I met with a patient some time ago who described to me the extent of her motivation to never drink again.  She was strong in her intention, there was no doubt in my mind.  The question I had for her was “Why do you place so much weight on your intention to stop drinking?”  This opened the door for a deeper discussion regarding what we identified in the session as the dilemma of ‘intent versus motivation’ when it comes to recovery.  Intent always implies having a choice, but the diagnostic criteria for alcoholism (or any other addiction) includes the loss of control.  Hence we need to rethink if a choice is actually being made.

Alcoholism is a disease.  Neuroimaging studies have shown that there are remarkable brain changes occurring involving the reward and reinforcement pathways in the brain, not to mention the genetic data telling us that addiction often runs in the family.  The director of the National Institute on Drug Abuse (NIDA), Nora Volkow, illustrated the addictive process as one of a ‘highjacked brain’ (Volkow 2004).  This brings me back to our above conversation…

Intent is an important first step to recovery, but when given too much credence, leads to complacency and potential relapses.  I prefer the term ‘motivation.’  Motivation implies the will to stay on the right track, and also the commitment to making good choices BEFORE having the opportunity to relapse.  Once the drink is in your hand, what choice is left despite the good intentions?