Cravings exist to direct our behaviour, that is their sole purpose, and we can’t prevent them coming because it happens entirely automatically. They are launched by our drinking triggers but we have so many of those that avoiding them all is impossible. Cravings are going to come, it is inevitable, and they will continue to come until our brain learns that alcohol does not follow, no matter how vigorously it insists. But it never completely learns this. What it learns is that demanding alcohol doesn’t work as often as it used to, so it slowly reduces the importance of acquiring it, and that means that the intensity of the cravings is also diminished. There is a crucial piece of knowledge about cravings that was mentioned previously but it is repeated here because it is so important: – Every time we resist a craving then the intensity of the next craving induced by that trigger is diminished.
This is how we overcome cravings. We do not have to resist powerful cravings forever, we have to resist them to reduce their intensity and eventually they become small enough that they no longer disrupt our daily lives. Each time we overcome a craving improves our chances of beating the next one, so every craving we overcome is progress. At first they are excruciating. I remember the times that the primal scream in my head to go and get a drink was so insistent that it had me crying into a pillow to hide the noise and tears. But every time we overcome a craving we improve our position, so celebrate that. If you beat a big one then this is a win and it means that the next craving from that trigger will be slightly smaller. It means that you have overcome the biggest craving that this trigger can throw at you, so you can beat the next one too. Every craving we overcome is progress and this is how we win through: one craving at a time.
Do not underestimate the severity of this challenge. Stopping drinking is hard and people that say otherwise are either lying, don’t understand, or are trying to sell you something. Those that have stopped drinking don’t say it is easy, they say it is worthwhile, and that it gets easier as long as you keep going. But when we first stop drinking the cravings can be huge and come so close to each other that they seem virtually continuous. At first the fight is exhausting and this places us at great risk because our mind’s ability to launch cravings is limitless but our resolve to fend them off is finite. For us to succeed we need to be able to keep going without being crushed by the weight of the challenge. We can’t simply avoid all triggering circumstances because we need to experience cravings and overcome them in order to make the individual triggers lose their power, but there two things that we can do that will help us get through the first few weeks. We can reduce the number of cravings that we experience, and we can reduce their duration. This will cut down the effort that goes into fending off cravings and this in turn prevents us from completely depleting our resolve.
We must confront and overcome cravings because that is how we make them decline. But when they come one after another, relentless and ferocious, then they can wear down our ability to fight back. If we can reduce how severely our resolve is tested, and if we can spread the cravings out, then we greatly improve our chances of getting through. We can’t prevent all cravings as almost every aspect of our daily lives has drinking triggers attached, but we can remove some for a while and reduce the load. Ultimately we have to face the cravings of all of our drinking triggers to take the power out of them, but we don’t have to face them all on Day One.
The previous chapter described how cravings work, how they work differently in us, and explained why we have no control over how much we drink. But it also contained some really important features of triggers and cravings that we can use to help us stop.
- Stopping drinking is completely necessary. We have no control over alcohol; we never have and we never will. There is no time in the future that we can ever safely drink again because we have no “off” switch. We may take strength from our triggers but they never disappear completely. They will re-strengthen if we drink again and our drinking will again spiral out of control.
- Triggers gain strength when we repeatedly drink in response to the craving they launch.
- Cravings are stronger when we are close to the triggering circumstance.
- Cravings have limited duration. A single craving does not go on forever; it comes and then it will fade away.
- Cravings are automatically triggered by circumstances in which we have drunk before. The more often we drink in a particular circumstance then the stronger that trigger becomes. If we place ourselves in circumstances that we drank regularly then this will trigger powerful cravings.
- We reduce the intensity of cravings by not giving in to them. If we repeatedly resist the urge to drink then eventually the intensity of the cravings will reduce to a point that we can step past them without disturbing our day.
These pieces of knowledge give us ways to help ourselves stop, and we need to engage all help available.
