Addicts often relapse because they are overwhelmed by a powerful sense of craving. The physiological craving is powerful and, as a result, the issue of craving needs to become a primary concern in preventing relapse—especially during the first 90 to 120 days of recovery. To responsibly focus upon the issue of craving requires a comprehensive bio-psychosocial model that will help us understand the craving process.
In 1990, I developed a three-stage model for managing craving. The three stages of craving are:
Stage 1: Set-up behaviors: Ways of thinking, managing feelings, and behaving that increase the risk of having a relapse
Stage 2: Trigger Events: Events that activate the physiological brain responses associated with craving.
Stage 3: The Craving Cycle: A series of self-reinforcing thoughts and behaviors that continue to activate and intensify the craving response.
It is important to note that craving is the last step of a three-stage process. It is self-defeating to focus on the end result, craving, without focusing on the factors that cause the craving.
Recovering people unconsciously set themselves to experience cravings. The set-up behaviors lower their resistance to craving. When their resistance is down, they’re vulnerable to trigger events that cause the actual feeling of craving to start. Once they feel the urge to use, they start using habitual behaviors that amplify or make the craving worse. This is the craving cycle. Fortunately, there are prevention and intervention techniques available in this high time of need.
Stage One Set-Up Behaviors
Set-up behaviors are a combination of physical, psychological, and social factors that lower resistance to craving.
Physical Set-ups For Craving
There are five common physical set ups for craving.
1. Brain Dysfunction From Drug Use: Mind altering drugs damage the brain and leaves recovering addicts physically set up to experience powerful cravings. The result of this physical predisposition to experience craving is if recovering addicts don’t do special things to avoid craving, they will experience craving.
2. Poor Diet: Recovering addicts are often nutritional disaster areas because they live on junk food and don’t know what a healthy meal is. Many have coexisting eating disorders that lead to binges on junk food and/or starving for days at a time to deal with the result of weight gain.
3. Excessive Use Of Caffeine And Nicotine: Both caffeine and nicotine of these are low-grade stimulant drugs and increase the likelihood of having a craving.
4. Lack Of Exercise: Aerobic exercise reduces the intensity of craving. Regular aerobic exercise is a protective factor against craving, especially in the first six to nine months of recovery. Not doing aerobic exercise on a regular basis sets the stage for craving.
5. Poor Stress Management: When recovering people don’t manage stress appropriately in recovery, they increase their risk of having craving by becoming stress sensitive. Regular stress management activities such as meditation, relaxation exercises, taking regular breaks and rest periods are all protective factors against craving.
Psychological Set-Ups For Craving
There are five major psychological ways that recovering addicts set themselves up to experience craving.
1. Euphoric Recall: Euphoric recall is a way in which addicts “romance the high” by remembering and exaggerating the pleasurable experiences of past use, while blocking out painful and unpleasant aspects of the memory.
2. Awfulizing Abstinence: When addicts “awfulize” abstinence, they notice all of the negatives and exaggerate them while blocking out all of the positive aspects of recovery. This leads the recovering addict to feel deprived in recovery and to believe that being sober is not nearly as good as using the drug.
3. Magical Thinking About Use: Magical thinking about use is the belief that using will solve all of their problems. This magical thinking is brought about by the euphoric recall (“Remember how good it was!”), and the “awfulizing” of sobriety (“Look at how awful it is that I can’t use it.”).
4. Empowering The Compulsion: They exaggerate the power of the compulsion by telling themselves that they can’t stand not having the drug and telling themselves that there is no way to resist the craving.
5. Denial and Evasion: The final psychological set-up is denial and evasion. Addiction is a disease of denial. This denial does not go away simply because they are not using the drug. Many addicts deny their need for a recovery program to reduce the likelihood of craving. They also deny that they are setting themselves up to have craving for the drug. Because this denial is an unconscious process, many addicts believe they are doing the best they can in recovery when, in fact, they are not.
Social Set-Ups For Craving
There are three major social ways that addicts set themselves up to experience craving.
1. Lack Of Communication: Addicts stop talking about their experiences in recovery and, as a result, they get into trouble. They replace rigorous honesty with superficial communication. This isolates them and prevents them from doing a sanity check on their recovery experiences.
2. Social Conflict: Out of isolation and a refusal to communicate comes a tendency to get into arguments and disagreements with other people. This social conflict prompts the recovering addict to avoid sober social situations and isolate themselves from others, spending more time alone.
3. Socializing With Other Drug-Using Friends: Out of loneliness and desire to be with people who understand them, many recovering addicts decide to associate with people who they used to drink and drug with. This puts them in the proximity of the drug and sets them up to have a craving.
Stage 2: Trigger Events For Craving
There are four primary types of triggers that activate immediate craving. These triggers include thoughts, feelings, behaviors, and situations that activate craving. Once these triggers are activated, a powerful craving to use emerges.
1. Thought Triggers: Thought triggers arise out of addictive thinking or an addictive mind-set that creates thoughts about the role that alcohol or other drugs play in a person’s life.
2. Feeling Triggers: Feeling triggers come from sensory cues – seeing, hearing, touching, tasting, or smelling something that reminds them of drug of choice. It also results from experiencing feelings or emotions that were normally medicated by use.
