Riding the Wave: How to Manage Your Cravings
Cravings are a useful source of information that can illuminate the complex interplay of cognitive, biological, and affective processes associated with substance use.
According to Witkiewitz and colleagues (2013), a mindfulness perspective on cravings assumes a push-pull dynamic wherein an individual may wish to prolong pleasurable states while minimizing and avoiding unpleasant states. However, engaging in substance use or other addictive behaviors may lead to more discomfort and distress in the long-term and may reduce one’s coping resources. Taking a mindfulness approach, with its emphasis on acceptance and acknowledging the transitory and impermanent nature of our experiences, may offer an alternative path for managing cravings.
I frequently hear my clients describe cravings and urges to use substances in a negative light and it’s clear that some of them view cravings as something that one must “battle” with. What they may not realize is that by focusing one’s attention on cravings and adopting a negative stance towards them, we inadvertently prolong their duration and possibly increase the intensity of how they are experienced. Instead, I suggest that cravings can offer important data and that we have the capacity to stop, slow down, and observe them without acting on them. I also propose that a craving itself does not necessitate action. Of course, this takes time and practice. Once we have a sense of the information that is contained in a craving, we can then consider how we would like to respond to it.
…by focusing one’s attention on cravings and adopting a negative stance towards them, we inadvertently prolong their duration and possibly increase the intensity of how they are experienced.-Jenifer Talley
In my discussions with Dr. Andrew Tatarsky about cravings, he has said, “an urge is the axis of change. It’s where biology, psychological meaning, and habit come together. It’s where personal and social meaning converge.” Often, my clients report that cravings are experienced instantaneously and they may act on them without fully considering the consequences or outcome. I offer my clients a different way of relating to this phenomenon we call a craving by starting with observing how it manifests itself. What are the physical sensations associated with a craving? What are the thoughts and emotions that accompany it? Under what context does a craving present itself? Does it feel inevitable to act on this craving?
If we shift away from the narrative that a craving is “bad” or “unwelcome,” then we can invite an exploration of the function and meaning of the craving itself. From there, we begin to “unwrap the urge” and consider an alternative solution or expression that may be the pathway towards recovery (Tatarsky, 2007). By adopting this accepting and non-judgmental stance about cravings, we can reduce the intensity of the reaction and help our clients access other resources to respond skillfully in the moment rather than reacting based on aversion or desire. It is also an opportunity to help boost self-efficacy and demonstrate that they can tolerate their experiences by shifting how they relate to them.
Mindfulness Approach in Action
Here is an example of a recent session I had with a client who is currently in a period of abstinence so that he can pursue his goal of moderation. In the past, he had a tendency to over-drink, particularly during weekends after a stressful workweek.
During our latest session, he reported a strong craving to drink on Friday night, but didn’t act on it, and we explored what happened that evening. He remarked that he was aware of a surge of energy in his body and a series of thoughts stating, “Let’s go! Let’s go to the bar and have some drinks.” After noticing this reaction and recalling our discussions about not reacting to cravings with an action right away, his response was based on an assumption that he had to “get rid” of these thoughts. This led to a state of increased distress that lasted for several hours as he “fought” the urge while continuing to feel tension in his body. He also reported self-critical thoughts associated with his inability to effectively “get rid” of this craving. He was able to not drink that evening by distracting himself and noted that the craving subsided with time.
This led to a state of increased distress that lasted for several hours as he “fought” the urge while continuing to feel tension in his body.-Jenifer Talley
When I asked him if he paused and shifted his focus to breath during this process, he smiled and laughed gently. We both laughed and talked about how it is not necessary to view a craving as a battle. We then began to explore the “why” behind the craving and what that particular moment taught him about his relationship to alcohol. I speculated that perhaps he felt as though he had worked hard all week and was ready to connect to others, which would have been achieved had he made the choice to go to the bar. I wondered whether there might be another way to feel connected besides through drinking. That question remains, but we have begun to explore how his alcohol use has allowed him to shed feelings of social anxiety and feel more connected to others. He also reported seeking the euphoria and excitement he feels after the first few drinks and how it helps settle the anxiety and physical tension he regularly experiences during the week. Our long-term strategy includes stress management and relaxation techniques during the week, and in the short-term, we discussed strategies to use when he experiences cravings.
Understand Cravings with Urge Surfing
One useful strategy for working with cravings is the practice of “urge surfing” as developed by Bowen and colleagues (2012). Urge surfing relies on an image of a wave paired with breathing practices to help reduce the intensity of the physical and psychological reactions to a craving, and also to help foster an accepting and compassionate stance towards one’s experiences in the moment.
This alternative stance is one that allows for observation of the experience with an open and curious attitude rather than judgment.-Jenifer Talley
As highlighted in my case example above, many people have a negative reaction to a craving and may want to either avoid it or try to suppress it. This alternative stance is one that allows for observation of the experience with an open and curious attitude rather than judgment. I guided my client through the practice of urge surfing by inviting him to focus on the sensations in his body along with the emotions and thoughts he was aware of during the craving. We then incorporated an image of a wave and noted how a craving is like a wave in that its intensity ebbs and flows. We reflected on how he could use his breath as a “surfboard” to help ride out the craving. As part of this practice, we were also curious about what was underneath the craving and what the craving might actually be about. For instance, did the craving reflect a desire to relax? Did the craving signify a wish to be free from anxiety?
By observing the craving with this curious and compassionate stance, we can begin to gather information about what is missing and develop other possibilities to meet those needs.
Expand for Resources
Article ReferencesBowen, S., Chawla, N., & Marlatt, G.A. (2010). Mindfulness-based relapse prevention for addictive behaviors: A clinician’s guide. New York: The Guilford Press.
Tatarsky, A. (2007). Harm reduction psychotherapy: A new treatment for drug and alcohol problems. New York: Aronson.
Witkiewitz, K., Lustyk, M.K.B., & Bowen, S. (2013). Retraining the addicted brain: A review of hypothesized neurobiological mechanisms of mindfulness-based relapse prevention. Psychology of Addictive Behaviors, 27(2), 351-365.
Witkiewitz, K., Bowen, S., Haley, D., & Hsu, S.H. (2013). Mindfulness-based relapse prevention for substance craving. Addictive Behaviors, 38, 1563-1571.
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