Stopping drinking is completely necessary. There is no wriggle-room here. Stopping drinking isn’t optional, it is essential. This isn’t what we want to hear but facts are facts. We lack the means to control our drinking: we’ve never had that ability and we will never develop it. If we carry on drinking then everything will get worse and worse and eventually it will kill us. But the whole idea of stopping fills us with dread because our mind screams at us that stopping drinking means stopping fun! But this is a lie. The whole idea that we are consigning ourselves to a miserable future is false and the idea that we are missing out on fun is also false. These will be discussed later in the book so for the moment just take is on trust: it is an illusion that we will be unhappy if we don’t drink. It is a piece of self-sabotage that our mind creates to try to make us drink again. We can never safely drink again and this is non-negotiable. Our minds can spin as many plausible sounding justifications as it likes for having a drink but none of them defeats the very simple fact that we lack the normal means to keep our drinking under control. We are never going to “regain” this control because the truth is that we never had the ability in the first place. It is non-existent and we do not suddenly develop it by stopping drinking for a spell. If this was how it worked then curing alcoholism would be easy. You would simply need to deprive people of alcohol until they grew the means to control it. But “drying people out” does not restore the means to control their drinking because that control is forever absent. We don’t grow a new one just like we don’t grow a new limb if we lose one in an accident. Nobody that has become alcoholic has ever been able to safely drink again. Millions have tried and all have failed. You might be tempted to try too but you will fail. Nobody has ever done this and you will not be the first. If the idea jumps into your head that you might be able to control your drinking now then crush it because you cannot. This is not a failing on your part; it is a fact of life. The idea that we will never be able to drink again is a bitter pill to swallow, and most of us really struggle with this truth, but it is the reality of our position. Whether or not we accept it on the say-so of others, or because it is written in a book, or whether we learn this through first-hand experience is up to us, but we must learn it somehow because relapse is guaranteed until we do. If relapse is the price we pay for fully knowing that we can never drink again then so be it; it is worth it.
Triggers gain strength when we repeatedly drink in response to the craving they launch. The message here is “stop strengthening the triggers!”The secure knowledge that we can never safely drink again is a firm barrier against taking the first drink and that is the best boundary we can set ourselves. “Don’t pick up the first drink” is the single most important advice we can be given. It might seem that the reason for this guidance is that if we don’t have a first drink then we can’t get drunk, but that is not what’s behind this advice at all. Our problem isn’t actually the fifth, sixth or tenth drink, it is the first one, because having one dissolves all objections to having another. If we take one drink then we have almost certainly placed ourselves somewhere that alcohol is available which means we are in close proximity to many triggers. This also means that as soon as we have finished the drink then we will immediately be urged to have another and that craving will be strong because we are close to the triggering circumstance. The idea that “just one won’t hurt” is wholly incorrect. One will hurt because it is extremely likely to lead to a second and a third. The idea that one won’t hurt, whether it comes from someone else or from within ourselves, is not only wrong; it is absurd. When I drank I never had “just one”; never! The idea that I might now somehow keep my drinking to just one is a complete fantasy; I never could before and nothing has happened to change that. I found this to be an invaluable mantra when “just one” called as it spoke my new truth about alcohol: “One is too many, ten is not enough”.
Cravings are stronger when we are close to the circumstances of a trigger. It is extremely difficult to get sober if there is alcohol in the house and this feature of cravings explains why. If we know there is alcohol nearby then this will trigger almost continuous cravings and these cravings will be powerful because the source of the trigger is close. The great risk here is that confronting continuous and powerful cravings is exhausting and if it continues for too long then our resolve becomes depleted and resistance fails. This is why it is so important to remove alcohol from the house if that is possible. Buying alcohol also puts us close to it and is just as impossible to manage. If the idea pops into our heads that it might be good to have a bottle or two handy “just in case” then it needs to be crushed. If we buy alcohol then we are going to drink it, all that is undecided is when. So stay away from places that sell alcohol and remember that the closer we are to alcohol then the stronger are the cravings. So don’t even pull into the car park of places that sell alcohol because once there the intensity of the motivation to go in and buy some will be even stronger.
Many people can avoid having alcohol at home but the world is awash with it and virtually every social occasion is accompanied by drinking. We can’t avoid alcohol forever, indeed there are good reasons that we must not, but in the early days and weeks of stopping drinking it is extremely challenging to be in circumstances where people are drinking. But there is still something important that we still have control over and that is closeness. If we are at an event of some sort and the presence of alcohol is pulling us strongly then those cravings will lessen if we move away. We can step away for a spell, or if necessary we can leave. If we are going to an event where there will be alcohol then we know this could be a problem so we should prepare a way to leave if we need to. Often the simple knowledge that we have a way to leave if necessary is sufficient to get us through a challenging occasion. Another thing we can do to help ourselves on these occasions is arrange to be accompanied by someone who knows that we aren’t drinking. Having someone there that knows we are not drinking both provides encouragement to persevere and also makes us very directly accountable in that time of heightened risk. This will boost our resolve but we can also lift it with a little awareness. If we know that we are going to an event at which there will be alcohol then we can prepare ourselves. We know that cravings will come and we should anticipate them. Then, as they arrive, we can acknowledge them rather than be surprised, and we can let them do their thing and pass because we know that they will. If the cravings become problematic then we can be confident that we have two ways to deal with it, we can either give ourselves a short break by moving away for a while, or we can leave altogether. These actions will lessen or remove the craving but social events are about the occasion, not the alcohol, and this is a completely new concept to us. For years we regarded social gatherings as opportunities to drink and we need to readjust that because the other people aren’t there for the drinking, they are there for the event. They aren’t thinking about their next drink, they are enjoying the occasion. We are the only ones fretting about alcohol and we are the ones whose thoughts are preoccupied with drinking; other people can take it or leave it.
