Routine is a set of behaviours we do regularly, but not automatically, in a particular order.
Habit is a process by which a stimulus generates an impulse to act as a result of a learnt stimulus-response association. ...Ben Gardner
40% of daily decision-making processes are unconsciously driven by habits...
Addiction is a primary chronic disease of brain reward, motivation, memory and related circuitry. ...American Society of Addiction Medicine (ASAM)
[Note the older definition: Addiction is a state in which an organism engages in a compulsive behaviour, even when faced with negative consequences.]
Our lives are organised around habits and routines. A recent feature describes how diet, sleep and exercise routines are fundamental to a child's proper development. Adults need routines too - we do many things at particular times in some definite order - routines give structure to our lives. We intentionally devise routines because we hope to derive some benefit out of them - to achieve some desirable goal/objective.
Many of the routines when repeated over time become habits and we carry them out without even thinking about them; the benefit or reward gets hard-wired in our brain. Routines and habits have powerful influence on our health and well-being.
Routines and habits: what is the difference?
Routines: A set of behaviours we do regularly, but not automatically, in a particular order.
A routine requires a high degree of intention and effort. Generally, routines are not thought of as fun or pleasurable but they help us in self-development by focusing on things that are important for our physical, social and emotional well-being. Good routines have a purpose - a why. Examples of routines: Setting alarm for 7 am, preparing a healthy breakfast and doing some exercise; Having dinner with family in pleasant environment; etc.
Routines are powerful because it is only through a well-designed routine that bad/undesirable habits may be changed (broken).
Habit: An acquired mode of behaviour that has become nearly or completely involuntary.
Habit is behaviour that we do automatically in a regular and repeated way with little or no conscious thought. We engage in habits because there is some kind of payoff/reward - we get some kind of physical or emotional pleasure that, in some cases, may only be transitory. All habits are not necessarily beneficial.
Some habits are good - They have positive outcome and enrich life by improving health, relationships, finances - they generally make you feel good and relaxed. For example, going for a walk after meals, talking to a friend, taking tea-break at 11 am; keeping your place tidy etc.
Habits can be bad too - Some habits have negative outcome and create stress, anxiety, affect your sleep pattern, annoy people around you. For example - picking your nose in public, poor posture (or slouching), watching TV for hours etc. Such habits should be avoided.
How habits form?: Habits make up a major part of our behavioural and cognitive lives. Many acts (behaviours), after repetitive practice, would transform from being goal directed to automatic habits, which can then be carried out subconsciously and efficiently. Habits free up the cognitive load required for routine procedures, and allow the brain to attend to new situations; habits make us utilise our energies more efficiently. On average one needs about 66 days to form a habit - although sometimes it may take much longer.
Driving a car or riding a bicycle are demanding activities. Initially, it requires a lot of attention and concentration but with practice, it becomes more or less effortless. There are occasions when I would drive six or seven miles before realising that I have covered such a distance - it is like being on auto-pilot. This certainly frees the brain to become more efficient and concentrate on dealing with other situations. Life would be impossible if we had to pay attention to every little part of all the task we do - how to take the next step while walking, or how to use knife and fork at the dinner table etc. Our brains have an “inborn tendency to maximise reward and minimise cost".
Over the past 25 years, numerous studies have linked habit formation with the basal ganglia. We now have a good understanding of how our brain forms habits and which parts are involved in this process. The following slide shows the main parts of the brain.
The basal ganglia (BG) are a group of subcortical nuclei that represent one of brain's fundamental processing units. BG are present in brains of all vertebrates and situated at the base of the forebrain and the top of the midbrain.
The Habit Loop: Repeated execution of a routine develops into a habit.
Essentially, a routine starts with a trigger - be it alarm at 7 am or nice smell of baking or the clock showing a particular time of the day. The trigger then causes a behavioural action - getting out of bed or serving yourself a freshly baked cake or having a coffee break at work. The action leads to a reward - feeling of accomplishment or satisfaction.
We say that a habit has been formed when encountering a trigger (or cue), the brain involuntarily executes the action anticipating that the reward will be forthcoming.
Experiments with monkeys have demonstrated that, once a habit is formed, the expectation of the reward is strongly felt as soon as the trigger appears - even before any action happens. One kind of craves for the reward which - so does the brain believes - is bound to follow the trigger. If the reward is denied, the subject feels disappointed, angry and can become very upset. This is particularly evident in case of addiction where an extreme form of reaction may be observed. For example, a smoker must have the cigarette after his meal or a chocoholic denied her favourite treat to go with a nice cup of tea.
How Does the Brain form Habits: What goes on in the brain during the time when a routine becomes a habit? The reward from the routine generates a good feeling -- striatum (part of basal ganglia) is central in processing the reward system. In the reward system, via a reinforcement learning process or temporal difference learning, the brain makes a prediction before a reward is delivered; it then compares the reward yield to predicted expectation and, depending on the difference, the brain makes an adjustment leading to a learning curve.
The brain, thus, begins to expect an appropriate reward as soon as a trigger is encountered.
