05 May Alone and Miserable – Fighting the Urge to Use
Are you up all night, tossing and turning, unable to sleep because of drug cravings? Or does that gnawing, incessant urge to drink torture your every waking moment – no matter how hard you try to ignore it? Is there no one who can help you through this? If you answer yes to any of these questions, you’re among the many addicts who are alone and miserable – and fighting the urge to use.
There is a way out of this situation. But – and there’s always a disclaimer, isn’t there? – it won’t be easy and it will take time. Of course, there’s no guarantee the urges and cravings won’t come back, but when and if they do, you’ll be in a much better position to cope with them.
Cravings and Urges – What Are They?
You certainly know what you feel, but what are cravings and urges, really? What is the physical and/or psychological basis for them? Do they happen to every addict? How can they appear months and years after you’re clean and sober? Will they ever go away for good? These are excellent questions that frequently come up during treatment for addiction.
Cravings and urges are best described as strong memories that are linked to the effect of drugs (alcohol, cocaine, marijuana, methamphetamine, prescription drugs used for nonmedical purposes, etc.) or addictive behavior (such as compulsive gambling, spending, or sexual behavior) on the neurochemistry of the brain.
Using brain imagery techniques, researchers have been able to pinpoint intense brain activity when addicts are shown pictures of crack pipes, alcoholic drinks or other visual images of addictive substances or behavior. Research shows that these images or cues can be as brief as 33 milliseconds before they activate the brain’s “go” circuit – even before the person is even aware of it happening.
What actually happens is this: The brain remembers the intense relief or pleasure of the previous drug experience or addictive behavior. It is a kind of programmed response to past association with drug use that activates the cortical areas of the brain by just the sight, sound, smell or thought of the drug itself. You don’t have to be using the drug to experience the craving or urge. Simply seeing or hearing or smelling a trigger – a beer commercial, the sound of ice tinkling in a glass, the sweet aroma of marijuana – makes you relive the experience and produces a strong emotional reaction. This is the craving or urge that you feel.
Tied to memories of such intense pleasure and relief, cravings and urges are both very powerful and tough to ignore. As to whether all addicts have them, the consensus is that they do, although how they react to them is very much individualized.
Some addicts can have the urge and not act on it. Maybe their addiction wasn’t as deep-seated, or they didn’t have any genetic predisposition to addiction (family history of alcoholism, for example). Their addiction may have been more of an environmental and social nature than a hard-core, chronic manifestation of the disease.
Even so, there are many hard-core addicts who successfully overcome their addiction – and are able to combat cravings and
urges effectively. That is not to say that the ability to cope with cravings comes easy or that it doesn’t require conscious effort – especially in early recovery when the memories are the most vivid and insistent.
What Happens in a Craving?
You know you’re experiencing a craving when you start to feel a tingle of anticipation. You hear, see, or smell the trigger and your thoughts center on the memories of using. You can’t get it out of your head.
Cravings aren’t something that you can schedule around, since you never know when they are going to occur. You can get a craving just by watching television or going to the beach, while you are trying to work or go to sleep. All you know is that your body is telling you how much better you’d feel if only you took that drink, smoked that joint, used that drug, went to the casino – you get the picture. Actually, that’s the point: You do get the picture and now you need to know what to do about it.
Help to Deal with Cravings
Isn’t it ironic that most cravings seem to come to you when you’re by yourself, overwhelmed, stressed out, feeling blue – in other words, when you’re alone and miserable? It’s as if the area of your brain – the limbic area – knows when you are the weakest and picks that moment to strike. Chances of you succumbing to the craving are generally higher when you are in early recovery. This is the time when you are fresh out of treatment and may not yet have your offensive and defensive coping strategies firmly in place. You haven’t had enough practice yet to feel comfortable in dealing with the cravings. You feel helpless, anxious, depressed, angry that you have these urges, desperate to hold onto your sobriety.
There is help to deal with cravings. It all begins with you. Here are some tips that may prove useful – as they have for countless others.
