Craving (21 page)

It is very important to talk about cravings. But talking about them in the wrong environment can sometimes do more harm than good. One of the worst mistakes that people make is discussing their cravings with someone who is critical, shaming, or judgmental. I’ve often seen people who struggled with cravings finally agree to talk to someone about it and end up telling someone who responds with disgust, dismissal, or derogatory comments. I don’t think this is an accident—there are powerful unconscious forces that may lead you to seek out judgmental people to discuss your cravings, even though (or perhaps
because
) such discussions are likely to lead to further shaming. As we discussed earlier, shame plays a key role in addiction, and a response like that can intensify shame and subsequently cravings. On balance, however, it’s a good idea to talk about your cravings, particularly when you can speak to someone who understands or has been there.

The deceptively simple act of saying that you are craving, out loud, to someone who really understands can sometimes make the difference between success and suffering. However, as members of Twelve Step fellowships have noted for decades, sometimes the telephone can weigh a hundred pounds. In other words, in the midst of the craving, it can be very difficult to initiate behaviors such as making a phone call to an understanding friend. This may also be due, in part, to prefrontal cortex effects described in
chapter 2
.

Thus, the old adage that the time to fix the roof is when it’s not raining applies to cravings as well. Establishing a habit of discussing your goals, successes, and struggles on a daily basis (whether or not you are craving) will make it much easier to make the call when the craving hits. Again, the power of the group, as we reviewed in
chapter 7
, can be leveraged for success in dealing with cravings. Many members of self-help and mutual-help groups learned this long ago and emphasize the importance of getting phone numbers and regularly connecting with others who struggle. The fear that such discussions will trigger additional cravings (which, by the way, can occur) is outweighed by the overwhelming benefits of this type of interpersonal connection and the extraordinary ability of the group to achieve what the individual often cannot.

Another cognitive distortion that interferes with the simple and successful act of talking about your cravings is the belief that “if I don’t think about it, it will go away.” This powerful but dangerous belief has resulted in many heartbreaking relapses or a return to the unhealthy behavior, as the sense that what’s really needed is to simply forget about the self-destructive behavior crowds out the more rational suggestion that taking simple actions is the best way to prevent and manage cravings.

Actions to Prevent and Manage Cravings

Help Others

The core “rediscovery” made by early AA members was that helping others reduces the desire to drink. These two things may seem unrelated. While helping people is a good thing, of course, what could it possibly have to do with cravings?

We continue to learn about the important role of helping others in reducing cravings, but the simple idea that helping others can help our cravings leads us to the next suggestion of an apparently irrelevant action that can suppress cravings: help someone. A recent study of 195 addicted adolescents found that helping others during treatment was linked to substantially improved substance abuse outcomes.
¹¹⁸
One of the cofounders of Alcoholics Anonymous, Dr. Bob Smith, in his farewell talk before he died, noted that “Our Twelve Steps, when simmered down to the last, resolve themselves into the words ‘love’ and ‘service.’” As we noted in
chapter 3
, love neutralizes shame, and service to others (in other words, helpfulness) reduces obsession and craving. The fundamental observation that serving others reduces cravings is actually much older than AA, which is why I call it a
re
discovery. Lao Tzu wrote, in the
Tao Te Ching:

The Master has no possessions.

The more he does for others,

the happier he is.

The more he gives to others,

the wealthier he is.

Each of these suggestions can make a difference in your cravings, but don’t fall prey to the idea that any one of them will solve your problem. The exclusive reliance on helpfulness to others to manage cravings has resulted in many avoidable relapses. I have seen many recovering alcoholics who work as counselors, treatment center directors, and medical directors of addiction rehabs go through relapse. Often these people were involved in tireless service to others precisely when the relapse occurred. They were then very surprised that service and helpfulness to others did not stave off their cravings and prevent relapse.

In many of these cases, these were active participants in recovery programs who stopped attending meetings or participating in recovery-related activities outside of their workplace. They erroneously concluded that the service they did at work would be sufficient for them to maintain sobriety. In interviewing dozens of such individuals, I have learned that they often began to see themselves as fundamentally different from the people they were helping. The treatment principle of therapeutic distance (the importance of maintaining social boundaries with the people we help) reinforced that. Often these people also started feeling uncomfortable at recovery meetings that their own patients were also attending. As a result, they simply stopped going, and later relapsed. It turns out that this is so common that most sensible employers of recovering counselors consider this line of work to be an occupational hazard, and AA has even published guidelines suggesting that members maintain their own personal AA lives outside of their work environment.
¹¹⁹

The role of service within recovering communities cannot be overemphasized. Long-standing sober members of these communities have noted the importance of making coffee, setting up chairs, leading meetings, cleaning up afterward, and other types of helpfulness as key to their ongoing success.

For another helpful action to reduce cravings, consider this adage: “If you want self-esteem, take ‘esteemable’ actions.” It’s particularly true for people who suffer from cravings. As shame is endemic to addicts, addressing it is crucial to reduce ongoing cravings and relapse. This may be, in part, why taking and sharing one’s “moral inventory” and making amends are so essential to Twelve Step recovery (Steps 4, 5, 8, and 9 of the Twelve Step program). The guilt, shame, and resentment from years of self-destructive behavior emerge in the form of obsession and craving, and serve to disrupt success in recovering from addictions. (By the way,
self-destructive behavior
is in some ways a terrible term, as it downplays the hurtful nature of these behaviors toward others.)

