What heroin addicts can teach us about eating well: a belated take @nprnews and @aspiegelnpr

I spent the day after New Year’s careening—if a resolute dedication to the speed limit can be called careening—down I-80 from Detroit to Brooklyn, so it’s taken be a few days to double back and re-listen to this beautiful piece by NPR correpondent Alix Spiegel, What Vietnam Taught Us About Breaking Bad Habits.

What I love about this story is how it lays bare the underpinning of our annual ritual of making resolutions. We take a deep breath, and, dammit, we are gonna change this time. For real. We mean it! January 1 finds us a nation enthralled to an unspoken command: Buck up, buttercup, and make it work this time.  

Spiegel’s story is more nuanced than that of course, tracing a study of soliders addicted to heroin in Vietnam who tried to get clean upon returning to the U.S. and linking it to the arc of American psychological research. But here’s what really caught my ear:

From the 1960s to the 1980s:

“The research was very much focused on trying to understand how to change people’s attitudes,” Wood [a psychology researcher] says, “with the assumption that behavior change would just follow.”

Sound familiar? It did to me. It’s the same stategy we’ve been using to talk about changing people’s diets. Tell them the right thing to do, and they’ll do it. Right? MyPlate or the Food Pyramid, even persuading people to eat local….it’s all based on the idea that if you tell them, they will change.

Which is why the next part of the piece was so fascinating:

So researchers studied how to organize public health campaigns, or how to use social pressure to change attitudes. And, says David Neal, another psychologist who looks at behavior change, these strategies did work.


“They do work for a certain subset of behaviors,” Neal says. “They work for behaviors that people don’t perform too frequently.”

Got that? Lectures work for infrequent behavior. Which is not a category into which eating falls.If you want, for example, to increase the number of people who donate blood, a public campaign can work well. But if you want them to quit smoking, campaigns intended to change attitudes are often less effective.

“Once a behavior had been repeated a lot, especially if the person does it in the same setting, you can successfully change what people want to do. But if they’ve done it enough, their behavior doesn’t follow their intentions,” Neal explains.


So, back to the heroin addicts I referenced in the headline. Most studies of heroin addiction showed that relapse rates of recovering addicts were around 90 percent. But the soldiers who came back from the war? Only about 5 percent fell back into addiction. Here’s Spiegel:

It’s important not to overstate this, because a variety of factors are probably at play. But one big theory about why the rates of heroin relapse were so low on return to the U.S. has to do with the fact that the soldiers, after being treated for their physical addiction in Vietnam, returned to a place radically different from the environment where their addiction took hold of them.

The parallel with eating isn’t a perfect one—there’s a bit of nuance in Spiegel’s piece about the very specific nature of environmental cues, things like where you are sitting and so forth. But it’s enough to give one pause, too, about considering poor diet simply a matter of preference.

Did those addicts prefer the drug? On some level, yes. But when you are in an environment where getting to it was foreign to them, most went back to living (on some level) a healthier life. It stands to reason that putting resources into building a foodscape where eating well is easy — and eating crap is not— might get us farther than just continuing to lecture.



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