Is the ability to stop a choice?

I think it’s totally fair and totally real, neurologically speaking, to say that some people, at some times, literally cannot stop.

To say the addict has a choice is very much like saying we have a choice about whether or not we breathe.

We do.

We can choose to hold our breath and stop breathing.

That’s our choice.

But the brain will ultimately demand the oxygen it needs and we will find ourselves breathing again.

The fact that it happens within 30-90 seconds makes it clear to most of us that we DON’T really have a choice.

We need to breathe.

In much the same way, but over a timescale of minutes, hours, or days, the alcoholic needs to drink and the food addict needs to eat.

In the immortal words of the big book of Alcoholics Anonymous (World Services, Incorporated, New York City, 2001, Fourth Edition, p. 24):  “At a certain point in the drinking of every alcoholic, he passes into a state where the most powerful desire to stop drinking is of absolutely no avail. This tragic situation has already arrived in practically every case long before it is suspected. The fact is that most alcoholics, for reasons yet obscure, have lost the power of choice in drink. Our so-called willpower becomes practically nonexistent. We are unable, at certain times, to bring into our consciousness with sufficient force the memory of the suffering and humiliation of even a week or a month ago. We are without defense against the first drink.”

It is the same with food.

The reason is that the neurons in the nucleus accumbens literally have no access to information about consequences, goals, past punishments, or future outcomes. They see only the potential reward in the immediate moment, and when those neurons are sufficiently wired for addiction, the strength of their agency on the system that motivates us to act is so powerful that it thwarts all efforts of the frontal cortex to rein it in. This is very much like the power of the brain stem to force us to breathe. Certain actions are just primitive and too powerful for our more recently evolved systems of “choice” to have an effect.

I have experienced this in my own history with food, too many times for me to count. Hundreds. Thousands. No matter how powerful my desire to stop eating, to stick with my plan, I just simply couldn’t. Maybe I could for an hour, but not for ten days. Somewhere between that one hour and those ten days, the need in my brain would drive me to eat, just like the need in our brain drives us to breathe again when we’re holding our breath.
Of course, the natural question is: what happens that allows the addict to break free? That’s such a good question. I’m not sure I have a fully satisfying answer. There’s some grace in the mix for sure. And a comprehensive SYSTEM is needed—of that I’m sure too. Social support. Daily accountability. Habits and rituals that break long standing cue-association patterns. I’m not sure exactly what the magic formula is, to be honest, but what we’ve got here comes close.