As a parent, teacher, pediatrician, or friend who is supporting someone who is battling addiction, understanding the complexities of drug cravings is vital. Failure to understand drug cravings and the role they play in addiction is one of the most common mistakes people make, which leads to unnecessary pain for both you and your loved one.
In our adolescent intensive outpatient program (IOP), we primarily see many parents who are understandably afraid of cravings, believing the presence of cravings means their teenager will inevitably use drugs or relapse. Parents can feel hopeless, angry, and afraid in the face of these very powerful urges and often resort to punishing or shaming teens for this very normal part of addiction recovery. Sadly, this usually accelerates the cycle of relapse, potentially pushing the teen into even deeper use.
In this blog, we’ll break down what cravings are, the best ways to relate to them, and how to help someone experiencing them. Helping your teen relate to cravings in a healthy way is an important part of their recovery and a part of the process that families can play a big role in. With this understanding, you can begin to heal and strengthen your relationship with your teen. Cravings do not need to be a barrier in your relationship with your child.
So, what are drug cravings?
Cravings are often seen as one of the most troublesome and frequent complications in the recovery process. A drug craving is a strong, often intense, and persistent desire to use a substance. It is the compelling need to use a mind-altering substance that individuals experiencing addiction feel. Cravings can range from mild to overwhelming. Dr. Anna Lembke describes cravings as an intense itch that never goes away for some people struggling with addiction in this interview, “Understanding and Treating Addiction” with Dr. Andrew Huberman.
Watch this short clip to hear Dr. Anna Lembke describe cravings:
Cravings can appear suddenly, disrupting your teen’s daily life and making them feel like substance use is not only desirable but inevitable. For some individuals, cravings are a daily and relentless battle. For others, they come in waves throughout their recovery process and eventually go away entirely. The unpredictability of cravings is a key reason why they can be so frightening and difficult to deal with, both for the individual experiencing them and their loved ones standing by.
The four different types of cravings
Reinforced use cravings
Reinforced use cravings are cravings that occur while an individual is already using a substance(s), leading them to want to use more and more. Individuals experiencing these cravings find it challenging to limit their intake of whatever substance they’re using. This often looks like someone who, as soon as they have one drink of alcohol, can’t stop drinking.
How to help: Emphasize the avoidance of use in the first place. If you don’t start, you can’t keep going.
Overt interoceptive cravings
These cravings occur after substance use has stopped and are triggered by bodily sensations rather than external factors. They often arise due to physiological changes occurring in the body during withdrawal and recovery periods. They are driven by internal discomfort and feelings associated with the body’s adjustment to the absence of the drugs. It’s important to note that individuals cannot control these cravings, which can be a frightening experience for family members.
How to help: Residential treatment programs and detox centers are specifically designed to address and treat overt interoceptive cravings. They are often very challenging to manage and require specialized support and strategies to address them effectively. Sometimes, pharmacotherapy will be employed under medical guidance to alleviate withdrawal symptoms and reduce cravings. Unfortunately, these cravings may last weeks to years.
In addition, exercise can be hugely beneficial in supporting people with strong interoceptive cravings. For instance, this study on exercise and its effect on drug cravings shows that exercise immediately reduces drug cravings for a period of four hours post-exercise.
Finally, the use of Urge Surfing, a meditation technique, may be useful in combating these cravings.
Covert cravings
These cravings are hidden from the individual experiencing them but visible to those of us on the outside. The symptoms are usually restlessness, irritability, and a false sense of confidence in their ability to maintain sobriety, often leading the client to believe they’ll never use substances again. They typically occur 7 to 90 days into abstinence when the person feels “amazing” and in control. The client will often try to convince family and staff members that they will be sober forever and aggressively insist on being discharged early from a program. Usually, if allowed to leave a program, individuals experiencing covert cravings will go straight out to use. Even if they say and consciously believe that they would never do that.
How to help: Rehab centers tend to use tactics to delay discharge long enough for this type of craving to pass. This will often look like a long discharge checklist that requires a sign-off from multiple staff members, notably requiring the signatures of a few who might not be in the office until next week. Typically, after a few days, the client will express deep gratitude and relief for not being discharged, change their mind, and want to stay in rehab longer.
