There was one thing about my drinking that I simply couldn’t understand. I was perfectly capable in every other aspect of my life but for some bizarre reason I couldn’t control my drinking. I drank more than I should, I drank more often than I should, and I drank at times and places that I shouldn’t. This inability to control my drinking was beyond confusing. It seemed like I didn’t have an “off” switch when it came to alcohol, and it turns out that this is quite literally the truth.
When an urge to drink comes on us it doesn’t come because we’ve willed it to, it comes entirely automatically… there is no conscious involvement at all. Sometimes we will get a gentle longing for a drink and sometimes we get “I need a drink now!” All of these are cravings and they are all caused by the same mental mechanism; all that differs is the intensity. Cravings don’t come randomly; they are “triggered” by parts of the brain that are collectively known as the “reward system”. The reward system is a group of connected parts that work together to encourage us to do things that aid our survival and to discourage us from doing things that could be dangerous or harmful to our survival. It is a self-learning system that operates entirely automatically. The reward system isn’t unique to humans; indeed it evolved long before we did. The component parts of the reward system lie right next to the brain stem and evolved before our distinctively human cognitive capacity. Our awareness of self and analytical capacity not only evolved after the reward system, it evolved independently of it. Our higher cognitive functions are not directly connected to the much older reward system and this is why we are unaware of its operation. But older does not mean lesser. It directs our behaviour not with language or ideas but with feelings and this makes it incredibly fast and incredibly compelling. The reward system was such an enormously successful evolutionary advance that almost every animal on the planet has it.
The reward system is where our problems with alcohol begin and intensify, but its actions are invisible to us. The only part of its operation we are aware of is the craving sensation, whether this is a gentle, romantic idea that a drink would be pleasant, or the wordless scream that demands we have a drink now. Cravings may appear to pop up in a fickle manner, but they aren’t random at all and neither is their intensity. Cravings are launched when we find ourselves in circumstances that we have drunk before, and the intensity of the craving is determined by how many times we have previously drunk in that circumstance.
The reward system works by invoking feelings of wanting, longing for, or desire for things that are beneficial to us, and then motivating us to approach them. For things that may be harmful we experience feelings of disgust or fear, and we are motivated to move away. But we aren’t born knowing all the things that help or harm us; we learn new ones as we go along… this is why the reward system was such a huge evolutionary advance over instinct. As our life experience grows we encounter more and more things that are good for us or bad for us, and the appropriate behaviour for each circumstance is remembered: approach or move away. In this way we progressively improve our chances of survival. When we meet something beneficial or harmful that we’ve come across before; a circumstance, place, thing, etc. then our brain automatically encourages us to follow the action that was beneficial before; e.g. approach and eat, or hide or escape. When we take the action our brain has suggested as the way to act in this circumstance then then intense urge to act is stopped abruptly and we feel an instant sense of relief. If we were being encouraged to do something beneficial for survival then we first feel the motivation to act in a certain way and then we are rewarded with a sense of relief when we do it. If we are being encouraged to avoid something harmful then we feel fear, dislike or disgust to make us move away, and again, we feel relieved when we do so. The motivating urge to act in a pre-determined way comes from the release of a chemical in our brain called dopamine.
In alcoholics the reward system latches onto alcohol as something very beneficial and it motivates us to drink whenever alcohol is available or nearby. It recognises circumstances that yield alcohol and forms a new process for each of them, we call these “drinking triggers”, and each time we drink in a new circumstance then a new drinking trigger is formed; we end up with thousands of them. But another feature of the reward system is that it reinforces successful triggers. If we were motivated towards alcohol by a trigger, and then did so, then this trigger was a successful one. Successful triggers are more valuable than unsuccessful ones and the brain strengthens the successful ones. If a trigger is successful in securing the outcome sought then its power is increased: more dopamine is released and this makes the motivating urge stronger. If we take the action we are being motivated to perform then the dopamine release is stopped immediately and if the motivation urge was powerful then the sense of relief when it stops is also powerful. The “aaahhh!” sense of ease and comfort that we get on taking our first drink does not come from alcohol (it happens far too quickly for this to be the case) it is the reward system in operation. That surge of relief comes from the abrupt absence of dopamine and this is the “reward” component of the “reward system”.
Evolution made the reward system impart urgency to doing things that benefit survival. However, something beneficial like a food that is available now might not be found again for some time, so the reward system encourages us to take advantage of the opportunity while it is present; but it also encourages us do so efficiently. If for example there is a bird in the middle of a field of fruiting berry bushes then there are berries all around it. There is good food in every direction but it would be inefficient in terms of energy use for the bird to pick berries randomly from all corners of the field. So the reward system evolved to use energy efficiently by encouraging the bird to take the closest ones first. The motivating urge launched by a trigger is stronger when its subject is closer than when the subject is more distant. In terms of alcohol this means that a craving to drink is far more powerful when we are close to the triggering circumstance. But it also means that if we begin drinking in a location where alcohol is freely available then we experience another craving for a drink as soon as we have finished our first one. So once we have started drinking in a circumstance where alcohol is available then our reward system demands that we continue. This encourages us to drink more and to drink for longer than we intended when we began.
