Triggers and relapse, a craving connection for addicts

I’ve already written about one reason why cravings make quitting difficult (find it here). However, cravings and triggers are not just abstract concepts; they are well known, important players in addiction research and I think they deserve some more attention.

What are triggers?

A trigger can be thought of as anything that brings back thoughts, feelings, and memories that have to do with addiction (like a computer reminding a sex addict of porn). In addiction research, these are often simply called cues. The word comes from learning research in which a reward (or punishment) is paired with something (the cue).

For instance, in Pavlov‘s classic experiment, a dog heard a bell ring right before it would get served its daily portion of meat. The dog quickly learned to associate the bell with food, and would begin salivating as soon as the bell would ring, even before the food was presented. In this case, the bell was the cue, and food the reward it was paired with.

The story in drug addiction is similar. I’m sure many of you can relate to the overwhelming memories and emotions that seem to come out of nowhere when you hear music you used to get high to or pass a street where you used to buy drugs (or sex). Each of those examples is a trigger that is simply bringing about a similar reaction to Pavlov’s dog’s salivation. Seeing these things, or hearing them, creates an immediate response to the reward that it was paired with, the drug!

Triggers, cravings, drugs, and relapse

As if matters needed to be made worse, triggers not only bring about responses that make you think about the drug. In fact, over and over in learning and addiction research, it’s been shown that triggers actually bring back drug seeking, and drug wanting, behavior. As soon as a cue (or trigger) is presented, both animals and humans who have been exposed to drugs for an extended period of time, will go right back to the activity that used to bring them drugs even after months of being without it. In fact, their levels of drug seeking will bounce back as if no time has passed. Sound familiar?!

Given these findings, is it any wonder that cravings bring about relapse in so many addicts who are trying to quit? If simply thinking about, or hearing, something that was always tied to drugs can bring about such a strong response, what is an addict to do?

Is there a solution for addicts??

For now, the simplest way to break the trigger-response connection is simply repeated exposure without the reward. As bizarre as this may seem, staying away from the triggers can make their ability to bring back the old drug-behavior stronger. Obviously, this isn’t something that should be undertaken lightly. I’m currently working on putting together a drug treatment system that specifically addresses these issues so that with help, users can eventually release the hold that triggers have over them.

In the meantime, be honest with those around you, and if you’re seeing a therapist, or a good case manager, tell them about your triggers so that you can hopefully start talking about them, and re-triggering them in a safe environment. As always, feel free to email me with any questions you might have.

Cravings – The all consuming experience of wanting something

In my studies of addiction, the concept of cravings comes up often. Researchers talk of “wanting” versus “liking” of drugs and of the idea that cravings are a programmed response to environmental signals that have been connected to drug use through experience.

What are cravings?

I agree with these descriptions and the idea that cravings are strong memories that are linked to the effect of drugs on the brain’s neurochemistry. The immense neurotransmitter release that is often brought on by the ingestion of drugs is responsible both for the experience and the lasting effects on learning. When it comes down to it, memories are really the brain re-experiencing an event, so it makes sense that reliving a drug, sex, or other past-compulsive experience would cause a serious emotional reaction.

But aside from all the research, I know very well what cravings feel like. I know the intoxication you feel the moment that memory hits you and your entire body tingles with anticipation. It’s as if your whole being is crying out saying “This is what we’ve been waiting for. Give it to me!!!” I never know to expect it, but when they hit, there’s no questioning – I know that a craving has just taken over me. It’s no wonder that people go out over these things, especially early on in recovery.

How to deal with cravings

I’m now at the point where no matter how strong the craving, I’m not about to throw everything I’ve worked for out the window for another hit. But still, it’s just so damn tempting.

When you have a craving, recognize it for what it is. You might as well enjoy the rush, it’s like a freebie you don’t get to control. By being scared of the feeling, you induce more anxiety and shame that may lead you to act out. Instead, recognize your lack of control over the craving, let the experience happen, and go on with your life.

If the experience is overwhelming, make sure there’s someone you can talk to about it (a therapist, partner, parent, or 12 step sponsor). As time passes your cravings will become less and less frequent, though without specific treatment, their intensity will likely not go away.

Cravings are a part os the reality of addiction – knowing what to do with them is a key to success.