Our actions may not be fully aligned with our long-term goals. But in the moment, there is a reason for what we do. We may want to feel better or avoid immediate pain. We may do something we’ve always done without really thinking. We may act because we feel lonely or frustrated or angry.

You aren’t broken because you made the wrong choice. You’re human. Step back and think, “what does that behavior do for me?” Because whether it’s sugar, YouTube, or heroin, there’s some reason we keep going back. Until we recognize why we do something, it’s hard to have lasting change in our lives. 

“I’m an addict” doesn’t explain anything. It’s a label, and usually not a helpful one. What about  “I like _, because _” (even if you hate other things about it). Be honest with yourself. Sit with that thought. It might be painful. It might make you realize that things aren’t so bad. 

It’ll take compassionate practice to change. But when we realize why we do something, change becomes much more realistic. 

Here’s a common example I hear almost every day: “I can’t do that because of anxiety.” It might be true; it might not be. How could you possibly know unless you try? But more importantly, the thought isn’t very useful if the thing you “can’t do” is something you really want. It provides a convenient excuse that you can turn to when you feel overwhelmed. Fighting against it, however, can often make the thought stronger. So rather than trying to contradict the thought or reframe it as something more helpful, it might be worthwhile just to recognize that the thought is there, and that you get to choose what you do with it. This thought doesn’t represent you. It doesn’t predict the future. And you can’t know if it’s true unless you commit yourself to action.

When I sat down to write this post, I was struck with the thought “this is too hard to do today.” I felt an immense weight behind posting something meaningful. I thought of writing a brief, low effort post. And that would have been fine. My current goal is to publish a single post every week; to build a habit first, and hope that skill develops with practice. Thankfully, the practice I’ve been doing with cognitive defusion–techniques used to “unstick” myself from my thoughts–kicked in. I noticed that what I had experienced was just a thought, and I started writing something anyways. It was painful and difficult at first. I still didn’t want to do it. And yet after a few minutes, I started to feel some relief. It felt right, and I’m glad I did it. It doesn’t always work that way, but I’m hopeful that I’ll get better with practice.

“I can’t do that because…” is almost never helpful. And, well, it’s just a thought. Recognize the noise your mind presents to you, but don’t believe it. Focus on what matters most. And then take a small step away from the darkness. You might find yourself enjoying the journey. 

There’s a movement to classify all mental health problems as brain disorders. And to some degree, these advocates aren’t wrong. All of human life is experienced by the brain. We can’t usually identify individual anatomical changes that distinguish one mental disorder from another, but there’s little pushback against the idea that the brain is at the center of our experience.

Brain-based explanations of mental health may also reduce some forms of stigma. And at the same time, we all have a natural tendency to be skeptical of recovery from brain-related deficits.

For example, we know that opioid use disorder (the clinical term for people who continue to misuse substances like heroin, morphine, or oxycodone despite negative consequences) can be convincingly modeled as a chronic, relapsing brain disorder. And at the same time, there are concrete behavioral changes that people can make to recover from opioid use disorder. 

My patients with opioid use disorder absolutely benefit from medications that stabilize the brain-based opioid system, just like someone with diabetes benefits from medications that stabilize blood sugar. At the same time, we can be so much more empowering by exploring behavior and providing coaching on ways to better manage the problem. For opioids, that might include education, changing contacts, identifying cravings, managing triggers, approaching trauma, and so much more. For diabetes, these interventions often fit the same mold. But to say “this is an insulin resistance problem” or “this is a brain-based opioid system problem” without saying “and I want to help you find ways to overcome this” sets people up for suboptimal outcomes. 

Like anything else in life, there are things we can change, and things we cannot. We can reduce stigma by normalizing the things we cannot change. And at the same time, we can empower each other emphasizing the depth, breadth, and reality of effortful improvement. Because at the end of the day, there is always some way we can improve our lives by changing our behavior.

Everyone is comfortable with applying the term addiction to people who repeatedly use injection drugs. Less problematic substance use is much harder to define. 

Here’s a relatively simple, non-technical definition that roughly coincides with the current psychiatric definition: addiction is the persistent use of unnecessary substances or gambling in a way that is harmful to the participant or others.

(There’s a lot more that needs to be defined. What about food, sex, video games, and the internet? There are clearly people who have problems with excesses in these domains, but defining boundaries turns out to be a difficult and contentious problem.) 

I like to think of addictive disorders as a broad spectrum of problems. The most severe (and correspondingly less common) addictions can cause disability, death, and chaos. Other problems are much less obvious. 

For example, is marijuana addictive? Yes. Some people have difficulty cutting back, damaged relationships, impaired work, drug tolerance, physical dependence, and the whole range of other problems we associate with addiction. The average harm from cannabis use is small compared to alcohol or tobacco, but it is not wholly risk free. (I’m not arguing that cannabis use results in addiction in everyone. That isn’t true of any drug. At most, cannabis use disorder develops in fewer than one in five people who use it; I suspect the number is closer to one in ten.)

That’s why I call some problems indolent addictions. Indolent processes usually start slow and cause little initial pain. Many benign tumors are indolent and never cause problems. Other indolent processes–like Alzheimer’s dementia–go unnoticed for years and yet still inevitably progress towards death. Indolence defines the process, not the outcome.

Cannabis use disorder (a very real addiction diagnosis) is generally indolent. Most cannabis users don’t use marijuana in a disordered way. Of those who do, the consequences of ongoing use tend to be relatively small. Is it still an addiction if the consequences are small? Technically? yes. Practically? That’s a risk-benefit decision for the individual to decide.

(I have treated people with florid, acute psychotic symptoms related to first-time cannabis use. Those people don’t typically return to the drug, which effectively prevents the development of addiction. I’m more concerned about the correlation between cannabis use and chronic psychosis in adolescents and young adults.)

Tobacco use disorder is another common, indolent addiction. In fact, the indolence of tobacco use led industry executives and lobbyists to argue that tobacco was not addictive at all. But make no mistake: indolence isn’t the same thing as harmless. Tobacco overdoses are rare, but the drug is still responsible for more ongoing deaths than any other psychotropic substance.

Is the distinction meaningful? I’m not sure yet. There are certainly some indolent behaviors in my life that are worth changing. I imagine that’s true for you too. Writing them off as “not a problem” because they are small doesn’t fix anything, and beating ourselves up because we aren’t perfect doesn’t help either. Let’s accept where we’re at and make small, consistent steps to reach our goals.

It’s important to recognize where things aren’t going well and apply deliberate pressure. At the same time, there is power in being able to recognize problems, set aside the ones that aren’t priorities to change, and find joy in the midst of broken systems. 

Gratitude is recognizing the good things in your life–even if you feel overwhelmed. It’s a deliberate practice: find one thing that is going well. Recognize it. Give thanks to those who contributed. Set aside the negative for a moment and focus on what is good. Repeat often. 

Practicing gratitude won’t fix all your problems. But it might provide a little lift to your outlook. And ultimately, approaching problems with grace, gratitude, and generosity will do more for you than wallowing in anger at the things you cannot change.