Dealing with Cravings 1: Introduction & Gate Control
This article has been recorded to audio for convenience. All Podcasts can be heard on: This Website (Podcast Episodes), Podbean, Spotify, Apple Podcast, Amazon Music Podcasts, Google Podcasts, Google Chrome, TuneIn, iHeartRadio, and more
Photo Credit: @theblowup
Hello Sobertown,
When a craving for alcohol begins in your mind the sensation can be powerful as though the floodgates of a giant dam are opening in your mind and millions of liters of water are rushing out and sweeping you up in the flow, pushing you in one direction and that is toward the thought and then action of drinking, you want to resist, you try to resist and you hang on as the current forces you backwards, sometimes the force is so strong you just can’t persist with the battle, sometimes you fold. Without question this can be difficult to fight and without pre-planning it may beat your will power alone. This is where we learn methods to throw a wrench in the gears as they clunk along opening the flood gates set in motion by a sensation and a thought of alcohol cravings and we prevent the oncoming and powerful tsunami from ever happening.
Sometimes the answer in the early days of sobriety is to do “whatever it takes”. In short, the whole basis for my strategies are essentially distraction from cravings through activity, movement, stimulus and action. Whatever it takes, pushing through one craving successfully can literally mean the difference between a slip that would turn to another two years of hard drinking or broken relationships or severe disease, one craving battled and beaten can literally transform your life from what could have been into who you want to be, it can save you, so whatever it takes to beat that craving. Whatever it takes.
Cravings tap into a distinct pathway in the brain. This is located in our reward system, separate to our hunger centers which originate in the hypothalamus. Craving centers are different, located in the center of our brain throughout multiple brain regions such as the nucleus accumbens which includes a shell and a core and a location on each side of the brain hemispheres, the nucleus accumbens is just one part of the reward system which will process and reinforce stimuli such as food and water and will reward stimuli such as drugs, sex and exercise. The prefrontal cortex, now this region is key, this region is so vital, located at the front section of the frontal lobe, right there behind your forehead. The prefrontal cortex is considered to be responsible for the orchestration of thoughts and actions in accordance with our internal goals. This region is involved with quote: “executive functions, such as planning, decision making, short-term memory, personality expression, moderating social behavior and controlling certain aspects of speech and language. Executive function relates to abilities to differentiate among conflicting thoughts, determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social "control" (the ability to suppress urges that, if not suppressed, could lead to socially unacceptable outcomes).” (1) “The frontal cortex supports concrete rule learning. More anterior regions along the rostro-caudal axis of frontal cortex support rule learning at higher levels of abstraction” (1). If the prefrontal cortex were a muscle I would tell you to strain it and work it every single day to build its resilience, strength and function as often as possible. During rewarding activities these regions and others act by releasing the neurotransmitter dopamine which is associated with pleasure and so this experience is then connected to areas responsible for memory and behavior so once you finish your tasty treat, sex or alcohol this is then consolidated through pathways in the brain with a strong link between pleasure through dopamine release then linked to memory and behavior, the net result is the building of pathways causing CRAVINGS, an intense desire for something. The more we feed this pathway, the more deeply engrained the response to the pleasurable behavior becomes, the more deeply engrained the memory becomes and the more your brain will scream at you to go back to engage in this behavior be it bad food, be it alcohol. This is engrained in your brain, go back and listen to my recording “if it fires together it wires together”. This means when you deprive yourself of your trained habit, alcohol, your brain will tell you you need it, this is only a neurological circuit causing this craving but it can feel very strong. This is what you are up against and this is what this series of articles aim to help you overcome, overcoming these desires is the key to a better life my friends. This is the price of admission. To overcome, to battle, to beat your brain, to change your pathways.
Differently to hunger which will not simply pass in time if we do not provide ourselves with food to satiate our hunger, cravings do go away with the passage of time. Let me repeat this because this is KEY INFORMATION. Cravings DO GO AWAY WITH THE PASSAGE OF TIME. Unlike hunger cravings are psychological not physiological, that doesn’t make them any less real to us, but the fact is THEY WILL PASS. Due to the fact that craving is a psychological experience they can be triggered by many experiences or feelings or states of being, these may be specific to you for example if you associate a location, a person or an event with drinking alcohol then these will likely induce cravings in your mind whereas some causes are quite common to most people such as being tired and fatigued, stress, boredom, loneliness and interestingly often excitement is also a common trigger for alcohol cravings among other common causes. When we would drink alcohol just like eating food packed with sugar, salt or fat we teach our brain these make us feel better as dopamine and reward pathways are utilised and if we do not learn how to process the emotions and experiences associated with life without drinking then we set ourselves up for failure, but, to begin with in early sobriety the goal is simple, beat the cravings one craving at a time until we begin to reteach our brain that we no longer require alcohol to feed this dopamine gobbling part of us and that we can very well create these positive effects in healthy and sustainable ways. We may not be able to always be in control of the environment we find ourselves in this is true, BUT what we can do is control how we react in the very same environments which may have previously caused us to crave hard.
