The odd science of adherence

It’s a week into January, 2020. How are your New Years’ Resolutions going? Was this the year you were going to lose weight? Spend more time with your kids? Organize the basement? Are you on track?

Staying on track with your resolutions is an eery corollary to staying on track with anything of great importance; like, for instance, medical treatment. Doctors call this adherence, and it’s the key to balancing expectations with reality to produce real behavior change. Last year, we talked about how to upgrade your resolutions so you could follow through on them. This year, I want to talk about how applying the strange science of adherence can engender sticktoitiveness in even the most vaguely defined of resolutions.


We should know better by now

Self-reported statistics indicate that 75% of resolutions are off the rails within a month, and fully 92% end up in a heap at some point in the year. Real stats, and my personal experience, make the above seem rosy. Month on month gym usage, for example, regresses inexorably towards the mean. The developed world buys and eats more detritus year-over-year, with momentary purges in either category being handily offset by new deposits.

If health, family, and money are so important to us as a species to make up over 80% of all New Years’ resolutions, why are we so awful at following through on them? It’s because we prescribe treatments with terrible adherence properties.

Adherence, in the world of medicine, is the level to which a prescribed therapy is applied by the patient. Imagine 3 therapeutic approaches:

  1. No therapy, no effort, no effectiveness
  2. 50% therapy, 50% effort, 50% effectiveness
  3. 100% therapy, 100% effort, 0% effectiveness

WHOAH! What happened to option 3? What happened to our 100% effective therapy?

There’s a hidden “multiply by zero” error in option 3. Though the therapy is 100% effective if followed to the T, it requires 100% effort. Therapies that require exorbitant effort to follow, such as intense calorie restriction or high-intensity exercise, have adherence rates that trend towards zero. That zero, when multiplied against any theoretical therapeutic value, renders an effectiveness of … ZERO.

Even seemingly simple therapies, such as asthma inhalers, suffer from clinically significant adherence churn. Could you imagine if there was an inhaler that burned calories? We wouldn’t be able to stop people from pulling the trigger.

Adherence must be considered when matching “remedies” to “goals.” The more compelling the goal, the more extreme the remedy can be — up to a point. The juncture at which that remedy stops being sufficiently therapeutic is precisely the point where you stop adhering to it due to an imbalance of effort and motivation.


3 Adherence Hacks for Resolutions

Boosting adherence can make even the most vaguely defined resolutions into candidates for life improvement. Here are some examples:

  1. Get Fit. Dieting is too hard to pick up from a dead stop. This is well established, even though diet is the 80 part of the diet/exercise fitness 80/20. So start on the 20 side. Pick a hero exercise. Sit ups, pull ups, push ups. That’s your specialty now. You’re going to start with 1 rep a day, and add 1 rep per day. Is 1 pushup a day absurd? Sure. How about 365 pushups a day? I bet that somewhere along the line, probably around the 100 pushup mark, you’ll start adding in some walking and situps. You’ll also probably adjust your diet slightly, because of the loss aversion principle. Beats flaking out on your gym membership after a month.
  2. Be Good. Committing to go to every piano recital and soccer game is a recipe for failure. Pick a hobby, one that’s just for you and your daughter. Is it Brazilian jiu jitsu? A fine choice. The two of you decide on a schedule to practice, even if it’s just one class a week. Did you have to miss a week for work travel? That’s fine, you’ll make time for her to teach you what you missed before the next class. You’re showing interest, you’re involved in her life, you’re building the key “peer bridge” that will survive when she flies the coop, and you’ve made an accountability buddy out of your Resolution target.
  3. Mo Money. Is this the year you get your finances together? Gonna get a raise, pay off all your cards, and start saving half your paycheck? Cool story. Grab last month’s statement from all of your bank/debit/credit accounts. Find the $50–500 bucks getting siphoned from you every month by various scams and get out of them. Don’t try to use some sheisty online service to do this. They don’t work, and it won’t have the effect we’re looking for anyway. Un-used gym membership? Kill it. Recurring Apple payment for a service you don’t use anymore? Kill it. URLs that GoDaddy renews yearly which you’ll never use? Kill them with fire. Remember, every MRR dollar you kill is the equivalent of 24 bucks. Twelve months in the year, and double it because you payed tax on the money, for Pete’s sake. This sort of ROI gets the flywheel going and makes you feel like you’re not spitting into an ever-swelling ocean. Plus, you’ll actually do it. And that’s what matters

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