Every new circumstance in which we drink forms a new trigger and our brain constantly scans incoming information looking for triggering circumstances that have been met before. Directly seeing or smelling the subject of a trigger will make that trigger fire, but triggers are by no means limited to this direct identification. A flying bird may not be able to see the actual berries on a bush but it can see that the bush is of a type that bears good fruit. And the bird may be so far away that it can’t even see the bush but it can see the terrain that bushes of this type grow. The bird forms triggers for the berries, bushes of the correct form and for the terrain that supports this type of bush and we do exactly the same with alcohol. Yes, we form a trigger to drink whenever we see or smell alcohol but we also form a trigger for a place at which we’ve drunk previously and we also form triggers for the roads that lead to that place. Over an extended period we accumulate hundreds and hundreds of triggers that urge us to drink. The cravings brought on by these triggers grow stronger each time we act on them and they grow stronger as we draw closer to the trigger’s location. But the reward system can be fooled regarding closeness. The reward system evolved before the existence of pictures, photographs, television etc. and it evolved before our human ability to visualise and imagine. To the reward system all of these things are recognised as real. It cannot distinguish between a glass containing alcohol and a picture of a glass containing alcohol; both cause cravings to be launched. Photographs of alcohol and images of people drinking will bring on cravings and even imagining these things will cause the related triggers to fire. We can bring powerful cravings on ourselves by simply daydreaming about drinking.
Whether or not drinking becomes compulsive rather than chosen depends on the vigour that the drinking triggers acquire. The intensity of a craving is determined by how close we are to the circumstances of the trigger and also by the number of times that this trigger has been successful in delivering alcohol. The more often we drink in response to the craving initiated by a trigger then the more powerful that trigger becomes. This means that the next craving we get from that trigger will be stronger. The reward system encourages us to drink more and it encourages us to drink more often, and if this continues unchecked then the triggers strengthen without limit and we become addicted. But everybody has this reward system, so how come that everyone that ever has a drink doesn’t become alcoholic?
Triggers exist to encourage some behaviour and discourage others, but a single subject can have multiple triggers for different circumstances. For example, we might have two triggers for lemons; we may feel the urge squeeze some lemon juice over fried food, but we would recoil strongly from the suggestion we should eat a whole one. Just like the example of the lemon most people have some triggers that encourage them to drink and other triggers that urge them not to. Normal drinkers have triggers motivating against drinking too much and they have triggers motivating against drinking at the wrong times. They have triggers linked to the discomforts of drinking too much; hangovers, vomiting, and loss of control, and they have triggers relating to the unwanted consequences of drinking; failing to meet important obligations, doing things that are regretted or shameful and so on. It is the balance of these competing triggers that most often prevents them from drinking unwisely. But alcohol-avoiding triggers do not form properly in us. We get the strange feeling that we seem to have no “off” switch when it comes to alcohol but we have no direct way of knowing that this is quite literally true. Other people are motivated to avoid drinking or to avoid drinking more, but we never are. Our drinking switch is permanently fixed in the “on” position. It is the absence of these alcohol-avoiding triggers that launches us on a catastrophic trajectory.
In the absence of drink-avoiding triggers finding alcohol becomes increasingly important. The motivation to find and move towards it becomes stronger and so does the sense of relief we get when we secure a drink. Each time we drink alcohol in response to the craving launched by a trigger then the reward system increases the importance of that trigger even further. It is a vicious cycle that leads to us drinking more and it strengthens without limit. Without the drink-avoiding triggers to hold this in check our reward system enters a runaway state which propels us along an ever more urgent pursuit of alcohol. The condition ALWAYS becomes more severe; never better.
The triggers of the reward system, once established, remain in place forever. This is a feature of how the brain works: what has become known cannot become unknown. Once a trigger has been formed then it can never be removed and neither can its associated motivating urge. But while a trigger can never be removed the strength of the craving that it invokes CAN be changed… and this is our way out.
The reward system aids survival but in the wild the availability of something beneficial like an important food can be unpredictable and the reward system accommodates this variability. For example, if we’d learned to sit under a tree because good fruit fell from it then the reward system would motivate us to return to the tree and look for more food and this urge would strengthen each time we found food there. But if the tree stopped producing fruit then we would visit there forever if the motivating urges did not change and this would be an inefficient use of our energy. So the reward system evolved to be adaptable as well as compelling. Firstly, the cravings that are invoked have a limited time-span. If there isn’t any fruit available at the tree when we visit then the urge to continue to search there fades after several minutes and so we lose interest and move on. Secondly, if things stop happening the way that a trigger anticipates then the importance assigned to that trigger is lowered. In exactly the same way that a trigger strengthens through repeated success it is weakened by repeated failure. When a trigger consistently fails to return the object sought then the importance of acting on it (the intensity of the craving launched) is reduced. The brain can’t unlearn that something has been identified as something to be sought out, but the importance of securing it CAN be changed, and it is by successively denying cravings that we reduce their intensity.