Cravings will pass and they are neurological and psychological but be aware the cessation of alcohol WILL cause very real physiological effects in our body and so if levels of consumption had been VERY HIGH and it is not for me to define very high, it is for a medical professional, then you need to have medical oversight when you quit.
Next, to introduce you to a concept. The concept is called the gate control theory. This theory is key to us working in any area of pain management as I am, in fact most of my days involve helping people with pain management and so the biology of pain is something I understand very well and as such my own methods of dealing with cravings have sprung from my knowledge of and methods in helping people with shutting down pain. The gate control theory was never meant to translate to controlling cravings for alcohol, but to me it translates well in a very modified fashion.
Firstly a quick explanation of the gate control theory. When you hurt yourself, for example a knock on the head, what is the first thing you do instinctively? Think about this. What do you do when you hurt something by knocking it?
You grab the area right? You rub it, sure you might swear or yell, but physically you generally rub the area you bumped or hurt. Recall a time you stubbed your toe, you smash it into a table leg and await the slow pain build up, you know it’s coming and it builds rapidly, you reach down and grab your foot and toe and squeeze it or rub it or you shake it. Let’s look at another stimulus. If you get bitten by a mosquito, the sensation of itch compels you to scratch it. Same concept. Did you ever ask yourself why? Why would I scratch the itch, why would I rub the bump? Seems silly to ask right? But no it is not, there is a reason you instinctively attack the area of pain or itch with pressure, scratching or rubbing. There is a reason you you do this, and you probably don’t even realise it.
To understand why you rub the area you bumped I need to explain to you the gate control theory. This underpins my strategies for dealing with cravings. As with most of my strategies I like to bring things back to neurological concepts and adapt them.
The gate control theory in a nutshell states that non-painful stimulus essentially closes a gate to other neurological input such as PAIN being transmitted to the brain. Essentially, you hurt, you rub, pressure input overrides pain input which then leads to less pain perceived by the brain. So the idea is to block one unwanted experience by overriding it with another input because the neurological structures are governed at the level of the spinal cord by an interneuron which can downgrade a stimulus such as pain to allow only the transmission of the other stimulus, the pressure of the rubbing. When I quit alcohol, my method of dealing with cravings was to employ a variety of overriding stimulus to my body and mind before the sensation and feeling was able to turn to thought and action. Once the craving has forced past sensation to perception, to feeling it can be difficult to prevent action unless an overriding stimulus is interjected to STOP that process from playing out the well engrained habit loop in your mind.
So, I think of it in terms of old grannies, that’s right, grannies.
Two grannies are in the store, they both want prune juice. Grannie in the blue cardigan is looking into the distance at the refrigerated section and there is only ONE prune juice left on the shelf. Grannie in the yellow cardigan spies the same single bottle of prune juice on the shelf at the same time. Grannie blue looks right and can see grannie yellow gearing up hit the throttle and grab that last bottle of prune juice. The yellow grannie looks left and can see the same of grannie blue, and so now it is on. Off they go at a snails pace left foot right foot, trying to be the one to get to the prune juice first, maximum heart rates of 90 BPM and a smashing snails pace they go, they clash trolleys and shake fists. Blue grannie pulls ahead by a nose but oh no, right at the shelf when grannie blue reaches for the juice a friend steps in front of her, “hello Janice” her friend says and as the path is blocked by the friend, grannie yellow catches up and snatches the last bottle of prune juice from the shelf much to grannie blue’s dismay. Only one of them can win, today it was grannie in the yellow cardigan.
So in the story grannie blue was the craving (ouch, bump), grannie yellow was the pressure (rubbing the sore spot), both were heading along the same pathway with the same destination and then grannie blue’s friend who stopped her from taking the juice was an interneuron which blocks the pain stimulus from passing into the spinal cord and up to the brain. In a wildly simplified form, the gate control theory is just saying that one stimulus can block another neurologically. This is the primary concept I use in every single method of dealing with cravings when they came or come around.
Is dealing with cravings exactly the same as the gate control theory? No, the gate control theory relates to physical stimulus and blocking it from entering the brain at the spinal cord but the theory is how I can best describe the goal of dealing with cravings that is, distraction, replacement, action and overriding stimulus. Kill the cravings through activity, movement, overriding thoughts and actions to replace the habit.
