Falling off the Wagon

It's great when you are able to successfully make a change in a healthy behavior, like getting more sleep, improving your diet, or reducing your alcohol use. But what happens when you hit a bumpy spot, and things stop going so well for a while? One of the great paradoxes of behavior change is called the abstinence violation effect, also sometimes known as licensing, or simply feeling like you have permission to indulge yourself in an unhealthy behavior. The problem is that when people stop a new, healthy pattern (for whatever reason), they sometimes really let things go, and it can be even harder to get back on track than it was to initiate the new behavior in the first place.

Let's look at each step in the sequence: First, people work hard to initiate a new behavior. This can take up to 3-6 months of conscious effort before the new habit becomes fully ingrained and automatic, and there are lots of opportunities to get lost along the way. People work hard at changing during this phase, and they feel a justifiable sense of accomplishment when they reach their goals. Next, the effort finally eases. People find that they are better able to maintain the behavior that previously had taken a lot of work, because it has now become a habit or just "the new normal." This is a pleasant time. It's also just when life often gets in the way. Now the person relapses to their old ways, often through no fault of their own. Maybe they got busy at work and didn't have time for the same activities as before. Maybe they or a family member had a health issue that derailed them. Maybe they went on vacation, and didn't have the usual environmental cues or resources available to them. Things just happen -- it's a reality of life. The final stage, then, is where the abstinence violation effect comes into play. Once someone "falls off the wagon" and stops a previous healthy behavior, they may have the sense that all their progress has been lost. In that case, they think, why not just enjoy themselves? Yet another name for this phenomenon is the "what the hell effect," for obvious reasons!

The initial lapse in healthy behavior is, of course, due to Intuitive-level forces. These are acting on us all the time, but when we are actively engaged in a health-behavior-change effort we are often able to implement the stop-and-think loop that allows for an active narrative (like "I want to make healthier choices") to have a beneficial effect. When we are no longer actively working to change, that loop never gets activated, the narrative stays dormant in the back of our minds, and the intuitive-level forces dominate our behavior. The relapse, therefore, is entirely predictable. All that's needed is to take your eye off the ball for a moment.

The abstinence violation effect is a secondary step, and it isn't actually necessary. The problem is that a normal lapse or relapse gets interpreted as a "failure of willpower," as evidence that we "didn't really want it enough," or as a sign that "all is lost." The unhealthy behavior often does feel better than the healthy alternative, but this reward mechanism isn't the main reason that a momentary lapse often becomes a full-blown relapse. Instead, a self-critical narrative is activated, which someone might already have in the back of their mind due to past lapses or other behavior-change efforts that were then critically reviewed. That narrative says "you can't do this, you're too weak-willed" or "now you've blown it." This type of secondary narrative is what leads people to abandon their behavior-change effort altogether; therapeutic approaches such as Marlatt and Gordon's Relapse Prevention focus on interrupting the self-critical narrative and simply resuming the behavior. The truth is that most healthy behaviors can be resumed after a brief lapse without much trouble. But the longer an unhealthy pattern of behavior goes on, the harder it is to resume efforts toward health. For example, if you don't exercise for a few days you will probably still be fine, but if you don't exercise for a month you have lost some of your conditioning, and the same level of exercise will legitimately be harder for you than it was. That can, in turn, lead to even more negative narratives, and might lead someone to give up on the healthy behavior altogether.

A good cognitive-behavioral principle to counteract this downward spiral (from Donald Meichenbaum, I think) is that "a lapse is not a relapse; a relapse doesn't have to become a collapse." Because the Intuitive Mind dominates behavior, lapses and relapses are entirely normal and expectable parts of the cycle of behavior change. What we need to avoid is the self-critical and self-defeating narrative that comes after a momentary lapse, because that is what turns a relapse into a collapse.