Wednesday, March 29, 2017

The Power Of Habit - Part 1

By Charles Duhigg 

The Magic Formula for Habit Change

When you woke up this morning, what did you do first? Did you hop in the shower, check your email, or grab a donut from the kitchen counter? Did you tie the left or right shoe first? Did you choose a salad or hamburger for lunch? When you got home, did you put on your sneakers and go for a run, or eat dinner in front of the internet?

Most of the choices we make each day may feel like the products of well-considered decision making, but they’re not. They’re habits.

The basal ganglia, a small region of the brain situated at the base of the forebrain, plays an important role in stored habits. Habits, scientists say, emerge because the brain is constantly looking for ways to save effort. Interestingly, scientists have discovered that mental activity in the basal ganglia actually decreases as a behavior becomes more habitual. When a habit emerges, the brain becomes more efficient (and needs fewer resources) because automatic patterns take over. When we get dressed in the morning or drive a car, instead of needing to remember and decide what to do at every step of way, the brain has chunked hundreds of routines into habits that we no longer have to think about when we do them. This effort saving instinct is a huge advantage. An efficient brain allows us to stop thinking constantly about our basic behaviors, such as walking and eating, so we can devote mental energy to more important tasks.

And at the core of every habitual pattern is a habit loop.

The habit loop can be broken down into three basic steps:
A cue (or trigger)
A routine
A reward 

First, there is a cue, a trigger that tells your brain to go into automatic mode. The cue can be internal, such as a feeling or thought, or external, such as a time of day, place or the company of certain people.

The second part of the habit loop is the routine, the behavior that leads to the reward. The routine can be physical (eating a donut), cognitive (“remember for the test”), or emotional (“I always feel anxious in math class”).

The third part is the reward. Not surprisingly, the reward can also be physical (sugar!), cognitive (“that’s really interesting”), or emotional (“I always feel relaxed when reading the news.”). The reward helps the brain determine if a particular habit loop is worth remembering.

In the habit loop illustrated below, a mouse learns to automatically run through a maze after hearing a click, because the habit has become ingrained through a chocolaty reward.

When a habit emerges, the frontal lobe of the brain, where decisions are made, stops fully participating in the process. It stops working so hard, or diverts focus to other tasks. So unless you deliberately fight a habit – unless you find new routines – the pattern will unfold automatically.

However, simply understanding how habits work – learning the structure of the habit loop – makes them easier to control. Once you break a habit into its components, you can fiddle with the gears.

Habits never really disappear. They’re encoded into the structure of our brain, and that’s a huge advantage for us, because it would be awful if we had to learn how to drive after every vacation. The problem is that your brain can’t tell the difference between bad and good habits, and so if you have a bad one, it’s always lurking there, waiting for the right cues and rewards.

This explains why it’s so hard to create exercise habits, for instance, or change what we eat. Once we develop a routine of sitting on the couch, rather than running, or snacking whenever we pass a doughnut box, those patterns always remain inside of our heads. By the same rule, though, if we learn to create new neurological routines that overpower those behaviors – if we take control of the habit loop – we can force those bad tendencies into the background. And once someone creates a new pattern, studies have demonstrated, going for a jog or ignoring the doughnuts becomes as automatic as any other habit. In other words, once we learn to override the old pattern, the new pattern takes over and becomes a new habit.

The Golden Rule of Habit Change

Studies have shown that you can never really extinguish habits (as they say in the 12-Step groups “Once an addict always an addict”). But understanding how habits work—or, understanding the habit loop—makes them easier to control.

To change a habit, we only need to attack the middle step, the routine. It’s easier to adopt a new behavior if there’s something familiar at the beginning and end. And that’s the Golden Rule of Habit Change, which is based on keeping the old cue, delivering the old reward, but inserting a new routine. 

If you use the same cue, and provide the same reward, you can shift the routine and change the habit. Almost any behavior can be transformed if the cue and reward stay the same.

The Golden Rule has influenced treatments for alcoholism, obesity, obsessive compulsive disorders, and hundreds of other destructive behaviors, and understanding it can help anyone change their own habits. (Attempts to give up snacking, for instance, will often fail unless there’s a new routine to satisfy old cues and reward urges. A smoker usually can’t quit unless he finds some activity to replace cigarettes when the nicotine craving is triggered.)

