Why is it that we often can’t live up to our goals when it comes to addictive behaviors? What undermines us every time? As a psychiatrist and addiction expert who has helped thousands of people change their habits and get back on track, the answer is remarkably simple: cravings. Cravings make us smoke “just one more cigarette” when we’re trying to quit. Cravings make us eat that cheat-meal-cheesecake. Cravings lead us back into the bar if we’re alcoholics. Why do we let that happen?
Cravings are intense urges that can be very uncomfortable to resist. They may feel like they are going to last forever unless they are satisfied. They trick us into thinking that “this time will be different”, or “I deserve this”, or even “one time can’t hurt.” They are powerful thoughts and feelings that drive our behavior in ways that are clearly against our self-interest. How can we stop them?
Well, that’s exactly why I wrote Craving: Why We Can’t Seem to Get Enough (Hazelden Pub. 2013). As an addiction psychiatrist I’ve seen people giving up just as they were starting to get successful, families torn apart and jobs lost, all because of cravings. I’ve also seen people spend thousands of dollars on miracle “cures”, geographic cures and fads. The people I was helping truly believed their problem was the sugar (or the gambling or the pot or the sex) and couldn’t see past that to learn that the craved object was really just a symptom of a deeper need that couldn’t ever be met with “one more cigarette.”
In Craving, I review the complex causes of cravings (the brain science and psychology behind cravings, the powerful social forces that affect cravings and even the genetics of cravings) and then explore what we really know about what works to kick them. Strategies that have published, peer reviewed, scientific support are emphasized, and myths are debunked. The book contains practical suggestions that a reader could use to immediately begin to gain control over their cravings and achieve their goals.
When I was researching the book, I reviewed thousands of articles on addictions and cravings. In many of the cases, I spoke directly with the researchers who conducted the cravings studies to clarify what exactly their research showed. In Craving I distill those down to the essential suggestions that can improve cravings.
I hope you enjoy this excerpt from the first chapter.
From Chapter 1, Craving: Why it Matters
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-betterbrain- 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. 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.
Why do cravings matter? In 2013, 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.
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. 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, 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.
Where to buy: Craving is available at Classic Bookshop in Palm Beach, FL and wherever books are sold.
Omar Manejwala, M.D., is the senior vice president and chief medical officer of Catasys in Los Angeles, California, and is the former medical director at Hazelden Foundation. Dr. Manejwala is a transformational speaker and appears frequently in the national media to address the topic of addiction.