Craving (20 page)

If going to groups is now a bright spot in your week, something you look forward to instead of it being a chore, then you may be in the confidence zone. If reaching out and asking for help no longer feels like a burden, but something you enjoy doing, you may be in the confidence zone. If spiritually focused behaviors, as I’ve described them in
chapter 6
, are actions that you want to do more of rather than less of, then you may be in the confidence zone. And because sometimes you may want to take these actions more than at other times, it really is a zone. It’s perfectly normal to hover between wanting to do these actions and not feeling like it. Gaining freedom from cravings is a process. But if you want to take constructive actions more often than not, you’re in the zone. That’s because confidence is
not
a change in what you do or what you believe you are capable of doing. True confidence is a change in what you
want
to do, and what’s most remarkable about it is that it occurs as the result of the kinds of actions described in this book. It’s a change in your attitude, not toward the object of your cravings, but toward the very behaviors that help resolve the cravings, in the parlance of AA members “one day at a time.”

In Twelve Step meetings, newcomers often ask, “How long do I need to go to these meetings?” One answer that old-timers (those who have achieved substantial success and recovery—usually years or even decades of sobriety) will often give them is “Go until you want to go, and then go some more.” The essence of that recommendation is the change in attitude we have been discussing. That’s the secret. The real solution to the sense that you are immune, the perception that often comes on strongly when you are doing well, is simply this:
the actions you take to produce recovery will themselves be as desirable to you as the thing you originally craved.
I’m aware that this may sound completely crazy or impossible to you right now. The experience of thousands of recovering people confirms that finding release from cravings is a fundamental change in what you want, which is produced by what you do—
not
the other way around. And that’s what is so amazing about gaining freedom from cravings: the process sustains and fuels itself. One simple example of this is when people improve their fitness and health through exercise. At first it’s a chore, but gradually it becomes an activity they do because they enjoy it, not because they have to. The action is more of a driver than the result, yet the result continues. Actions change desires, healing produces more healing, and connectedness and spirituality are both the drivers and the results of recovery. You will learn much more about this powerful cycle in
chapter 10
.

***

In this book you have read many examples of people who suffered from cravings and gave in to them despite their best attempts to “be good.” The paradox is that when they are occurring, cravings feel like they will last forever; when they go away, it feels like they will never return. Time and again people succumb to this vicious cycle, this roller coaster, without ever being able to step off. In this chapter, you’ve learned about a particularly devastating aspect of this cycle: that people who suffer from cravings often believe they are immune because they have discovered precisely what they need to stop acting out on their craving. It’s that very belief that renders them most vulnerable. By taking steps to become aware of your blind spots, and not simply trusting your own gut when it comes to cravings, you can begin the process of stepping off that self-destructive roller coaster.

…

9

Apparently Irrelevant Decisions (AIDs)
How Simple Actions Can Reduce Cravings

“If you do not change direction, you may end up where you are heading.”

— LAO TZU

What you believe affects what you want. Even more so, what you do affects what you want. In
chapter 3
we reviewed that, in certain cases—and contrary to popular belief—when what you want is out of reach, you actually want it
less.
In this chapter, we’ll be exploring how simple actions you take, many of which seem irrelevant, can actually affect your cravings. Many of the recommendations I make will even seem counterintuitive, but they are backed by scientific evidence. Remember that your intuitive responses while in the throes of your cravings may actually be partially responsible for fueling your cravings, so it will sometimes be necessary to do things that run counter to your common sense if you are to successfully lick your cravings.

Apparently Irrelevant Decisions

The father of craving research, the late Dr. Alan Marlatt, used the term “apparently irrelevant decisions” (which he called AIDs) to describe the actions that people with addiction sometimes take that don’t seem to them to be related to their cravings but that actually lead to their relapse. The technical name for this is “covert antecedents.” The original example that Marlatt used was an alcoholic who was sober, but who purchased a bottle of alcohol “in case guests dropped by.” Marlatt used apparently irrelevant decisions to describe the actions that lead to relapse, but what I’m proposing takes it several steps further. It turns out that many of the actions you can use to
reduce
your cravings will also be apparently irrelevant. Let’s look at some of them.

Removing access to the object of craving is, of course, critical, especially early on in your process. If you hadn’t read this book, you might have drawn the conclusion that removing access to the object of craving would usually make you want it more. Scientific evidence, however, suggests otherwise.

Although there are exceptions, if you are trying to lose weight, it’s probably a bad idea to get a job at Krispy Kreme. If you are trying to stop drinking, being a bartender is probably not the best option. And if you are trying to quit gambling, you may want to find a job far from the Vegas strip. Creating the awareness that the self-destructive behavior is truly off limits can be very helpful in managing cravings. In fact, in what is now considered to be a classic study by Dr. Roger Meyer, only 50 percent of alcoholics craved alcohol when exposed to the sight, smell, or even touch of their favorite beverage if they
knew that they would not be able to drink it.
The mere fact that the alcohol was completely off limits reduced the craving.
¹⁰⁷
Behavioral economic research shows similar effects with alcohol price escalation, suggesting that the mere difficulty of obtaining the object of the craving can also reduce cravings. Of course, there are situations where removing access increases desire, but by and large it’s likelier that “out of sight, out of mind” will be effective.

