Helping Clients Manage Their
Cravings continued from page 16
Covert craving is a behavioral craving , and the client usually reports an intention to remain in recovery . Instead , they are drawn out of their treatment mindset by outside issues . A client may feel the sudden need to return home to mend their lives ( which took years to shatter ), not realizing that their distraction is very subtly placing them in jeopardy . Acting on this impulse , they attempt to leave treatment early . Anyone who endeavors to talk them out of leaving early is pushed away with anger .
Irritability is a primary symptom of covert craving . Treatment staff are trained to implement any number of interventions to prevent a client leaving treatment , with the primary goal of allowing 48 – 72 hours to pass so that the episode resolves . Interventions used typically reduce confrontation , engage the peer group , and honor autonomy for decision-making . The paradox of the profound loss of insight that is secondary to advanced-stage substance use disorder combined with honoring autonomy for decision-making is intentional — and necessary .
• VIDEO : A scene in a bar from the 2012 movie “ Flight ,” featuring Denzel Washington , that depicts covert craving
VIDEO LINK : https :// www . youtube . com / watch ? v = yZbvbWznmaM
“ Nothing in our evolutionary training prepared our brains for the massive surges that modern drugs release in comparison with more predictable rewards like food or sex . “
Conditioned cue craving involves seemingly strange associations with things outside of substance use : people , places , sights , sounds , and smells that have become associated with substances . Clients are trained to begin making a list of those triggers so they might anticipate them if they are tripped . Opioid users who enter withdrawal might describe feeling “ flu-like symptoms ” such as runny nose , nausea , vomiting , aches and pains , etc . The first time they get a cold in early recovery , they get triggered to return to using opioids . Why ? Because in the past , these symptoms were completely extinguished by the use of opioids .
Conditioned cue craving is an undercurrent to the other three craving types . It is independent on the timeline and resolves over a longer span . Just as Pavlov ’ s dogs eventually stopped salivating when he removed the food , clients eventually will stop associating triggers with substance use . It just takes longer than Pavlov ’ s dogs .
( For a four-step process in how to help clients tolerate a moderate or high-risk situation without relapsing , see the box on page 18 .)
• VIDEO : On classical conditioning , which demonstrates conditioned cue craving
VIDEO LINK : https :// www . youtube . com / watch ? v = hhqumfpxuzI
CONDITIONED CUE CRAVING
The final craving type identified by Dr . Earley , conditioned cue craving , is the result of the capacity of the human brain to learn . Through evolution , the primate brain became an expert in identifying , prioritizing , and anticipating rewards in the environment consistent for survival .
Through his work measuring canine saliva , Dr . Ivan Pavlov named this process “ classical conditioning .” For the substanceuse disorder client , this should be referred to as hyperconditioning due to the sheer volume of dopamine released by substances . Nothing in our evolutionary training prepared our brains for the massive surges that modern drugs release in comparison with more predictable rewards like food or sex .
CRAVING NEED NOT BE A ‘ LIFE SENTENCE ’
By the time a client comes to you or initiates formal treatment , they have already begun to manage their cravings inherently . Counselors and treatment staff can assist them in further recovery by engaging them in discussion and helping them build the necessary skills for extended freedom from harmful substance use .
Note : A similar version of this article by Doug Paul appeared online in Sober Nation on April 28 , 2017 : https :// sobernation . com / how-to-effectively-manage-cravings /. continued on page 18 The Advocate Magazine Fall 2021 American Mental Health Counselors Association ( AMHCA ) www . amhca . org
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