Families can support this process by honestly sharing that they believe this type of craving is occurring and encouraging them to stay longer. Families should expect and accept covert cravings as part of the process, remembering that they are normal, common, and will pass quickly. It’s important to note that the patient is not trying to lie and be sneaky – this craving is truly unconscious. It is normal for family members to feel betrayed, lied to, and frustrated during this type of craving. We encourage family members to remember that this is not a conscious attempt to betray those the client cares about.
Condition cue cravings
This type of craving is triggered as a result of the brain attaching meaning to minor events, things, or thoughts associated with substance use. For example, if someone frequently used drugs in their car, a seat belt might trigger a craving. Unusual associations, such as certain plants, smells, or clothing, can serve as a craving cues. In rehab, we typically break these cues down as:
- Unavoidable – cues that you won’t be able to avoid in your daily life, for example – seatbelts, the smell of bread, or eating with spoons.
- Avoidable – cues that are usually possible to avoid in daily life. Such as tattoo parlors or visiting a house you previously used in.
- Danger Cues – situations that will likely lead to relapse, for example – being around friends who use drugs, drug dealers, or going to a place where you know others will be using drugs.
How to help: Outpatient treatment programs are particularly effective at addressing this type of craving. Most outpatient programs consist of 3-15 hours of programming a week, where people can come and work through cravings that come up throughout the week. The goals with outpatient programming include developing stability, endurance and dramatically improved self-confidence and self-reliance.
Another way to help is through an exercise we like to call Breaking Up With Your Drug Dealer. This is a simple but sometimes difficult exercise that involves going through one’s phone and both deleting and blocking drug dealers and drug friend’s phone numbers and other social accounts, eg. Snapchat, IG, TikTok, etc. This is a great way to get rid of Danger Cues.
More information here.
Two things that will make your teen’s cravings more challenging
In addition to understanding the types of cravings your teen will likely experience, it’s important to understand these three behaviors that can worsen their cravings. Your teen will need your help to call them out, call them in, and re-frame each of these three experiences throughout their recovery journey.
Dreams about using
Vivid, often intense dreams about using drugs or alcohol are commonplace while in recovery. They are usually highly realistic and emotionally charged, leading to waking up feeling distressed, anxious, ashamed, and guilty. As a means of further understanding these experiences and the impact they can have, we really like the following videos from individuals in recovery sharing their experiences with dreams of using.
What parents need to know about this: Dreams are a normal part of recovery. They often parallel your teen’s growing awareness of the negative consequences of substance use. Discussing these dreams and their meaning can be helpful for and support your relationship with your teen. They don’t need to feel guilty or ashamed because of a dream. Their dreams do not forecast future use or mean they are destined to relapse. Teenagers may feel like this means they are broken or will never get better, and that’s simply not true. Remind your teen that dreams are normal, and encourage them to discuss these dreams with their therapist or to journal about them.
Drug Glorification
This is when individuals romanticize their past drug use, viewing it as a grand adventure and themselves as brave explorers. These memories are often accompanied by euphoric recall – meaning the drug use in the stories is viewed through rose-colored glasses. Only the good parts are remembered and the situation seen as more appealing than it actually was at the time. An explanation of the differences between sharing about one’s experiences and glorifying them can be found here.
What parents should know about this: At most treatment programs, drug glorification is strictly banned, and if a client starts to glorify, staff will end the conversation quickly and call it out. If staff do not do that, typically, a kind of group trance starts to happen, where the clients will begin reminiscing and craving together, jumping in with their own stories and false memories of ecstasy. The euphoric recall can increase the risk of relapse, and harm the recovery of multiple individuals at a time. We encourage parents to have a similar boundary at home, or to encourage their teens to ‘let the movie play to the end’. Remind the teen of what happened after this grand adventure, the challenging parts of it, and how it eventually led them to the situation they are currently in.
Taking action
If your teen is experiencing cravings, we recommend talking to your teen about them honestly and directly. Do not try to support them with this alone – we recommend looking for support from an experienced addiction counselor, outpatient program, or detox facility. If you are looking for a program for your teen, make sure the program you choose has the strategy and capabilities to address the kinds of cravings that your teenager is experiencing. Different types of programs can help with certain types of cravings more than others, and choosing the right program can make the difference between success and failure in recovery. Managing cravings is an essential part of addiction recovery, and an important part of reducing the risk of relapse for your teen.