Craving (4 page)

At times in this book we’ll discuss the types of mild cravings (properly speaking, these are more “urges” than cravings, as they are milder and rarely yielded to) that this man is experiencing. His discomfort can be managed with some specific strategies to reduce the unpleasantness of these urges and can give him a better shot at a more personally satisfying approach to meeting his goals. But nobody would say he is addicted to alcohol, that he is an alcoholic, or that he
needs
those extra drinks. In these examples, and the others you will read in this book, you can replace drinking with any other behavior you are trying to change, such as eating sugar and carbs, gambling, or Internet compulsions, and the principles will generally be the same. (In
chapter 4
, we’ll discuss how most of these behaviors, when they become compulsive, are essentially the same, and we’ll also explore some of the differences that do exist.)

Then there is another type of person who is trying to change her behavior. This person may really recognize she is drinking too much. Her husband may be pestering her to cut down. She may have received a DUI or called in late to work on a Monday morning after a bad drinking bender. Or maybe it hasn’t affected work at all, but she did some things she was embarrassed about, such as “drunk dialing.” Clearly, she hasn’t always been this way. She wonders if it’s a phase. The idea of stopping drinking altogether is pretty unattractive to her. She doesn’t want to stop drinking forever. She enjoys drinking. She’s tried to cut down and she can…for a while. Sooner or later, though, she’s back to her old ways, and maybe worse. Often, but not always, when she is cutting back on her drinking, or stopping for a while, she experiences a strong desire to drink—a
craving.

These cravings can take many different forms, as we’ll explore later in this book. Sometimes they can show up as an innocent thought: “I can have just one more,” or “I’ve been doing so well, I
deserve
this.” Sometimes the thought is not so benign, like “I hate this…. I’m giving up on this abstinence idea.” At other times, thoughts can be very subtle or deceptive, such as “It’s beer, so it doesn’t count.” At still other times, the craving can be almost
dissociative.
Have you ever had the experience of driving down the freeway and planning to get off at a certain exit, and making a note to yourself to get off at that exit, but then drifting off in your mind and missing that exit completely? Perhaps you had actually driven several miles before you noticed it. That’s a close approximation to what happens with what I call “the absent-minded craving.” In that case, the person may take a drink without even thinking about it, almost automatically. He has no obvious desire to drink, and no thought of the promise he made to himself, but suddenly he finds himself with half a drink in his hand, because he drank the first half without even realizing it.

It’s worth noting that the woman described above may not actually be an alcoholic. This type of craving does occur in non-alcoholics, and some of these cases are described by experts as “alcohol abuse.” Drinking leads to consequences, the person still uses, and the cravings can be intense, but some support, some very severe consequences, a strong motivation, or maybe just a change of heart can lead, in some cases, to the person moderating or stopping the drinking. If your behavior falls into this category (whether it’s drinking, compulsive eating, or some other behavior you are trying to control), you probably should seek a professional to at least help diagnose the issue and offer some strategies for helping you meet your goals. If this is you, the description of cravings in this book will apply to you, and the explanations and recommendations will be relevant and useful as you make more successful attempts to modify your behavior. You can do some very specific things once you have a better sense of what you are dealing with that can help you change your behavior and meet your goals, and I’ll lay those out very clearly so you can be successful.

Of course, these are just examples and many more variations exist, but there is an important one we haven’t covered yet—an even more severe type of craving that is generally found only in people who have addiction.

What Is Addiction?

Let’s take a look at the word “addiction” Some think of addiction as a dirty word or something pejorative, but it’s really nothing more than a description of a set of behaviors that are hardwired into the brain. In fact, it comes from the Latin word “addictionem,” which basically means “a devoting.” As you’ll see in this book, when it comes to addiction, the thoughts, perspectives, behaviors, and even the very neurons or brain cells of the person are
devoted
to the craved substance or behavior. The causes of addiction are complex and multiple, and the types of addiction are myriad as well. But all addictions share some key features, and the most important of those is craving.

People who suffer from addictions experience milder desires and urges as well. Often they drink not because they need to, but simply because they want to. And they also may sometimes experience the mild or even the stronger cravings I’ve described above. But most people with addiction also experience another type of craving, one that is devastatingly destructive. This is the fist-pounding, can’t-live-without-it, absolutely-gotta-have-it severe addictive craving. This craving cannot be ignored, it cannot be voluntarily suppressed, and it can’t be wished away. It often feels like it will last forever and that the only choice is to give in. It feels as powerful as the biological drive to breathe or the thirst for water. It won’t allow itself to be ignored until it’s satisfied. The tragedy is that giving in or succumbing to the craving and acting out is not the end of it; it often leads, later, to even stronger cravings or cravings for even more. In some cases, giving in to the cravings leads to craving another substance or behavior. It’s a vicious cycle that affects more than 10 percent of the U.S. population, and it won’t be eliminated by stronger willpower, an ad campaign to “just say no,” or any number of scare tactics or legal interventions. What we’re discussing is addiction and, sadly, it can be deadly. People with addiction need their substance or behavior to function. In some cases, stopping the drug use or behavior can produce life-threatening consequences, such as seizure or delirium (with alcohol), or the equally deadly refeeding syndrome with anorexia, where suddenly resuming normal eating after starvation can sometimes lead to heart failure and even death.