Delay: Cravings have limited duration. The advantage we can win from this piece of knowledge is simple: when we know that each craving will fade then all we have to do is ride it out because it will end. Cravings last about 15-20 minutes, so what we have to do is delay acting on it until the craving has passed and then we will regain control. When a big craving comes we need to buy ourselves some time and the best way to do this is to do something. Don’t just sit there and endure it waiting for it to pass, do something to make it pass. Do anything at all; do some housework, tidy something, build something, cook something, re-arrange something, clean something, go somewhere, go for a walk, jog, swim, write something, or call someone. Don’t just sit there and suffer, because this will make it worse. If the craving is so severe that it is making you panic then calm yourself with some deep breathing. Breathe in for four seconds and then breathe out for six. Concentrate on counting the breaths so you can hear it in your head really clearly. Feel the air going in and then feel it go out. Hear the breath going in and going out. Keep going for a few minutes and keep concentrating on what you can hear and feel. This will calm you.
Distract: Sitting and enduring a big craving is about the worst thing we can do. If we sit there alone with our thoughts then the craving is going to direct our thoughts towards alcohol which will bring in other related thoughts, and soon it is all we can think about. What this does is it keeps the craving growing and it re-triggers us because we don’t have to be in the presence of a trigger for it to fire; imagining it will do the same thing. This is why doing something is so important. If we choose the right sort of activity then we can occupy all the thinking capacity of our mind and leave no space for thoughts of drinking or other triggering ideas. If we can distract ourselves powerfully enough then the craving will pass while we are busy doing something else and we will not finish one craving only to have it replaced by another. If our mind is fully occupied doing something else then a craving cannot grow and being engrossed in something that requires our full concentration achieves this. But the opposite is also true. If our brain has spare capacity then it is going to fill with thoughts that initiate cravings and time alone is when we are most exposed to this. The best activities for overcoming this are those that require us to think and also use hand-eye coordination, and the list of activities listed earlier all do this with one exception, and that was “talk to someone”. The reason this works is that talking to someone else makes us concentrate on what they are saying in order to respond and this forces a change of subject on us. If people have said “call me if you get into trouble” then when you are really struggling with a fierce craving is the time they were talking about. If you have some numbers then make the calls; this is why you were given them. People gave them to you because they know that talking to someone else can help you past the peak of a craving and back to safety.
Big cravings are inevitable and it is well worth taking the time to prepare for when they come. Prepare some tasks that will fully occupy your mind and hands and have them ready-to-roll for when you need them. If the task requires some materials and/or tools then have them gathered together somewhere and ready for an immediate start. If these jobs can leave you with a sense of accomplishment then there is an added bonus: not only will it get you past the craving you will come through it feeling good within yourself.
Deny: We can delay acting on a craving, and we can distract ourselves until a craving passes but there is one more thing we can do as a back-stop: we can deny ourselves the opportunity to drink even if resolve collapses. If we lack the means to acquire alcohol, then even if we can’t beat the cravings we can still avoid acting on them. We can do things that will prevent ourselves from being able to buy drink even if we want to. Not having alcohol in the house is an obvious start on this but I had the good fortune to be living with a very supportive partner and this gave me some extra opportunities. They kept my keys and wallet so that I couldn’t go out without being accountable. If I went out then I told them where I was going and for how long and they could call me at any time. I kept my phone with me and turned on at all times. If I needed to turn my phone off then I let them know why and for how long.
If you live alone or with someone that isn’t so supportive then these opportunities to be held accountable may not be available, but there are still things you can do. Find ways to be accountable for the times you are alone and with the means to buy alcohol. Ask people to confirm where you go and when you return. You can pre-arrange to call people to do this or ask them to call you. If you are out, then have someone with you that knows they should stop you from drinking and give them permission to be assertive if necessary. Assure them you will thank them for it later even if you protest at the time, because it is true; you will. Assume that you will be confronted by a craving of such intensity that you want to drink, and plan in advance to deny yourself the opportunity to do so when it happens. I had to assume that I could not be trusted to stay away from alcohol in my time alone. I had failed to do so for years previously and had no reason to expect that this had suddenly changed for the better.
