In “Willpower with and without effort,” George Ainslie clarifies the resolve and suppression mechanisms involved in the manifestation of willpower. However, Ainslie's article underplays the importance of cultural contexts and framing in understanding how individuals perceive the associated costs and benefits of self-control. The article acknowledges some cultural institutions that orient and strengthen willpower, but throughout our evolutionary history a host of specific practices have culturally evolved to support willpower. A closer look at these practices, and the cultural contexts in which they are employed, can broaden the applicability of Ainslie's theory. Here, we examine Alcoholics Anonymous's (AA) method of temptation resistance known as “playing the tape through” (PTT) and explore its resonance with Ainslie's framework.
One of the key tenets of recovery in AA is complete abstinence from alcohol. AA argues that, for alcoholics, consumption of a single alcoholic beverage guarantees the onset of a drinking binge (Wilson, Reference Wilson1976). That first drink triggers a bottom-up signal from the amygdala which overrides the alcoholic's conflict detection system, thereby allowing compulsion to overpower reasoning at the neurological level (Bechara, Reference Bechara2005; Derks & Scheepers, Reference Derks, Scheepers, Major, Dovidio and Link2018). Essentially, AA asserts, alcoholics have no ability to moderate while drinking. Accordingly, alcoholics must avoid any consumption of alcohol or risk falling into old, destructive behaviors.
The PTT method is a relapse prevention technique involving exertion of willpower, specifically resolve, over temptations. Resolve entails a cost–benefit analysis of the hypothetical outcomes of exercising self-control versus conceding to compulsion (sect. 3.2). PTT enables alcoholics to compare the net benefits of abstinence and relapse and use this assessment to decide their next step. The need for PTT is triggered by an alcoholic's cravings for alcohol, often resulting from rumination on the positive foresights of drinking with simultaneous repression of the risks. This phenomenon, coined “euphoric recall” by Gorski (Reference Gorski, Daley and Carruth1988), constitutes the beginning of “the tape.”
The first phase of PTT involves conceptualizing the images and feelings associated with relapsing. As if watching a mental “tape,” the alcoholic visualizes the entire scenario from the first sip through the consequences that follow. The alcoholic then identifies the costs and benefits of the hypothetical situation. Relapse often leads to a rapid downward spiral rampant with costs and the alcoholic quickly finds herself reliving the experiences which originally convinced her to get sober. Common ramifications include mental and physical turmoil, loss of loved ones, arrest, and hospitalization (Wilson, Reference Wilson1976). Although the costs of relapse are immense, if the alcoholic chooses to drink she would be rewarded with almost-instant gratification as the alcohol takes effect. The alcohol-induced influx of dopamine and serotonin temporarily increases feelings of happiness and peace whereas the increase in GABA lowers inhibitions, relieving anxiety and increasing confidence (Banerjee, Reference Banerjee2014). PTT forces the alcoholic to identify and assess the costs and benefits of relapsing, which are specific to her personal experiences with drinking.
The second phase of the PTT method involves considering the implications of remaining abstinent through use of the previous start-to-finish visualization process. Similar to the preceding phase, the alcoholic recognizes the costs and benefits of maintaining sobriety. Remaining abstinent in the presence of cravings can be very uncomfortable (Kavanagh et al., Reference Kavanagh, Statham, Feeney, Young, May, Andrade and Connor2013). Thus, the predominant short-term cost of remaining abstinent is enduring the discomfort until cravings subside. Although choosing abstinence can be temporarily costly, benefits can include enhanced cognitive skills, financial security, and improved social, psychological, and legal outcomes. The alcoholic identifies the costs and benefits of remaining abstinent to assess its worth as an option.
