Behavioral Addiction – How do people change?

Can an individual’s resistance to change hamper their recovery?

Is resistance normal?

by Sanam Naran – Counselling Psychologist

You may be asking yourself some of these questions about Behavioral Addiction, either for yourself or a loved one struggling with addiction. Addiction can ruin lives and have a detrimental effect on all those involved.

Through addiction, one may lose their job, their marriage, their family, their health, their assets and their dignity and self-respect, amongst other things.

Even though the consequences of their addiction may be apparent to the addict. There may still be a pervasive unwillingness to reach out for help, go into treatment or even fully commit when they are in treatment. This is what we call resistance.

What is Resistance and Behavioral Addiction?

In traditional psychotherapy, Sigmund Freud conceptualized resistance as an individual’s unconscious process, protecting them from unwanted and intolerable anxiety. This can prevent them from facing uncomfortable and unresolved feelings of behavioral addiction.

Resistance can be seen as a completely normal part of the process. Part of resistance, is motivation for behavioral addiction change. Motivation can be understood not as something that one has but rather as something one does.

It involves recognizing a problem, be they addictive substances or an addiction to alcohol, and searching for a way to change. Then beginning and sticking with that change strategy (Miller, 1995).

An individual’s level of motivation can be influenced by a number of factors, one of them being their loved ones and/or family members. Although, internal factors form the basis of change, loved ones’ support can be pivotal in a motivation for change. It is important to note that a motivation for change is fluid and can oscillate between levels. However, one does not need to have “hit rock bottom” or have destructive and damaging consequences, to realise that they need change.

Resistance can take form in substance use disorders, manifesting in various ways and behaviours. It is not limited to simply refusing treatment. Resistance can sometimes be seen through compliance.

This is noticed when an addict complies with addiction treatment, appears agreeable and passive. Not permitting themselves to fully immerse into the recovery process, but rather “go with the motions”.

This type of a resistance is difficult to work with. It is often overlooked, as the addict uses manipulation as a tactic to make others perceive them as willing. Other forms of resistance include, constantly focusing on other people or their problems during treatment.

Finding faults and grievances with the system, an unwillingness to open up about one’s struggles and keeping secrets or hiding ones dysfunction.

Aspects that Influence Motivation for Change

There exist four aspects that influence an individual’s motivation for change. An addict’s distress levels regarding their behavioral addiction become an indicator for change. They may have experienced periods of stress, depression or anxiety that pervade their daily functioning.

Secondly, important life events become another factor in motivating change. Such as a death of a loved one, a birth of a child, a spiritual realisation or losing employment, just to name a few.

An individual may become inspired by an important life event or even realise the damage or seriousness a traumatic event can have. Another factor to change can be a realisation of the negative consequences the addiction has on their life.

Taking a holistic view of the impact that the substance or behavior has had, financially, physically, psychologically and socially, can lead to change. Lastly, as mentioned previously, external incentives such as support from friends, family, support groups and the broader community. Can help stimulate an addict’s motivation to want to change.

The process of behavioral addiction change can be identified within five steps

as conceptualized by Prochaska and DiClemente (1992):

• Pre-contemplation- This stage involves being unaware of any problem related to their addiction and the addict is often unconcerned about their addiction. They tend to ignore anyone else’s belief that they are doing something harmful.
• Contemplation- Individual’s at this stage are considering whether or not to change. They enjoy using drugs, but are sometimes worried about the increasing difficulties the use is causing. They are constantly debating with themselves whether or not they have a problem.
• Preparation- Addicts at this stage are deciding how they are going to change. They may be ready for change.
• Action- Addicts at this stage have begun the process of changing but require help identifying realistic steps, high – risk situations, and new coping strategies.
• Maintenance- Individual’s at this stage have made a change and are working on maintaining the change.

Factors that Influence Resistance

The concept of self-efficacy is also imperative when addressing resistance in recovery. Self-efficacy refers to an individual’s belief in oneself to achieve something or to reach a specific goal. This can be related to an individual’s self-esteem and whether they believe in their own abilities. The lack of this belief in oneself may result in resistance to drugs and alcohol and becoming sober or clean.

The addict may also be in a sense of denial within their addiction. They believe that their dysfunctional behaviour is not as bad as it seems. Often minimizing the extent of their addiction. This becomes a cycle, as the addict tends to disregard the effects of their behaviour and how their addiction is affecting various spheres of their lives.

For instance, an individual may lose employment due to their addiction. In turn, use that an excuse to use their substances again due to an inability to cope with it. This denial often comes with blaming other people for their addiction and a refusal to take accountability for their actions. Through this, an apparent resistance to treatment is evident due to a denial of the severity of the addiction.

It is also common for addicts with behavioral addiction to fear a life without their substances. They may have become so accustomed and dependent on their substance, that a life without it may seem bleak and terrifying. Addiction takes over all spheres of an individual’s life and essentially, forms part of an individual’s identity. With this being said, addictions include these substances which may come with other “benefits”, or what is perceived as benefits.

The addict may be unable to cut certain friends, who they may have used with, out of their life. Having to unravel an individual’s identity and way of being in the world, through treatment and therapeutic activities, becoming a daunting process for many.

Other aspects of recovery such as the twelve steps and attaining a higher power, may cause resistance in some. However, part of this process is opening oneself to following suggestions. To“give up” any power or control that may be holding them back from making a change.

How Can I Overcome Behavioral Addiction Resistance?

There are a number of ways one can overcome resistance. Having a counselling session with a psychologist or addiction counsellor can help the addict explore where their resistance may be stemming from. It is also important to remember that resistance is something that should be worked with and not something to get rid of. The resistance will not lessen unless it is faced, by discovering it and showing the risk factor to the addict.

• There exists a large body of literature that suggests the best way to deal with resistance is to confront it. However, respecting this resistance is also another important factor, or what we sometimes call “rolling with the resistance”. It is not helpful to get into a power struggle with an addict who is resistant as the resistance often becomes stronger.
• It is beneficial for family members to approach the addict when their resistance is at its lowest. This could be when they have made a bad decision related to their addiction. They may also be facing a difficult period, thus be more receptive to the feedback.
• Having the addict listen to another individual who is in recovery and has managed to maintain their recovery. This assists in motivating the addict and instilling hope in the treatment approaches and recovery process.
• Offering support and understanding to the addict without expectations, whilst maintaining firm boundaries can also be seen as important when confronting their resistance.

Resistance is an intriguing phenomenon and has been medically reviewed and researched extensively in the psychological and addictions field. It is largely common for most addicts.
Resistance is a completely normal part of making a change. What must be borne in mind, is that resistance can be worked with and broken down with the use of empathy and not authority or power.

The polar opposite of resistance is acceptance, and one must work towards acceptance in order to lessen the resistance.

Remember, what you resist will persist.