Millions of people around the world struggle with addiction. Despite genuinely wanting to succeed, many people struggle to maintain their recovery goals. Why is this? In this paper, I address what I term the “difficulty problem” of addiction—the puzzling challenge of maintaining recovery goals despite genuinely wanting to succeed. I first show that prominent models of addiction—including the disease, learning, and choice models—only partially account for why recovery remains challenging even for those genuinely wanting to succeed. I then introduce the concept of “confidence distortions” to help illuminate this difficulty problem. People with addiction can develop two distinct distortions: overconfidence in their ability to control substance use and underconfidence in their ability to function without substances. These distortions can coexist and interact in ways that undermine recovery efforts. I demonstrate how empirical research on self-efficacy and metacognition supports this framework. I then explore how treatment approaches might be enhanced by targeting these confidence distortions. This confidence distortion framework complements existing models while offering new insights into why recovery remains challenging even for those who genuinely want to succeed and offers new hope for addressing one of addiction’s most persistent challenges.
S. Liao (Sun,) studied this question.