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Dealing with Reward-Motivated Behavior: Tapering Methods vs. Cold Turkey

Mark Dombeck, Ph.D.

Relapse prevention methods are designed to help you avoid engaging in undesired often self-destructive behaviors which are nevertheless quite compelling (such as drugs and alcohol, cigarettes, pornography, gambling, etc.). They are slightly less useful for helping wean you from those behaviors in the first place, however. A taper method can be useful when weaning is what you need.

To taper something means to lessen it over time. Tapering methods are thus methods for lessening the number of times you use or do something over time, until you no longer need to use or do that thing.

A good example of a taper method is the use of tapering to help people quit smoking. The nicotine in cigarettes is a highly addictive drug. People who smoke regularly develop a physiological dependence on nicotine. Their efforts to quit are typically defeated by the sudden onset of withdrawal symptoms. Not smoking causes them to feel anxious at first, and then to feel ill. Though not actually dangerous, these feelings are very uncomfortable and don't go away for a long while unless the addicted person lights up another cigarette.

By tapering the number of cigarettes a person smokes in a day, it is possible for that person to lessen the amount and intensity of withdrawal symptoms they must face. Each day, over the course of many days, they smoke slightly fewer cigarettes, spacing the distance between each one longer and longer. As the tapering continues, the body gets used to having less nicotine in it, and the addiction weakens. Slight withdrawal symptoms may be experienced during the taper process, but they are generally tolerable; nothing compared to the full on withdrawal symptoms. Ultimately, if the taper is conducted properly and consistently, it becomes possible for the smoker to stop smoking entirely without experiencing significant discomfort or craving.

Tapering from cigarettes is fairly difficult, as nicotine is an incredibly addicting drug that doesn't easily let go and withdrawal symptoms are uncomfortable. It is easy to try to taper too fast and experience too many symptoms, or too slowly, and not make enough progress. Fortunately, various means of helping you structure and organize your smoking taper program are now available.

  • Computer devices and various websites are available to help you generate a taper schedule that is neither too fast or slow for you, and then to help you stick to that schedule. The better devices are designed to be carried around with you. We've seen one that is a computerized cigarette case, and another that is a key chain holder. These devices beep at you when it is time to smoke another cigarette and count down to the time when your next cigarette is due. By alerting you and providing a count-down function, these devices help you stick to the taper pacing.
  • Various nicotine patches and gums are available by prescription which help you to dose yourself with nicotine without having to smoke it. Nicotine patches help you to crave less because they help you maintain a steady level of nicotine in your blood. It is necessary to taper the patch doses over time, however, in order to actually quit the addiction.

People sometimes get impatient with tapering approaches and instead try an all-at-once quitting method, commonly known as "Cold Turkey". While it is perfectly safe (if terribly uncomfortable to go cold turkey for many substance addictions, there are a few where it is very dangerous to do so. The withdrawal symptoms associated with alcohol can be lethal - they can kill you. Do not try to go "cold turkey" from alcohol. Instead, check yourself into a hospital or licensed medical detoxification program and let professionals gently and safely taper you off of your alcohol dependence. During a hospital supervised detoxification from alcohol, patients are often given benzodiazepines (a class of drugs that work similar to how alcohol works). Being on the benzodiazepine keeps alcohol withdrawal symptoms at bay. Then a gradual taper of the benzodaizapine is initiated, and drug doses are gradually lessened until it is safe to take the patient off the drugs entirely.

Addictions that have no chemical/substance basis but rather are psychological in nature, such as pornography and sexual addictions, or compulsive gambling are best treated in a cold turkey manner. Continuing exposure to these things simply reinforces their power over the addicted person. Abstainence from these things does not put a person at increased risk of health problems. People are generally better off deciding to avoid such things completely and then following through on this decision.