Cravings are triggered by circumstances in which we have drunk before. This tells us that if we go somewhere where we used to drink regularly then this will trigger powerful cravings. To a certain extent we can anticipate when we are going to be triggered strongly and this gives us options; we can prepare ourselves for cravings that we know are going to come or we can avoid the circumstance altogether. This second option can be a good choice in the early days of stopping drinking when the cravings can be massive and our resolve to overcome them is limited. We don’t need to avoid everywhere that we used to go forever but it can be a prudent precaution for a while. What can be surprising though is the all-embracing extent of our drinking triggers. The more obvious drinking triggers are the direct sights, smells and sounds of alcohol. But we are also triggered by everywhere we have drunk regularly and the routes leading to these places. We will also be triggered by the times of the day and times of the week that we routinely drank, and additionally, all of our drinking triggers can be fired indirectly. We don’t need to be physically in the circumstances of the triggers; imagining them or seeing them in the media will fire them just as though we were actually there in person.
There will be certain places that are guaranteed to bring on powerful cravings. These are places that we used to drink and places that sell alcohol; bars, restaurants and liquor stores etc. So avoid them all. Do not expect to be able to get sober if you walk into a bar every day after work because it’s not going to happen. Do not expect to be able to resist buying alcohol if you walk into an alcohol shop while you have a think about it; you won’t. Do not expect to be able to leave alcohol in the bottle if you have some at home; you won’t. So avoid situations that you know are going to bring on severe cravings until you are better able to fend them off. But of all the circumstances that will trigger the most powerful cravings the commonest are associated with the times and places that we drank regularly in, and we can do something specific about these.
In the early days of recovery it is wise to take quite extreme measures to reduce the pace that we get hit by cravings. Some are unavoidable, but many are not and there are many things in our daily routines that will initiate cravings. In particular there are times of the day and times of the week that we normally drank and these times are themselves triggers. But we can radically change our normal activity around these times and this will remove a lot of severe cravings from our path. By deliberately planning to be busy at the times we would normally drink then we can make getting through these periods much easier. Activities that involve us being with other people in a non-drinking setting are good, but so are tasks like the ones that were mentioned earlier as distractions. However we negotiate these periods the main thing is to fill those times with some sort of deliberate activity. If we sit idle at those times then we guarantee bringing severe cravings on ourselves. We don’t have to avoid these times and places for the rest of our lives, but we do need to avoid them until the cravings that come with them reduce in intensity. In time we will be able to go into places where alcohol is available and retain proper free-will and we will be able to choose to not drink, but that time is significantly later. We need the cravings to subside to a level that we are confident that we can manage them before any of this is achievable. Before we reach that stage we need to keep the cravings spaced out enough that we have the strength to confront them when they do come, and if this means becoming a social absentee for a while then so be it. This is what will allows us to live freely in a world awash in alcohol later on, but early on we need some space between major cravings to keep our resolve up. Occasionally though we find ourselves hit by a sudden intense craving that comes apparently out-of-the-blue. While we take the vigour out of the triggers that we meet frequently we do not strip much strength from triggers that we rarely meet, and this is where those startling and sudden cravings come from. They are usually triggers associated with a drinking routine that we no longer follow because we changed jobs, or where we live etc. These cravings are alarming and intense but most often we get past them fairly easily because by the time we are hit by them our resolve is usually in reasonable shape. But recognise that it will happen, and when it does it is not that you have suddenly gone backwards, it is because you have fired a trigger that has not yet been de-powered.
The last circumstance that is virtually guaranteed to trigger strong cravings is time alone and this is one of the most challenging times for us. Not only can no-one see us (“no-one will know!”) but our racing mind churns over all our problems and the distress this causes triggers cravings. Worry isn’t an accidental process; it evolved for a specific reason. Our brain needs information to be orderly and resolved in order to make effective decisions, and good decision-making can be critical to survival. This is why we worry: to try to bring uncertain or conflicting information to a conclusion. Our brain uses its spare capacity during idle time to review unresolved issues. This is why time alone doing nothing is so problematic for us because sitting doing nothing is guaranteed to bring out all the issues that we are dissatisfied with. Going over and over all the things that worked out badly and stressing about current problems are all triggering so we soon we find ourselves in severe need of a drink. Time alone is guaranteed to bring on strong cravings in the early days of stopping drinking. We need to do what we can to negotiate it successfully and we help ourselves in two ways. We can deliberately fill as much of our time as possible with activities that involve other people, and we can deliberately prepare to keep our mind occupied during the times that we are alone. These are the same types of activities that were mentioned when talking about distraction and they serve the same purpose here, except that we can use them pre-emptively. We know that time alone with our own thoughts will be challenging so we can start doing the things on our list of distracting activities before the cravings even come. Anything that can command our concentration will prevent our mind having the spare capacity to worry and this in turn will prevent unnecessary cravings.
