness is a state of quietly and gently paying attention to your thoughts and feelings and avoiding responding automatically.

                           

Next time you are struggling with the urge to smoke, try this:

·         “Urge surfing”: Rather than try to ignore or suppress the urge to smoke, acknowledge the urge and accept it.  Ride the urge like a wave, paying quiet attention to your body, your thoughts and your feelings.  Notice the urge crest, let it wash over you like a wave, and then notice it fall again.

o   Remind yourself:  “Some discomfort is tolerable.”  And “This will pass.”

o   Be kind to yourself.  Don’t judge yourself for having urges – they’re normal, and a normal part of the process of stopping smoking.

o   Pay attention to yourself.  What are you feeling in your body or your emotions?  Are you operating on automatic pilot?

o   Breathe.  Bring focus to your breath as an “anchor” to help you focus on the present.

o   Be patient.  Over time, urges get weaker and shorter through the process of learning alternative (non-reactive) responses.  Respond “mindfully” and not “automatically.”

Practicing mindfulness has been shown to dampen reactivity to stress, increase positive emotions, improve insight and self-awareness, and improve the ability to pause before reflexively responding to urges.  (Dr. G. Alan Marlatt, American Psychological Association, 2004)

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