The Craving Mind Why We Get Hooked and How We Can Break Bad Habits Chapter 2. Addiction, Straight Up

← The Craving Mind Why We Get Hooked and How We Can Break Bad Habits

The Craving Mind Why We Get Hooked and How We Can Break Bad Habits Chapter 2. Addiction, Straight Up

Author: Judson Brewer Publisher: Yale University Press. New Haven, CT. Publish Date: 2017 Review Date: 2022-8-17 Status:📚

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The more I looked at why mindfulness training helped people quit and stay quit, the more I started to understand why other treatments and approaches failed. A number of studies had clearly linked craving and smoking. Avoiding cues (triggers) might help prevent people from being triggered, but didn’t directly target the core habit loop. For example, staying away from friends who smoke can be helpful. Yet if getting yelled at by the boss triggered someone to smoke, avoiding the boss might lead to other stressors, such as unemployment. Classical substitution strategies such as eating candy have helped people quit smoking. Though in addition to weight gain (which is common with smoking cessation), this technique trains participants to eat when they have a craving to smoke, effectively trading one vice for another. Our data showed that mindfulness decoupled this link between craving and smoking. Further, decoupling craving and behavior seemed to be important for preventing cues from becoming stronger or more salient triggers. Each time we lay down a memory linking a cue with a behavior, our brain starts looking for the cue and its friends—anything similar to that original cue can trigger a craving.

We looked specifically at the relationship between craving and smoking because craving had been clearly linked as part of the habit loop. Without a craving, people were much less likely to smoke. Hani found that, indeed, before mindfulness training, craving predicted smoking. If people craved a cigarette, they were very likely to smoke one. Yet by the end of the four weeks of training, this relationship had been severed. Interestingly, people who quit reported craving cigarettes at the same level as those that didn’t quit. They just didn’t smoke when they craved.

Over time, their cravings decreased as they quit smoking. This made sense, and in our report we explained it thus: A simplistic analogy is that craving is like a fire that is fed by smoking. When someone stops smoking, the fire of craving is still present and only burns down on its own once its fuel has been consumed (and no more fuel has been added). Our data provide direct support for this: (1) a drop in craving lags behind smoking cessation for individuals who quit, suggesting that at first there is residual “fuel” for craving to continue to arise, which then is consumed over time, leading to the observed delay in reduction in craving; and (2) craving continues for individuals who continue to smoke, suggesting that they continually fuel it.5

Highlight(pink) - Location 493 When my patients told me their stories of getting addicted, there was a common theme. It was as if they had been one of the lab rats in Skinner’s experiments and were describing the reward-based learning process that they had gone through; “I would have a flashback [to some traumatic event]” (trigger), “get drunk” (behavior), “and this was better than reliving the experience” (reward). I could line up their habit loop in my head. Trigger. Behavior. Reward. Repeat.
Highlight(pink) - Location 497 they used substances as a way to “medicate”; by being drunk or high, they could prevent (or avoid) unpleasant memories or feelings from coming up, or not remember afterward whether those memories had surfaced.
Highlight(pink) - Location 507 They described their reward-based learning as a way to avoid situations, numb their pain, mask unpleasant emotions, and, most often, succumb to their cravings. Scratching that damn itch.

Highlight(pink) - Location 542 I know from reading the studies that medications at best help only about a third of patients stay smoke free. I know from the studies that these meds haven’t been shown to help cravings induced by triggers. Medications mostly help either by providing a steady supply of nicotine, leading to a steady supply of dopamine,
Note: sounds like adderall
Highlight(pink) - Location 581 My switch to studying mindfulness didn’t go over so well with the faculty, which was generally dubious of anything that didn’t come in pill form or had even a whiff of alternative medicine about it.

Highlight(pink) - Location 559 Then I asked whether there ever had been times when he couldn’t smoke—on an airplane or a bus, for example. Yes, he replied. “What happened then?” I asked. He pondered for a few moments and said something to the effect of, “I guess it went away.” “Let me make sure I understand,” I said. “If you don’t smoke, your cravings go away on their own?”
Highlight(pink) - Location 565 “Is this what you mean? You get triggered, and your craving builds, crests, and then falls as it goes away?” I asked. I could see the lightbulb go on in Jack’s head. Wait a minute. When necessary, he had made it without smoking, but hadn’t realized it. Some of his cravings were short, and others lasted longer, but all of them went away.
Highlight(pink) - Location 569 I made sure he really understood how each time that he smoked, he reinforced his habit.
Highlight(pink) - Location 569 I taught him to simply note to himself (silently or aloud) each body sensation that came on with a craving.
Highlight(pink) - Location 570 We used the analogy of surfing: my patient’s cravings were like waves, and he could use this “noting practice” as a surfboard to help him get on the wave and ride it until it was gone. He could ride the wave as if it were the inverted U on the board, feeling it build, crest, and fall. I explained how each time he rode the wave, he stopped reinforcing the habit of smoking. He now had a concrete tool—his own surfboard—that he could use each time he craved a smoke.

