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Health & Exercise Forum

The Commonwealth Medical College Hosts Substance Abuse Symposium

Nov 4, 2013

Dr. Mackarey's Health & Exercise ForumGuest Columnist: Lani Hassani, 3rd Year Medical Student, TCMC

On Saturday, November 16, 2013, The Commonwealth Medical College (TCMC) will hosted a symposium on substance abuse for health care providers in NEPA. The following column on current research regarding the neurology of self-control and substance abuse was written on by Lani Hassani, 3rd year medical student at TCMC.

"Regulatory Depletion"

A recent study from the University of Iowa led by neuroscientist William Hedgcock has shown through functional magnetic resonance imaging (fMRI) that the brain has no trouble consistently recognizing temptations. However, the brain’s self-control components can in fact be used to the point of exhaustion, contrary to the prior belief that self-control can be strengthened through repetitive use. The study purports that once self-control stamina has been depleted, the brain will have a harder time regulating activity to avoid the red-flagged temptations. The researchers termed this phenomenon “regulatory depletion”.

“I know I really shouldn’t, but I’m going to anyway,” is a phrase that may indicate you are experiencing self-control fatigue. It is also relevant to note that self-control is separate from impulsiveness. While the self-control portions of the brain stop a person from completing a certain action due to long-term consequences, impulsive behavior is positively motivated by small, immediate rewards. For example, stealing a piece of candy from a coworker’s desk to satisfy a craving would be impulsive behavior. The immediate reward is the candy. Not eating the sweet, stolen loot is self-controlled behavior because the thought of extra dietary calories, cavities from the sugar, and repercussions from the candy’s prior owner are all consequences that would deter the impulsive behavior.

Hedgcock’s revelation means that testing ones’ self-restraint does not build stronger powers of avoidance and can actually be detrimental. Say the sweet-toothed thief had recently quit smoking and had braved lunch in a smoky bar just an hour earlier. The self-restraint regions of his brain would already be burned out from battling tobacco cravings, so he would be a lot more likely to give in to his sugar cravings and eat the piece of candy.

What does this mean for me?

Because the one part of the brain fatigues while the other remains strong, there is no change in how we perceive temptation and relate it to our short and long term goals. Yet, relying solely on self-control to eat healthily or quit smoking can mean disaster when stress and repetition have literally chemically and metabolically exhausted the brain’s willpower.

When it comes to healthy habits, the right kind of motivation can help overcome self-control fatigue, says a 2012 review in the International Journal of Behavioral Nutrition and Physical Activity.

Identify the conflict and modify the behavior

  1. Get to the root of the matter: what are you trying to avoid and why? A healthy eater, for example, knows not to eat junk food. The novice healthy eater should ask himself, what do I define as junk food? The answer helps to clarify what one is actually avoiding. What is so bad about junk food? Calories, nutrition availability in the food, excess sugar, fat and salt may all be reasons to exclude a food from a diet. Remembering why something should be avoided in the first place aids in sticking to a healthy habit.
  2. Determine how to make your motivation personal. Following through with a nutritional lifestyle change is often immediately motivated by weight-loss or a desire to be healthier overall. ‘Health’ is an ambiguous concept, however, and will not win out over a delicious, flaky piece of pie. Connecting the idea of health or a trim physique to something that makes you feel a strong emotion, whether joy from feeling fitter, sadness from not being able to keep up with the kids, etc., gives the personalized motivation extra fighting power.
  3. Identify all the possible temptations throughout the day and use your motivation to make a plan. Neurologically, the brain can always readily identify temptations and hoists red flags that initiate self-control activity. Preempting potential pitfalls allows one to rely less on self-restraint, reducing the risk of self-control fatigue. You know you have to go to that holiday party tonight, so eat your regular, planned healthy dinner before heading to the party and bring a low calorie snack so that the crackers smeared with caviar and calories won’t beckon quite as strongly.
  4. Celebrate your successes and be patient. Overhauling habits and instating new ones is a challenging, but feasible, task. Appreciating your significant efforts will positively reinforce your progress. Forming new healthy behaviors also takes time, and according to a University College London study led by psychologist Phillippa Lally, it can take anywhere from a week to a year.

Guest Columnist, Lani Hassani, is a 3rd Year Medical Student at The Commonwealth Medical College (TCMC) where she plans to practice family medicine in an underserved region. She was born in Switzerland and has lived on both coasts of the US. Lani received her undergraduate degrees in Environmental Science and Anthropology from the University of Virginia, where she was also the section editor of the university paper’s Health and Science section. She is currently the president of TCMC’s Healthcare in Journalism Club and one of four class officers. When she needs a break from studying, Lani loves to do anything outdoors, travel, and cook for her friends.

Read “Health & Exercise Forum” – Every Monday in the Scranton Times-Tribune.  This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.