In general, attempts to explain the role that the ingredients of Twelve Step programs play in establishing and maintaining abstinence are usually misguided, incomplete, or grossly oversimplified. This is reflected in the partially sarcastic response that some members give to the question “How does it work?” “It works just fine” Nevertheless, there are core features of Twelve Step programs that can, in my experience, be extracted for the benefit of others who suffer from various cravings.

Avoid Dangerous Situations

Another useful suggestion for dealing with cravings is to
avoid dangerous situations.
The hardest part about this suggestion is that you may not know what’s dangerous. If you trust your gut, situations that feel safe may simply feel that way because they are familiar but are, in fact, very risky. You may also fall prey to a trick your mind plays on you that convinces you that you need to “test” your recovery to determine if you can handle these situations. Those tests don’t often go well. This is one of the reasons that so many recovery programs emphasize sharing with others and obtaining an accountability partner to run your ideas and plans by. To really know what’s unsafe, you’ll need to autopsy your relapses: What was happening before you gave in? What was your state of mind? And what other environmental factors were at play?

I always recommend that my patients ask themselves, “Am I ASPHALT (anxious, scared, preoccupied, hungry, angry, lonely, or tired)?” Were you having negative thoughts about yourself? Or perhaps just the opposite: were you wanting to celebrate something? All of the circumstances leading up to your acting out on the craving need to be inventoried, and for that you’ll need help, someone nonjudgmental but compassionate enough to genuinely listen and courageous enough to tell you the truth.

Finding the right person can be a challenge for some people. They may have taught themselves over the years that being vulnerable is dangerous, having impulsively placed themselves in vulnerable positions and thus repeatedly had their trust violated. If you are someone who feels like people often betray you and that “nobody can be trusted,” consider seeking professional help in finding the right person to open up to.

Develop Healthy Habits and Routines

Yet another helpful suggestion for managing cravings is to form new habits and routines. As you’ve seen throughout this book, old habits can often very subtly lead to acting out on cravings and can increase the chance of experiencing cravings. In general, habits aren’t forgotten, but replaced. Think of habits as recordings on magnetic tape. The only way to remove them is to write over them. Another way of thinking of habits is as grooves. To really solidify them, they have to be repeated. That process etches them in. If you decide that a particular action is helpful to your efforts to gain freedom from cravings, do it on a set schedule. Go to the same meetings each week, call your support person at the same time every week, and so on. This will make you more resilient to the effects of stress and impulsivity. Although this type of routine may seem unnecessary or unrelated to your cravings, do it anyway. When times get tough, your car will do a better job of steering itself away from a danger zone if you have new habits in place.

Many of the suggestions I’ve already made for helping with your cravings may sound apparently irrelevant. Connecting to others in a group, being accountable, and being helpful to others may not intuitively seem related to freedom from cravings, but as we showed earlier, they definitely are.

Find a Sense of Purpose

Here is another suggestion that can really make a difference in reducing cravings and the risk of acting out on them: develop a sense of purpose. Having a purpose, a mission statement, or a clear goal can motivate you, ground you, and give you a sense of focus that can help you deal with cravings and stay connected to your recovery program. Once again, we can turn to AA and other Twelve Step groups for examples. AA states that its primary purpose is for its members to stay sober and help other alcoholics achieve sobriety. Its textbook
Alcoholics Anonymous
states, “Our real purpose is to fit ourselves to be of maximum service to God and the people about us.”
¹²⁰
The purpose of Celebrate Recovery (a Christian-based recovery program) is to “fellowship and celebrate God’s healing power in our lives.” Similarly, secular organizations focused on recovery have purpose statements. If you can develop a sense of purpose, it will certainly help you as you work toward freedom from cravings.

Meet Your Needs in a Healthy Way

Throughout this book I’ve emphasized that what seems unrelated to cravings can often be exactly what you need to look at or focus on. Your cravings thrive, in part, because your brain has learned to selectively ignore the things that are driving them. Many of the actions you need to take in order to get well are “apparently irrelevant.” There is another way of looking at this important phenomenon that may be very helpful as you develop your own plan to reduce or eliminate your cravings, and it’s based on the following principle: if you don’t meet your needs in a healthy way, you
will
meet them artificially. That usually means that you will crave self-destructive ways of meeting your needs. In fact, most of the suggestions I’ve been giving you to address your cravings are designed to meet these very needs in a new, healthier way.

Let’s take a closer look at what that means. If you think of all the things you need to live a happy, fulfilling, and joyous life, you can generally divide them into twenty categories.

When you look at this table, you might think, “Those sound interesting, but do I really
need
all of those things? I thought I only needed food, shelter, clothing, water, and love. Do I need emotional creativity or mental adventure? Do I really need physical adventure and spiritual identity?” You shouldn’t be surprised that you are asking yourself those questions. Chances are pretty good that if you don’t think you need those things, then you probably are not meeting those needs, and that could be driving your cravings, even if the connection is apparently irrelevant to you.