Holidays are meant to be a happy, festive time of merriness and cheer, and they often are for the most part. However, they also bring with them a number of challenges, especially for those suffering with an eating or substance use disorder. Eating Disorders and Substance Use Disorders act very similarly on the brain. For example, prominent cognitive neurobiologist Hugh Garavan states that recovering substance users experience “very strong urges towards use, often against their own better judgment”[1]. Cravings have been identified as a predictor of relapse[2] for both Substance Use Disorders (SUDs) and Eating Disorders (EDs).
However, we don’t have to act on cravings. There are many strategies and coping techniques that people can employ to manage cravings, and medical science has made major advancements in helping people keep their recovery intact and their cravings at bay. This blog will first outline some of the neurobiological causes of craving, whether it is craving to binge and purge, extreme food control, or for certain substances, and then explore how those in recovery can manage their urges during this festive season.
The Reward System
SUDs and EDs are now recognized as health conditions[3], and many advancements have been made in the past thirty years – both medically[4] and therapeutically[5]. We now know that our bodies have an inbuilt reward system that is designed to keep us propagating our species. It rewards us for taking part in activities that benefit us, such as eating, having sex, or socializing.
According to the Journal of Abnormal Psychology, Substance Use Disorders and Bulimia have a two-factor mechanism of action. First, the substance or chosen food reflects a “common neural mechanism of positive reinforcement.” Secondly, substances suppress distress signals. This is especially pronounced if the substance in question is physically addictive (such as alcohol, opiates, and benzodiazepines). This causes “negative reinforcement” in which the user associates not using substances or food with suffering[6].
Cravings are highly subjective, and as such, their clinical significance is hard to measure[7]. However, there is no doubt that cravings can be a significant factor in the lives of those recovering from an eating disorder or an SUD.
Self-Management During the Holidays
Cravings can sometimes seem to appear out of nowhere, which can be both confusing and upsetting for those in recovery. Multiple things can trigger cravings, including but not limited to familiar sights, people, smells, feelings, and situations. Going back home during the holiday season can also be triggering for many people. Most family dynamics are difficult to deal with in the best of times, and it’s even harder when there are so many tempting foods and drinks around during the holiday season.
Research has shown that keeping a diary helps to build our awareness and understanding of what is happening with our cravings and allows us to identify patterns[8].
It is also crucial to understand the nature of SUDs and EDs and how they relate to cravings. These disorders are characterized by repeated engagement in a behavior that we know to be harmful to us. As such, many people experiencing them feel a great deal of shame and guilt for how they feel. It will help people process these feelings if they understand that cravings are a direct effect that substances have on the brain rather than a moral failing. It is also helpful to know that over time, cravings for food and substances will diminish. The brain is an amazing organ with a fantastic ability to heal itself.
The Three D’s
It is helpful for people in recovery to become familiar with these easy and highly effective strategies:
Delay
If you are experiencing a craving this holiday period, simply put it off for a minute. Then, put it off for another minute. Commitment to not using for the rest of your life is a lot to process – our brains don’t typically work that way. It may help if you keep telling yourself “this feeling will pass.” If we break it down into smaller, more manageable segments, we feel more accomplished in general.
Distract
Once you have delayed the urge to use or binge, do something to distract yourself from the intrusive thoughts. This could include going for a cold winter’s walk, listening to music, exercising, or calling someone from your support network. Once your brain is focused on something else, you will feel the craving subside, and you can get back to enjoying the holidays.
Decide
After the urge has subsided, examine your motivations for wanting to act out. It is also helpful to examine why we decided not to and congratulate ourselves.
Mindfulness and Breathing in the Holidays
Although this originated as an Eastern spiritual practice, Mindfulness has shown great promise in helping people maintain their recovery. One study of a Mindfulness-Based Relapse Prevention (MBRP) showed that it significantly lowered substance use relapse rates [9]. Another study found that mindfulness could reduce opiate cravings in dependent subjects[10].
