Addiction Archives - Your Mind Matters

The Craving Cycle: A CBT Concept for Managing Addiction

laura on 16/06/2023

In psychological therapy, we’re almost always looking to make progress. This often comes back to behaviour change – i.e., how we’ll behave differently in the face of difficult situations and feelings. In therapy targeting addiction, our behavioural goal is basic but difficult – we want to cease the addictive behaviour causing us harm.

If you’re someone who struggles with addiction, Cognitive Behavioural Therapy (CBT) is one of a host of different treatments that can help you recover. CBT aims to a) provide education about the various thoughts, feelings, and behaviours that maintain addiction, b) devise tailored strategies for encountering addiction-related thoughts and feelings, and c) making meaningful changes to behaviour to reduce or cease the cycle of addiction.

This blog will be talking about The Craving Cycle – one of the most fundamental concepts in CBT for addiction. As it applies to a whole range of different addictions – including drugs, alcohol, gambling and food – we’ll refer to all of things generically as the ‘addictive object’.

What is craving?

Craving is the physiological and psychological response to our addiction-related triggers. Triggers can be external (e.g., people, places, things, situations) or internal (e.g., thoughts, memories, images, feelings).

In CBT, we consider a craving any response that increases your motivation to engage in addictive behaviour. It could be an overwhelming sense of stress, intolerable anxiety, or just an irresistible pull towards whatever we’re craving. Understandably, we become motivated to ‘dampen’ these feelings by using the addictive object.

For better or worse, our choice to engage in the addictive object has consequences. The Craving Cycle is called a ‘Cycle’ for a reason – the more we use an addictive object to dampen our cravings, the more frequent and intense our cravings will become in response to our triggers. If we pull into the McDonald’s drive-thru every night after work, we’re only going to become more and more stimulated when we see those golden arches!

We often think of craving as a ‘wave’ – and on a graph of time vs. intensity, it literally looks like one.

Image source: https://www.greatergeelongpsychologyclinic.com.au/blogs/surfing-your-way-to-new-habits

The fact a craving looks like a wave – i.e., reaches its intensity slowly and then dissipates quickly – leads us to call a key CBT strategy ‘urge surfing’. In urge surfing, we are up-skilling ourselves in the ability to handle difficult craving-related feelings.

What is the Craving Cycle?

The Craving Cycle is understood as having four component parts – 1) the trigger, 2) the addiction-related thought/s (i.e., thoughts that justify using the addictive object), 3) the craving itself, and 4) the choice to use.

Trigger Thought/s Craving Choice to Use

How can I better manage these cravings?

The first and most basic step is to, as much as possible, eliminate both a) triggers, and b) access to the addictive stimulus. Eliminating triggers can be easy in some cases (e.g., not driving past an outlet for the object) but harder for others (e.g., inevitable thoughts, memories, and feelings). This is why eliminating access is so critical – if we have access to the addictive object in our household, we’re vulnerable to lapsing if/when a craving arises.

When most people think about eliminating triggers and/or access, they can become pretty overwhelmed. Sometimes, it’s near-impossible to totally eliminate triggers or access. In those cases, it becomes critical to learn how to ‘urge surf’ and deal with the difficult thoughts and feelings associated with this. Once we have a tried-and-true strategy to manage these, the urge to use becomes less daunting. In CBT, urge surfing is one of the most important strategies you’ll learn.

The good news is that the more we crave without using the addictive object, the less intense and frequent our cravings become. Cravings are a ‘use it or lose it’ response – the less we give in to them, the less likely they are to return. For this progress to be consistent, though, our behaviour also needs to be consistent. Lapses and relapses, no matter how short, can bring our cravings roaring back.

If you’re looking for some individualised and structured support, and want to start beating your cravings, the team at Your Mind Matters can help. Give us a call to book in an initial consult, and make mention if addiction is a particular concern for you.

There are also support groups available in the community (such as SMART Recovery and various Twelve Step programs) that can make recovery a less lonely experience. Lots of self-help resources can be found online, and online/telephone support services are listed below:

Alcohol and Drug Counselling Online: https://www.counsellingonline.org.au/

Positive Choices (Drug and Alcohol Information): https://positivechoices.org.au/

Family Drug Support: 1300 368 186

Gambling Help Line: 1800 858 858

Lived Experience Telephone Support Service (LETSS): 1800 013 755

References

Centre for Addiction and Mental Health. (2020). Cognitive behavioural therapy (CBT) for problem gambling. Centre for Addiction and Mental Health. https://kmb.camh.ca/ggtu/knowledge-translation/cognitive-behavioural-therapy

Fong, T. W. (2006). Understanding and managing compulsive sexual behaviours. Psychiatry (Edgmont), 3(11), 51-58.

