Addiction and self-control:A three-layered model to support recovery

Background: Loss of self-control in addiction is often hard to understand. addictive behaviour has both voluntary and involuntary aspects. A better understanding of how people with addiction lose control over their lives gives more options for recovery. Aim: To gain insight in the different factors that undermine self-control in addiction, and to develop a model to better identify these factors. Method: Longitudinal, qualitative research (n = 69) among people with (mostly) opioid and alcohol dependency. Respondents were interviewed four times over 3,5 years to gain a better understanding of their goals and what frustrated the achievement of those goals. Results: Different theories have a different understanding of what self-control is, or when behaviour counts as self-controlled. Self-control can be exercised on three different levels:to carry out our intentions (short term),to achieve goals (long term), or to live life according to our values and selfunderstanding. These three layers of self-control influence each other, as well in loss of self-control as in recovery. Conclusions: Loss of self-control or agency in addiction almost never has a single cause, but is caused by a set of complex, interacting factors. The three-layered model of self-control makes these different levels of self-control (intentional, instrumental, normative) explicit and offers important leads for recovery.