By successively denying a craving the reward system recognises that the likelihood of a particular trigger being successful is less than anticipated and the urgency given to seeking out its subject is progressively reduced. This is an incredibly important piece of information for anyone attempting to stop drinking:
EVERY TIME WE RESIST A CRAVING LAUNCHED BY A TRIGGER THEN THE INTENSITY OF THE NEXT CRAVING LAUNCHED BY THAT TRIGGER IS DIMINISHED.
This is how we escape addiction. If this did not happen then the cravings would remain at their peak intensity forever and we would eventually fail because of the enormous effort required to continue fighting them off. We do not manage to stop drinking because we get better at resisting the cravings, though we do get better at navigating them, we are able to stop drinking because over time the cravings fall to an intensity that we can overcome without undue effort.
Success lies in overcoming cravings for a sustained period. Whether this craving comes as a romantic notion that a drink would be nice, or whether it comes as a primal scream that demands that we drink now the process is the same. First we get the motivation to secure alcohol that has been launched because we have found ourselves in the circumstances of a trigger: a time, place, emotion, sound, memory, or daydream of a situation when we have drunk previously. The intensity of the craving will depend on how many times that particular trigger has been successful in delivering alcohol and how close we are to the circumstances of that trigger. Our brain automatically encourages us to drink and our attention is focussed on securing alcohol. What we have to do is interrupt that automatic process and override it. We have to recognise that this urge is NOT what we actually want to do: our brain is deceiving us. We have to recognise the unwanted motivation and reject it. We have to do this time-after time, hour-by-hour, day-by-day. A single failure to intercept and overcome this urge will cause us to relapse. Our resolve to fend off these cravings is finite but our brain’s ability to present them is infinite. It is an exhausting process at first as the cravings come back-to-back and beating them seems like a game of whack-a-mole, but every time we overcome a craving is progress. We reduce the challenge of these cravings by taking the power out of them; one craving at a time, one trigger at a time. It seems at first that we are making no progress, the challenge seems relentless, but each craving we overcome brings us closer to the point that we can get past them without breaking our stride… and that is the goal with cravings. We can’t stop them completely, the triggers remain forever, but we can reduce their power to a point that the cravings they create no longer interfere with our day.
At first the challenge is relentless but over time it eases as more and more triggers are stripped of their vigour. Occasionally we find ourselves in the circumstances of a trigger that still has its full power, a powerful trigger that belongs to a circumstance we haven’t met for a long time, and we get a shocking out-of-the-blue craving. These are alarming and intense but most often we get past them fairly confidently because by the time we are hit by these cravings our resolve is usually in good shape. As time passes more and more of our drinking triggers have their vigour stripped away and we no longer have to constantly fight off the demands that we drink. It takes time, but it happens and for as long as we don’t drink this is guaranteed to happen.
So after all this reading here are the key takeaways about cravings:-
- We do not drink because we are weak. We drink because we are compelled to by the automatic mental processes of our reward system.
- The reward system remembers each circumstance that we drink in and creates an urge to drink if we find ourselves in that circumstance again. The circumstance is called a drinking trigger, and the motivation to drink that it creates is called a craving.
- Cravings are explicitly evolved to direct behaviour. They motivate us to seek, approach, and secure alcohol.
- The reward system operates beneath our awareness. We have no knowledge of the number of drinking triggers we have, or how powerful they have become. Our only awareness of the reward system responding to alcohol is when we get a craving to drink.
- Cravings rise to a peak and then subside.
- Cravings launched by a drinking trigger become more intense the more times we drink in response to that trigger being fired.
- Cravings get more intense when we are closer to the circumstances of the trigger.
- Regular drinkers have a balancing set of drink-avoiding triggers that keep their drinking moderated. We only make alcohol-avoiding triggers very weakly so we do not have an effective “off” switch for alcohol; ours is always “on”.
- Unopposed cravings make us drink more often which further strengthens triggers and tips the reward system into a self-reinforcing feedback loop. This causes drinking triggers, and the cravings they launch, to strengthen without limit.
- Drinking triggers are never forgotten but they slowly lose their vigour when they fail to deliver alcohol. When triggers lose their strength then the intensity of the cravings they launch diminishes.
- The effort of resisting cravings is enormously demanding at first but it subsides as long as we don’t drink in response to cravings. Eventually the cravings become small enough to overcome them without disturbing our day. This is guaranteed to happen as long as we don’t drink.
© Copyright David Horry 2020