Beginning the road to recovery is by no means easy. One of the biggest barriers to a drug free life is an inability to fully overcome cravings.

‘Craving, defined as the subjective experience of an urge or desire to use substances, has been identified in clinical, laboratory, and preclinical studies as a significant predictor of substance use, substance use disorder, and relapse following treatment for a substance use disorder.[1]’ However, cravings and urges do decrease in strength and frequency over time as long as they are not reinforced by use. In order to fight cravings, it helps to develop some coping strategies for when they arise. Medical assistance is often a necessity in cases of excessive use.

Medical Assistance

Over the last 30 years, many advancements have been made in the development of effective medications to treat Substance Use Disorders (SUD’s).[2] Medication generally serves to achieve three goals; management of withdrawal symptoms through detoxification, weakening of cravings and urges to use, and prevention of relapse.

In managing alcohol cravings, Naltrexone is an effective long-term treatment. It works by occupying opioid receptors, which prevents alcohol from stimulating the brain’s dopamine centres.[3]

In managing cravings for opioid use, common effective medications include methadone and buprenorphine. Methadone works by antagonizing the brain’s opioid receptors, thereby reducing the effect of opioids on the brain. Buprenorphine works in a similar way, but is only a partial opioid antagonist, unlike methadone, and therefore safer in terms of risk of overdose.

Clinical Significance of Cravings

Though there have been no comprehensive examinations of the overall clinical significance of craving across substance-use disorders[4], those who suffer from cravings would argue that cravings are a highly significant factor in repeated use. Cravings often intrude on an affected individual’s daily life, overpowering and controlling thoughts and patterns of behaviour and causing great distress.

Methods of Self-Management

Keep a Diary

According to the Institute for the Psychology of Eating, ‘One of the most effective ways to build our awareness of what’s going on with our cravings and understand what we really need is to keep a cravings journal.[5]’ Cravings can be triggered by many things, including people, places, things, feelings, and situations - anything that you associate with past substance use, so it’s important to know your triggers. If you’re not sure what your triggers are, it can help to keep a diary of your cravings and urges. In this diary, keep track of your cravings and what is happening around you, as well as your thoughts, feelings, and emotions at the time. This can help to give you a better perspective on how your environment might be influencing your cravings.

Education

Knowledge is power. Educate yourself on what cravings are and how they work. This can reduce feelings of isolation and helplessness, because you will begin to understand that the cravings you experience are the same cravings anyone else in your circumstances would be experiencing, and they are not a reflection of your character.

Behavioural Strategies

Become familiar with 3 D’s of coping with cravings:

Delay
When a craving hits, delay the decision to use for minute at a time or longer, depending on what you can manage.

Distract
Once the urge to use has been delayed, distract yourself from thoughts of using. Use a distraction technique like going for a walk, listening to music, or calling a support person. Once you are focused on or interested in something else, you will notice that the cravings reduce in intensity.

Decide

After the craving has passed, revisit the reasons why you wanted to stop using in the first place, and decide not to use again, again.

Cognitive Strategies

Positive self-talk can work wonders in taking the power away from cravings. Remind yourself that cravings are short term feelings. Tell yourself ‘this will pass’, ‘I can handle this’, or ‘this feeling will leave by itself’. When you do this, the urges will be easier to deal with. When experiencing cravings, it is common to catastrophise, feeling that the worst is about to happen if you don’t satisfy the craving. De-catastrophise the feeling by acknowledging that it is uncomfortable but also that it will pass.

Mindfulness and the Breath

Mindfulness has been identified as a promising strategy for managing cravings for alcohol, drugs and food. In 2009 Sarah Bowen conducted a study of participants who partook in an 8 week outpatient Mindfulness-Based Relapse Prevention (MBRP) programme, and compared the results with people who had normal treatment for substance abuse. Results from the study showed in both follow ups, 2 and 4 months after the intervention, that those who had been through the mindfulness programme had significantly lower rates of substance use compared to those who had had normal treatment. Additionally, MBRP participants demonstrated greater decreases in craving, and increases in acceptance and acting with awareness compared to the others[6].

Cravings can also subside when you practice relaxation/deep breathing techniques. A study conducted by Adrian Muele and Andrea Kübler looked at the effects of slow paced breathing on current food cravings. They found that controlling and slowing your breathing had a delayed influence on state hunger[7].

The following are a couple of mindful breathing techniques that can be used when facing cravings:

Technique 1:

  • Empty your lungs, exhaling through your mouth.
  • Breathe in through your nose for a count of four
  • Hold for four
  • Exhale through your mouth for four
  • Hold for four
  • Repeat

Technique 2:

  • Let out a big exhale through your mouth, joined with a sigh
  • Inhale through your nose for a count of four
  • Hold for seven
  • Exhale through your mouth for a count of eight
  • Repeat

Mental imagery is also a powerful tool in dealing with cravings. Though it can be the cause of a craving, like seeing yourself using and then wanting to use, mental images are an opportunity to freeze that particular image and imagine it to be different. If you see myself smoking, for example, you might want to smoke. But you can also choose to hold this image in your mind, and remove the cigarette, or replace it with a healthier alternative. This may be difficult at first, but will become easier over time.

Recognise

When cravings arise, it’s best to recognise it for what it is, just a feeling. If you fear the feeling, you’ll likely induce feelings of anxiety and shame, which may lead to you act in a way that doesn’t suit your idea of how things should be moving forward. In other words, if you feel anxiety and shame you may be more likely to use again in order to alleviate these feelings. Instead, it’s best to accept your lack of control over the feeling, let it happen, and move forward. The attitude you have towards the craving is integral in how you respond to it.