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Lloyd I. Sederer, MD Headshot

How to Break Free From Your Unhealthy Habits

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Let's face it. People do what they want, not what they should do. That's why New Year's Resolutions are so infrequently fulfilled.

How successful have you been when you say "I should do this, or that?" To do lists go unread, or aren't followed. Even when someone is watching we wait and then do what we really want to do.

People don't smoke because it makes them smell bad and gives them cancer. Painful relationships don't persist because of their disappointments and grief. Troubling habits endure because of what they do for us. Our motivation to change comes from getting more out of changing than staying where we are, which is the basis for an effective technique called Motivational Interviewing or MI.

Motivational interviewing is non-judgmental. No one is saying you are bad or shameful, nor that you should beat yourself up. Quite the opposite: MI starts by recognizing that you are doing something for powerful reasons. MI is a cognitive technique that enables you to see how you will gain more than you will lose. With MI you make changes first in your head then in your behavior. MI also appreciates that letting go means losing something, and none of us tolerates loss very well. But we can bear change when we know that something we want lies ahead.

As examples, let's focus on smoking or drinking too much (not uncommon problems people try to tackle with a New Year), though the same approach applies to troubles in a relationship, not getting enough exercise and many other problem behaviors.

You can't wait until the evening to knock down that first drink, and the many that follow. Your buddies have noticed, and once in a while try to limit how many you have. You smoke over a pack of cigarettes in an evening. The mornings get off to a slow start and sometimes your head doesn't clear until the afternoon. You don't want anyone to get on your case about smoking or drinking though you know they have reason for concern.

Here is how you might use MI to take charge of the behaviors that gnaw at you. Start by answering the following questions. Writing your answers down works better:

  • What do you like about smoking or drinking?

This is the most crucial question and where you need to start. Typically, we (or our friends and family) go right to what is wrong. Scolding does not help. You need to record how a cigarette or a drink makes you feel good, takes your mind off what is nagging you, relaxes you and makes you more sociable. These are the reasons you keep doing what you are doing.

  • On the basis of what you are getting from smoking or drinking how much do want to keep doing what you are doing? On a scale of 0-5 (5 the highest), where are you now? Fill in below.

0 - 1 - 2 - 3 - 4 - 5

The higher the number, the more you want to keep doing the same thing -- and a good reason that your resolutions have not been successful. If you have been honest that number should be high, like 4, which helps explain your repeated behaviors. You are doing what you want to do.

  • But also nagging at you is that feeling you want to cut down. Ask yourself, then, what is not working for me because I smoke or drink?

Here is where you list what bothers you. How you and your clothes always smell of cigarettes, or how you have to stand in the cold in front of buildings and restaurants to get that nicotine into your brain. Or the time and money you spend on drinking, or the fuzzy headedness in the morning or into the afternoon, or the growing distance from friends, and the shame of wanting a drink more than anything else. Be really honest here so you can see the price of what you are doing. When you face the consequences of your behavior you can generate the motivation for change.

Beating yourself up or having friends and loved ones confront you doesn't help. Change can and does happen. MI has been proven to work with the toughest of problems, including smoking, excessive drinking and risky behaviors. With MI there is reason to be hopeful -- for you to change and do what will get you more of what you want.

Let's continue with what you need to ask yourself:

  • How might you feel better if you quit smoking or cut down your drinking?

Detail here how you would be able to spend time inside someone's home or your office instead of anxiously waiting to get outside for a smoke. Consider how much money you would save and how you use it. Imagine how you could feel clear enough to go to a gym instead of nursing a hangover. Think of how your dating life might improve.

  • Be sure to ask again: What will you lose by quitting tobacco or cutting down your drinking?

Double back and remind yourself that change will be hard. You smoke or drink for reasons that drive your habits.

  • Who can you talk with and what can you do that will support that part of you that wants to change?

You now have an inventory of what smoking or drinking does for you and its consequences. When you turn to others who care for their support they need to appreciate both sides of your motivation. They need to know that change will take work and time. Get help. Quit rates from smoking can be doubled or tripled by nicotine replacement, counseling and other supports. Plan your evenings so you will have alternatives to hanging out in a bar. Call that girl or guy who didn't want to see you because you smoked. Remember, if it were easy you would have already changed: You need to do something not just promise to do something.

Every (small) step is important. Behaving differently is incremental. And we all need ongoing support from people who understand it is hard to let go of what serves our needs. People do what makes them feel good. That makes sense. Let's stop telling ourselves what we should do and figure out how to feel even better. That's a New Year's Resolution worth making.
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The opinions expressed herein are solely my own as a psychiatrist and public health advocate.
Dr. Sederer receives no support from any pharmaceutical or device company.
Visit Dr. Sederer's website at www.askdrlloyd.com for questions you want answered, reviews and stories.

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