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1. Unsuccessful attempts to quit.
Addicts often express a desire to quit completely, but are unable to follow through. Short-term abstention is common, but long-term relapse rates are high. As Mark Twain said about the pains of quitting smoking: "It’s easy. Done it a thousand times."
2. Cue-triggered relapse.
Experience with an addictive substance sensitizes the user to environmental cues that subsequently trigger cravings. These cues (e.g., clinking ice cubes) signal opportunities for consumption. For example, upon exiting rehab, addicts who return to their old environment are more likely to experience cravings and resume use. A recovering addict is also significantly more likely to “fall off the wagon” if he receives a small taste of his drug of choice or experiences stress. This is the very phenomenon that AA warns of, that abstinent alcoholics can’t resume occasional drinking without losing control.
3. Loss of control.
Loss of control means that one is knowingly acting against their prior determination to abstain — for example, consuming a larger portion of dessert after deciding to go on a diet. The typical reaction to this failure involves strong negative emotions (e.g., depression and self-loathing). It is instructive that the 12-step program of Alcoholic Anonymous begins, “We admit we are powerless over alcohol—that our lives have become unmanageable.”
4. Desire without pleasure.
Addicts commonly continue their behavior even while reporting that the substance (e.g., cigarette or drink) is no longer pleasurable. Addicts often express that they continue to use drugs even when they no longer derive any pleasure. For example, some cigarette smokers express a deep hatred of smoking, but they continue to smoke regularly.
5. Staying vigilant.
Despite the development of some effective treatments, there is no cure for addiction. Recovering addicts often manage their tendency to make mistakes by exercising cognitive control, such as voluntarily reducing or eliminating future options. The main purpose is to reduce the probability of encountering cues that will trigger relapse. For example, even addicts who have stayed clean for years attend the meetings of support groups like AA—settings in which no individual therapies or drugs are provided.
6. Cross-addiction.
Many addicts often substitute one compulsive problem for another. They become compulsive workers or gamblers, or use sex as they once used chemicals to combat the emptiness, boredom, anxiety, and depression that constantly threaten to overwhelm them.
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