How to Break a Habit: Old Habits Never Die.
Good habits are useful but sometimes it is good to be able to break a bad habit.
We can only make a habit latent (mask it) but it will come back to life if proper conditions are present. Even if you have controlled the habit of not eating chocolates with your coffee, it is very hard to resist the temptation if you happened to be feeling tired and a good opportunity presents itself.
It is really difficult to break a bad habit. I must be seriously motivated to do so - first step is that I should be convinced that the particular habit is something I want to eliminate.
The next step is to study the habit and find the trigger, behavioural pattern and reward - effectively identify the habit loop.
For example, if I prepare a cup of coffee and go for the box of chocolates then coffee is the trigger and action is the process of finding and eating the chocolate. The reward is obviously the feeling of satisfaction.
It is best to use the same trigger but change the behaviour - may be I should replace the chocolate by a small quantity of nuts and dried fruits - which will still give me a sugar/energy boost and similar reward.
Essentially, I am forming a new habit; and it takes time to establish a new habit - I need to persevere and remember to go for the nut/fruit mixture. After a couple of weeks, I can start reducing the amount (in small steps) of dried fruits (rich in sugar) and eat only nuts with my coffee. The next stage will be to reduce the amount of nuts (again in small steps) until I am able to drink coffee on its own.
The reward system will adjust itself and I should be able to get same pleasure from a cup of coffee that I was able to derive from coffee cum chocolate. However, my brain will still remember the old habit and the enjoyment that chocolate provided and it will be all too easy to fall back into that routine - I shall be on guard not to give in to the temptation at the next opportunity.
Breaking a habit is not an easy process and can not be done in haste. Forming a new habit takes on average 66 days - breaking one will need similar length of time but also greater motivation.
Habits and Addiction: what is the difference?
Habits may be good or bad. Good habits are desirable and help us to live our lives in a relaxed and efficient manner. Bad habits are undesirable but they are under our control. In bad habits, even when a cue/desire is present, we can normally control and stop behavioural actions, and consciously decide to forgo rewards - we are in control.
Although initial experimentation with a drug of abuse is largely a voluntary behaviour, continued drug use can eventually impair brain circuits and connectivity to such an extent that we lose control (prefrontal cortex is responsible for such executive judgements) on our behavioural actions and continue with substance abuse or other addictive activities like eating, drinking, sex, gambling etc. even though it is clear that such actions are causing harm - drug use turns into an automatic compulsive behaviour (addiction).
Studies have shown that impairment begins in the more primitive areas of the brain that process reward; and then moves on to other areas responsible for more complex cognitive functions. The addicted person can experience severe disruption in learning, decision making, cognition and emotional functions.
Addiction is now accepted as a primary disease - not caused by something else, such as a psychiatric or emotional problem.
Addiction: In the following slides, I shall describe addiction in a more formal way. I feel it is important to understand that addiction is a disease and not just a bad habit that has become much worse. In the following three slides, the information is directly obtained from the public policy statement by the American Society of Addiction Medicine (ASAM) - in my opinion this is the best source for the purpose of this publication (the emphasis - italics and colour text are mine)
Dopamine (DA): The Master Molecule of Addiction
(Ref.) The brain's reward system uses the neurotransmitter (a molecule that carries signals across the gaps - synapses - between neurons) dopamine (DA) as its major currency to relay information (dopaminergic pathways). All addictive drugs work by triggering exaggerated but transient increases in DA in nucleus accumbens (NAc) located in the ventral striatum of the limbic system. Such DA surges resemble, and in some instances greatly surpass, the increases triggered by pleasurable stimuli (food, water, sex, gambling etc.).
Brain imaging studies (PET) have shown that in the NAc, drug induced increases in DA are linked to euphoria (highs) during intoxication. In awake human trials, greatest changes in DA levels result in the most intense euphoria.
The rate at which a drug of abuse enters the brain determines the speed at which DA increases in NAc and hence the euphoric effect it produces. The drug has to raise DA abruptly.
For example, smoked and intravenous cocaine act faster and produce greater high than snorted cocaine (which is faster than oral cocaine). While the fast rate at which cocaine act on the brain plays a major role in its rewarding effects, cociane is rapidly removed from the brain. This promotes a craving and frequent use leading to rapid addiction to cacaine.
Drugs like MPH (methamphetamine a.k.a. meth) or amphetamines are much less effective when orally administered because of their slow uptake in the brain but are potent drugs when administered intravenously or inhaled.
In the following slides, I shall describe the regions of the brain that are most directly implicated in addiction.
Final Word: This blog was meant to be a discussion of routines and habits but expanded into a longer discussion to include addiction. To keep the article of manageable length, I have missed out some important aspects of addiction, particularly relating to dug dependence, tolerance and treatment. Addiction can also happen with prescription drugs.
Teenagers are most susceptible to addiction as their prefrontal cortex is still developing and may be easily manipulated by drug use. Ironically, the society is moving in a direction that young persons feel more alienated and mental illness has been on increase. This can be a potent factor in experimentation with drugs leading to addiction.
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