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An escalating problem


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Changing unhealthy behavior


Why do we continue unhealthy behaviors knowing that they are detrimental to our well-being?

Former first lady Nancy Reagan’s slogan “Just say no” was a simple, but ineffective solution. Economics, environment and culture are powerful stimuli. And so are habits.

Researchers funded by the National Institutes of Health (NIH) are taking a closer look at what happens in the brain as habits form.

“Understanding the biology of how we develop routines that may be harmful to us, and how to break those routines and embrace new ones, could help us change our lifestyles and adopt healthier behaviors,” Dr. Nora Volkow, director of the National Institute on Drug Abuse, recently wrote in the NIH News in Health.

Generally, we are creatures of habit. We perform daily routines, such as bathing and combing our hair without giving them a thought. We’re on auto-pilot as we drive to work. In one sense, these habits are good, according to Volkow, as it frees up the brain to concentrate on other matters.

Habits form not only from repetition but also from the stimulation of the brain’s reward centers. Often these habits are not particularly good. When we indulge in behaviors that bring us pleasure, such as smoking, using drugs or eating too much food, the brain releases dopamine, a chemical responsible not only for motivation, compulsion and perseverance, but also for pleasure.

In other words, our brains become hardwired to crave and continue bad habits. That does not mean that it’s impossible to change. It means that change is just not easy.

There is not one set of rules for change. One size does not fit all, but there are some rules that apply across the board. One must first recognize and accept the habit and acknowledge that change is necessary. In addition, goals for change should be specific. Instead of vowing to exercise, be more exact. How often will you exercise? What type of exercise?

There are several models of behavior change, but one of the most applied and tested in the health care field is the transtheoretical model (TTM) developed by psychologists James Prochaska and Carlo DiClemente in 1983.

TTM has been successfully applied to health related behaviors such as smoking, diet, exercise and safe sex practices. Practitioners have also used it to change mental health related behaviors, including alcohol, drug abuse and stress.

The theory behind TTM is that at any given time, a person is in one of five different stages: precontemplation, contemplation, preparation, action and maintenance. People move from one stage to the next without skipping since each stage offers preparation for the one following. The time frame to remain in each level depends on the individual.

In precontemplation, a person has no conscious intention of making a change, while in the contemplation stage the person is considering a change, but has not made a commitment to a particular action.

In preparation, people acknowledge the need to change and are developing an action plan, such as membership in a health club. Action occurs when the person has actually modified behavior, such as to stop smoking. Maintenance occurs once the person has practiced the new behavior for six months.

Counselors readily admit that it can take several rounds of these stages for a permanent change to occur. Smokers quit, then quit again. Many new health center memberships go unused. That’s to be expected.

Relapse is common, perhaps even inevitable. Experts often look at these relapses as partial successes. People know why they failed and can hopefully avoid that response the next time around.

Some make the mistake of relying solely on willpower to change unhealthy habits. Mental health professionals warn that willpower is like a muscle and fatigues when used too much. A recent issue of Mayo Clinic Health Letter cites examples of how self-control may be more effective in changing certain behaviors.


Although Stephen Wright is familiar with the transtheoretical model of change, it was still difficult to apply the model to change his behavior. Wright now works out at Body By Brandy Fitness Center & Day Spa in Roxbury. (Ernesto Arroyo photo)
For example, a person using sheer willpower to curtail drinking will decide to keep liquor in the house for visitors, but vow not to drink. A person practicing self-control, on the other hand, vows not to not keep liquor in the house at all.

People with emotional disorders, such as stress and anxiety, have an even more difficult problem changing behavior since stress is often the cause of that behavior. Dr. James Jackson, an African American professor of psychology at the University of Michigan, found an unexpected paradox in recent research.

He discovered that some blacks adopt certain behaviors, such as smoking and drinking, to cope with environmentally produced stresses. While those are unhealthy behaviors, they nonetheless contribute to lower rates of mental disorders among blacks, according to Jackson. However, that is a high price to pay for a positive outcome. That practice plays a significant role in higher rates of physical health problems.

These results may partially explain the higher incidence of obesity and the lower rates of exercising and healthy eating among minorities.

Stephen Wright, 58, is well versed in TTM. He learned about it while working with drug abusers. But he is also quick to point out that teaching these changes and applying them personally are two different issues.

It wasn’t drugs that caused Wright problems. His predicament stemmed from lack of exercise. Wright said that he has exercised off and on throughout life, and played sports in high school.

In recent years, exercise has been mostly off. Advancing years, a demanding job and family responsibilities began to intrude on his time to work out. It’s not as though he didn’t know the medical benefits of exercise. He did. And he also knew that he had three medical conditions that could profit from regular exercise — diabetes, high blood pressure and a steadily increasing waistline.

This awareness still did not spur an action plan, but an A1C of 9.1 did. The A1C test measures how well the body has controlled glucose, or blood sugar, for the past two to three months. In diabetics a reading below 7 is desirable. “That was a wake up call,” Wright admitted.

It was a wake up call for his doctor as well, who referred him to Body By Brandy Fitness Center & Day Spa in Roxbury. Exercise was now a prescription rather than an option.

Know your triggers


Source: Duke Integrative Medicine
According to Wright, he is well within the action phase of his change. He exercises four days a week. Occasionally, he misses a day, but tries not to. “It makes it harder the next time,” he admitted.

For Wright, the gym is unavoidable — it is located between his work and his home. In this phase it is important to be clear about his motivation. He is. He needs to lower his A1C and his BMI.

A support system is also essential to keep him on track. That support comes from his wife, who is also a member of the gym. They work out together at times.

Wright has not hit the “maintenance” phase of change yet. According to TTM a time period of six months or more is needed to reach that level. He has three more months to go, but so far so good.

There are a couple of other habits Wright says he must work on. He’s a smoker, but he’s taking it one habit at a time. Wright has a definite plan. He knows that exercise can add years to life. He also said that he recognizes the difficulty in making behavioral changes to lifestyle.

“I need a few years,” he said. “It’s hard but doable.”