Can we use behavioral science to fight for Vermonters struggling with opioids?
2024-08-12
Dear friend,
While other kids in grade school would complain about seeing the dentist, I felt a guilty pleasure. For reasons I’ll never know, my parents didn’t take me to the dentist for most of my childhood.
As neglect goes, it seemed fairly benign. They did tell me to brush twice a day, and I didn’t eat many sweets. When my mom took me to a dentist one day in my teens, he found no cavities. But Dr. Mathieson was concerned about seeing my ground-down molars from bruxism. And after giving me my first-ever flossing, he didn’t like my inflamed and bleeding gums.
When he told me to floss twice a day, I nodded in agreement without telling him that I didn’t know how. I repeated the same smile-and-nod to the dentist’s flossing lecture every year through my early thirties.
Have you ever started a fitness routine by running 5k, only to be glued to the couch by soreness for the next week? Then you’ve faced my issue. The dentist would tell me that flossing prevents heart disease. As a father there should be no greater motivation. But after trying out the sample floss, and facing the pain of bleeding gums and the frustration of reaching molars, I’d give up till next year.
By my late twenties, the gingivitis led to receding gums, which led to fillings, which led to me smiling without my teeth.
When I did find a path to happier smiles, it came from an unexpected source—Silicon Valley. In 2015 I earned a position as a researcher at Stanford University with B.J. Fogg, Ph.D. and his Persuasive Technology Lab. My experience working with Fogg changed me. His research has also informed me on difficult questions, including how to vote this year on H.72, the bill to legalize an “Overdose Prevention Center,” or OPC, in Vermont.
Access to a quiet patio in a busy Harlem neighborhood was one of the compassionate features of the OnPoint Overdose Prevention Center that Rep. Tristan Roberts and other legislators witnessed on a recent tour. Photo: Tristan Roberts
I felt relieved when B.J. validated that I should not feel ashamed for lacking willpower. “Motivation is slippery,” he taught me. “Shoulding” myself into flossing was no match for inconvenience and bleeding. Having bad habits did not make me a bad person.
B.J. encouraged me not to start small, but to start tiny. He advises building habits so easy that they make overachievers smirk. He advised me to floss one tooth. I flossed one front tooth every day for a week. Done.
B.J. also taught me how to harness positive emotion. As soon as I flossed that one tooth, I celebrated with a fist pump as if I were Serena Williams crushing a match point. “Yes!” I said out loud. Corny? Perhaps. It felt good, though, and it built new neural pathways.
I anchored the new habit inside of an existing habit. I sit on the toilet every morning. Now, I also floss there. After a week of nailing my new habit I asked B.J., “What about the other teeth?”
“You can floss two teeth if you want,” B.J. said, lovingly and with no pressure. Weeks later when I’d graduated to the whole mouth at my own pace, I felt empowered, and I’ve had no backsliding.
B.J. taught me that changing your environment to make new habits easier is far more effective than hanging an inspiring quote on the wall. I keep a jar of flossers right there opposite the toilet. If I forget to grab one before I sit down, they’re right there in front of me.
When I led a legislative tour to OnPoint NYC in 2023, I saw Fogg’s principles all over. Some see it as “enabling” to provide a home for the consumption of harmful, illegal substances. But the way I see it, testing your black-market drugs and consuming them under supervision is a small step out of a deep hole. As a staff member at OnPoint told me, “Progress to an addict might be going from three bags [of crack] a day to two.”
Many Vermonters currently struggling with opioid use are motivated to get clean. However, many grew up in unstable households with drug use and never built skills that others take for granted. Judging them for failing to “Just say no” would be as compassionate as handing 10-year-old Tristan floss and judging him when he couldn’t reach his molars.
I gave myself permission to use flossers because they made it possible for me to reach every tooth. I felt guilty because they’re more wasteful but do you know what? They might save me from a heart attack.
At OnPoint, community members are greeted—and sometimes brought back from a near-death—by name. They receive loving care that isn’t always feasible for EMTs and fatigued downtown business owners to provide on the street. A center like OnPoint meets addicts where they are, and gives them a tiny step toward better health.
Addicts can do laundry at OnPoint, or get a same-day acupuncture appointment, not a future referral requiring more paperwork. I spoke there with one OnPoint client who started coming years ago to exchange needles. Now clean, he keeps coming back for the positive emotion and relationships, anchored by pancake breakfasts and 12-step meetings.
Rehab and sober housing might be further steps on someone’s recovery, but there’s not enough of those to go around. And like running 5k, they might not make sense as someone's first step.
I’ll admit that flossing is very different from crack. But you know what’s not? Social media. Big Tech has made billions on behavioral science. Instagram’s easy interface and endorphin-generating “likes” and filters made it the fastest-growing app in history. Instagram was invented in Fogg’s classroom.
Both tech and pharma companies use behavioral tactics to hook Vermonters on their products. I voted “Yes” on H.72 because I would consider it irresponsible to not deploy behavioral science to fight back.
Tristan Roberts writes from his farm in Halifax, where he serves as Representative for Windham-6 in the Vermont Legislature. Rep. Roberts is not running for re-election this fall in order to spend time with his new baby.