16 Feb The Enemy of the Good
Recently, the director of the National Institute on Drug Abuse (NIDA), Dr. Nora Volkow, wrote an essay critiquing abstinence-only and relapse thinking in addiction treatment.
The unhelpful assumption that abstinence is the only successful outcome of treatment is something the addiction treatment field has struggled with for years. I was encouraged as I read her words asking professionals to “not let the perfect be the enemy of the good” – and instead, to reduce stigma and offer more pragmatic treatment that meets people where they are. I agree that we should take all the good we can get when it comes to reducing adverse consequences of substance use, and the science does, too.
I read this essay while eating my lunch exactly 40 days into the new year. For the first 38 days of 2022, I had done what I had announced to my family as I polished off a big piece of chocolate cake on New Year’s Eve. I was going to commit to my fitness in the new year by doing one 10-minute “crush your core” workout every day. I told my family I was soon going to be well on my way to the workout’s promise of abs of steel.
But one Tuesday (day 39 of this new year), I didn’t crush. I didn’t even crunch. If I am being completely honest, I likely didn’t flex a single core muscle the whole day. I was gloomy about it because I had opened my email to find a message from my fitness program telling me my streak of consistent workout days had ended. The email showed a calendar with a big empty white space over Tuesday. Bright blue dots covered the 38 days before. I felt crummy. I thought about eating ice cream for lunch instead of a sandwich. I considered deleting the app and forgetting about having abs made of anything other than soft, chocolate ice cream.
Then I read this essay from Dr. Volkow. For fun (recognizing the similarities that span all types of behavior change), I replaced key terms related to substance use and abstinence with “crushing your core.” Here’s a snippet of the modified essay, tailored to my own experience:
But as long as [core crushing] is only regarded as successful if it produces [consistent core crushing without ever skipping a single day], then even one-time lapses can trigger unnecessary guilt, shame and hopelessness. If an individual feels like they are bad, weak or wrong for [not crushing their core one single day after a period of daily, consistent core crushing], it could potentially make it more likely for those [days skipping core crushing] to become more frequent…
Shoot. I had mistakenly fallen into the unhelpful, black-and-white, relapse thinking pattern. I had let perfect become the enemy of the good.