3. Behavioral Triggers: The behavioral triggers deal with drug-seeking behaviors and rituals that activate a craving.
4. Situational Triggers: Situational triggers include any stressful relationships or situations that used to be engaged in on a regular basis while using.
Stage 3: The Craving Cycle
The third and final stage of craving is the actual craving cycle. This cycle is marked by obsession, compulsion, physical craving, and drug-seeking behavior. This cycle can be prevented and there are helpful intervention techniques when it arises.
1. Obsession: When the obsession is activated, the person has out-of-control thinking about using. Intrusive thoughts invade their mind and they can’t turn them off. The obsession quickly turns into a compulsion.
2. Compulsion: When compulsion is activated the person begins experiencing an overwhelming urge to use the drug even though they consciously know that it is dangerous to do so.
3. Craving: The obsession and compulsion merge into full-blown physical craving. Physical craving is marked by a strong desire to use the drug, rapid heart beat, shortness of breath, perspiration, and at times the actual sense of tasting, smelling, or feeling the drug of choice. Physical craving is very powerful.
4. Drug Seeking Behavior: In an effort to manage the obsession, compulsion, and physical craving, many addicts activate drug-seeking, ritual behavior. They begin to cruse old neighborhoods, talk with old drug using friends, and go to bars and other places where a drug of choice is available. This exposes the person to more triggers–which intensify the craving cycle. Eventually, the person becomes overwhelmed with a compulsion that they cannot control and they return to drug use.
Craving can be prevented by following a number of simple guidelines.
1. Recovery Program: Develop a structured recovery program that puts you in continuous daily contact with other recovering people.
2. Know Your Triggers: Identify the things that activate the craving and learn how to cope with those triggers.
3. Know & Avoid And Set-up Behaviors: Know your set-up behaviors and learn how to avoid or cope with those set-up behaviors. If you don’t set yourself up for craving, when you do have a craving they will be less severe and last for a shorter length of time.
4. Dismantle Euphoric Recall: Carefully examine past pleasant memories about using and search for the hidden negatives in the experience. Most people find that they had no purely positive experiences while using their drug of choice. There were always hidden negatives.
5. Stop Magical Thinking: It is also important to stop magical thinking about future use and to stop “awfulizing” your current sobriety. This will allow you to deal with the physical set-ups and let you know what to do to stop a craving.
Intervening On An Episode Of Craving
Since craving is a normal and natural symptom of addiction that follows the addict into recovery, it is important for addicts to learn how to deal with craving in recovery. This is done by learning and practicing a number of steps.
1. Recognize Craving: Addicts must learn how to recognize a craving while it is happening. Many addicts fail to identify mild cravings as problematic and wait until they are in a full-blown, severe craving before taking action.
2. Accept Craving As Normal: Many people experience a craving, panic, and believe there is something wrong with their recovery or that they are condemned to return to their drug of choice. This is not true.
3. Go Somewhere Else: The craving was probably activated by an environmental trigger, so get out of the setting you’re in and get into an environment that supports sobriety.
4. Talk It Through: If you talk it through, you don’t have to act it out. Addicts need to talk about their cravings as soon as they occur to discharge the urge to use.
5. Aerobic Exercise: This stimulates brain chemistry and reduces the physiology of craving.
6. Eat A Healthy Meal: Eat a healthy meals in order to nourish the brain. Consume some lean fish or meat for protein and eat some whole wheat bread or baked, potatoes or brown rice for complex carbohydrates. It also helps to take some vitamins and amino acids to help stabilize brain chemistry imbalances.
7. Meditation And Relaxation: Cravings are worse when a person is under high stress. The more a person can relax, the lower the intensity of the craving. See a related blog on Mindfulness Meditation:
8. Distraction: divert attention from the craving by engaging in other activities that productively distract the person from their feelings.
9. Remember Cravings Are Time-limited: The ninth step is to remember that most craving is time limited to two or three hours. If you can use the previous eight steps to get yourself fatigued enough to fall asleep, most people wake up and the craving is gone.
It is possible to understand drug craving and to learn how to manage craving without returning to use. A model that allows people to identify set-up behaviors, trigger events, and the cycle of craving itself, and intervening upon this process has proven effective in reducing relapse among addicts.
Gorski, Terence T., Addiction & Recovery Magazine, April 10, 1991
Gorski, Terence T., Managing Cocaine Craving, Hazelden, Center City, June 1990
About the Author
Terence T. Gorski is the President of the CENAPS Corporation a training and consultation firm specializing in relapse prevention, addictive relationships and treating chemically dependent ACA’s. He holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. from Webster’s College in St. Louis, Missouri. He is a Senior Certified Addiction Counselor In Illinois. He also contributes articles and interviews to major magazines, acts as a consultant to the health care industry, and conducts workshops in the U.S., Canada, and Europe.
Some of his books include Passages Through Recovery, Staying Sober: and Relapse Prevention for African Americans. These and many more are provided in our Recovery Bookstore under the heading “Relapse Prevention. For more information about his leading techniques used by some of the nation’s top rehabilitation facilities or to enroll in one of his training programs, you may also visit his site directly at www.relapse.org
LIVE SOBER – BE RESPONSIBLE – LIVE FREE