Craving (3 page)

Marlatt used AIDs to describe behaviors that contribute to relapse. But in my experience, there is another, entirely different set of AIDs that contributes to freedom from compulsive behaviors. We’ll explore these
positive
AIDs in
chapter 9
. Like their destructive counterparts, these positive AIDs also usually operate outside our awareness, but they often make all the difference. Diet gurus learned long ago, for example, that going to the grocery store when hungry is a terrible idea for anyone trying to control their weight. So that’s a simple, relevant decision. But several years ago I treated a woman who worked the overnight shift, had breakfast, then shopped for groceries at the discount store near work before driving over an hour to get home. She did this because the grocery stores near her home were too expensive. When she finally changed jobs, she gained weight. She assumed it was the stress of a job change, and that may have been a contributor. But when we analyzed her choices, we discovered that the process of eating breakfast and then shopping afterward was driving her to make healthier shopping choices. She never intended that…
it just happened.
We worked together to schedule her shopping trips and arranged for an accountability partner to accompany her to the grocery store. Within a few months she had restored her healthy weight and, much more important, the sanity that comes with freedom from compulsive behavior. Although this is a simple example, there is a set of positive apparently irrelevant decisions associated with all cravings that can lead you toward healthier choices and freedom from craving and compulsivity.

In my experience, that freedom and the sense of satisfaction that comes from making healthy decisions without the pressure and destructiveness of cravings is within reach for nearly everyone. The tenth chapter focuses on hope, joy, and recovery. Most research on cravings is focused on people who are unwell, people in the throes of addiction. What do we know about recovery? What is different about men and women who have managed to gain freedom from their self-destructive behaviors and who are now satisfied and live deeply contented, productive, and fulfilling lives? How do healthy decisions and behaviors sustain and develop these changes? What actions consistently sustain healthy, recovery-based living? We now know many of the answers to these questions, and they form the basis of contented, joyful, and successful living.

At the end of the book you’ll find a list of tips for dealing with a variety of cravings. Some tips are good rules of thumb for coping with any craving, while others are very specifically tailored for certain substances or behaviors. It’s important to find a strategy that works for you and doesn’t leave you feeling discouraged; eventually you’ll land on a positive and healthy strategy.

Craving is the core feature of all compulsive, self-destructive, and addictive behaviors. Cravings can undermine years of hard work and dedication. They can lead to heartbreak and despair. In the long run, cravings, and the behaviors that cause and result from them, are truly optional. In the case of cravings, the adage that “suffering is optional” proves to be exceedingly true. Healthy, positive choices and contented living are possible, but require thoughts, behaviors, experiences, and, in a broad sense, spirituality to sustain them. This book explains what we know about how that happens and how you can make it happen for you.

…

1

Craving: Why It Matters

What Are Cravings?

As early as 1899, aromatic spirits of ammonia and hot water were recommended in the
Merck Manual
(a medical textbook) as treatments for alcohol
cravings.
By the late 1940s, craving was described as a symptom of opiate withdrawal, and by the 1950s the term extended to other drugs. For many years since, craving has usually been described as a symptom of withdrawal from alcohol and other drugs. We now know that people who have addiction can experience cravings even after years or decades of abstinence, long after their withdrawal symptoms have vanished.

Everyone has, at some point or another, experienced craving. Craving is a universal phenomenon, and while people may not easily define it, everyone generally knows what it is.

Cravings can be defined as intense desires that produce unpleasant mental and physical symptoms if not satisfied. For some people, that’s putting it mildly. Part of the problem in talking about cravings is that people use the word to mean so many different things. I have seen people go to extraordinary lengths to escape the discomfort of cravings, to the point of jeopardizing their health, their family, their jobs, or even their own lives. Like any other physical and psychological phenomenon, cravings can vary in intensity, and they can be brief or feel excruciatingly long. I have had patients describe cravings that lasted weeks, months, or even years. Closer inspection usually reveals that the craving itself didn’t last that long, but the experience was so intense and recurrent that it seemed like it lasted an eternity. Most cravings last no more than a few hours, but they certainly sometimes feel like they will last forever.

