Feeling fine isn't the test

The hook

Chapter 21 · 2 min read

The second half of the method is for the fade, and it's about design rather than resolve.

Pick the hook. One fixed thing you do every day without deciding to. The kettle in the morning. Brushing your teeth. The alarm going off. The dose is tied to that, always, so that the trigger for taking it is the event and not the memory of the event. The NHS levothyroxine page says to try to take it at the same time each day, and for that one there's a further rule about an empty stomach, which is exactly the sort of detail the leaflet holds.

Put it where the hook is. The packet lives next to the kettle, the toothbrush, the phone charger. Not in a drawer, not in a bathroom cabinet, not in a bag. If you can't see it at the moment of the hook, the hook doesn't fire. For medicines that need to be kept away from children or heat, the leaflet says so, and the hook moves to where the packet can safely be.

Make the miss visible. A weekly organiser with a compartment per day turns "did I take it" from a memory question into a glance. Pharmacies sell them for a few pounds and some will fill them for you. A phone alarm is a hook too, but a single alarm is easy to swipe, so the organiser is the check on it.

Expect it to take weeks. In a study of 96 volunteers forming a daily habit, the behaviour became automatic on a rising curve over weeks to months, and a single missed day didn't set the process back. That's the research on habits in general, and it's the most useful thing to know about a tablet. The first fortnight will feel like effort. It stops feeling like effort, and the review of 771 adherence trials found that building the medicine into routine did more than any amount of information about it.

Two hooks for two doses. If it's twice a day, the second hook is a second event, the evening meal or the front door being locked. Not "twelve hours later", because nothing happens at twelve hours later.

The fade is what happens to a medicine with no hook. A hook isn't willpower. It's what removes the need for any.