To me, dealing with cravings is about getting the fuck up, getting the fuck on, getting the fuck out and getting the fuck through the craving. Most reports show that cravings for an addictive substance reduce or pass after around 20 minutes. 20 minutes, keep this front of your mind, you can endure all sort of hardships for 20 minutes, cold water, hard exercise, hot weather, annoying people, pain, so many hard things can be sustained for 20 minutes or longer and cravings can feel like the most difficult of tasks at times especially while the neurological circuitry is so strong within your mind HOWEVER, you can endure them and they will pass. Repeat THEY WILL PASS.
This leads me to a commonly slung concept today. Sit in it, sit with it, sit with your feelings, just sit with them, sit with it, sit, sit, sit dog sit. At the risk of infuriating some people. DO NOT SIT WITH CRAVINGS WHEN YOU HAVE AN ADDICTION this is misunderstood as a concept it applies well when applied at the right time. Here is the concept explained, when we expose ourselves to unwanted feelings such as sadness or anger or any undesirable emotions we can indeed acclimatise our mind to feel more at ease with these emotions, this is very positive growth and this is absolutely effective, in allowing the unwanted emotions to wash over us and accepting them, even speaking to them we will generally become more able to deal with these emotions or to accept that they are ok, they are a part of our life and there is nothing wrong with that. This is a positive example of how sitting with feelings is a very valid and productive thing to do. When you first quit alcohol you have one goal TO NOT DRINK ALCOHOL and so it is not the time to retrain the ability to sit with cravings, this will come later. When you first quit alcohol your goal is not to just sit with cravings, do not sit with anything, get up, get out, get going, get moving, get distracting and OVERRIDE those cravings. This is craving survival, not emotional retraining and these are two different things during early sobriety. Sobriety is a wonderful thing, it’s longer term goal truly is growth and improvement which includes retraining oneself to feel ok with unwanted feelings but this is long term sobriety not early sobriety.
Think of it this way. You fall and break your arm. You go to a physiotherapist requesting they help you within hours of breaking the arm, before even seeking medical attention, rightly the physical therapist is going to tell you to go to the hospital and get it cast, wait 6-8 weeks and then return for rehab when the cast is off and the bone is adequately healed to being joint and tissue rehabilitation. Trying to just sit and be comfortable with your cravings during early sobriety is the same as breaking your arm and trying to jump straight to strengthening the limb with the broken bone instead of having it cast and letting it heal, not a safe or reasonable idea.
When you first quit alcohol you should treat it as though you have an acute injury like a broken bone or a huge gash because either way your body and mind will be going into shock and going into battle. You need first aid not long term physical rehab, likewise in addiction you need methods to battle cravings not attempts to sit and learn how to be comfortable with them. You are at war in your mind and so you need to act accordingly. The sitting and learning, yes that will absolutely come, but not yet.
To review. How does all of that relate to craving?
DISTRACTION! OVERRIDING ONE STIMULUS that is CRAVINGS with ANOTHER STIMULUS. The MORE INTENSE the alternative stimulus is, THE BETTER.
CRAVING
Sensation, Perception, Feeling, Thought and Action
Sensation, Perception, Feeling, Thought and Action
Sensation, Perception, Feeling, STOP…. Thought, STOP…… Control the Action
Sensation, Perception, Feeling STOP… STOP…
STOP! Override!!!
You are early on in your alcohol free journey. Lets say 2 weeks. You think things are looking good, you are getting through and this life is becoming normal. Suddenly 5pm comes around, the witching hour, the hour you were likely in the past to start splashing the poison around. The craving becomes you, the voice calls you, the magnet pulls you. You suddenly want it, you need it, the pull is so strong.
Here is where you STOP and OVERRIDE that craving.
This is where you override that fucker!
Sensation, Perception. STOP…
Ok so how? As with most things, there are many methods and no one will be perfect every time. Having a method for different situations is vital and knowing the most effective methods for yourself will be helpful so that the primary fall back method is well known, as are its effects.
This article/recording is the first in a line of methods to deal with cravings. Many variations of activities and habits to beat cravings will follow soon.
Stay tuned Sobertown, you got this.
Dr. Todd Crafter
AHPRA Reg Chiro/FA Reg Trainer
BAppSc(human movement), BHSc(chiro), MClinChiro
REFERENCE
(1): Taken from https://en.wikipedia.org/wiki/Prefrontal_cortex on 21/10/2021
To contact the author please email soberaustralia@gmail.com
The Sobertown Blog articles and recordings are created as a means of assisting others in achieving and maintaining sobriety and freedom from alcohol. Experiences, entries, research and article content are that of the author and should be applied in a safe manner deemed best by the reader and applied safely, if relevant, with medical oversight. This is not medical advice and the author is not a medical doctor. No advice within is based on or crosses over with the authors profession or professional opinion as an AHPRA registered allied health practitioner or FA registered exercise professional.
