- Why do people continue to use alcohol and other drugs when they have so much to lose?
- Why is an addiction so challenging to overcome?
- Why do people in recovery relapse?
Addiction is multifaceted, but cravings and triggers have a lot to do with why people keep using drugs even though they are ruining their health, relationships, and lives. By understanding the cause and effect link between cravings/triggers and substance abuse, you or your loved one can begin finding ways to overcome addiction.
What Are Cravings?
In everyday terms, a craving is a strong desire for something. For example, common cravings are for foods or sex. People can also crave drugs and alcohol.
Although cravings may seem like a simple fact of life, finding a consensus regarding an official definition is difficult.1 A possible explanation for this is that cravings are subjective and highly individualized.1 One person’s craving can vary widely from that of another.
Accepted definitions of cravings as they are associated with drug use and addiction include:1
- A state where the person is focused on acquiring the drug.
- The desire to use a drug given the opportunity.
- The psychological want for the positive effects of the drug.
Brain Changes and Cravings
Cravings are associated with the psychological and physiological effects of drug use.2,3 The brain changes that someone using drugs experiences can bring about cravings. Each time a drug is consumed, it modifies brain functioning. With repeated use, the brain is significantly changed by the influence of a substance.3,4 Rather than associating healthy activities like eating or exercising with rewarding feelings, the brain is conditioned to link drug use with the highest sense of reward.4 Over time, the drug may be the only thing that provides a sense of real pleasure to the user.
With repeated use, the brain is significantly changed by the influence of a substance.
With some drugs, once the high ends or the use stops, the person may experience uneasiness due to changing levels of chemical messengers in the brain.3 Since drug use is now connected to positive feelings and happiness, the brain will produce cravings to encourage use and combat the discomfort.1,2 Of course, restarting drug use only covers the problem in the short term and delays the pain.
Cravings can vary in duration and intensity. Some cravings can last only a moment while others can last for days or longer.1 A person could feel a craving immediately after the high ends or 30 years in the future.
What Are Triggers?
A trigger is a stimulus that sparks a craving. Triggers are the people, places, and things that make you want to use more drugs or drink more alcohol.5
Triggers vary among individuals but they generally fall into 4 broad categories:5
- Pattern. These are the places and things that incite the desire for drugs and alcohol. Pattern triggers can also include certain times of day, the season, or significant events.
- Social. Social triggers can be a single person or a larger group of people that have become associated with drug use. When a recovering individual encounters these individuals, they can have cravings to use.
- Emotional. Drug use often has emotional roots—to celebrate happiness or to self-medicate for sadness and anxiety. Emotional triggers are feelings that have become related to drug use. When these feelings are present, cravings tend to emerge.
- Withdrawal. While the triggers above are psychologically conditioned, withdrawal triggers are biological responses to a lack of the substance in your body. Withdrawal triggers will usually occur in the days and weeks that follow substance use as the body works to return to its balance.
Triggers can be random, though they are usually linked in some way to your previous drug use. The most dangerous triggers will be the ones that span several categories. For example, if past Thanksgivings have been spent excessively drinking alcohol with family members, this situation could touch upon pattern, social, and emotional triggers while producing very strong cravings.
How Can I Identify My Triggers?
Anything can be a trigger. Below is just a small list of examples:
- Emotions (anxiety, sadness, excitement, etc.)
- People you previously used with
- Bars or restaurants
- Environmental cues like smells or objects
- Major life events
- Professional stress
- Relationship turmoil
One person may have a seemingly endless list of triggers while another may seem to have only a few. Your triggers might be difficult to identify, especially early in recovery. To start, begin paying close attention to yourself and the level of your current cravings. As your cravings change, take note of the people, places, things, and feelings associated with the fluctuation.
Another method to identify triggers is to reflect on past use and ask questions like:
- Where was I when I usually used?
- Who was I with?
- When did I use?
- How did I feel before, during, and after I used?
The answers may uncover additional triggers. For a comprehensive list of triggers, keep a journal of your experiences and add as many examples as you can.6
Overcoming Triggers and Cravings
To better respond to triggers and cravings, you need to identify them and understand them. Various triggers will require unique strategies to manage, so overcoming them is not a one-size-fits-all proposition. The same is true with cravings. As cravings come and go, different strategies will be more effective than others. In both cases, experimentation and patience are necessary.
Options for overcoming triggers and cravings include:5-8
- Avoidance. When there are people, places, and things that constantly trigger cravings, it may be best to avoid these completely. Stay away. Pursue alternatives. Unfortunately, some triggers cannot be avoided, but for those that can be, avoidance is a simple solution.
- Stay busy with healthy behaviors. Avoiding triggers is important, but it’s important not to only avoid but to proactively engage in healthy behaviors that will help you to fight off and manage cravings like:
- Eating healthy foods.
- Spending time with positive influences.
- Engaging in activities and habits you enjoy such as painting or reading.
- Leaving plenty of time for good rest.
- Watching funny shows or movies.
- Listening to calm or hopeful music.
- Practicing meditation and relaxation techniques.
- Attending support group meetings.
- Change your thinking. The way you think about cravings and triggers will impact their effect on you. If you panic when confronted by a trigger, the craving will seem overwhelming; however, if you remain calm and “go with the craving,” knowing it’s time-limited, you can ride it out. Decide to take control over your thoughts and feelings by:
- Making encouraging and optimistic statements to yourself like “I can get through this.”
