A key concept of cognitive behavioral therapy is anticipating likely problems and enhancing self-control. This is achieved by developing effective coping strategies to deal with cravings and avoid high-risk situations. These skills continue to be extremely useful and beneficial long after drug and alcohol rehab has ended and are an essential part of recovery and relapse prevention.

Understanding and Identifying Cravings

People in drug and alcohol rehab typically experience strong cravings early on in treatment, although they may persist for weeks, months, and even years (depending on the person’s circumstances). Individuals in treatment should expect to experience cravings, as it is very common, and should be prepared to manage those experiences without resorting to drug and alcohol use.

All individuals will experience drug and alcohol cravings in different ways. Some people may deny feeling any cravings at all, others may misinterpret cravings for some other emotion or feeling, and some may have overwhelmingly strong physical experiences. Although it will be different for everyone, a craving may present itself in one of the following ways:

• The person’s heart may start racing.
• The person may begin to taste or smell the substance.
• The person may feel strong sensation in the pit of their stomach.
• The person may begin to feel nervous, anxious, or bored.
• The person may experience obsessive thoughts about using drugs or alcohol and be unable to think of anything else.

What Causes Cravings?

Cravings are frequently triggered by something in the environment, whether it be a person, a place, a smell, a sight, a sound, or an emotion. In drug rehab, clients will work with their therapist and recovery specialist to identify situations that trigger urges or cravings. These may include:

• Exposure to a substance
• Particular times of the day or week (after work, lunchtime, late at night, on payday, etc.)
• Seeing or visiting places associated with alcohol or drug use (bars or clubs)
• Watching other people use drugs or drink alcohol
• Seeing an advertisement for alcohol while driving or watching TV
• Feeling anxious, depressed, excited, or joyful

Although triggers will be different for everyone, cognitive behavioral therapy techniques such as self-monitoring can be used to recognize situations that may cause a person to crave drugs or alcohol. Once these situations are recognized, the client and therapist can work together to develop strategies for avoiding these situations and coping with cravings.

Examples of Coping Strategies

Individuals in recovery will have natural inclinations for coping with cravings and high-risk situations and if the therapist can get a sense of their characteristic coping styles, he or she can begin to help the client develop effective coping strategies that will work for them. The following coping strategies are some of the most common.

• Engaging in a distracting activity – In many instances, doing something physical such as taking a walk, playing a sport, or meditating can help a person resist a craving for drugs or alcohol. The most effective way to utilize this approach is by making a list of distracting activities in advance and referring to the list when the craving begins to appear.
• Talking about the craving – Confiding in a sober friend, family member, or mentor can help reduce the feelings of anxiety and stress that accompany cravings in early recovery. These discussions may also help clients identify triggers and cues that they may not have previously been aware of.
• Riding out the urge – This technique is referred to as “urge surfing” and works by fully experiencing the craving, taking control of it, and riding it out until it subsides. This coping strategy may take practice but can be very effective when dealing with strong cravings.
• Thinking about negative consequences – Focusing on thoughts like “If I have this drink, I could lose my family” or “If I take a hit of this drug, I will lose my job” can help remind clients of the negative consequences they will face if they choose to give in to their cravings. Having something to lose, such as family, friends, or employment, helps keep individuals in recovery on the right track.
• Using self-talk – Recognizing the automatic thoughts that accompany cravings and countering them with positive thoughts and self-talk is a powerful tool that many people in recovery use to cope with cravings. For example, while experiencing a craving, a person may think, “I have to have a drink or I will die.” In countering that negative thought with a positive one, such as, “I do not need that drink to survive; I can handle this craving and make it through without a drink” individuals will increase their self-efficacy and reinforce their belief that they really can experience a craving without giving in.

In drug and alcohol rehab, clients may work individually or in groups to practice exercises that reinforce some of the above coping strategies and develop strategies that work best for them to help maintain their sobriety.