These individuals cannot consistently use in moderation. Unlike our other examples, where a person could use or act out in a limited, controlled fashion, people with addiction generally cannot consistently control their behavior when it comes to the addictive substance or process. One important caveat is that some people with addiction actually
can
control their behavior…for a time. This temporary control wreaks havoc on the mind of someone with addiction, because it convinces him that he has finally regained control. Then later, when the behavior spirals out of control again, it’s often far more devastating than it was before. This, by the way, is one reason why experts describe addiction as a progressive disease. Over time, the natural development of addiction is that it gets worse, although there may be periods (often long periods) of improvement.

Yet over the years I’ve observed that when this happens—when the behavior temporarily appears to be getting better—the mind is actually getting worse, setting the person up for relapse. Here’s an example of this
behavior-better-brain-worse
scenario. Consider a guy named “Lance” who struggled with gambling for years. At first it was sports betting, then it was day trading, and these days it’s some combination of online and casino gambling. Like most people who are struggling with gambling addiction, he had some winning streaks and some losing streaks. When he won, he knew it was because of his strategy. When he lost, he knew it was temporary—he didn’t even really think of himself as losing; rather, he would say, “The casino is holding my money for me right now until I win it back.” That sounded bad enough, and it was. However, at one point, with enough pressure and when he was in the hole financially, he finally decided enough was enough. He acknowledged he had a serious problem, even that he was addicted to gambling, and then he simply stopped gambling. His wife was proud of him, his friends (at least the few who knew about his problem) were supportive, and Lance really got the sense that he was free of this issue. He called his gambling “a phase.”

From the outside, it would really appear that things were looking up for Lance. The behavior wasn’t just reduced—it was gone. Lance was not gambling at all. But let’s take a look at what Lance was
thinking.
Lance began to reflect on how he was able to simply stop gambling by putting his mind to it. He looked with scorn on people who needed gambling addiction treatment and at people who described themselves as gambling addicts. He started to ask himself why they didn’t just “man up and quit, like I did.” He then made a startling conclusion: if he was able to quit on his own when he wanted to, he must not be addicted. Now, mind you, when Lance was gambling (toward the end), he was aware that he was addicted. In some regards, his mind was actually healthier because he knew he had a problem. He had insight. Later, after stopping for a while, he became convinced that he didn’t have a problem. His insight was actually worse—his mind was lying to him at a furious pace even though he was not gambling. You can imagine what happened next; because he knew he wasn’t addicted, he told himself that he could gamble recreationally, just occasionally and for fun. Before long, he was back in a deeper hole than ever, asking himself how he had let it happen again. Lance’s behavior was better but his mind was worse, which is why we emphasize that quitting isn’t enough; it has to be followed up with a genuine recovery-oriented program, which I’ll describe later in this book. The great thing about focusing on recovery rather than on the problematic/addictive behavior is that not only do your brain and behavior improve, but your happiness and sense of satisfaction dramatically increase as well.

If you fall into any of the above-mentioned categories of addiction, you absolutely should get professional help to assess the problem and support you in developing individualized strategies to obtain relief and freedom. But even if you fall into the severest category of addiction and craving, the explanations and methods in this book will be very helpful as you progress along your journey toward personal recovery.

Cravings Matter

Why do cravings matter? In 2012, craving was finally added to the upcoming fifth edition of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders
(DSM-V) criteria for addiction. Doctors are paying more attention to cravings now than ever before. Why is that? There are three main reasons. First, cravings are correlated with relapse. People who crave more are more likely to return to the craved substance or behavior. Second, cravings are distressing and uncomfortable. People who have severe cravings will often describe them as maddeningly uncomfortable. And finally, cravings matter because they can be affected, they can be improved, they can be relieved, and, in many cases, they can even be prevented. Recently, medications and other therapies have been developed to help reduce or eliminate alcohol and other drug cravings. Some evidence suggests that these medications may also be helpful with “process” cravings, like gambling and compulsive eating. This book will explore the evidence behind all of these options so you can decide a course of action that’s right for you.

Perhaps the most important reason that cravings matter is because they are
yours.
They are deeply personal. You can paint a vivid picture of them or even show someone what happens to you when you experience them. But no matter how thoroughly you describe or explain your cravings, you are the only one who is experiencing them. This is very important because, in the effort to get a handle on their cravings, many of the people I work with try to compare their cravings to what others are experiencing. Often, they will either see that their cravings seem worse, and become convinced that they are different and thus cannot get well, or that their cravings are milder, and so conclude, “I don’t really need all this help.” Either way, comparing your cravings with what other people experience is a losing game and can only serve to undermine your success. As we’ll see later (particularly in
chapter 7
), if you must share and compare your experiences with that of other people, be sure to look for similarities rather than differences.

Your cravings matter because you alone are experiencing them, they are influencing your behavior, and your actions can directly influence them. You are not helpless when it comes to your cravings, nor are you destined to experience them forever. There are specific actions you can take, which I’ll describe in detail, that can affect the frequency and intensity of your cravings. Your actions can also reduce the likelihood that, should you experience a craving, you will act on that craving and relapse to the behavior you have been trying to control.

Whether you use the term “craving” to describe a simple urge or desire, or even if you mean the kind of severe craving found in addiction, cravings matter. Whether it’s craving for a drink, a drug, a slot machine, a chocolate cake, or a cigarette, cravings matter because they either influence or directly drive your behaviors. But even more important, changes in your actions and behaviors can influence your cravings and improve your ability to get relief and find freedom from the self-destructive things you are craving.

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