It sounds easy in theory, but given the strength of most habit loops, changing behaviors can be very difficult.

To understand the Golden Rule of Habit Change better and begin to apply it to our own bad habits, let us explore one of the largest and most successful attempts at wide-scale habit change, which was born in a dingy basement on the Lower East Side of New York City in 1934.

Sitting in the basement was a thirty-nine-year-old alcoholic named Bill Wilson. Years earlier, Wilson had taken his first drink during officers' training camp in New Bedford, Massachusetts, where he was learning to fire machine guns before getting shipped to France and World War I. Prominent families who lived near the base often invited officers to dinner, and one Sunday night, Wilson attended a party where he was served rarebit and beer. He was twenty-two years old and had never had alcohol before. The only polite thing, it seemed, was to drink the glass served to him. A few weeks later, Wilson was invited to another elegant affair. Men were in tuxedos, women were flirting. A butler came by and put a Bronx cocktail-a combination of gin, dry and sweet vermouth, and or ange juice-into Wilsons hand. He took a sip and felt, he later said, as if he had found "the elixir of life."

By the mid-1930s, back from Europe, his marriage falling apart and a fortune from selling stocks vaporized, Wilson was consuming three bottles of booze a day. On a cold November afternoon, while He was sitting in the gloom, an old drinking buddy called. Wilson invited him over and mixed a pitcher of pineapple juice and gin. He poured his friend a glass.

His friend handed it back. He'd been sober for two months, he said.

Wilson was astonished. He started describing his own struggles with alcohol, including the fight he'd gotten into at a country club that had cost him his job. He had tried to quit, he said, but couldn’t manage it. He'd been to detox and had taken pills. He'd made promises to his wife and joined abstinence groups. None of it worked. How, Wilson asked, had his friend done it?

"I got religion," the friend said. He talked about hell and temptation sin and the devil. "Realize you are licked, admit it, and get willing to turn your life over to God."

Wilson thought the guy was nuts. "Last summer an alcoholic crackpot; now, I suspected, a little cracked about religion," he later wrote. When his friend left, Wilson polished off the booze and went to bed.

A month later, in December 1934, Wilson checked into the Charles B. Towns Hospital for Drug and Alcohol Addictions, an upscale Manhattan detox center. A physician started hourly infusions of a hallucinogenic drug called belladonna, then in vogue for the treatment of alcoholism. Wilson floated in and out of consciousness on a bed in a small room.

Then, in an episode that has been described at millions of meetings in cafeterias, union halls, and church basements, Wilson began writhing in agony. For days, he hallucinated. The withdrawal pains made it feel as if insects were crawling across his skin. He was so nauseous he could hardly move, but the pain was too intense to stay still. "If there is a God, let Him show Himself!" Wilson yelled to his empty room. "I am ready to do anything. Anything!" At that moment, he later wrote, a white light filled his room, the pain ceased, and he felt as if he were on a mountaintop, "and that a wind not of air but of spirit was blowing. And then it burst upon me that I was a free man. Slowly the ecstasy subsided. I lay on the bed, but now for a time I was in another world, a new world of consciousness."

Bill Wilson would never have another drink. For the next thirty-six years, until he died of emphysema in 1971, he would devote himself to founding, building, and spreading Alcoholics Anonymous, until it became the largest, most well-known and successful habit changing organization in the world.

An estimated 2.1 million people seek help from AA each year, and as many as 10 million alcoholics may have achieved sobriety through the group. AA doesn't work for everyone-success rates are difficult to measure, because of participants' anonymity-but millions credit the program with saving their lives. AA's foundational credo, the famous twelve steps, have become cultural lodestones incorporated into treatment programs for overeating, gambling, debt, sex, drugs, hoarding, self-mutilation, smoking, video game addictions, emotional dependency, and dozens of other destructive behaviors.