In the final stage of PTT, the alcoholic practices resolve by comparing the values of relapsing and remaining abstinent to determine which option produces the greatest ultimate rewards. Delivering quick relief with long-term expenses, relapsing provides smaller, sooner (SS) rewards. Remaining abstinent has short-term costs with long-term benefits. Thus, demonstrating self-control generates larger, later (LL) rewards. Ainslie (sect. 3.2.1) argues that bundles of LL rewards gradually produce greater gains than bundles of SS rewards. Choosing abstinence, through techniques such as PTT, ultimately produces greater benefits than relapsing. Furthermore, through engagement in intertemporal bargaining, the alcoholic often realizes relapsing in the present could negatively impact her ability to exercise self-control in future decisions about drinking, eventually resulting in larger costs and more lost benefits (sect. 3.2.1). Completing PTT, the alcoholic reviews these factors and often chooses abstinence over relapse. If cravings persist, alcoholics may reimplement the PTT method, among others, to continue systematically assessing their options. Note that suppression, the act of disregarding any option except self-control, is not included in PTT, because the method requires active consideration of all options, including relapse.
Consistently practicing resolve through PTT can prompt alcoholics to habitually choose abstinence over relapse. Over time, the alcoholic may conclude that relapse is not a promising option. Meanwhile, abstinence is reinforced through the accrual of LL reward bundles, ultimately leading to the formation of this “good habit.” Complete abstinence is the most important determinant of habit maintenance (sect. 3.3.2). Relapsing, even once, can drastically reverse progress, and prolonged practice of recovery mechanisms, such as PTT, is required again to regain habitual abstinence. Many long-term AA members have practiced PTT enough to internalize the results and no longer need to consciously review them. Nevertheless, predisposition toward abstinence can waver in alcohol-salient situations, so conscious, repetitive enactment of the PTT method is valuable at any stage in recovery (Kavanagh et al., Reference Kavanagh, Statham, Feeney, Young, May, Andrade and Connor2013).
Alcoholics must exert considerable willpower to remain sober. Little is known, however, about the cross-cultural variation in popular relapse prevention methods, such as PTT. The relevance and efficacy of each method may depend on cultural traditions, beliefs, and taboos. Further research should identify and compare relapse prevention methods across cultures, using Ainslie's framework to analyze differential expression of willpower. It is hoped that such study will help to refine existing self-control techniques or develop new methods to combat addiction in all its forms.
You have
Access
In “Willpower with and without effort,” George Ainslie clarifies the resolve and suppression mechanisms involved in the manifestation of willpower. However, Ainslie's article underplays the importance of cultural contexts and framing in understanding how individuals perceive the associated costs and benefits of self-control. The article acknowledges some cultural institutions that orient and strengthen willpower, but throughout our evolutionary history a host of specific practices have culturally evolved to support willpower. A closer look at these practices, and the cultural contexts in which they are employed, can broaden the applicability of Ainslie's theory. Here, we examine Alcoholics Anonymous's (AA) method of temptation resistance known as “playing the tape through” (PTT) and explore its resonance with Ainslie's framework.
One of the key tenets of recovery in AA is complete abstinence from alcohol. AA argues that, for alcoholics, consumption of a single alcoholic beverage guarantees the onset of a drinking binge (Wilson, Reference Wilson1976). That first drink triggers a bottom-up signal from the amygdala which overrides the alcoholic's conflict detection system, thereby allowing compulsion to overpower reasoning at the neurological level (Bechara, Reference Bechara2005; Derks & Scheepers, Reference Derks, Scheepers, Major, Dovidio and Link2018). Essentially, AA asserts, alcoholics have no ability to moderate while drinking. Accordingly, alcoholics must avoid any consumption of alcohol or risk falling into old, destructive behaviors.
The PTT method is a relapse prevention technique involving exertion of willpower, specifically resolve, over temptations. Resolve entails a cost–benefit analysis of the hypothetical outcomes of exercising self-control versus conceding to compulsion (sect. 3.2). PTT enables alcoholics to compare the net benefits of abstinence and relapse and use this assessment to decide their next step. The need for PTT is triggered by an alcoholic's cravings for alcohol, often resulting from rumination on the positive foresights of drinking with simultaneous repression of the risks. This phenomenon, coined “euphoric recall” by Gorski (Reference Gorski, Daley and Carruth1988), constitutes the beginning of “the tape.”