You don’t
crave
everything you
want.
Desire and want are obviously universal, and while people may occasionally (or even often) confuse wants for needs, by and large, the difference is clear. You might want a promotion at work, a date with that woman who lives down the street, a beach body, or a better return on your 401 (k), but those aren’t really needs, and they (usually) aren’t cravings. These wants and desires are part of the joys and spice of life, and philosophers and poets have known for centuries that having the material things you think you want may not make you happy. Desire makes life interesting. Friedrich Nietzsche once wrote that “ultimately it’s the desire, not the desired, that we love.” And the sixteenth-century philosopher Francis Bacon wrote in his essay “Of Empire”:

It is a miserable state of mind, to have few things to desire, and many things to fear; and yet that commonly is the case of kings.

Wants, desires, passions, and interests are the subjects of philosophers, poets, and religion. They are also the focus of much fascinating science. However, they’re not what this book is about. In this book, we will be focusing on cravings rather than simple wants or desires. Cravings, distinct from desires, are truly unpleasant and disturbingly intense, and in this context, are directed toward substances or behaviors that are really not good for us.

Cravings can be much more than simply unpleasant. In addictions (whether chemical addictions like alcoholism or process addictions like gambling), cravings are often the very reason a person acts out on their addiction. Numerous studies have shown that cravings predict relapse or acting out on the craved substance or behavior. For example, studies have shown in alcoholics, gambling addicts, and cocaine addicts (among others) that when people crave, they are more likely to relapse. In other words, craving matters because it actually drives many of the self-destructive behaviors of addiction.

These intense, overwhelming cravings that are core to addictive behaviors are one end of the spectrum, but not all craving is addiction. Rather, cravings come in all sorts of shapes and sizes. There is a difference between an urge for something and a gut-wrenching, devastating, absolute
need
to have it. The simple interest, desire, or even urge to have or do something can of course also be self-destructive. A person on a diet who pulls off the highway on the way home from work to buy a large, sweet coffee drink may not be addicted but is, nevertheless, undermining his own goals and success.

Urges or Cravings?

To understand some of the differences between urges and cravings, it’s important to understand the difference between being truly addicted to something (a substance or a behavior) and abusing or overusing it. Let’s take the example of alcohol. Some people really want to cut back on their drinking. They haven’t lost jobs or relationships because of their alcohol use, they haven’t had legal consequences from it, and they’ve never experienced withdrawal (sweats, tremors, increased blood pressure and pulse). They haven’t become tolerant to the effects of alcohol either (needing to use more and more to get the same effect, or experiencing a diminished effect when drinking the same amount that they used to). They just want to drink less.

Perhaps such a person might simply want to cut back for health reasons or because a few glasses of wine in the evenings is interfering with restful sleep. Maybe she doesn’t want the calories in that glass of wine, or maybe she just wants to be more alert when interacting with her children. I’ve actually worked with many parents who were motivated to cut back on their drinking for this very reason. For them, it was important to be more alert and present during the evening hours with their children, and they wanted to be as clear-thinking as possible during those intimate family times.

When a parent in that situation decides to cut back on drinking, say, from three glasses of wine a night to one, several things can happen, and what does happen can paint a picture of what, if any, underlying problems may exist. If you want to know whether a behavior is a problem or not, don’t just look at what happens when you do it.
Look at what happens when you don’t.
One group of parents in just this situation will cut back to one drink a night and never miss the other two. In fact, they may ask themselves why they didn’t cut back before. They’ll feel better about themselves, maybe shed a few pounds, feel more alert, and take some pride in following through with what they set out to do. Or they may simply reduce the amount they drink and not spend a minute thinking about it. They never end up missing the other two drinks, except maybe on New Year’s Eve or a special occasion when they feel a slight urge and tell themselves, “I think I might like to have another,” which they do and then return to drinking a single glass of wine per night, and perhaps not even every night. You probably know many people like this (maybe it’s even you): they set their mind to it and follow through without a thought, or even a struggle.

Then there is another type of person who drinks. This guy may decide, for a variety of reasons, to cut back to one drink a day but really notices the absence of those other two drinks. Maybe not at first—maybe a few days, weeks, or months later—but the absence is clearly noted. He may start to tell himself, “I’m not going to drink more than one”; he may make commitments to himself or maybe even to his wife or best friend. He feels the urge to drink more, but he’s committed to his goals. He stays at one drink, maybe slips up and has an extra one or even two on occasion, but on the whole he sticks to it. If he’s honest with you, he’ll admit he often wants another, but his goals are more important to him than that extra drink. He might tell you he craves that second drink, but he can live without it. It’s not so intense that he’s forced to give in—he can still resist it. It’s an urge or maybe a mild craving. But it passes, and he stays on track with the goals he set for himself.