The group's techniques offer, in many respects, one of the most powerful formulas for change. All of which is somewhat unexpected, because AA has almost no grounding in science or most accepted therapeutic methods. Alcoholism, of course, is more than a habit. It's a physical addiction with psychological and perhaps genetic roots. What’s interesting about AA, however, is that the program doesn’t directly attack many of the psychiatric or biochemical issues that researches say are often at the core of why alcoholics drink. In fact, AA’s methods seem to sidestep scientific and medical findings altogether, as well as the type of intervention many psychiatrists say alcoholics really need.

What AA provides instead is a method for attacking the habits that surround alcohol use. AA, in essence, is a giant machine for changing habit loops. And though the habits associated with alcoholism are extreme, the lessons AA provides demonstrate how almost any habit - even the most obstinate - can be changed.

Bill Wilson didn’t read academic journals or consult many doctors before founding AA. A few years after he achieved sobriety, he wrote the now-famous twelve steps in a rush one night while sitting in bed. He chose the number twelve because there were twelve apostles. And some aspects of the program are not just unscientific, they can seem downright strange.

Take, for instance, AA's insistence that alcoholics attend "ninety meetings in ninety days"-a stretch of time, it appears, chosen at random. Or the programs intense focus on spirituality, as articulated in step three, which says that alcoholics can achieve sobriety by making "a decision to turn our will and our lives over to the care of God as we understand him." Seven of the twelve steps mention God or spirituality, which seems odd for a program founded by a onetime agnostic who, throughout his life, was openly hostile toward organized religion. AA meetings don't have a prescribed schedule or curriculum. Rather, they usually begin with a member telling his or her story, after which other people can chime in. There are no professionals who guide conversations and few rules about how meetings are supposed to function. In the past five decades, as almost every aspect of psychiatry and addiction research, has been revolutionized by discoveries in behavioral sciences, pharmacology and our understanding of the brain, AA has remained frozen in time.

Because of the program's lack of rigor, academics and researchers have often criticized it. AA's emphasis on spirituality, some claimed, made it more like a cult than a treatment. In the past fifteen years, however, a reevaluation has begun. Researchers now say the program's methods offer valuable lessons. Faculty at Harvard, Yale, the University of Chicago, the University of New Mexico, and dozens of other research centers have found a kind of science within. Their findings endorse the Golden Rule of habit change: AA succeeds because it helps alcoholics use the same cues, and get the same reward, but it shifts the routine. Researchers say that AA works because the program forces people to identify the cues and rewards that encourage their alcoholic habits, and then helps them find new behaviors.

Take steps four (to make "a searching and fearless inventory of ourselves") and five (to admit "to God, to ourselves, and to another human being the exact nature of our wrongs").

"It's not obvious from the way they're written, but to complete those steps, someone has to create a list of all the triggers for their alcoholic urges," said J. Scott Tonigan, a researcher at the University of New Mexico who has studied AA for more than a decade. "When you make a self-inventory, you're figuring out all the things that make you drink. And admitting to someone else all the bad things you've done is a pretty good way of figuring out the moments where everything spiraled out of control."

Then, AA asks alcoholics to search for the rewards they get from alcohol. What cravings, the program asks, are driving your habit loop? Often, intoxication itself doesn't make the list. Alcoholics crave a drink because it offers escape, relaxation, companionship, the blunting of anxieties, and an opportunity for emotional release. They might crave a cocktail to forget their worries. But they don't necessarily crave feeling drunk. The physical effects of alcohol are often one of the least rewarding parts of drinking for addicts.

"There is a hedonistic element to alcohol," said Ulf Mueller, a German neurologist who has studied brain activity among alcoholics. "But people also use alcohol because they want to forget something or to satisfy other cravings, and these relief cravings occur in totally different parts of the brain than the craving for physical pleasure."

In order to offer alcoholics the same rewards they get at a bar, AA has built a system of meetings and companionship - the "sponsor" each member works with - that strives to offer as much escape, distraction and catharsis as a Friday night bender. If someone needs relief they can get it from talking to their sponsor or attending a group gathering, rather than toasting a drinking buddy.

"AA forces you to create new routines for what to do each night instead of drinking," said Tonigan. "You can relax and talk through your anxieties at the meetings. The triggers and payoffs stay the same, it's just the behavior that changes."