The first phase of PTT involves conceptualizing the images and feelings associated with relapsing. As if watching a mental “tape,” the alcoholic visualizes the entire scenario from the first sip through the consequences that follow. The alcoholic then identifies the costs and benefits of the hypothetical situation. Relapse often leads to a rapid downward spiral rampant with costs and the alcoholic quickly finds herself reliving the experiences which originally convinced her to get sober. Common ramifications include mental and physical turmoil, loss of loved ones, arrest, and hospitalization (Wilson, Reference Wilson1976). Although the costs of relapse are immense, if the alcoholic chooses to drink she would be rewarded with almost-instant gratification as the alcohol takes effect. The alcohol-induced influx of dopamine and serotonin temporarily increases feelings of happiness and peace whereas the increase in GABA lowers inhibitions, relieving anxiety and increasing confidence (Banerjee, Reference Banerjee2014). PTT forces the alcoholic to identify and assess the costs and benefits of relapsing, which are specific to her personal experiences with drinking.
The second phase of the PTT method involves considering the implications of remaining abstinent through use of the previous start-to-finish visualization process. Similar to the preceding phase, the alcoholic recognizes the costs and benefits of maintaining sobriety. Remaining abstinent in the presence of cravings can be very uncomfortable (Kavanagh et al., Reference Kavanagh, Statham, Feeney, Young, May, Andrade and Connor2013). Thus, the predominant short-term cost of remaining abstinent is enduring the discomfort until cravings subside. Although choosing abstinence can be temporarily costly, benefits can include enhanced cognitive skills, financial security, and improved social, psychological, and legal outcomes. The alcoholic identifies the costs and benefits of remaining abstinent to assess its worth as an option.
In the final stage of PTT, the alcoholic practices resolve by comparing the values of relapsing and remaining abstinent to determine which option produces the greatest ultimate rewards. Delivering quick relief with long-term expenses, relapsing provides smaller, sooner (SS) rewards. Remaining abstinent has short-term costs with long-term benefits. Thus, demonstrating self-control generates larger, later (LL) rewards. Ainslie (sect. 3.2.1) argues that bundles of LL rewards gradually produce greater gains than bundles of SS rewards. Choosing abstinence, through techniques such as PTT, ultimately produces greater benefits than relapsing. Furthermore, through engagement in intertemporal bargaining, the alcoholic often realizes relapsing in the present could negatively impact her ability to exercise self-control in future decisions about drinking, eventually resulting in larger costs and more lost benefits (sect. 3.2.1). Completing PTT, the alcoholic reviews these factors and often chooses abstinence over relapse. If cravings persist, alcoholics may reimplement the PTT method, among others, to continue systematically assessing their options. Note that suppression, the act of disregarding any option except self-control, is not included in PTT, because the method requires active consideration of all options, including relapse.
Consistently practicing resolve through PTT can prompt alcoholics to habitually choose abstinence over relapse. Over time, the alcoholic may conclude that relapse is not a promising option. Meanwhile, abstinence is reinforced through the accrual of LL reward bundles, ultimately leading to the formation of this “good habit.” Complete abstinence is the most important determinant of habit maintenance (sect. 3.3.2). Relapsing, even once, can drastically reverse progress, and prolonged practice of recovery mechanisms, such as PTT, is required again to regain habitual abstinence. Many long-term AA members have practiced PTT enough to internalize the results and no longer need to consciously review them. Nevertheless, predisposition toward abstinence can waver in alcohol-salient situations, so conscious, repetitive enactment of the PTT method is valuable at any stage in recovery (Kavanagh et al., Reference Kavanagh, Statham, Feeney, Young, May, Andrade and Connor2013).
Alcoholics must exert considerable willpower to remain sober. Little is known, however, about the cross-cultural variation in popular relapse prevention methods, such as PTT. The relevance and efficacy of each method may depend on cultural traditions, beliefs, and taboos. Further research should identify and compare relapse prevention methods across cultures, using Ainslie's framework to analyze differential expression of willpower. It is hoped that such study will help to refine existing self-control techniques or develop new methods to combat addiction in all its forms.
Conflict of interest
None.