• Kim May

Craving.


There is a lot about addiction that seems paradoxical. Illogical even. However, it turns out one can be perfectly rational and have a substance use disorder. This duality is confusing and part of why “outsiders” don’t understand why “addicts” don’t just stop their drinking and drugging ways. It forms some basis of internal shame too. When one can objectively see the problems, the harm done, the pain caused and choose to do it anyway—surely, they must be fundamentally flawed. Or weak. Or immoral. Of course, none of those are true.


A curious and frustrating thing occurs with many people who suffer from addiction. They want the substance, more, but they enjoy the experience less.


As Maia Szalavitz writes, in Unbroken Brain “In addiction, this means that because being addicted escalates wanting more than liking, the drug experience gets deeply carved into your memory. Anything you can associate with achieving a drug high, you will. As a result, when you try to quit everything from a spoon (you could use it to prepare drugs) to a street (this is where the dealer lives!) to stress (when I feel like this, I need drugs) can come to drive craving. Desire fuels learning, whether it is normal learning or the pathological “overlearning” that occurs in addiction. You learn what interests you with ease because desire motivates.”


So crucial is craving (wanting) to the addictive experience that it is one of the eleven diagnostic criteria for a substance use disorder.


Triggers, cravings, and urges


Even once we are beyond physiological dependence, craving does not easily dissipate. A craving often begins with a trigger. Something that reminds us of that substance and sets off the craving mind. A trigger can be a memory or any kind of sensory stimulus, a smell, a sight, a song, etc. The trigger then sets off a craving, which is a powerful desire for something. Then the urge which tells us, “I have to do it now!”.


As behaviors are learned, they become automatic. Each time we succumb to our cravings, we actually reinforce them, teaching ourselves that the only way to manage a craving is to give in to it. But over time, cravings will reduce in both intensity and frequency. Until then, there are some strategies that may help.


3 Strategies for managing cravings


1. Urge Surfing


Ocean waves begin small, they gain in strength and size and then they crash. Cravings and urges are the same. The idea is to join and ride the wave rather than trying to oppose it. Most intense cravings will last around 5-20 minutes.


During this time, you can “ride” it out however fits best for you. You might rate your craving on a scale 0-10 and noticing how it increases or decreases as time passes.


You could incorporate a mindfulness exercise. Notice how you are feeling, notice where you are feeling. For example, sit in a comfortable chair, focus on your breathing and try to identify where in your body you feel the craving (i.e. your stomach, your head) and focus on how your body feels (i.e. hot, cold, tingly), etc. By focusing on your bodily sensations and describing them to yourself, it can help give you some perspective and feel less controlled by your craving.


During urge surfing, try reminding yourself that the urge will eventually pass whether or not you use.


2. The 3 D’s: Delay, Distract, Decide


Delay. You know the craving will subside. You are not managing your forever abstinence in this moment. You are just putting time between the urge and the act. If you are still using, this is a good time to begin implementing delay. Even making yourself wait a little bit is important to retrain your brain, getting used to managing discomfort and empowering yourself.


Distract. You are going to find something to do to help distract from your craving. Whatever you choose needs to be a good fit for you and be something you will actually do. (An intense craving is not the time to try a new hobby for the first time.)

It is good to have several different distractions on the ready. Depending on where you are or the time of day, not all activities will be appropriate. Some ideas to get you started:

· Lift weights

· Read something

· Listen to music or a podcast

· Watch a television show

· Go on a walk

· Cook something

· Call someone

· Take a shower/bath

· Meditate

· Stretch

· Watch cat videos


Decide. Remind yourself of all the reasons you are choosing to abstain from alcohol and/or drugs. Legal reasons, health reasons, family, job—to have the life you want to have. In this moment, you are making the decision to not use.


3. Cognitive Reframing


Our own brilliant minds sometimes work against us. Overcoming irrational thinking patterns that tend to coincide with cravings can be a key to success for many people. Shifts in the way we think and perceive can have a big impact on making positive changes, both big and small. Here are just a few examples, based on cognitive behavioral therapy (CBT) practices.


  • Overgeneralization: avoid thinking in words like always and never. Especially when it comes to cravings. For example, “cravings will always be this intense and they will never get better” can be reframed as “right now my craving is intense, but over time it will get better”.

  • Mental filter: avoid selecting one negative detail (of your craving, your day, your life) and exclusively focusing on it. Practice thinking more broadly.

  • Discounting the positive: this is when you reject something positive, telling yourself it was not good enough, or did not really count. Practice accepting positivity about yourself.

  • Labeling: an extreme form of all or nothing thinking. For example, if you make a mistake, rather than acknowledging you are human, learning from it and moving forward, you label yourself. You say, I am a f**k-up, so what’s the point? This thinking leads to low self-esteem and stagnation.


A final tip for success


Learning to manage cravings takes time and practice. You may find you need a lot of support, or discover these strategies are not working for you. That is okay. It does not mean you failed. It means you tried and that is worthy of acknowledgement and praise.


Every time you try a new strategy, every time you reach out for support, congratulate yourself. If you delayed a craving even for just a little while, celebrate it. To quote Ken Anderson, “better is better”. If you wait until some big, far away milestone to acknowledge your efforts and your successes (even the small ones), then you are missing an opportunity. Making big changes is a marathon, not a sprint (cliché I know, but it is true).


Punishing yourself for not being at the end point will rarely yield success and continued motivation. Maia Szalavitz says it perfectly in Unbroken Brain, “if punishment worked to fight addiction, the condition itself couldn’t exist.”


Get support to manage your cravings


This will be easier with support. Whether it is loved ones, a support group, therapy, or some combination, getting the right support can be critical for success. You don’t have to face it alone.


Sources:

https://www.regen.org.au/images/Education/RelapsePreventionPDFs/Cravings--Triggers.pdf

https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-cogamph-toc~drugtreat-pubs-cogamph-3~drugtreat-pubs-cogamph-3-2~drugtreat-pubs-cogamph-3-2-4

https://www.smartrecovery.org/5-ways-to-deal-with-urges-and-cravings/

Anderson, K. (2010). How to Change Your Drinking. HAMS Harm Reduction Network.

Denning, P., & Little, J. (2017). Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. The Guilford Press.

Szalavitz, M. (2016). Unbroken Brain: A Revolutionary New Way of Understanding Addiction. Picador St. Martin’s Press.



About the Author:

Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.

4425 Mopac South Building III,Suite 600

Austin, Texas 78735

(512) 766-7955

© 2020 Substance Use Therapy