Yesterday I looked at motivation as a way of understanding how and why people make decisions about their health-related behaviours, and how changes in motivation can affect how they pass through the various stages of change. Hopefully there were some useful pointers there to help with your decision-making processes.
Today I want to consider how you can keep going with any changes you make in your behaviour. Everyone knows how difficult it can be to keep to a diet or to refuse a cigarette when you are trying to give them up. However, I first want to look a bit more at some aspects of motivation. I noted yesterday that motivation is a mercurial being, always in a state of flux depending on a range of internal (your thoughts and feelings) and external factors. While we can control and prioritise the things we need to do, sometimes our brains hijack us to ensure our safety and survival. A classic example is the freeze response when we are faced with a severe threat – we may want to fight or flee, but our bodies have other plans. This is completely involuntary, but it can lead to lots of feelings of guilt in victims of sexual assault or witnesses of a catastrophic event.
Less dramatically, our brains will prioritise activities such as eating and drinking to maintain our well-being. I am not referring to alcohol here, but I will come to that later (as a topic, not as in pour myself a glass of beer). You will have experienced how this works. You are busy doing something when you notice a little pang of hunger. You continue what you’re doing, and the pang gets a bit bigger. Eventually, the desire to eat will disrupt your ability to concentrate on anything else – evolution has won again!
This perhaps gives us an insight into cravings and urges. The terms are often used interchangeably but there are some subtle differences. A craving tends to be a psychological thing – you have a desire to do something that will activate the pleasure circuit we had a ride on in an earlier post. There is a belief and expectation that by acting on the craving you can satisfy it – there will be that dopamine hit telling you “well done” and increasing the chances you will do it again – what we call positive reinforcement. An urge is a more physiologically-based process, like providing the energy and drive to act on the craving.
The picture gets a little more confusing when we talk about wants and needs. Our motivational gubbins are there to ensure our survival – they deal with our needs such as food, drink, avoidance of pain and so forth. When I am hungry I need food. I do not need chocolate fudge cake – I want chocolate fudge cake. In a sense our motivational and reward centres have been corrupted – they want the good life! Foodstuffs with high sugar or fat taste good – they are rewarding to eat! It has been shown that laboratory rats will work hard for sugary rewards that have no nutritional value – evolution does not always win the day.
It is therefore not surprising that alcohol and other psychoactive substances can subvert the evolutionary functions of the motivational and reward architecture. Heavy drinkers and drug users will forego food to satisfy their needs, because when there is physiological addiction (i.e., changes and adaptations in underlying biochemical and anatomical structures that have the potential to produce severe withdrawal symptoms), what may have started out as a want has now become a real need. This is why detoxification is the necessary first step towards change when people present with such addictions.
Sorry, this is a bit of a long-winded introduction. What does it tell us? We know that the maintenance stage, the let’s keep it going stage, the I’m gonna be super healthy stage, is always at risk of coming to an end. All those good intentions, those new habits, all gone out of the window, defenestrated. We are of course talking about relapse. I have run many alcohol relapse prevention groups over the years, both in residential settings and in the community. It has also been a large part of my individual work with clients in addiction and eating disorder services. I hope I can impart a bit of wisdom…
The starting point is to keep in mind why you decided to make a change. There is no point in changing unless the change offers you the chance of something better. This may take a while to achieve, so patience is important. Rather than having one big goal, try to set a series of small sub-goals so you can mark your progress. For people with severe addiction problems the initial period of abstinence is often very rewarding, they notice improvements in their health and relationships fairly early on. Problems can arise later because they miss the chaos and drama of their previous life – normal daily living can be boring.
The next thing to be aware of are what we call high risk situations. As the name suggests, these are situations where you are at most risk of relapsing. Emotional discomfort is the most common cause of relapse. Situations in which you feel sad, anxious, angry or bored can often trigger a desire/craving to drink. These situations cannot always be avoided so you need to have other strategies to deal with those feelings. The workshops on this site might provide some help in this regard. It is important to recognise your thoughts when you have these feelings because they may be amenable to change.
Other high risk situations include people and places. It may be best in the early stages at least to keep away from people you used to drink with and the places where you used to drink. Be aware of SID. No, he is not some shady character leading you astray. SID stands for seemingly insignificant decisions. An example would be deciding to take a short-cut home which coincidentally goes past your favourite pub or best drinking buddy’s house. Or, if eating is the problem, past your favourite bakery.
Other risky situations can be more mundane, Daily activities like sitting down to watch TV might have become strongly associated with eating or drinking in the past. Think about how you could make environmental changes to reduce being exposed to triggers – moving the furniture, moving drinks and tempting foods to more inaccessible places. If you have to work to satisfy a craving then this creates time to think more about your actions and their consequences.
Cravings are normal. You can try a bit of mindfulness, just acknowledging those thoughts and feelings are there, not judging them. You could try to identify any unhelpful thoughts. One category of unhelpful thinking is permission-giving thoughts. “Oh, just the one drink won’t hurt”, “After the day I’ve had anyone would want a stiff drink/tub of ice-cream”. When you are tempted to give in, try to remind yourself why you made changes. Do you want to sabotage those goals? Sometimes it is like a barrier comes down in your brain and helpful thoughts become inaccessible. It is thus a good idea to have flashcards with key words or phrases that relate to your goals. You could also try time-bridging. This involves thinking ahead to the next day. How will you feel about yourself and your behaviour if you give into the craving? Is it going to be worth that guilt and loathing, that disappointment in yourself?
I am going to take a bit of a curve now. When I was researching Pisang Ambon yesterday, the famous trapeze artist, I saw that Bols launched a new recipe in 2021 with the following endorsement…
…a natural, more intense and more complex banana experience.
Who wouldn’t want a more complex banana experience? So, another strategy to help cope with cravings is distraction! Do something to occupy your mind, take your thoughts away from what you most desire at that point. And remember – cravings reach a peak and then decline, they don’t go on forever, they will pass without you acting on them. Be patient, be aware, be strong, be hopeful, but don’t be a banana.
I hope this has been helpful. Whatever you goals and struggles, keep safe and well. Only a few more days of these ramblings to go.
Alcohol Trivia Quiz
Yesterday’s answers:
1. Watney’s.
2. 5 years old.
3. A Dutch banana-flavoured liqueur. Not a trapeze artist.
Today’s questions:
1. Name of the pub in EastEnders?
2. What country do you associate with sake?
3. What drink is made from the blue agave plant?
Understand Yourself Better 