• Recognize the feeling – It’s important that you recognize the craving for what it is. Some addicts in recovery refer to the craving as a kind of freebie, something that you get without having to pay for it – in the sense of consequences. That’s not to say that many treatment professionals would refer to it this way, but the fact of the matter is you know what that pleasure feels like, so acknowledge it, recognize it – and then you can deal with it.
• Don’t be afraid of cravings – When cravings occur, don’t allow yourself to feel fear – or guilt or shame or regret. You don’t have any say over when cravings hit, and it certainly isn’t anything that you consciously do that prompts them. Don’t give the craving power by giving into it. By not fearing it, you are less likely to act out and use.
• Understand control – The fact that you recognize the craving for what it doesn’t mean that you can control it. You can’t. Cravings will occur regardless of how you feel about them. Everyone has cravings of one sort or another. It isn’t the existence of the cravings, but what you do about it. So there are two issues of control here. You can’t control when cravings occur, but you can control what you do about them. Always remember that you are the one in control. You are the one who determines what you will do or not do.
• When you’re overwhelmed – Sometimes the cravings are just too much to bear. You feel as if you’re destined to fail, to relapse. It’s as if you’re falling into an abyss and you can see yourself slipping back into your habit. This is a particularly vulnerable time for you – and, don’t you know it – it probably occurs when you are least able to handle it. Now’s the time to activate your coping mechanisms. Get in touch with your 12-step sponsor immediately. Don’t worry that it’s the middle of the night or Easter Sunday or whenever. Your sponsor has pledged to help you through such difficult times – that’s what he’s there for. One day you may be able to help another recovering addict in the same situation, but for now, you need the help. Reach out and take it. If you don’t have a 12-step sponsor, make sure there’s someone else you can trust. This may be your therapist, counselor, parent, spouse, other loved one or trusted friend. It doesn’t matter who it is, just that you have complete trust in the person – and know that they will be there for you when you need them most.
• Learn about craving triggers – Do yourself a big favor and become educated about the triggers that produce cravings. Write down situations, circumstances, events, people, sounds, smells, even thoughts that occur just before you’re aware of the craving. These are your triggers. Rate them on a scale of 1 to 10, with 10 being the highest or most intense craving. Now, write down next to each type of craving the techniques or things that you have done that seem to minimize the cravings. Do you notice a pattern? Are the coping mechanisms you use for little cravings the same as for the more intense ones? Are there ways that you can modify the effective ones to work on all your cravings? You don’t have to be an expert at this for it to have some benefit. The point is that you are teaching yourself to see the relationship, the cause and effect, of triggers and cravings – and how what you do can help reduce, minimize or eliminate the craving. You will, in effect, be learning how to manage your cravings, and this is a big part of recovery.
• Utilize the 5-minute rule – While cravings are different for each individual, they do have one thing in common. They tend to last only for a short time. One of the most practical ways of dealing with cravings, then, is to get through this brief period. Addiction treatment professionals refer to this as the “5-minute rule” or “5-minute contract” or “anti-craving behavioral strategies.” Basically, you pledge to yourself that you will not act on the desire – the craving or urge – for 5 minutes. In the interim, distract yourself with some activity that requires your complete concentration, or do mind exercises, crossword puzzles, counting, or physical exercise – whatever works to pass the time. Keeping your brain and your body occupied will help you get through this period of craving – without acting on it.
• Get professional help – You may benefit from professional counseling to help you better manage your cravings. If you have aftercare as part of your treatment program, you have access to a counselor or therapist who can help you with behavioral techniques to manage cravings. If aftercare is not part of your treatment program or if you haven’t been through treatment, look for counselors and therapists that may be available through federal, state or community addiction treatment resources. Cognitive behavioral therapy (CBT) is one technique that has proven very effective in helping addicts to manage cravings – but this is something that you need professional help to learn. There are other behavioral techniques that may also be employed, in conjunction with CBT or separately.