- Focusing on the desirable aspects of your life.
- Remembering that all cravings end.
- Keeping a journal to track your triggers, thoughts, and feelings.
- Setting goals for the future.
- Reminding yourself of the ways that substance abuse negatively impacted your life.
As cravings come and go, different strategies will be more effective than others.
Some people prefer concrete relapse prevention plans that outline exactly what to do when cravings present, while others attempt to respond to cravings in the moment without a set plan. As with many aspects of addiction, there is no one right way to manage cravings, so you’ll need to experiment to find what works best for you.
Handling Triggers in Times of Stress or Sadness
Triggers are problematic at any time, but when you are feeling high levels of stress, sadness, or anger, the ensuing cravings may be harder to ignore. Without relying on your previous primary coping skill (drug abuse), you can feel hopeless or trapped. Some emotional situations resulting in heightened triggers include:
- Anniversaries of trigger events, such as a death or divorce.
Though these are challenging, you can reduce your risk of relapsing by:9
- Understanding that certain days like anniversaries will be difficult and planning strategies to deal with the emotions they bring up.
- Discussing your concerns with your support network, e.g., your sponsor.
- Allowing yourself to feel your emotions instead of looking for ways to suppress them (i.e., turning to drugs).
- Practicing kindness and patience with yourself and others. Let yourself lean on friends and family for support.
- If you are spiritual, turning to your faith and/or spiritual community.
- Finding positive ways to spend your time and energy.
- Helping others is a great way to take the focus off of your negative emotions and replace stress with a positive, healing feeling.
How Addiction Treatment Helps
It’s easy to overestimate your ability to manage triggers and cravings without help, but trying to go it alone usually doesn’t work very well. Professional treatment is often necessary to overcome addiction.2 In treatment, you’ll learn skills to stay abstinent from drugs and to manage triggers and cravings that may potentially lead to relapse.
Drug rehabilitation (rehab) typically refers to the process of treatment for addiction through intensive therapy and sometimes medication.2 Rehab might begin immediately after or incorporate a detoxification stage—the period during which your body is cleared of substances. Inpatient or residential rehab programs remove the individual from their normal environment to begin the process of recovery while eliminating many pattern and social triggers.
Rehab programs can effectively:
- Teach people about addiction and physical dependence.
- Warn about the dangers of ongoing substance use.
- Help you identify triggers and alternatives that reduce the risk.
- Assist you in building coping skills to effectively manage cravings when they emerge.
Medication-assisted treatment involves using medications specifically prescribed to reduce cravings and manage withdrawal symptoms for opioids and alcohol.2 When combined with behavioral therapies, MAT can promote long-term recovery. MAT options available for opioid treatment include:2
- Methadone: This long-acting opioid agonist is administered daily to minimize cravings and prevent the onset of withdrawal following discontinuation of heroin or abused prescription painkillers.
- Buprenorphine: This partial opioid agonist is often combined with naloxone (Suboxone) to reduce the risk of misuse.
- Naltrexone: This opioid receptor blocker prevents opioids from eliciting a euphoric high, in the hopes of diminishing the impetus for continued drug abuse. A once-monthly injection, Vivitrol, is also available.
Approved MAT options available for alcohol treatment include:2
- Naltrexone: Blocking the opioid receptors also reduces the effects of alcohol, while alleviating cravings.
- Antabuse (Disulfiram): When alcohol is consumed after use of this medication, the person will experience uncomfortable symptoms like nausea and palpitations, which can reduce the motivation to drink.
- Campral (Acamprosate): Very effective for severe alcohol dependence, this medication limits long-acting withdrawal symptoms by reducing:
- Depression/low mood.
After more intensive levels of care, aftercare options allow you to keep focusing on your recovery with continued treatment. Since longer periods of treatment are linked to longer periods of recovery, aftercare options are invaluable and include:2
- Outpatient therapy: Available in a range of settings and intensities, outpatient treatments allow the individual to attend therapy sessions while living at home. Individual, group, or family sessions will address triggers, cravings, and effective coping skills.
- Support groups: These groups will not offer professional facilitators, but they will provide assistance building a sober support network and helpful advice from others in recovery.
Cravings and triggers are formidable opponents for anyone hoping to get clean from alcohol and other drugs. Seeking out professional assistance can reduce the frequency and intensity of these unwanted effects while building the positive coping skills needed to manage them. If you worry about cravings, seek out professional addiction treatment today.
- Sayette, M. A., Shiffman, S., Tiffany, S. T., Niaura, R. S., Martin, C. S., & Shadel, W. G. (2000). The measurement of drug craving. Addiction (Abingdon, England), 95(Suppl 2), 189–
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
- Medscape. (2016). Withdrawal Syndromes.
- National Institute on Drug Abuse for Teens. (2017). Brain and Addiction.
- Smokefree.gov. (n.d.). Know Your Smoking Triggers.
- National Institute on Drug Abuse. (n.d.). A Cognitive-Behavioral Approach: Treating Cocaine Addiction.
- Smokefree.gov. (n.d.). How to Manage Cravings.
- Australian Government: The Department of Health. (2003). Phase 4: Strategies to Cope with Cravings.
- Substance Abuse and Mental Health Services Administration. (2015). Anniversaries and Trigger Events.