Gonzales, M. (2020, February 27). What is Cognitive Behavioral Therapy (CBT)? DrugRehab. https://www.drugrehab.com/treatment/types-of-therapy/cognitive-behavioral-therapy/

McHugh, R. K. (2010). Cognitive-Behavioral Therapy for Substance Use Disorders. Psychiatry Clinics of North America, 33(3), 511-525.

Naqvi, N. H. (2015). Cognitive regulation of craving in alcohol dependent and social drinkers. Alcohol: Clinical and Experimental Research, 39(2), 343-349.

National Institute of Clinical Excellence. (2011, February 23). Alcohol-use disorders: Diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence. National Institute of Clinical Excellence. https://www.nice.org.uk/guidance/cg115

This blog was written by Patrick (Paddy) Carey – Clinical Psychologist at YMM.

Paddy works with adults presenting with anxiety disorders, mood disorders, trauma and stressor-related disorders, obsessive-compulsive disorders, substance and gambling issues, psychosis spectrum disorders, and grief and loss. He is trained in Cognitive Behaviour Therapy (CBT), Acceptance and Commitment Therapy (ACT), Cognitive Processing Therapy (CPT), Metacognitive Training (MCT), and mindfulness approaches.

Paddy is focused on developing warm, trusting, and strengths-based relationships with clients. He recognises that his clients are the foremost experts in the room, and unearthing their own expertise is crucial to applying his skills. Most importantly, he’s invested in moving towards a client’s own definition of recovery – i.e., what will be the most meaningful and fulfilling life for them beyond their current struggles.

To learn more about Paddy, check out the “Our Team” page on our website! https://yourmindmatters.net.au/our-team/

A Word on Addiction

laura on 21/10/2016

Addiction is defined as not having control over doing, taking or using something to the point where it could be harmful to you. Addiction is a physical and/or psychological need to use a substance, often caused by regular continued use. It is most commonly associated with gambling, drugs, alcohol and nicotine (smoking).

However it’s possible to be addicted to just about anything such as shopping, mobile phones, solvents (volatile substance abuse is when you inhale substances such as glue, aerosols, petrol or lighter fuel to give you a feeling of intoxication ) and work.

Signs and symptoms of substance abuse or addiction:

Regular or continued substance use to cope emotionally, socially or physically
Neglecting responsibilities and activities that are important or enjoyable (e.g. work, study, family, hobbies, sports, social commitments)
Participating in dangerous or risky behaviours as a result of substance use (e.g. drink driving, unprotected sex, using dirty needles)
Relationship problems (e.g. arguments with partner, family, friends, or losing friends)
Physical tolerance – needing more of the substance to experience the same effects
Withdrawal – physical and mental withdrawal symptoms when you are not using the substance or needing the substance to feel “normal”
Losing control of your substance use – being dependent or unable to stop even if you want or try to
Substance use takes over your life (e.g. spending a lot of time using, finding or getting the substance and recovering from the effects)

Main reasons people misuse substances:

People use drugs and alcohol for many reasons

To relax
Have fun
Socialise
Cope with problems
Escape life or dull emotional/physical pain.

However using substances to cope doesn’t make problems go away, and can make them worse or add new problems to the mix. Substance abuse and addiction can have short-term and long-term impacts on physical, mental, social and financial health.

Get help if you are experiencing any of these effects:

Physical health– nausea, aches and pains, sleep problems, weight gain/loss, infections, accidents, illness or chronic disease.
Mental health– depression, anxiety, paranoia or psychosis
Personal relationships– family problems, arguments, relationship breakdowns or a loss of friends
Work or financial– job loss, trouble at work or study, debt or unemployment
Social impacts– loss of interest or time to do things you like, reduced participation in social activities, criminal problems, anti-social behaviours or isolation

What you can do

It is difficult to accept you have a problem and to ask for help. Be honest with yourself and others and get the help and support you need.

Recognise when your substance use has become a problem– realising and accepting that you are abusing or addicted to substances is the first step to finding help.
Get support– getting through this on your own can be difficult. Talk to friends, family, your doctor, other health professionals or a telephone helpline (e.g. Lifeline, 13 11 14) about your substance use. The following will provide help and assistants and point you in the right direction if you need further help.
Investigate options for help– manage and treat substance misuse and addiction through counselling, medication, rehabilitation centres, self-help programs or support networks. You might need to try a number of options before you find what works for you – it’s important to keep trying. DONT GIVE UP!!!!!
Find alternative coping strategies– if you are using substances to cope with life or escape personal problems, find other ways to manage the situation and deal with life’s stress and pressures. By dealing with other problems in your life you can make it easier to recover and not relapse.
Deal with setbacks and keep going– Recovery can be a long and difficult road. Expect some setbacks and don’t focus on failures, focus on your plan and understand your triggers and how to best respond to them in future.

The information within the blog has been sourced through https://www.lifeline.org.au/Get-Help/Facts—Information/Substance-Abuse—Addiction/Substance-Abuse-and-Addiction and http://www.nhs.uk/Livewell/addiction/Pages/addictionwhatisit.aspx