Cocaine addicts often relapse because they are
overwhelmed by a powerful sense of craving.
The physiological craving of cocaine is far more powerful than
the physiological craving of alcohol or other drugs.
As a result, the issue of craving needs to become a primary
concern in relapse prevention therapy with the cocaine addict,
especially during the first 90 to 120 days of recovery.
To responsibly focus upon the issue of craving requires a
comprehensive biopsychosocial model that will help us understand the
In 1990, I developed a three stage model for
The three stages of craving are:
Set-up behaviors: Ways of thinking, managing feelings, and
behaving that increase the risk of having a relapse
Trigger Events: Events
that activate the physiological brain responses associated with craving.
The Craving Cycle: A
series of self reinforcing thoughts and behaviors that continue to
activate and intensify the craving response.
It is important to note that craving is the last
step of a three stage process. It
is self-defeating to focus on the end result, craving, without focusing
on the factors that cause the craving.
Recovering people unconsciously set themselves to
experience cravings. The set-up
behaviors lower their resistance to craving.
When their resistance is down, they're vulnerable to trigger
events that cause the actual feeling of craving to start.
Once they feel the urge to use, they start using habitual
behaviors that amplify or make the craving worse.
This is the craving cycle.
behaviors are a combination of physical, psychological, and social
factors that lower resistance to craving.
Physical Set-ups For Craving
There are five common physical set ups for craving.
Brain Dysfunction From Cocaine Use:
Cocaine damages the brain and leaves recovering addicts
physically set up to experience powerful cravings.
The result of this physical predisposition to experience craving
is if recovering cocaine addicts don't do special things to avoid
craving, they will experience craving.
Poor Diet: Recovering
cocaine addicts are often nutritional disaster areas because they live
on junk food and don't know what a healthy meal is.
Many have coexisting eating disorders that lead to binging on
junk food and/or starving for days at a time to deal with the result of
Excessive Use Of Caffeine And Nicotine:
Both caffeine and nicotine of these are low grade stimulant drugs
and increase the likelihood of having cocaine craving.
Lack Of Exercise. Aerobic
exercise reduces the intensity of craving, especially cocaine craving.
Regular aerobic exercise is a protective factor against craving,
especially in the first six to nine months of recovery.
Not doing aerobic exercise on a regular basis sets the stage for
Poor Stress Management:
When recovering people don't manage stress appropriately in
recovery, they increase their risk of having craving by becoming stress
sensitive. Regular stress
management activities such as meditation, relaxation exercises, taking
regular breaks and rest periods are all protective factors against
There are four major psychological ways that
recovering cocaine addicts set themselves up to experience craving.
1. Euphoric Recall: Euphoric
recall is a way in which cocaine addicts "romance the high" by
remembering and exaggerating the pleasurable experiences of past cocaine
use, while blocking out painful and unpleasant aspects of the memory.
2. Awfulizing Abstinence: When
addicts awfulize abstinence, they notice all of the negatives and
exaggerate them while blocking out all of the positive aspects of
recovery. This leads the
recovering cocaine addict to feel deprived in recovery and to believe
that being sober is not nearly as good as using the drug.
3. Magical Thinking About Use:
Magical thinking about use is the belief that using cocaine or
other drugs will solve all of their problems.
This magical thinking is brought about by the euphoric recall
("Remember how good it was!"), and the awfulizing of sobriety
("Look at how awful it is that I can't use it.").
4. Empowering The Compulsion:
They exaggerate the power of the compulsion by telling themselves
that they canít stand not having the drug and telling themselves that
there is no way to resist the craving.
Denial & Evasion: The
final psychological set-up is denial and evasion. Addiction is a disease
of denial. This denial does
not go away simply because they are not using the drug.
Many cocaine addicts deny their need for a recovery program to
reduce the likelihood of craving. They
also deny that they are setting themselves up to have craving for the
drug. Because this
denial is an unconscious process, many cocaine addicts believe they are
doing the best they can in recovery when, in fact, they are not.
There are three major social ways that cocaine
addicts set themselves up to experience craving.
lack of communication: Cocaine
addicts stop talking about their experiences in recovery and, as a
result, they get into trouble. They
replace rigorous honesty with superficial communication.
This isolates them and prevents them from doing a sanity check on
their recovery experiences.
Social Conflict: Out
of isolation and a refusal to communicate comes a tendency to get into
arguments and disagreements with other people.
This social conflict prompts the recovering cocaine addict to
avoid sober social situations and isolate themselves from others,
spending more time alone.
3. Socializing With Other Drug-Using Friends:
Out of loneliness and desire to be with people who understand
them, many recovering cocaine addicts decide to associate with people
who they used to drink and drug with.
This puts them in the proximity of the drug and sets them up to
have a craving.
There are four primary types of triggers that
activate immediate craving. These
triggers include thoughts, feelings, behaviors, and situations that
1. Thought Triggers: Thought
triggers arise out of addictive thinking or an addictive mind set that
creates thoughts about the role that cocaine plays in a person's life.
2. Feeling Triggers: Feeling
triggers come from sensory cues - seeing, hearing, touching, tasting, or
smelling something that reminds them of cocaine.
It also results from experiencing feelings or emotions that were
normally medicated by cocaine use.
3. Behavioral Triggers: The behavioral triggers deal with
drug-seeking behaviors and rituals that activate a craving.
4. Situational Triggers: Situational
triggers include any stessful relationships or situations that used to
be engaged in on a regular basis while using cocaine.
Once these triggers are activated, a powerful
cocaine craving emerges.
The Craving Cycle
The third and final stage of craving is the actual
craving cycle. This cycle
is marked by obsession, compulsion, physical craving, and drug-seeking
1. Obsession: When
the obsession is activated, the person has out-of-control thinking about
cocaine use. Intrusive
thoughts invade their mind and they can't turn them off.
The obsession quickly turns into a compulsion.
2. Compulsion: When
compulsion is activated the person begins experiencing an overwhelming
urge to use the drug even though they consciously know that it is
dangerous to do so.
3. Craving: The
obsession and compulsion merge into full blown physical craving.
Physical craving is marked by a strong desire to use the drug,
rapid heart beat, shortness of breath, perspiration, and at times the
actual sense of tasting, smelling, or feeling the cocaine.
Physical craving is very powerful.
Drug Seeking Behavior: In
an effort to manage the obsession, compulsion, and physical craving,
many cocaine addicts activate drug-seeking, ritual behavior.
They begin to cruse old neighborhoods, talk with old drug using
friends, and go to bars and other places where cocaine is used.
This exposes the person to more triggers which intensify the
craving cycle. Eventually,
the person becomes overwhelmed with a compulsion that they cannot
control and they return to drug use.
Since craving is a normal and natural symptom of
cocaine addiction that follows the addict into recovery, it is important
for cocaine addicts to learn how to deal with craving in recovery.
This is done by learning and practicing a number of steps.
It is possible to understand cocaine craving and to
learn how to manage cocaine craving without returning to cocaine use. A
model that allows people to identify set-up behaviors, trigger events,
and the cycle of cocaine craving itself, and intervening upon this
process has proven effective in reducing relapse among cocaine addicts.