Craving—the obsessive desire to use drugs—is a natural byproduct of drug use itself. A person can have cravings on and off well after drug use stops and the physical signs of withdrawal are complete. The idea of having cravings is remarkably similar, regardless whether the drug used is alcohol, cannabis, heroin or cocaine. Triggers and the Brain’s Response Craving can be stimulated by almost anything. If a recovering person associates certain personal experiences with the patterns of former drug use, cravings can be automatically triggered. Some of these triggers are the people, places, things and situations that are associated with the drug use, but others can be driven by internal moods such as depression or anxiety. For a recovering alcoholic or drug addict, any drug use—even prescription medications—can keep the cravings strong. That is why the attitude of, “I’ll just have one (beer, hit off a joint)” or “I’ll just do it now and then” does not work. Dabbling with a drug keeps the flame of the craving alive and able to flare up at any time because some critical brain neurons that responded to the chemicals have been transformed from their normal state into drug-seeking machines. They have literally come to expect the drug; to the neuron, it means they must have it to function. When the drug is withdrawn through abstinence, the neurons still seek out the drug in the blood stream and, when they don’t find it, the receptors signal the neuron that they are desperate for a chemical they have come to think of as essential for their functioning. When they do not have these chemicals they have come to expect, the effects of this disappointment are felt in the uncomfortable signs and symptoms we call cravings. “Medicine” vs. “Drug” Gradual exposure to the craving triggers and NOT getting high, with the help of friends in recovery and good planning, can weaken or even extinguish the cravings. In effect, recovering people re-train the neurons—that they do not need the drug to function—and the drug receptors that the drug created on the neuron cease to function. Psychologists call this the “deactivation of craving.” People in recovery call it “living life on life’s terms.” Complete abstinence—not using any drug or alcohol at all—is the surest way to reduce cravings. Yet, it is difficult to stay away from drugs entirely. Occasionally, people will need to take pain medications for illness. They will literally need to take the drug that can make them relive the cycle of obsession and compulsion characterizing the disease of addiction. For recovering people, it is essential to make a distinction with prescription medications between the everyday use of the word “drug” and what we commonly call a “medicine.” The difference is really in the use of the medication. Opiates are good examples. Taken as prescribed, opiate medications do what they are designed to do: relieve pain and not become addictive if taken as uniquely prescribed for that person during the course of their treatment. Done so, it is a medicine. This is why medicines are regulated by doctors; they know the true value of each dose and only prescribe amounts and frequencies that meet the patient’s need for relief. The trouble is that often such medication produces pleasurable side effects that many people misinterpret as the desirable “bonus” of the medication, and they take more of it or more frequently than prescribed. They sometimes get accustomed to the pleasurable feeling the medicine provides long after the cause of the pain has subsided. This is a trap. Essentially, at the point where a person goes off the prescribed use of the medication, that “medicine” becomes what we call a “drug” of addiction. Medicines heal; drugs kill. It’s important for recovering people to know the difference. Recovering people know that proper preparation and execution of a relapse prevention plan is critical to avoid falling into the trap. That will include making sure that the medicine is taken as prescribed, that perhaps someone dispenses the medicine for the person, or that the medicine is not taken unless there is justifiable pain. Building Recovery Management Skills to Combat Cravings Despite every precaution, people who take medicines that can produce pain relief coupled with euphoria must work extra hard to not respond to the false demand that some neurons make once re-stimulated by a “drug” into thinking that it is essential for the neuron’s survival. This is where a strong relapse prevention program, such as the use of recovery management skills or a Twelve Step program can come in so handy. The axiom, “Don’t use no matter what,” was created in Twelve Step programs to cope with this need for a reminder that craving signals from addicted neurons in the brain are merely side effects of the medicine. People who abuse these kinds of “medicines” mentally convert them into a “drug” the instant they start thinking it should do things in a way different than that which it was intended to do. Recovering people learn that it is not necessary to give into these “drug” cravings, or to abuse the medicine in order for it to do its work. Everything about cravings depends on the situation. Certain old triggers that have not been properly handled—such as old friends, neighborhoods, or places where drugs were taken—can lead to quick relapse. Alcoholics and addicts have conditioned themselves to think of drug use when around these old people, places or things, and they can be deadly for the recovering person. However, given the chance to be in such places when accompanied by close recovering friends (never alone) can make a difference in how the trigger is handled. Such triggers can remain strong even after many years of abstinence and only constant vigilance will protect the recovering person. Determination and willpower are notoriously poor defenses against craving. In fact, addiction robs alcoholics and addicts of their ability to make healthy choices during early recovery, and it sometimes takes years to have this ability restored to the point where it can be relied upon to help prevent a relapse. Real strength in this area comes from time, work, guidance and support. Certainly a Twelve Step program helps a person change their life enough so that cravings management becomes a habit of their daily life in recovery. But, changing lifestyle, gaining friends through support networks, learning new ways to relax and have fun, and being a productive person again, go a long way toward neutralizing cravings. The absolute requirement for turning away from cravings is to have some sense of being safe with oneself, or knowing that there are principles and values that act as guides in life, and practice a life-change program of recovery every day. Even though cravings are the natural aftershocks of being addicted, it is important to honor a voice inside that questions whether to give in to the craving each time it arises. A recovering person gains confidence this way and begins to recognize that cravings do not have the power to overcome a person who has transformed themselves in recovery. Roger Watts, PhD, has practiced chemical health counseling since 1989, working with both adults and adolescents on recovery from addictions. He has worked in detoxification centers, treatment programs, outpatient programs, and half-way houses in Florida, Massachusetts, Maine and Minnesota.