Highlight(pink) - Location 637 I would send them home that evening with an admonition to simply pay attention to their triggers and to what it felt like when they did smoke.
Highlight(pink) - Location 642 Many of them couldn’t believe how their eyes had been opened; they had never realized how bad smoking tasted
Highlight(pink) - Location 644 This patient knew cognitively that smoking was bad for her. That was why she had joined our program. What she discovered by simply being curious and attentive when she smoked was that smoking tastes horrible. This was an important distinction. She moved from knowledge to wisdom, from knowing in her head that smoking was bad to knowing it in her bones. The spell of smoking was broken; she started to grow viscerally disenchanted with her behavior
Highlight(pink) - Location 652 This awareness is what mindfulness is all about: seeing clearly what happens when we get caught up in our behaviors and then becoming viscerally disenchanted. Over time, as we learn to see more and more clearly the results of our actions, we let go of old habits and form new ones.
Highlight(pink) - Location 654 The paradox here is that mindfulness is just about being interested in, and getting close and personal with, what is happening in our bodies and minds. It is really this willingness to turn toward our experience rather than to try to make our unpleasant cravings go away as quickly as possible.
Highlight - Location 647 No force necessary. Why am I mentioning force here? With CBT and related treatments, cognition is used to control behavior—hence the name cognitive behavioral therapy. Unfortunately, the part of our brain best able to consciously regulate behavior, the prefrontal cortex, is the first to go offline when we get stressed. When the prefrontal cortex goes off-line, we fall back into old habits. Which is why the kind of disenchantment experienced by my patient is so important. Seeing what we really get from our habits helps us understand them on a deeper level, know it in our bones, without needing to control or force ourselves to hold back from smoking.

Highlight(pink) - Location 657 I used an acronym that a senior meditation teacher named Michelle McDonald had developed (and had been widely taught by Tara Brach), and that I had found helpful during my own mindfulness training.
Highlight(pink) - Location 660 RAIN.
Highlight(pink) - Location 660 RECOGNIZE/RELAX into what is arising (for example, your craving) ACCEPT/ALLOW it to be there INVESTIGATE bodily sensations, emotions, and thoughts (for example, ask, “What is happening in my body or mind right now?”) NOTE what is happening from moment to moment
Highlight(pink) - Location 675 Box 1 We can learn to ride the waves of wanting by surfing them. First, by RECOGNIZING that the wanting or craving is coming, and then RELAXING into it. Since you have no control over it coming, ACKNOWLEDGE or ACCEPT this wave as it is; don’t ignore it, distract yourself, or try to do something about it. This is your experience. Find a way that works for you, such as a word or phrase, or a simple nod of the head (I consent, here we go, this is it, etc.). To catch the wave of wanting, you have to study it carefully, INVESTIGATING it as it builds. Do this by asking, “What does my body feel like right now?” Don’t go looking. See what arises most prominently. Let it come to you. Finally, NOTE the experience as you follow it. Keep it simple by using short phrases or single words. For example: thinking, restlessness in stomach, rising sensation, burning, etc. Follow it until it completely subsides. If you get distracted, return to the investigation by repeating the question, what does my body feel like right now? See if you can ride it until it is completely gone. Ride it to shore.
Highlight(pink) - Location 665 The N is a slight modification of what I learned as “nonidentification.” The idea is that we identify with or get caught up in the object that we are aware of. We take it personally. Nonidentification is a bell in our head that reminds us not to take it personally.
Highlight(pink) - Location 667 “noting practice,” a technique popularized by the late Mahasi Sayadaw, a well-respected Burmese teacher. Many variations are currently taught, but in general during noting practice, someone simply notes whatever is most predominant in his or her experience, whether thoughts, emotions, bodily sensations, or sights and sounds.
Highlight(pink) - Location 669 Noting practice is a pragmatic way to work on nonidentification because when we become aware of an object, we can no longer be identified with it (as much).
Highlight(pink) - Location 670 This phenomenon is similar to the observer effect in physics, in which the act of observation, particularly at the subatomic level, changes what is being observed. In other words, when we notice (and note) the physical sensations arising in our bodies that make up a craving, we become less caught up in the habit loop, simply through that observation.
Highlight(pink) - Location 725 And finally to our original question: which mindfulness skill was the biggest predictor of breaking the link between craving and smoking? The winner: RAIN. While formal meditation practices were positively correlated with outcomes, the informal practice of RAIN was the only one that passed statistical muster—showing a direct relationship to breaking the craving-smoking link.

Highlight(pink) - Location 690 By the end of the two-year period, we had screened over 750 people and randomized just fewer than 100 of them for our trial. When the last subjects completed their final four-month follow-up visits, we took all the data and looked to see how well mindfulness training stacked up. I was hoping that our novel treatment would work as well as the gold standard. When the data came back from our statisticians, the participants in the mindfulness training group had quit at twice the rate of the Freedom From Smoking group. Better yet, nearly all mindfulness participants had stayed quit, while many of those in the other group had lost ground, yielding a fivefold difference between the two!

Notes

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