I teach patients that the time period in between substance craving and substance use is critical.
Cravings will progress to relapse unless an intervention is made.
There are a few specific CBT interventions that are used:
1.Going with the craving
Many patients are surprised to learn that cravings are actually time limited. Cravings start, intensify, reach a peak intensity, decrease, then finally resolve. Understanding that cravings are time limited gives patients a sense of control. They realize that there is an end in sight, and that they can get through cravings without using. This technique is sometimes referred to as “crave surfing” because patients are “riding out” the “wave” of the craving.
Physical activity can be very effective. Doing something as simple as taking a walk can definitely be helpful in dealing with cravings. I encourage my patients to join a gym as part of their treatment.
3. Talk about the craving
Talking about an acute problem with another person can be very helpful. I think that most of us can relate to feeling better after talking to a friend or family member about something that is emotionally distressing. The same is true for cravings. Patients can do this by talking to a “safe” person (i.e. someone who will not become alarmed by the conversation), going to a self-help meeting, or going to an online support group. In my practice, I have been pleasantly surprised that online support groups are very helpful for some of my patients.
4. Recall negative consequences and self-talk
“I eventually will not feel better if I use”
“I will remind myself of the benefits of sobriety”
Patients are taught to challenge automatic thoughts –
“I will die if I don’t use” – Is this really true?
“It’ll be just this one time” – Do you really believe that?
All of the above might sound simple in concept.
However, employing these techniques is not necessarily so easy…..