• Anti-craving medication – If your cravings persist, your therapist or physician may recommend anti-craving medication. Some cravings, particularly for certain types of addictions, can occur so rapidly and feel so overwhelming that, without medication, you may not be able to get through them – even with your arsenal of coping strategies and techniques. The point of anti-craving medication is only to get you to the point where you are better able to work through the craving without acting on it. It is not to get you dependent on medication. In fact, anti-craving medication has been the subject of a great deal of recent research. Medications to combat nicotine cravings and those to counter cocaine and methamphetamine cravings are currently in development and show great promise. If your therapist or physician does prescribe anti-craving medication for you, be sure to take it exactly as prescribed. Note any disturbing side-effects and alert your doctor immediately. Your dosing may need to be reduced or another medication substituted. Use medication only as part of multi-faceted therapy, including counseling, and when appropriate, your doctor will gradually wean you off the medication.
• Alternative treatments – You may also wish to consider alternative treatments to help put you in a better mindset to deal with cravings. Some addicts in recovery have found acupuncture or acupressure to help, while others report success with therapeutic massage, hypnotherapy, meditation, or other approaches. Look at it this way: If it makes you feel better, restores your strength, peace of mind, and gets you through the craving, why not make this part of your coping mechanism toolkit?
• Get out and get physical – Many experts in the field of addiction recovery recommend physical exercise to their clients. Why? The reason is simple: When you exercise vigorously, your body produces the natural feel-good chemical that helps elevate mood, reduces anxiety, stress and depression. It’s also great for your physical well-being in that it helps improve cardiovascular systems, tones muscles, helps you sleep better, aids in digestion, even cognitive abilities. In fact, rigorous physical exercise is like a highly-competent utility player – good at any position. Besides, when you’ve engaged in a vigorous bout of physical exercise, you feel a good kind of fatigue – the kind that makes you feel good about yourself. When you feel good about yourself, you’re better able to tackle everyday issues and challenges, including cravings that may pop up uninvited.
• Remember nutrition – In line with taking good care of your body with adequate physical exercise, remember your nutritional needs as well. Eat a well-balanced diet that consists of fresh fruits and vegetables, lean meat, good oils such as olive, fatty fish (salmon, mackerel), and reduce your intake of sugar and empty calories. Keep to a regular mealtime schedule. This is important because cravings can occur if you are hungry (or when you are sleep-deprived or stressed out). It’s also important to keep your body fueled with the nutrients it needs in order to ward off illness, maintain strength and vitality.
• Celebrate victories – As you grow more confident in your ability to fight off the urge to use, give yourself the credit you deserve. It’s not easy overcoming cravings, as you well know. Give yourself a reward for your victories. When you have reached milestones (weeks, months, years, etc.) of sobriety, have a little celebration – minus alcohol or drugs, of course. By celebrating your sobriety you are reinforcing your mastery of successful coping techniques – and the fact that you’re getting stronger in recovery.
• About relapse – What happens if you relapse? Well, it happens, and to some in recovery, it happens several times before they develop sufficient coping skills. But it isn’t the end of the world. You just pick yourself up and move on. Don’t beat yourself up over it. That won’t do any good. There’s no shame in relapse – so don’t even let that thought come into your head. Recovery is not a straight-line process for everyone. There are victories and set-backs, some major, some minor. Remember that it isn’t what happens that counts, but what you do about it. Re-double your efforts. Re-examine your strategies. Get help to deal with the problems. And keep moving forward in your recovery. You will have learned from your relapse and will be stronger as a result of the knowledge. Think of it this way: You have accumulated even more wisdom about what triggers affect you the most – and what to do to counter them.
Will Cravings Ever Go Away?
Chances are, no, but they will diminish over time. The key point to keep in mind is that the more knowledge you amass about cravings, what triggers them, what works best to eliminate them or get through them without acting upon the craving, the less they will trouble you when they do occur. Over time, you will find that cues or triggers that used to cause you great distress either no longer bother you with the same intensity, or they don’t bother you at all. You are able to recognize them, distract yourself while they pass, and get on with your life.
Find relief in recovery. Life gets better with addiction treatment.
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