In one adolescent treatment group the discussion topic was: “What is your decision today about future use: Quit? Continue? Haven't decided anything yet?” One teen answered this way: “What I want to know is, how do you stop the cravings?” The counselor's reply: “You can't right away, but you can work with your cravings to learn how to deal with them, and they will get less strong over time.”
The teen responded, with frustration: “What good is deciding to quit, then?”
It is a surprise to substance-using adolescents that deciding to quit and not using actually won't stop cravings for substances. In the teen's view, the using keeps the craving going, so stop the using and the craving will just end—sort of “on command.” When this formula doesn't work, the young person has a sense that making a decision to quit without an immediate change in wanting to use is not only useless, but really unfair.
Further, there may be an unwelcome realization for the teen: “I thought I was in control of using alcohol, drugs, and tobacco, and now I find out that I really am not.” In one treatment group an adolescent was trying to decide if she had a “drug problem” and talked about “wanting it” as a factor about which she was concerned. As the group counselor, I asked, “So, if you want it, you have a problem with the drug, and if you don't want it, you don't have a problem. Is that what you are saying?” She replied, “Yes!”
My conclusion from this and similar group conversations was that a teen's
perspective about wanting to use means a great deal as the young person not only decides about having a drug problem, but also tries to cope with drug cravings. This has strong implications for a counselor's approach when assisting teens who are worried that they continue to want alcohol or drugs. The teen is looking for practical self-help actions that he/she can immediately carry out and that work in coping with cravings.
What's so different about adolescents dealing with cravings? First, adolescents don't know what to do about wanting to drink or drug once they have decided to quit but their “on command” thinking about cravings doesn't work. They talk about it like they have come to a dead end in their choices.
Second, they try simplistic solutions to the feeling of wanting drugs, such as thinking they can handle it themselves and control their cravings simply by not talking about it. Therefore, being asked to talk about it in a treatment group amounts to an exercise in frustration.
In addition, adolescents are highly peer-influenced, and their support network often includes friends who use. Being around these friends is a craving trigger, but adolescents are reluctant to deal with two sensitive issues about their friends: They do not want to distance themselves from their friends, even when these friends are continuing to use, and they often assume they can be around friends who use without giving in to drugs themselves.
Also, teens are unconcerned or afraid to tell their parents about having cravings. Teens describe some parents reacting to their substance use with high anxiety, uninformed thinking, and naïveté about chemical use, and overly simple solutions or punishing. Given this, teens may think that telling their parents about having cravings will invite an explosive emotional reaction, and who wants that?
By the time they decide to stop use, teens already may have developed some initial signs of a substance use disorder, so stopping can be difficult. Also, they may have a co-occurring disorder with onset during early adolescence, making an alcohol, tobacco, or other drug craving even more challenging to address.
Finally, teens do not want to tell a teacher, school counselor, or other adult that they have been using. This means embarrassment or the possible setting in motion of events they want to avoid: referral for other evaluation, and that parental reaction.
For a teen to remain abstinent, cravings must be dealt with. Being aware of the craving is a vital issue when a teen makes a decision not to use again, since the efforts to avoid use are in their initial, fragile stages. The adolescent's changed direction can falter without self-help that works. What can be done about the cravings, then?
It is important to understand that cravings happen with a blended expression in body, emotion, and thinking. Adolescents say they “just want it,” but usually can't say where they are feeling the bodily “want,” the emotion that goes with it, and the thoughts that accompany both. Bodily changes with a craving can include an increase in heart rate and respiration, muscular tension, digestive system reaction, and perspiration. Emotion that accompanies a craving can encompass anxiety and tension, irritability, aggravation, frustration and anger, or a listless feeling. Thought process becomes constricted, with the teen focusing more on the wanting and “getting it” with repetitive self-talk about using. Self-help about coping with a craving will be strengthened as clinicians assist teens to recognize, learn, and deal with these craving signals in body, emotion, and thought.
The clinician can teach the adolescent to become aware of what she is experiencing and what to do about each “signal”: getting away from peer talk about drugs or a situation where someone is drinking or drugging; doing slow, deep breathing to assist the relaxation response; talking with a trusted someone who understands; intentionally changing thoughts in the moment (thought-switching); doing some mild stretching to release bodily tension; and meditating on a helpful scene or phrase or getting involved in some positive activity that is liked. The goal is to relax the body and tense feelings, to clear the mind of “use thinking,” and to get support from someone who understands.