One of the major obstacles to recovery from alcohol use disorder is having to deal with cravings for alcohol. Cravings are response patterns that are programmed in people and appear as a result of environmental conditions, changes in mood, stress, or other types of triggers that prime these response patterns. Although sometimes cravings may appear to simply come out of nowhere, they are most often triggered by some environmental situation, feeling, or memory that one has about former alcohol abuse.
Numerous environmental conditions can act as triggers for cravings. Many of the policies of well-known recovery groups, such as Alcoholics Anonymous (AA), advise members to avoid people, places, and things that are associated with one’s prior use of alcohol. In addition, the acronym HALT (for Hungry, Angry, Lonely, Tired) is often used to remind individuals in AA of the types of conditions that are very likely to foster cravings and spur a relapse to alcohol.
However, it’s not just a negative emotional state that can act as a trigger for cravings. Positive emotional states, such as feeling happy and being successful, can also induce cravings.
Cravings are vivid recollections that are emotionally driven by the pleasant reinforcing effects that continued to drive use of alcohol. They represent powerful reinforcements to engage in the use of alcohol for many individuals who are in recovery. Cravings are often very visceral in nature, such that one can actually experience the reinforcing effects that one used to get from drinking alcohol and forget all of the negative issues that resulted from such use. In some cases, cravings may become so powerful that people feel like they are unable to resist them, although this is certainly not the case. Cravings often spur an internal debate with oneself over whether one should just give in to them this one time or continue to remain abstinent.
Some individuals may even experience cravings as a result of their participation in therapy, AA meetings, or other activities associated with recovery. This may spur an even more difficult internal debate for them.
Cues, Triggers, Cravings, and Relapse
Triggers and cues are different names for the same type of situation that leads to a priming or activation of a craving in an individual. They can be very personal and subjective in nature, or they can be quite generalized and occur over many individuals. The effects of cues and triggers produce both physical and mental changes that eventually are interpreted as a craving.
- Psychological changes that can consist of stimulated central and peripheral nervous system activity, feelings of excitement, feelings of anticipation, and memories associated with past pleasant experiences with one’s drug of choice (alcohol).
- Physical changes that can include increased heart rate, elevated blood pressure, and increases in the activity of the sweat glands.
In a sense, triggers produce changes that are very similar to the types of changes that occur when one is about to be rewarded.
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In order to prevent relapse, addiction treatment specialists will rely on two major categories of intervention. The individual in recovery would be wise to choose alternatives from both categories as opposed to focusing on only one for maximum success in dealing with cravings quickly and efficiently.
Medically assisted treatments (medications) attempt to address cravings by affecting the actual physical process associated with the craving and then eliminating the strength of the craving in the person. There are numerous medications that have been used to address cravings for alcohol.
- ReVia (naltrexone) is a drug that was originally designed to address cravings for opiates but has been shown to be effective in addressing cravings for alcohol.
- Campral (acamprosate) has been used to address cravings with alcohol but is more successful in reducing the amount of alcohol one drinks once when one has started drinking.
- Certain anticonvulsant medications like Topamax (topiramate) have been successful in reducing cravings for alcohol.
- Gablofen (baclofen) is a muscle relaxant that has been used to control cravings for alcohol.
- The drug Antabuse (disulfiram) may actually reduce cravings for alcohol if a person using the drug drinks alcohol. When a person who has taken Antabuse drinks alcohol, they become violently ill. This reaction may reduce the experience of further cravings in some individuals.
Medications can only address the physiological issues associated with cravings and reduce them. Medications do not address issues dealing with cues and triggers in the environment that can lead to cravings. Instead, behavioral interventions that do not use medical management techniques can be used to address triggers and to also directly reduce cravings in both their intensity and number.
Behavioral interventions attempt to help individuals recognize triggers, change the feelings associated with triggers, and learn to reduce the intensity of any cravings they may experience.
- Helping a person to understand and recognize the types of triggers that typically result in cravings in everyone in recovery
- Helping the person to understand their own subjective personal triggers that prime their own cravings for alcohol
- Psychoeducation that instills the notion that cravings are actually a normal occurrence in recovery and do not represent signs of failure
- Continued psychoeducation on the vulnerability of cravings to techniques such as distraction, meditation, and time
- The development of formal personalized coping strategies to deal with cravings when they occur, often involving focus on the negative aspects of alcohol use as opposed to the positive feelings that alcohol gave them (urge surfing)
- The use of mindfulness meditation techniques that allow individuals to focus on their feelings in the moment but not act on them
- Recruiting support from others to assist them during periods of vulnerability
Some of the more effective behavioral interventions include:
Typically, the best source to learn behavioral interventions to deal with cravings is in formal substance use disorder therapy. There are numerous different techniques that can be utilized for different individuals to deal with cravings and reduce the risk of relapse. Therapists can instruct individuals in progressive muscle relaxation and diaphragmatic breathing that can be learned rather rapidly, and these can become tools to deal with cravings. Individuals can then focus on the more complicated aspects of cravings, such as learning about cravings, using distraction techniques, understanding triggers, etc. Individuals can also benefit from a combination of medication and behavioral interventions to address their cravings.
- Recognize that cravings are time-limited; they do not last forever. Cravings will typically go away within 15-20 minutes after they appear if a person can resist them.
- Distraction is one of the most successful approaches to dealing with cravings. Exercise, meditation, and socializing with friends are excellent ways to deal with cravings.
- Become involved in activities that have a higher purpose, such as going back to school, mentoring someone, training for a new job, etc., to reduce cravings.
- Learn stress management techniques (e.g., relaxation and diaphragmatic breathing) to address one’s reaction to perceived stress, which is one of the most common generalized triggers that produce cravings to drugs and alcohol.
- Engage in a healthy lifestyle, such as paying attention to one’s diet, remaining hydrated, getting plenty of exercise, socializing, etc., to reduce the effects of triggers and environmental cues.
There are other important strategies that can be useful in dealing with cravings.
Finally, it is important for individuals in recovery from an alcohol use disorder to be able to recognize the generalized signs that a relapse may be on the horizon.
- Romanticizing one’s past use of alcohol
- Beginning to adopt the attitude that just one or two drinks would be okay
- Beginning to engage in behaviors that fostered prior alcohol use, such as frequently going to bars, hanging out with past drinking buddies, etc.
- Becoming overconfident in recovery or thinking that one has conquered their past alcohol use disorder
- Skipping therapy sessions and/or not listening to others, such as peers in recovery or family members
There is no one-size-fits-all approach or a quick fix to dealing with cravings. Expect the inevitable onset of cravings for alcohol that occurs during recovery, understand triggers, and develop a plan of action to deal with cravings.
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