In another study of flight attendants who were nicotine dependent, their cravings were measured during two-leg short flights versus long flights. The short flights were about half as long as the long flights. The flight attendants’ cravings for cigarettes increased as they approached landing in the short and long flights, but not halfway through the long flights, suggesting that time of abstinence alone doesn’t predict craving as well as the sense that they were about to land. In that study, the effect of anticipating the post-landing cigarette was really quite significant.
¹⁰⁸
From that study, and several others, we can conclude that context is extremely important and that planning, anticipating, and creating access to the object of your cravings can really ramp up cravings.

What you believe about your cravings can also predict whether you will act on them. In 2010, Australian researcher Nicole Lee and her colleagues assessed 214 methamphetamine users, focusing specifically on what they believed about their cravings. I recently asked Lee about her research, and she explained that when using a questionnaire called the Craving Beliefs Questionnaire, she found a relationship between the addicts’ beliefs about their cravings and the probability of relapse.
¹⁰⁹
This suggests that addicts who believe that cravings themselves have a detrimental effect on them or their risk of relapse are more likely to return to drug use. In my experience, a simple awareness that cravings are
serious but definitely manageable
helps people commit to other strategies that ensure abstinence. It’s my sincere hope that you, too, can gain such awareness, as that very belief (which has the added advantage of being true) may help you stay away from the object of your craving.

Again, although it may seem to you that staying away from what you crave will increase your craving, research suggests just the opposite: the longer you can maintain abstinence, no matter how you do it, the less you crave. A recent study of 865 methamphetamine addicts followed over a four-month period of abstinence showed a clear, dramatic reduction in cravings over time.
¹¹⁰

Of course, abstinence alone does not produce recovery; this explains why so many people with addiction released from long prison sentences return to drug use before they even arrive home. One study of former smokers who had been abstinent up to ten years showed ongoing cravings in about 10 percent of them, even many years later.
¹¹¹
People who continued to crave tended to have a more severe history of nicotine dependence and to have more mental health problems. Abstinence is very helpful but hardly enough. Other research has suggested that non-cue-induced cravings do diminish over time, but cue-induced cravings are slower to diminish. (That cigarette display in the gas station tends to “speak” to recovering nicotine addicts for quite a while.)
¹¹²
This is why I always emphasize that if you are tempted to test yourself by being exposed to a cue or trigger, you should reconsider. Life contains enough tests—you don’t need to add your own.

No one solution will work for all cravings; however, many actions that reduce cravings can be deceptively simple. It can really seem like there is no way that these could work, and yet they do. For example, simply imagining your favorite activity as vividly as you can, can dramatically reduce cravings for food and cigarettes.
¹¹³
Several recent studies have shown that the scent of peppermint can reduce cravings for food and nicotine. Mindfulness exercises have also been shown to reduce cravings and substance use.
¹¹⁴
Long-established research shows that stress induces cravings (and this is only partly related to hormonal effects), so any strategies that reduce stress are also very helpful.

I strongly believe that many people with addiction will not be able to completely suppress cravings through cognitive (that is, thinking) methods. Nevertheless, these techniques can be extremely helpful, and they seem to affect the same regions of the brain that are involved in reward that you learned about in
chapter 2
. In a recent study, people with cocaine cravings attempted to suppress their cravings using cognitive therapy strategies, which functional imaging studies showed reduced the activity in their nucleus accumbens and orbitoprefrontal cortex.
¹¹⁵
That’s a fancy way of saying that just using thinking-based methods to suppress cravings affects the parts of the brain involved in craving and reward.

If you don’t exercise, you are probably sick of hearing experts extol the benefits of exercise. Add me to the list of those experts. Several studies show the beneficial impact of exercise on craving, and my experience confirms that it can really help. Recently, a small study demonstrated that exercise reduced cravings for marijuana, even in people who weren’t seeking treatment for marijuana addiction.
¹¹⁶
Another recent small but rigorous placebo-controlled double-blind study showed benefits of one gram of daily oral acetyl-L-carnitine in alcohol cravings and a higher abstinence rate at ninety days.
¹¹⁷
This compound is thought to somehow be involved in the beneficial effects of exercise. (But don’t get me wrong—I don’t think we are anywhere near exercise in a pill!)

Many decades of treatment experience confirm that the simple act of talking about a craving helps reduce its intensity and duration. Over the years, I have worked with many people who really struggled to talk about their cravings. The result was usually that these secret cravings became longer, more severe, and more likely to lead to acting out or giving in to the craving. A common belief among these people is that talking about a craving won’t help or that talking about it might make it worse. This belief is reinforced by the fact that the few times they discussed their cravings, the cravings
may
have gotten worse. However, the worsening may have been related to some other factor that they aren’t recalling, or the connection could be muddled by the attribution biases that we discussed in
chapter 3
. The extreme example of this belief is when alcoholics tell me that they don’t want to attend AA meetings because “talking about alcohol makes me want to drink.” It is true that AA meetings vary in how much they focus on illness versus recovery, and I always counsel alcoholics to try to find solution-focused meetings. However, for most alcoholics, any meeting is usually better than no meeting (of course, there are exceptions). I also think that if AA meetings make you want to drink, what hope do you have in the real world, filled with bars, friends who drink, alcohol in foods, billboards and television ads, drinking at sporting events and weddings, and so on? For the majority of alcoholics who benefit from the AA method, it’s important to push past this perception and keep attending.