Craving (15 page)

Several studies reveal that people struggling with addiction have very low levels of spirituality and religiousness and often lack purpose or meaning in life.
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This is not, of course, a universal finding. Attempts to use religiosity to predict response to addiction treatment have not, for example, been very successful. Furthermore, priests, pastors, and clerics with deep spiritual connections can often suffer from cravings and/or addiction. However, a lower level of spirituality does appear to be more common than not among people seeking treatment for addiction.

The two findings that seem to be most clear, then, are that religious populations have lower rates of addiction and that treatment-seeking addicted populations have lower levels of religiousness and spirituality. What can we infer from these findings? First, that religion has a protective (but not perfectly protective) effect. And second, that a low level of spirituality is a risk factor for the development of addiction. Several of my mentors at Duke (Drs. Keith Meador, Harold Koenig, and Dan Blazer) published a study in 1994 that examined the correlation between religious activity and substance use among almost 3,000 people.
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They found that, among other things, people who attend church at least weekly are one-third less likely to abuse or be dependent on alcohol. Prayer and religious study were also associated with an over 40 percent reduction in risk for having an alcoholic disorder in the last six months. A Harvard study of a ninety-day residential addiction treatment program that emphasized Kundalini yoga practice in Amritsar, India, found substantial improvements in recovery indicators among patients.
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Another study of American Muslim college students found that religious activity was protective against drinking, and parental approval was a risk factor for drinking. The incidence of drinking among these American Muslim college students was significantly lower than their non-Muslim peers, but higher than that found in predominantly Muslim countries.
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Several studies have also found a correlation between affiliation with AA and abstinence.
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On the other hand, the impact of religion on substance abuse has not been uniformly positive. Listening to or watching religious programs has been correlated with active alcoholism, and at least one study of intercessory prayer (prayer to God for the benefit of others) demonstrated that alcoholics who were aware that someone was praying for them were actually drinking more (doing worse) at six months, even after controlling for baseline severity.
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We haven’t yet demonstrated, in rigorous scientific fashion, that spirituality is the mechanism that drives recovery in Twelve Step or any other populations, although the overwhelming belief and experience of those who achieve recovery (that is, abstinence plus improved general wellness) is that spirituality is the essential ingredient. Small studies (including some very good ones)
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have suggested this, but more work is needed. From a research standpoint, we also still don’t know if religious conversion or increasing religious activity reduces the risk for substance abuse or if it enhances the chances of recovery, but certainly that also seems to be the overwhelming experience of many who choose that route to recovery. My experience in treating people who struggle with cravings is that those who pursue spiritual approaches are more successful at achieving a contented, joyous release from cravings than those who don’t, but there are always exceptions.

Numerous studies have, however, shown the beneficial impact of Alcoholics Anonymous attendance and participation on sobriety outcomes. Emrick and colleagues conducted a meta-analysis of studies on the effectiveness of AA participation and found that AA attendees are more likely to respond to alcoholism treatment.
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Another study conducted by Humphreys and colleagues found that among nontreated alcoholics, the frequency of AA participation in the first three years predicted sobriety at year eight.
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These and many more studies confirm the tremendous beneficial impact of Twelve Step attendance and participation on successful recovery.

It would be foolhardy to discount the experience of thousands of people who have achieved freedom from the compulsion to act out on their cravings by employing spiritual means. I think it’s only a matter of time before science catches up with the experiences of these communities of people who have found relief from craving and addiction. In the meantime, why not try what has worked so well for these groups?

I acknowledge that, for some people, the notion of participating in something religious or even spiritual is profoundly unattractive. In my experience, addiction itself can be a risk factor for holding that view. Many who start there shift toward an attraction to spiritual approaches, particularly when they come to the awareness that spirituality is deeply personal and driven by the core notion “to thine own self be true.” However, for those who do not prefer traditional approaches, there are other methods that may be helpful, including SMART recovery, which emphasizes self-reliance and self-directed change, and Women for Sobriety (WFS), which emphasizes growth, positivity, love, enthusiasm, and responsibility. Secular Organizations for Sobriety (SOS) defines recovery as an issue separate from religion or spirituality, and strongly de-emphasizes reliance on a “higher power.” Sadly, much energy is wasted as proponents of these various approaches debate which is more helpful or attempt to discount the benefits of Twelve Step methods. Another key disadvantage of some of these alternatives is that they seem to be defined by their opposition to or difference from Twelve Step approaches rather than their strengths; in the evolution of these potentially useful movements they haven’t yet transcended their definition-by-opposition. Much as third-wave feminism provided an important independence to feminist thought that was missing in the second wave, a similar evolution is needed among these newer recovery programs, and it’s my sincere hope that they get there. Nevertheless, in my experience, engagement and retention are the most important variables, so finding a fit, engaging, and participating fully seems to be what really matters.

These methods include some core elements that can be helpful in managing cravings and addictive behaviors. I’ll review them now, and you can see if some of them might fit for you.

