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How to deal with triggers and craving a substance in recovery

During treatment for alcohol or drug addiction, the individual in recovery will normal need to learn different ways to curb cravings to their substance of choice. Learning how to deal with triggers will help a recovering addict when an urge arises to use or drink as a result of excitement, emotions or physical ailments such as a headache or body tension. Medications, detoxification treatments and psychotherapeutic treatments can be utilized individually or together to minimize the instances of cravings.

Dr. Karen Steinberg who studied social work and management at University of California at Berkeley has developed a three-step model to deal with cravings for drugs or alcohol, called ‘Urge Surfing’. The first step is to take an inventory of how the craving is experienced. It’s important to sit in a comfortable chair with feet flat on the floor and hands in a comfortable position. After taking a few deep breaths and focusing attention inward, allow the concentration to wander through the body. Identify where tension lies in the body and if any craving being experienced is in any particular part of the body. Recognize each area that the urge is being experienced in and verbally speak where it is. For example, “My craving is in my mouth, nose and in my stomach.” (NIMH 2014)

The second step is to focus on a single area that the urge is being experienced. Notice the exact sensations of that particular area. Recognize whether it’s tingly or numb, if the muscles are tense or relaxed and how large an area is involved. Notice the sensations and verbalize them and write them down (NIMH 2014).

Dr. Steinberg’s third step to ‘urge surfing’ is to repeat the focus on each part of the body that experiences the craving. While describing to oneself the changes that occur in the sensations of the body, notice how the urge comes and goes and recognize whether the craving has vanished. The purpose of this exercise is not to make the craving go away, but to experience the craving in a new way. Practicing urge surfing will help a person become familiar with his or her cravings as well as learn how to ride them out until they go away naturally (NIMH 2014).

There are numerous ways that an individual can deal with cravings such as Steinberg’s “urge surfing” method. Other ways to deal with cravings can include:

  • Talk therapy—Talking to somebody like a sponsor, a supportive family member or friend
  • Distractions—Get exercise, listen to music, read a book, clean
  • Reminders—Reiterate why drugs and alcohol are off limits

Along with some of these methods to curb cravings, individuals may also look into the use of certain medications to help their endeavors to stay clean and sober. Some of these medications help with the detox process while other help with reducing cravings. The following medications are the most commonly used in the treatment of substance addiction:

  • Naltrexone –This is of the three medications used to treat opioid addiction and is also used to treat alcohol addiction. Naltrexone is FDA approved and works by blocking opioid receptors, which are involved in the craving of and all other side effects of drinking and opioids. According to the National Institute of Drug Abuse, naltrexone has shown to be helpful in decreasing relapse tendencies in some people. Naltrexone can be taken for days or years and when a person stops taking it, there are no withdrawal symptoms (SAMHSA 2014)
  • Acamprosate (Campral) – Acamprosate is FDA approved and has shown to be effective in treating withdrawal symptoms such as insomnia, anxiety, restlessness and dysphoria experienced during alcohol withdrawal. Acting on gamma-aminobutyric acid and glutamate neurotransmitter systems, acamprosate has been successful in curbing side effects experienced by heavy drinkers (USDHHS 2013)
  • Disulfiram (antabuse) – Antabuse is FDA approved and is the oldest drug on the market used to prevent alcohol cravings. Antabuse inhibits the production of an enzyme called acetaldehyde, which allows the body to absorb alcohol. As a result of acetaldehyde’s inability to break down, it builds up in the body and causes extreme side effects such as nausea, flushing and palpitations
  • Topiramate – While this medication hasn’t received FDA approval for treating alcohol addiction and is sometimes used off-label for this purpose. Topiramate is thought to work by increasing inhibitory (GABA) neurotransmission and reducing stimulatory (glutamate) neurotransmission. Some doctors believe that topiramate is an appropriate adjunct to psychotherapeutic treatment as an effective way to reduce cravings, as well as to treat depression and anxiety during early stages of alcohol withdrawal (Paparrigopoulos 2011)

For those recovering from alcohol and/or drug abuse, cravings can be hard to deal with. However by learning different coping mechanisms or finding effective medications to help combat these cravings the path of recovery can be a lot easier. If you or a loved one would like more information on treatment for an addiction to drugs or alcohol, you can call the Recovery Helpline at 855-441-4405.


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