The final word on things we can do to mitigate cravings goes to medication. There are medicines available to address cravings and if you haven’t been to visit a doctor before then it is worth doing so. A doctor’s visit will achieve several things; it lets somebody else know that you have recognised that you have a problem and are going to try to stop drinking. This stops it being a secret. The doctor may be able to prescribe medication that will help with the cravings, and they may be able to suggest or refer you to other support channels. At the very least you will feel as though you’ve done something to help yourself. All will help, but in particular the medication, and even the simple act of taking it, may help you through the first days and weeks.
There are three types of medication available to address cravings. The first is somewhat brutal as it will make you violently ill if you drink while taking it. Antabuse (Disulfiram) is the best known of these. What it does is it prevents the body from fully processing away alcohol and this causes a severe hangover that lasts a long time. Having drunk on it once leaves you with a powerful motivation to not repeat the experience and this shows just how brutal the medicine is. One of the features of addiction is that we don’t readily make alcohol-avoiding triggers, but the experience of drinking while on Antabuse is so unpleasant that it forces us to form one. The next group of medications are those that aim to reduce cravings; both the frequency and the intensity. Campral (Acamprosate) is the most well-known of these and it acts to slow down the brain slightly thereby reducing agitation. The third group works directly on the reward system. Naltrexone is the most well-known of these and it works by blocking the detection of dopamine in our brain. What this does is that it lowers the intensity of cravings and it also removes the “aaahhh” sensation of relief we get when we have a drink. By removing the reward component of the reward system our brain thinks the trigger has failed and it reduces its strength in exactly the same way we do when we experience a craving but do not drink in response to it. The other thing that blocking dopamine does is that it prevents the motivating urge of a craving from being detected in the brain: it makes alcohol uninteresting to us! This sounds like a wonder-drug but it has its drawbacks. It doesn’t work for all people, it can have some serious side effects that make it unsuitable for some, and to get the best benefit from it requires that we take the drug and also drink in a very specific manner. This requires taking Naltrexone in a controlled environment and few doctors are able to offer that. Naltrexone can also be prescribed in a low dosage. This is suitable for self-administration and can reduce the intensity of cravings, but this low dosage doesn’t work for everyone. Doctors may also be reluctant to prescribe naltrexone because it isn’t alcohol-specific; it blocks detection of all reward system dopamine. This means that naltrexone blocks all directives coming from the reward system, including the ones we still want. A doctor can advise on what medication is available to help with cravings and they can connect us with additional alcohol services. Both will help but a doctor can also give us important guidance on dealing with withdrawal. The principal action of alcohol on the brain is that it slows everything down. When we drink regularly and heavily then our brain puts in place defensive measures in an attempt to offset this impairment and it speeds things up in various different ways. To a certain extent we are already aware of the consequences of these changes because the morning-after ‘shakes’ are one of these. But when we stop drinking completely and abruptly then our brain continues all the defensive measures and for the first time we fully feel what our mind and body were being put through every single day just to keep them working while we drank. Withdrawal can be shocking but for some it can also be dangerous. The first signs of alcohol withdrawal appear within several hours after our last drink and peak over the course of the next three or four days. Symptoms of withdrawal typically include a pounding heart, overheating, cold-sweats, sleep loss, anxiety, agitation, nausea and tremors but in serious cases can include seizures, heart irregularity, confusion and even hallucinations. The serious consequences of withdrawal are uncommon but they are also not rare. About one in twenty people will suffer serious symptoms in withdrawal but there is no confident way to predict who will and who won’t. This is why it is important to seek advice if you are at all concerned. This chapter has looked at many ways we can help ourselves manage and negotiate cravings. It has shown how we can reduce the number of cravings we experience, reduce the duration of the cravings, and also reduce the intensity of the cravings. The aim is not to avoid all cravings because we must experience and overcome cravings in order for them to lose their vigour. The aim is to reduce and spread out the impact cravings have on us so that they don’t overcome our resolve. The drinking triggers we have looked at so far are all triggers that have a specific link to a drinking circumstance; the sight, sound, or smell of alcohol, a specific location or time of day, or certain types of social event. But there is a whole other set of drinking triggers that can fire independently of the availability of alcohol, or time, or place, and these triggers are emotions.