The Advocate Magazine Fall 2021 | Page 16

Helping Clients Manage Their Cravings
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• VIDEO : Overt interoceptive craving in action : “ Sesame Street : Ian McKellen Teaches Cookie Monster to Resist ”
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Dr . Earley points out in his book that as overt interoceptive cravings resolve , they are replaced by covert cravings . Treatment staff refers to this craving as the “ I gotta go ’ s .” It typically involves a feeling of restlessness and irritability combined with a false sense of confidence that the client will never be tempted to use substances again . continued on page 17
Romanticizing Substances and ‘ Using Dreams ’
Two phenomena that occur after substance use has ceased — romanticizing substances and “ using dreams ”— must be addressed in the treatment setting .
Romanticizing Substances
In “ The Cocaine Recovery Book ,” Paul Earley , MD , FASAM , describes romanticizing as “ a self-induced elaboration in which drug use is seen as a positive experience , a grand adventure .” Memories of past substance use can trigger the brain to release small amounts of neurotransmitters , such as dopamine , into the pleasure center of the brain . When romanticizing begins , other clients or friends may join the conversation and heighten the stakes by sharing stories . Before long , everyone is craving !
I often ask clients : “ Where on the property of the treatment program does romanticizing occur ?” The response that I hear most often is “ the smoking area .” Why is that ? I believe the primary reason that I get this response repeatedly is that there are usually no staff members around in this location to confront or comment on the clients ’ behavior . If clients were to start romanticizing in the group therapy setting , the counselor would typically redirect the group . Spontaneous cravings are difficult enough , and any opportunity to avoid a self-induced craving episode is a win .
Using Dreams
“ Using dreams ” are an important feature of overt interoceptive cravings because of the visceral nature of the client ’ s euphoric feelings from the substance use they “ experienced ” during the dream . Not everyone will have “ using dreams ,” but those who do typically describe waking up in a panic , fearing that they relapsed and will test positive the following morning . It usually takes a few seconds to minutes for the client to realize that it was just a dream .
Another response from “ using dreams ” is more sinister . Occasionally clients wake up wishing they could go back to sleep and resume the euphoria from the dream . Regardless of the type of “ using dream ,” it ’ s important for the client to share about their “ using dreams ” in therapy . Whether in group or individual therapy , clients are likely to learn that they aren ’ t alone with this experience and also that “ using dreams ” follow a pattern . This knowledge helps them process those events and can greatly reduce any associated risk of relapse from the dream .
“ Using dreams ” not only tend to follow a typical pattern in their intensity , duration , and frequency ( IDF ), but also in their content . Predictably , IDF would resolve due to the brain ’ s elastic healing : Over time “ using dreams ” are less euphoria-producing , are shorter , and happen less often . Not so predicable is the content of the dreams . Clients typically report in the early stages of recovery that the content of their “ using dreams ” is heavy on actual use of the drug of choice . Over time , the dream may shift to include other drugs the client may have used , sometimes drugs they never even tried , and other times they are simply chasing the substance but never using it . As the brain heals , it is constantly integrating things it learns while conscious into the subconscious , and this substitution appears to be a function of that integration .
Clients who continue to report “ using dreams ” well into the advanced stages of recovery often share that the content reflects the value of relationships and how substances might sabotage that . For example , a “ using dream ” might be about how a client never stopped using , was being dishonest to people they love , and felt the resulting peril to the relationship .
Regardless , “ using dreams ” can be disruptive . Typically , the client ’ s sleep is poor , and the day following a “ using dream ,” the client is likely to be distracted and unable to absorb much treatment . In this way , even though the client didn ’ t relapse , the craving alone has caused a significant deficit .
16 The Advocate Magazine Fall 2021 American Mental Health Counselors Association ( AMHCA ) www . amhca . org