Cravings Management : It ’ s More Than Helping Clients Deny or Redirect Their ‘ Strong Urge to Use ’
When the new DSM – 5 came out in 2013 , I was excited to learn that its drafters had included “ cravings ” as one of the 11 criteria for substance use disorders ( SUD ). The previous version of that manual , the DSM IV-TR , didn ’ t include cravings , which meant they didn ’ t exist , right ? I have found this not to be the case .
As Licensed Clinical Mental Health Counselors ( LCMHCs ), we ’ ve all had some level of training on identifying and treating substance use disorders . On a client-by-client basis , we must decide whether to refer a client to a specialist or retain the client , in which case we ’ d need to manage the symptoms and treat the underlying condition , within our area of expertise . This article is meant to enhance your knowledge base around treating SUD . If you feel you need more information , you may want to consult with your peers or attend training sessions on this topic .
Doug Paul , LPC , CPCS , LMHC , QS , has been in practice with a specialization in substance use disorders since 2007 . He completed a Bachelor of Arts in Liberal Studies from University of Central Florida in 2002 . He went on to complete a Master of Science in Rehabilitation Counseling from Georgia State University in 2007 . During his graduate training , he participated in university-sponsored research that culminated in presenting the findings at a national convention , and he then went on to present at more than 25 state , national , and international conventions over the next 15 years . From 2007 – 2014 , he assisted with development of a young-adult program at a nationally recognized treatment program in Atlanta . After moving into clinical administration in 2014 with outpatient programming in Atlanta , he is currently the clinical director at Buckhead Behavioral Health , where he continues to provide therapy , program management support , consultation , and supervision to growing clinicians . He continues to practice his own recovery program , as he has for the last 21 years .
The DSM – 5 refers to cravings as “ a strong urge to use .” This seems a bit simplistic , so I prefer this definition from the Substance Abuse and Mental Health Services Administration ( SAMHSA ), a branch of the Department of Health and Human Services : “ an urgent , seemingly overpowering desire to use a substance , which is often associated with triggers of drug use , that creates tension , anxiety , or other dysphoric , depressive , or negative affective states .”
When the drafters of the DSM – 5 wrote about “ a strong urge to use ,” they were making a statement about cravings , which every individual can relate to on some level , regardless of the presence of addictive behavior : coffee , salted-caramel shakes , and even things like exercise and sex ( of course ). The reward system of the brain is complex and is meant to recognize behaviors that are consistent with survival . For those suffering from substance use disorder , alcohol and other drugs hijack this system and use it against them . Repeated use of substances makes the brain believe that the substances hold survival value , and so the individual keeps using them , despite knowing that the substances are causing harm . This concept — continued use despite harm — is a hallmark of the disorder .
The DSM – 5 makes it clear that craving is the only criteria that continues into and past the period of post-acute withdrawal . For most people who receive proper treatment for a substance use disorder , whether that ’ s seeing a therapist once a week or attending a residential program , their social , interpersonal , occupational , physical , and psychological issues typically resolve in the first three to six months of recovery . The craving for substances , however , can continue well past that time . These cravings typically occur on a timeline from when an individual is using substances , through any attempts at abstinence or recovery , and into the period of post-acute withdrawal and beyond . continued on page 15
14 The Advocate Magazine Fall 2021 American Mental Health Counselors Association ( AMHCA ) www . amhca . org