“Akrasia” is a fascinating word. On the surface, it means acting against one’s own best interests, which economists call irrational and psychologists call normal. The word bears an unfortunate similarity to the word “crazy,” which itself has many definitions, most of which are unpleasant or derogatory.

A word of Greek origin, akrasia translates to “lack of self-control,” which is different from acting against one’s own best interests. Lack of self-control could result in the ruthless pursuit of one’s self-interests to the detriment of others. Akrasia is sometimes translated as “incontinence,” or lack of control over bodily functions. Some people translate the word as “lack of willpower,” which is different from sabotaging one’s best interests. Lack of willpower means you cave easily when pressed. It could be in your self-interest to lack willpower under certain circumstances.

Akrasia is a human tendency of vital interest to researchers in the addiction field. Most adults are able to consume alcohol, smoke marijuana, eat THC gummies, snort cocaine, and handle opioid painkillers without becoming addicted to these substances. However, something pulls some people across a line where they indulge knowing it is bad for them and want to stop but feel like a slave to the substance. Akrasia is one name for that force.

An eloquent description of the human tendency for self-sabotage comes not from the field of medicine but from economics and, specifically, behavioral economics. To hear Dan Ariely explain it, economics uses logic to explain human behavior whereas behavioral economics just watches what people do. And people behave Predictably Irrational, to quote the title of one of Dr. Ariely’s many books on the subject.

Dan Ariely is a professor of psychology and behavioral economics at Duke University and principal of the Center for Advanced Hindsight. Dr. Ariely has been at Duke since 2008, but in 2021 became part of Duke’s Division of Behavioral Medicine and Neurosciences in the Department of Psychiatry. He beautifully combines his two Ph.D.s, the first in clinical psychology from UNC Chapel Hill, and the second in Business Administration from UNC rival Duke University.

Like most economists, he is obsessed with understanding decision-making. However, unlike most economists, he wants to generate rules from watching actual behavior. Like the late, great Daniel Kahneman, Nobel Prize winner and the father of behavioral economics, Dr. Ariely comes at economics from psychology, which studies humans as they are, not how they theoretically should be.

In particular, he is deeply involved in the area of medical decision-making. Having suffered severe burns as a teenager that necessitated three years in the hospital, Dr. Ariely saw poor decisions being made around him on a daily basis. He resolved to improve decision-making in medical settings. Here’s part of his Duke job description:

Behavioral medicine faculty develop and implement innovative behavioral interventions that combine research, cutting-edge technology and the best clinical practices to promote healthy lifestyles, prevent disease and reduce the impact of chronic illnesses.

Which brings us to the overlap with drug addiction. Why do some people continue to use substances when they know it’s killing them? In the transcript from a video posted at BigThink, Dr. Ariely explains that part of the reason is the trade-off between the present moment and the long term:

[W]hen you face these trade-offs, we often do what’s called a present bias focus. We focus on the present too much and as a consequence, we undermine the long term, the long-term effect…[W]e’re tempted at the moment to do something that we realize is really stupid from the long-term perspective.

In psychology, this is referred to as delay discounting. Delay discounting, or the unwillingness to sacrifice a small, present reward for a large, future reward might be considered another form of akrasia, and it undergirds a great deal of depression, anxiety, and substance use disorders. A massive study of nearly 4,000 adults in the U.S. found that delay discounting problems are “transdiagnostic” and impact not only mental health and substance abuse, but also such problems as excessive social media usage, sleep disorders, and lack of exercise. The authors concluded:

[T]argeting delay discounting in co-occurring substance use disorder and/or mental health treatments may result in clinically significant outcomes.

How do you target delay discounting? That brings us back to Dr. Ariely and the work of many other researchers who are helping people to adjust their delay discounting using psychology to trick themselves. In his video on BigThink, Dr. Ariely refers to one method of tricking ourselves: reward substitution. If you’re used to having a beer when you get off work, and you want to stop drinking, it’s a lot easier if you substitute some healthier reward for the beer you’re giving up. That’s reward substitution, and Dr. Ariely’s research proves that it works remarkably well in adjusting delay discounting.

Through reward substitution and other tricks, such as cue avoidance, trigger avoidance, urge management, and emergency support, people with substance use disorders are able to retrain their habits. Instead of reaching for something unhealthy to soothe their anxiety, they pause long enough to make a better choice.

Written by Steve O’Keefe. First published August 5, 2024.

Sources:

“Why We Do Things That Aren’t in Our Best Interests,” BigThink. Undated. Retrieved August 1, 2024.

“Delay discounting is associated with addiction and mental health measures while controlling for health behaviors and health barriers in a large US sample,” Addictive Behaviors Reports, June 2024.

Image courtesy StockVault, used under Public Domain license.