Strategies for Managing Cravings

Create a Sense of Belonging

Whether it’s an Overeaters Anonymous meeting, Weight Watchers, or a neighborhood church, mosque, temple, or synagogue, one powerful driver of positive, healing behaviors is a sense that you belong somewhere, that there is a place for you. Yes, online or virtual communities can be helpful, but in my experience there is no substitute for shoe leather. Get out of the house, get to one of these community gatherings, and participate, participate, participate. Remember that in the religion studies noted previously, it was involvement and participation that made a difference. Similar studies of Twelve Step approaches confirm that mere attendance, while useful, is not nearly as powerful as active participation. Some research does support the theory that active involvement in a program predicts success more than which particular group you join.
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Find People with a Similar Problem

It helps if they have solved that problem, but, believe it or not, that may not be essential. A fundamental discovery in the evolution of the Twelve Step process was that its cofounder Bill Wilson was able to stay sober even when the people he was trying to help could not. Of course, if these people have not found a way to release their cravings, it’s crucial to try to help them. Bill found that the act of attempting to help others quelled his craving for alcohol and that the value of this experience was independent of the outcome. Of course, if your problem is cocaine addiction, hanging out with active cocaine users is obviously not a good idea, but spending time with people who are in solid recovery from cocaine addiction could be incredibly beneficial. The power of the group is such a strong contributor to success when managing cravings that I’ve dedicated the entire
next chapter
to the importance of groups in driving relief, recovery, and freedom from cravings.

Inventory Your Behaviors

Most of the people I’ve worked with who simply tried to ignore, forget, or distract themselves from self-destructive behaviors have not been successful in achieving relief. The “I’ll just do better tomorrow” approach does not work. The idea that “if I binge on food when nobody is looking, it doesn’t count” is, of course, preposterous. You still will experience the physical impact of those calories on your body and, for those with eating disorders, the guilt and shame of acting out yet again. Similarly, the psychological and spiritual effects of self-destructive behaviors don’t seem to be transitory. You cannot solve these problems or ignore them. You have to outgrow them, and that requires noticing them. Much like an abscess, the wound must be cleaned out if healing is to occur. Many people avoid this process because it’s unpleasant or because they fear that wallowing in the past will only drag them down. Of course, there is a difference between noticing and writing down what you did yesterday and sulking over it.

As an example, one approach that has been helpful for my patients who smoke is a tobacco use log. This type of log is actually kept with the tobacco itself—folded around the cigarette pack or attached to the snuff can with a rubber band. The smoker records the time of day, the context (alone, with others, at a restaurant, and so on), and the “need rating,” a score from 1 to 3 where 1 is “not very important/would not have missed it” and 3 is “very important/would have missed it.” One log is kept per day, and all the logs are reviewed with a support person just before the scheduled quit date to identify high-risk scenarios and triggers and to develop plans to address them.
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Successful dieters have also long known that the process of journaling food intake can make a huge difference in their results. Newer technologies can make this a lot easier; I have patients who have achieved remarkable success by leveraging these innovations (iPhone apps like MyFitnessPal that allow you to scan the barcodes of what you are eating, Wi-Fi scales that track weight and BMI, digital pedometers that integrate with your smart phone, and so on). Many religions emphasize the importance of confession, and Twelve Step programs emphasize the necessity of taking a personal inventory and sharing it with another trustworthy, nonjudgmental person. The bottom line is, if you are doing it and it relates to your addiction or craving, you should seriously consider writing it down and sharing it with someone, which leads me to the next point.

Be Accountable to Someone

If you are attempting in secret to quit smoking, to diet, or to quit drinking, good luck. You are needlessly handicapping yourself and dramatically diminishing your chance of success. There are many reasons why people choose not to involve an accountability partner when setting goals for themselves. The most common ones are embarrassment, shame, and fear. “What if I fail again?” This line of thinking can seriously sabotage recovery efforts, and I’ve seen cases where people struggle for decades without being able to escape from the effects of this type of distorted thinking. The reality is that you should “fail” as many times as you need to in order to succeed. The secret truth about failure is that it only tells half the story. The fourteenth-century Anatolian cleric Nasrudin is reported to have said that good judgment comes from experience, but experience comes from bad judgments. If you employ the approaches recommended in this book, learn from each of your so-called failures, and modify your approach each time, you will dramatically improve your chances of success. Accountability helps with that process. Laboring blindly or avoiding reality is not likely to produce success.

Another reason people sometimes don’t tell others their goals is because they truly believe they can succeed on their own. Often this notion is fueled by the person’s success in quitting other behaviors without help, so “why should this be any different?” We’ve all heard the old joke: “Sure I can quit smoking—I’ve done it a hundred times” Earlier, in
chapter 3
, we learned about the various cognitive biases that distort our thinking and lead to false conclusions when evaluating our experience and making choices. These biases can seriously interfere with the sound decision to be accountable. If you are considering trying to quit or controlling your behavior on your own for one of the reasons mentioned above, consider using a complete stranger for accountability. Online communities provide ample opportunity to connect with someone anonymously; while not ideal, when done safely it’s a step toward involving others in your recovery process.

Meditate

Several studies have shown a relationship between releasing craving and meditation, particularly a form called mindfulness meditation. These strategies have helped countless individuals reduce stress, pain, and anxiety. This approach has been adapted for cravings with great results. One recent randomized, controlled study of mindfulness-based relapse prevention involving 168 addicted people found a significant impact on craving in the mindfulness group.
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Another study of 248 addicted patients in a residential treatment setting found that those who used Qigong meditation were more likely to complete treatment and have fewer cravings than those assigned to SMART (Stress Management and Relaxation Training) therapy.
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Meditation as a stress reduction strategy (remember, stress is directly linked to cravings) has an extremely strong evidence base, and it is core to Twelve Step approaches. If you are new to meditation, an excellent introduction is Jon Kabat-Zinn’s work; he recently published
Mindfulness for Beginners: Reclaiming the Present Moment—and Your Life,
and it’s a fantastic introduction to mindfulness meditation. I strongly recommend this approach for anyone who is struggling with cravings.