Monday, August 31, 2015

Do Cravings Ever Go Away?

Do Cravings Ever Go Away?

 by Peter R. Coleman, MD

Recently, I have been asked by a few people if I still have cravings for drugs or alcohol.  The questions took me a little by surprise because I have not had any cravings for such a long time. Frankly, I had not e3ven thought about it for many years.  The question made me remember just how powerful the cravings were n the early days, and it got me feeling very grateful for the fact that the cravings have been completely lifted.  I have a lot of compassion for people in early recovery because, when I think about it, I can remember just how pervasive and painful those cravings were.  I remember sitting in group therapy unable to think about anything other than using.  I remember having dreams so vivid that I woke up in a sweat, positive that I had relapsed and lost my sobriety.

How do cravings go away?  Mostly, it is purely a function of time.  But there are also things we can do to help ourselves avoid cravings.  Please also read the "Ask the Doctor' article in this newsletter on what causes cravings.

Recovery is mostly a practice thing - the more we do it, the better we get at it.  I have often used the analogy of riding a bike to represent recovery.  When we start out we are wobbly and we can fall off if we go too fast or take too many risks.  It is best if we have a teacher to show us the ropes and its best if we ride in a group with other people.  It is more fun to ride with a group of friends.  Eventually, we can learn some things from them and we can teach some things to the newer riders in the group.  As we get better at riding, we can begin to look around and appreciate more and more what a great thing it is to be a rider.

After we have become skilled at riding a bicycle, we almost never fall off.  Unless, of course, we do stupid things - like take our hands off the handle bars, or not look where we are going.  We may have to negotiate difficult terrain at times, but we can even do that if we take it easy and if we are careful.  When riding in difficult terrain, it is usually best if we have some friends with us, especially those who have been on this trail before.

Recovery can become as easy as riding a bike.  After some time, it is easier, fun, and most people never fall off.  Of course, we do need to keep our wits about us and look our for tricky situations - loss if a job, conflict with spouse, death of loved ones, etc.  But even these don't need to trip us up if we are careful.  In difficult times, it is especially important to ask for help and get support.  As we learn to navigate difficulty in life, our confidence improves, our happiness expands, and our appreciation of just how fabulous this life continues to grow.

Friday, August 21, 2015

How to Start Breaking Your Worst Habit Today

Ideas and Actions for Kicking Bad Habits
Problem habits are high on the list of things that most people want to overcome. For example, do you worry too much? Do your friends joke about you showing up late? Do you shop and spend too much? Are you caught up in too many lies? Do you eat calorie-rich food when you want to lose weight? Do you live your life through Facebook? Do you bite your nails?  Do you procrastinate? 
What makes a habit a problem habit? Some of these automatic activities are both the causes and consequences of stress or anxiety.  Some you acquire or learn accidently or by imitating others.  Some, like nose picking, can cause you to look unappealing. Some can result in serious physical harm: smoking raises your risk for lung cancer. In short, problem habits normally have negative consequences.
You can learn to lessen or extinguish these and other undesirable habits. Let’s look at more than 12 options for getting them out of your life.

Habits of the Mind, Consumption, and Behavior

I divided problem habits into three categories: (1) habits of mind, such as worrying excessively, (2) habits of consumption, such as eating excessively, and (3) habits of behavior, such as nail biting. The categories suggest different remedies.  I’ll give brief tips for each type of problem habit (tips for one group of problems may also apply to another). Then I’ll share a general habit-breaking tip.
Before we go any further, what’s your worst problem habit?

Habits of the Mind

A habit of the mind is where you automatically repeat beliefs and thoughts that lead to the same emotional and behavioral troubles. For example, some anxieties are based on fictions where you exaggerate risks and threats that most would consider non-dangerous events. Here’s an example. You believe that strangers you meet will see your faults and reject you. You dread going to social gatherings where you may meet strangers and you habitually avoid them whenever you can. You often feel lonely and spend a lot of time feeling sorry for yourself.
Like most negative habits of the mind, fictional anxieties are correctable. They are based on situations that, when you are in them, evoke fears that are also based on fictions.  For example, face up to what you foolishly fear often enough, and you are likely to stop feeling afraid. You are less likely to feel anxious about something that you no longer fear1.  So, if you are afraid of rejection in social situations, daily expose yourself to a social situation. If, after a few weeks, you no longer feel so anxious, what changed? (Exposure is a gold standard for combating fear situations that arouse anxiety.)
You may do more than exaggerate or fictionalize threats.  You may also feel anxious about feeling and looking anxious. This is a double trouble situation. You feel anxious about a situation and anxious about feeling anxious2. By accepting anxiety over anxiety as inconvenient (not terrible), you may feel considerably calmer.

