By Tom Horvath, PhD
What’s the point of stopping an addictive problem if your life does not become better? It can get better by reducing the costs associated with the addictive problem, but also by having new rewards. Unfortunately, returning to previously established rewards, and if needed, developing new ones, can be a challenge.
A recent study looked at the experience of rewards in individuals in long-term recovery (average time 3.8 years) from opiate use disorder who were prescribed opiate medications (mostly methadone). Subjects (n=130) were asked to answer questions daily for three weeks, after getting a prompt on their phones. Subjects averaged 41 years of age, and were 57% women and 85% non-Hispanic white. Pre-tests measured their anhedonia (loss of pleasure), motivation to experience non-drug rewards, and the availability of non-drug rewards.
Individuals with higher average motivation to experience non-drug rewards, and with a higher perception that they had access to non-drug rewards, were significantly more likely to report the daily experience of these rewards. Presumably all of us have access to non-drug rewards, but some of us may see that access more clearly, and act on it more often.
In the early stages of the change process the experience of non-drug rewards may be minimal. After the intense rewards of the substance, other rewards are not likely to be as compelling. By comparison, if you have just been regularly eating candy, gooey chocolate bars, and highly sweetened muffins, and you switch to oatmeal, tomatoes, and walnuts, you are not likely to have a compelling taste experience. The taste of healthier foods takes time to develop. Patient persistence will be rewarded, but sometimes it is hard to maintain that persistence in the face of what seems like a boring life. Nevertheless, most people ultimately resolve their addictive problems, and start fully experiencing non-drug rewards, although it may take longer and be harder than they expected.
This study reminds us to think about non-drug rewards and how to bring them into our lives, and to persist in experiencing them even if the experience is not highly pleasurable at first. As a possible first step, many of us interact with others every day, even if they are strangers. We have multiple opportunities to say thank you, pay a genuine compliment, notice something interesting about them, or ask a good question. These experiences are generally accessible, free, and in time might even build a relationship or two. There are many other possible first steps also, with food, movement, music, other entertainment, reading, conversation, games, etc. You can start where it seems most likely to be pleasurable, and build in other pleasurable experiences over time.
Daily motivation for and perceived accessibility of nondrug reward among people in long-term recovery from opioid use disorder:
https://www.sciencedirect.com/science/article/abs/pii/S0376871626001353?via=ihub
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