Discuss Strategies for Coping With Triggers

The counselor presents several coping strategies:

C: Many times cravings can’t be avoided, and it becomes necessary to cope with them. Here are some possible strategies for coping with craving:

Get involved in a distracting activity. Reading, engaging in a hobby, calling a friend, going to a movie, and exercising (jogging, biking) are good examples of distracting activities. Once you get interested in something else, you’ll find that the urges go away in no time.

Talk it through. Talking to your supporter or a friend or family member can pinpoint the source of the craving and help relieve the feeling. It also can restore honesty in your relationship. Urge surfing. [Gives client Urge Surfing handout (form 5B) and reads sheet aloud.]

Delay the decision to use. Most urges to use are like waves—they build to a peak and then dissipate. If you wait 15 minutes, the wave will pass. Try imagining you’re a surfer riding the wave of craving until it subsides, or use another image that works for you.

Use imagery. If you feel as though you are about to be overwhelmed by urges to use ,imagine scenes that portray those urges as storms that end with calmness, mountains that can be climbed, or waves that can be ridden. Everyone can find an image to maintain control until the urge peaks and then dissipates. Some people imagine being a warrior who can defeat urges as if they were an enemy or an explorer who can slice through tropical underbrush and carve out a trail. Images can be made vivid by using relaxation techniques and all the senses (e.g., seeing the thick green jungle, hearing the blade swishing through the leaves, smelling the tropical plants). Photographs of loved ones also can distract you.

Challenge and change your thoughts. When experiencing cravings, many remember only the good effects of using and forget the negative consequences. You may find it helpful to remind yourself of the benefits of not using and the negative consequences of using. Remind yourself that you won’t feel better if you just get a little high and that you lose a lot by using. It’s helpful to have these benefits and consequences listed on a small card to carry around.

Self-talk. People constantly think about their actions and things that happen to them. These thoughts can influence strongly the way you feel and act. What you tell yourself about your urges to use affects how you experience and handle them. Your self-talk can be used to strengthen or weaken your urges. Making self-statements is so automatic you may not notice it. For example, a self-statement that is automatic for you may be, “I am a skilled photographer” or “I have no willpower.” Hidden or automatic self-statements about urges can make them hard to handle. (“I want to get high now. I can’t stand this. The urge is going to get stronger and stronger until I use. I won’t be able to resist.”) Other types of self-statements can make the urge easier to handle. (“Even though my mind is made up to stay clean, my body is taking longer to learn this. This urge is uncomfortable, but in 15 minutes or so, I’ll feel like myself again.”) We will discuss these automatic thoughts more in the next session.

There are two basic steps in using self-talk constructively:

1. Pinpoint the things you tell yourself that make it harder to cope with an urge. One way to tell whether you’re on the right track is when you hit on a self-statement that increases your discomfort, for example, “I will never be able to withstand this urge.” That discomfort-raising self-statement is a leading candidate for challenge.

2. Use self-talk constructively to challenge the statement. An effective challenge makes you feel better (less tense, anxious, panicky) even though it may not make the feelings disappear entirely. The most effective challenges are ones tailored to specific self-statements. Listed below are some challenges that people find useful:

• What is the evidence? What is the evidence that if I don’t get high in the next 10 minutes, I’ll die? Has anyone ever died from not using? What’s the evidence that people recovering from a marijuana problem don’t have the feelings I’m having? What is the evidence that I’ll never improve?

• What’s so awful about that? What’s so awful about feeling bad? Of course I can survive it. Who said that abstinence would be easy? What’s so terrible about experiencing an urge? If I hang in, I’ll feel fine. These urges are not like being hungry or thirsty; they’re more like a craving for a particular food or an urge to talk to a particular person—they’ll pass.

• I’m a human being and have a right to make mistakes. Maybe I worry about being irritable, preoccupied, or hard to get along with. What’s so bad about that? We all make mistakes and in a situation that’s complicated, there is no “right” or “perfect” way to get along.

Some of these strategies will be necessary or helpful only initially to distract yourself from persistent urges; in the long run, you’ll have an easier time if you replace the thoughts with other activities. After a while, abstinence will feel more natural; the urges will diminish in intensity and will come less often. You will also know how to cope with them. In the example below the counselor and client discuss craving triggers and self-talk strategies:

C: You identified one of your strongest triggers as seeing other people smoking, especially family members. Let’s try to pinpoint exactly what’s going on.

Shirley (S): I feel that if I don’t smoke with some family members, they might think I’m above them. They already make fun of me, calling me the college girl, and I want to fit in.

C: You’re sensitive to your family members and concerned that they’ll think you’re trying to be better than they are by not smoking. What is the evidence that this will happen?

S: Well, I guess it’s more of a fear than a fact. I really do love them and know that they love me. But I don’t know how they would respond.

C: What thoughts have you had about telling them?

S: I almost told my uncle the other day when he lit up. But then I ended up smoking, and I just couldn’t.

C: You realize that once you get high, it’s difficult to make changes.

S: I’ve been thinking that I need to tell them when there’s no chance that we would be smoking. But I dread it!

C: What are some other ways you might let them know?