Two Minds Blog

Opioid use is an extremely a difficult problem to overcome. During work on a pilot project from 2017-2019 to increase the availability of medication-assisted treatment (MAT) for opioid use disorders in rural areas of Colorado, we heard patients say things like "I don't have the willpower to resist opioids," or "I wish I were a stronger person." These statements reflect people's desire to change while also conveying the difficulty of changing opioid use. People often say that they don't choose  to use opioids, rather they feel that they must  use them in order to maintain daily functioning. The moral model of substance use treatment ("just say no to drugs") misses this important piece of the experience for people who are already using. And given that about three-quarters of people in our MAT project started their pattern of use with prescription  pain medication, they may not have felt they had a choice originally either -- they use opioids

In his landmark book Beyond Freedom and Dignity (1971), psychologist B. F. Skinner argued that the concepts of free will and responsibility for one’s own actions had outlived their usefulness. Instead, he suggested that human behavior could be explained entirely by the intersection of environmental contingencies, instinctive reactions, and learned responses. Together, instincts and conditioned responses made up a “behavioral repertoire” of pool of all possible responses for that individual at that point in time. Two Minds Theory incorporates this perspective in suggesting that the Intuitive System produces behavior, not the Narrative System. The Narrative System has been historically associated with ideas of “freedom and dignity” based on rational choice. Furthermore, TMT posits that the Intuitive System can be “trained,” adding potential responses to the behavioral repertoire and making some responses more likely than others by way of deliberate practice. Skinner articulated bas