The Problem of Immediate Gratification [The PIG] is a defining feature of Incentive Use Disorders.  So, naturally, those suffering the negative consequences of their excessive appetites want immediate gratification of the desire to be free of their problem. Overeaters want quick weight loss, but weight loss is not a cure for obesity!  The vast majority of the participants of diets and weight loss programs will weigh more a year later than they did when they began their program. One- and two-year outcome research for substance abuse, gambling, and other addictive disorders shows similar patterns of short-term behavior change (while the individual is under the influence of the program) followed by an increasing likelihood of relapse with time from program completion, typically reaching around 80% within the first year after treatment. 

There is no external salvation from dependence on an external agent. To the extent an external agent--a treatment provider, program, support group--was responsible for the behavioral control, relapse is likely when the salience of the external source of control diminishes with time. 

The Nature of the Challenge

An alternative to admitting powerlessness over a disease and turning responsibility for outcome over to an external agent is to accept the responsibility of developing the skills and faculties that enable you to act in accord with your interests and principles despite the influence of local conditions.

Volition is a controversial topic and many people believe that willpower is a destructive illusion.  Most everyone with an excessive appetite has tried what they call willpower--"white knuckling it"--without success.  [The "brute force" method may, perversely, provoke counter-regulatory motivation.]  However, if willpower is defined as acting as intended despite the influence of local conditions, then the term describes a faculty worth developing. Simply stated, you have a two-phase challenge:  First, you must decide how you intend to act when you encounter high-risk situations.  Second, you must get yourself to act in accord with that decision, despite the influence of the local stressors and temptations. 

You learn to exercise will[[1]|http://psyclink.apa.org/#_ftn1] during your encounters with a wide range of high-risk situations. At these critical moments, you have the opportunity to observe the cause-and-effect principles that govern your actions when exposed to stress and temptation.  An important component of exercising will is to shift from an emotional trance to a dispassionate trance.  This shift in perspective can enable you to become aware of your core motivation and act accordingly. 

Addictive traps are easy to fall into and hard to escape.  No escape plan works for everyone, because each trap is unique.  An external source, such as a book or generic program, cannot show you the way to good long-term outcome, or even tell you what good long-term outcome means in your particular case.  To act in accord with your interests and principles, you have to first define what they are.   No external agent can do this for you; the path to self-determination is for your steps alone. Experiential invitations designed to encourage contemplation will enable you to focus your cognitive resources on how you want to use the remainder of your lease on life---your core motivation.

Appreciating what you want and doing what it takes to get it are different challenges.  Acting as intended despite the influence of local conditions that would motivate you to lapse defines the "exercise of will*."*  

An Efficacy Enhancing Treatment Strategy

Some individuals who have developed an addictive relationship with a substance or activity are best matched with medical model based treatment in which the patient assumes the passive role as recipient of treatment while the treatment provide takes to role of effective agent of change.  Other individuals are best matched with a strikingly different approach. According to the latter view, preventing relapse requires that the individual is able to perform as intended during crises of stress and temptation.   

Completing the passage from dependence to self-determination is among the most important and demanding challenges of adult developmental. It takes more than wanting it to achieve the benefits of good long-term outcome.  Preventing relapse requires the ability to act as intended during the critical moments of crisis when one’s energies and cognitive resources are depleted or otherwise occupied.

Exercising will is a heroic undertaking. Conceptual models, concrete tools, and experiential invitations designed to strengthen the user’s ability to act in accord with his or her interests and principles, rather than yield in the direction of least resistance, are available on the Psychological ARTS website. 

For individuals who are capable of acting as intended, A major advantage of a self-directed approach is that it encourages the development of the faculties required to prevent relapse.

Consider Mr. Hasslebring who has been clean and sober during his stay at a 30-day rehab program.  Sadly, the content discussed in the psycho-educational groups was of little value during the critical moments of the actual crisis he encountered in his home environment, and the program staff and structure were not available to help him. 

The vast majority of the graduates of inpatient and intensive outpatient chemical dependence and weight loss programs relapse soon after the influence of the external agent disappears. Evidently, their treatment left them insufficiently prepared to cope with the high-risk situations they actually encountered. Good long-term outcome is the byproduct of developing the ability to perform as intended during high-risk situations.

[[1]|http://psyclink.apa.org/#_ftnref1] Will is defined here as the capability to act as intended in real time, despite the influence of local stressors and temptations that would motivate a lapse.