Habits of Consumption

It is tough to resist consumptive urges. You want to lose weight. You see a bowl of potato chips. You tell yourself you’ll eat only one potato chip. Then, almost as if you were in a trance, you gobble down one chip after another.  You smoke and want to quit.  You tell yourself you’ll stop someday. You drink too much. You know you have to quit.  But, the bottle is your buddy.
You don’t have to smoke or drink. Indeed, by the age of 30, most people kick their addictive habits without professional help3. However, you have to eat to live. But, you don’t have to eat fattening snacks. In a sense, they are like nicotine and alcohol.
You don’t have to devour potato chips as if you had no other choice. Nevertheless, when tempting snacks are before your eyes (or you have a craving for a particular fattening food) you have a first line of defense: do something constructive to take your mind off consuming the snack. If you don’t start eating chips, you avoid having your mind go on automatic pilot where you start consuming like a ravenous reptile.  Can you do better than what your reptilian brain dictates?
If you have a craving-urge problem to address, and have a hard time dealing with it, what's next? Perhaps you have a pink elephant problem. Here’s the situation. For the next minute, try not to think of a pink elephant. If you are like most the harder you try to suppress the elephant the bigger it grows4. In a sense, that is why some habit urges and cravings linger longer. Accept them without a felt need to act on them, and they tend to lose their power.
Here’s another option to the pink elephant problem.  Actively substitute a coping tactic. When you start to have a snack attack, before you do anything else, do something other than take the first morsel.
Here is a time interval experiment. When you have an urge to consume find out how long the urge lasts. Check your watch. Keep your eyes squarely on the time, Does the urge last two minutes? Twelve minutes? Watch for changes in your emotions. Do you get impatient watching your watch? Do you get bored? Do you feel intrigued by what is happening?  What do you make of your emotions?
Here is a hypothesis for you to test: Once the urge subsides, are you less likely to consume the snack?  If the timing technique works for you, keep practicing until you make this into a competitive, positive, habit to pit against the problem variety.
Here’s another. Try a combination technique and see if you can procrastinate on executing your worst problem habit.  Redo the time interval experiment. This time do the experiment with a different twist. Instead of watching your watch, fill the time with an activity. Here’s how. Between the start and end of an urge, use my procrastinationrewards technique. Intentionally do what you might do if you were procrastinating.
When you procrastinate, you always substitute something less relevant for what you are putting off.  You dust instead of read. You fiddle instead of doing a pressing report. You shuffle papers instead of making an important phone call. These habitual behavioral diversions extend delaying when you are probably better off not delaying.
You can turn procrastination distractions to your advantage. As you are doing your time interval measure, do things that might ordinarily reward a procrastination habit. You dust your desk. You text. You plan next year’s vacation.  You may find that distractions, that ordinarily reward procrastination, also reward delaying the habit that you want to delay, then end. Test it out. See what results from this combination experiment. If this doesn't work for you, try another way.
By the way, did you feel any different between when you watched your watch as time flowed on  and when you filled that time void with activity? Did you discover anything interesting that you can use to quiet your problem habit urges?