Mindfulness helps us be present in the here and now and attunes us to our own feelings. This can help us to apply rational logic to using and thoughts of using.
When we experience urges, it can be distressing. Deep breathing exercises calm our “fight-or-flight” response and lower our heart rate. Breathing exercises have also been shown to improve our self-control[11], while other research has shown them to reduce food cravings[12]
Allow yourself a few minutes every day over the next two weeks to just take time out and focus on your breathing. You will find that it really helps your outlook on life and the festivities happening around you, and can make the holidays much easier!
Conclusion
Although cravings are a part of many people’s festive holidays, they do not signify inevitable or even likely relapse. It is important to recognize them for what they are – simply feelings. If we can acknowledge this and practice self-forgiveness and tolerance, we will feel less guilt and shame about them. We need to know that we aren’t always in control of what we feel, but that our feelings don’t have to control us.
To learn more about the services offered by Heather R. Hayes & Associates and/or to become trained as a trauma-informed transporter, please call 800-335-0316 or email info@heatherhayes.com.
Sources
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[2] Witkiewitz K, Bowen S, Douglas H, Hsu SH. Mindfulness-based relapse prevention for substance craving [published correction appears in Addict Behav. 2018 Mar 21;:]. Addict Behav. 2013;38(2):1563–1571. doi:10.1016/j.addbeh.2012.04.001
[3] Hasin, Deborah S et al. “DSM-5 criteria for substance use disorders: recommendations and rationale.” The American journal of psychiatry vol. 170,8 (2013): 834-51. doi:10.1176/appi.ajp.2013.12060782
[4] Preston, K L, and G E Bigelow. “Pharmacological advances in addiction treatment.” The International journal of the addictions vol. 20,6-7 (1985): 845-67. doi:10.3109/10826088509047756
[5] Xu, Benjamin, and Kevin S. LaBar. “Advances In Understanding Addiction Treatment And Recovery”. Science Advances, vol 5, no. 10, 2019, p. eaaz6596. American Association For The Advancement Of Science (AAAS), doi:10.1126/sciadv.aaz6596. Accessed 14 Dec 2020.
[6] Wise, R A. “The neurobiology of craving: implications for the understanding and treatment of addiction.” Journal of abnormal psychology vol. 97,2 (1988): 118-32. doi:10.1037//0021-843x.97.2.118
[7] Tiffany, S. and Wray, J., 2011. The clinical significance of drug craving. Annals of the New York Academy of Sciences, 1248(1), pp.1-17.
[8] Epstein DH, Willner-Reid J, Vahabzadeh M, Mezghanni M, Lin J, Preston KL. Real-Time Electronic Diary Reports of Cue Exposure and Mood in the Hours Before Cocaine and Heroin Craving and Use. Arch Gen Psychiatry. 2009;66(1):88–94. doi:10.1001/archgenpsychiatry.2008.509
[9] Bowen S, Chawla N, Collins SE, et al. Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial. Subst Abus. 2009;30(4):295–305. doi:10.1080/08897070903250084
[10] Garland, Eric L et al. “Mindfulness-Oriented Recovery Enhancement reduces opioid craving among individuals with opioid use disorder and chronic pain in medication assisted treatment: Ecological holiday holidays holidays holidays holidays momentary assessments from a stage 1 randomized controlled trial.” Drug and alcohol dependence vol. 203 (2019): 61-65. doi:10.1016/j.drugalcdep.2019.07.007
[11] Kruschwitz, Johann D et al. “Self-control is linked to interoceptive inference: Craving regulation and the prediction of aversive interoceptive states induced with inspiratory breathing load.” Cognition vol. 193 (2019): 104028. doi:10.1016/j.cognition.2019.104028
[12] Meule A, Kübler A. A Pilot Study on the Effects of Slow Paced Breathing on Current Food Craving. Appl Psychophysiol Biofeedback. 2017;42(1):59–68. doi:10.1007/s10484-017-9351-7