Habits of Behavior                      

Problem habits of behavior can be self-defeating, especially when you make a negative impression on people that you want to impress. Chewing your pencil is an example. Here are a few others: lip smacking, finger tapping, and vocalizations such as "Ya know,” “Umm."  
Awareness is an antiseptic for habits of behavior. Developing competing actions is a second. Let’s start with awareness.
“Seeing is believing.” Video feedback can be a great source of information.  Observe yourself on tape. You may notice mannerisms and habits that merit eliminating. Self-monitoring is another great method.  Watch what you do and when. Target high-risk timeswhere your habit is likely to surface. Plan, and then practice  a competitive habit.
To deal with a habit of behavior start building a competing habit. For example, if you tap your fingers when you feel impatient, practice a different response. Fold your fingers together instead.  If you want to make this competing response automatic, try anovercorrection experiment.  When you are by yourself, move your finger as if you were ready to start tapping. Then, immediately fold your fingers together. 
How long does it take to find out if overcorrection can work for you?  It takes as long as it takes. Here’s an experiment. For the next week, for four  times a day, for three-minutes per time, practice your overcorrection technique.  See what happens.

Your General Habit Breaking Tip

Here is a technique that you can use with different problem habits, including your worst habit. It involves taking an easy attitude toward the problem habit.
Here is how the easy attitude technique works. You allow yourself to experience the urge.  You study your urge and habit in live time. You accept the urge as transitory: it is like a cloud flowing with a passing breeze.
From the time interval experiment, you know that urges have a relatively short lifespan. By accepting the urge, as part of what is going on now, that shift in perspective can transform the urge into feelings you can tolerate.  If you can better tolerate a feeling or urge, you’ll have less of a struggle5.  
Here is something else.  Habit urges and substance craving are not the only thing that are going on in your life. What else is taking place that is of greater importance? This shift in the locus of your focus puts your habit urge into a broader perspective. The habit urge or substance craving may not seem so compelling or important in the broader context of your life.
To learn more about procrastination, click on End Procrastination Now(link is external)


Here’s the American Psychological Association style for citing the procrastination reward technique, or other information, from this blog:
Knaus, W. (August 12, 2015). How to Start Breaking Your Worst Habit Today [Blog Post]  Retrieved from
1. Knaus, W. (2014). The Cognitive Behavioral Workbook for Anxiety (Second Edition). Oakland CA: New Harbinger.
2. Ellis, A. and Knaus, W. (1979). Overcoming Procrastination. NY: New American Library
3. Heyman, G. M.  (2013). Addiction and Choice: Theory and New Data. Frontiers in Psychiatry. 64: 31 Retrieved from is external)
4.  Knaus, W. (1982). How to Get Out of a Rut. Englewood Cliffs NJ: Prentice Hall.
5. Knaus, W. (1994). Change Your Life Now. NY: John Wiley.
© Dr. Bill Knaus

Monday, August 10, 2015

Anxiety is Normal!

by Joan Shepherd, NP

Just another word about anxiety.

We survived as a species because our brains have the ability to respond to what they perceive as dangerous. The brain perceives danger—usually either a Lack or Attack of some sort—and it prepares the body to react appropriately. In some cases, that means running away; in some cases, it means freezing and hiding; and, in some cases it means to stay and fight like hell.

Many people seek treatment for anxiety or self-medicate because they do not like the way they feel when their body is responding to a ‘dangerous’ situation. The racing heart, the tightness in their chest, the lightheadedness, the choking sensation….

It’s not unusual for me to hear from patients who are going through a detox that even before they became dependent on opiates, benzos or booze, they experienced anxiety. “I have anxiety,” they say. Their parents often nod in agreement, “He’s always been anxious—even as a kid.”

Well, that’s ok. We all have anxiety. We are all programmed to have these responses. It’s healthy and normal—unless you are letting these responses take up more than their fair share of your life. If you are allowing these feelings to get in the way of you acting on what you value most, then, there’s a problem.

Because, if anxiety is running the show, your life will become more and more constricted. If you believe you cannot tolerate the discomfort of anxiety symptoms, you will become an expert in avoidance. And, your life will become smaller. You will choose not to act in ways that support what you value.

But, you can learn to live with your anxiety, without defining yourself by it. The strategies for doing this are beyond the scope of this article, but it’s important for you to know, you do not need to live within the tiny prison walls you’ve created for yourself.

Courageously choosing to stop using an addictive substance may open the floodgates to increased anxiety at first. That’s why it’s so important to have a good plan going forward. Support and help are out there everywhere.