Month: June 2021

If you’re concerned about your loved one’s relationship with alcohol, you are not alone. According to the National Institute on Alcohol and Alcoholism, in a 2019 study, 25.8% of the population reported they had engaged in binge drinking and those numbers have significantly increased since the onset of the pandemic. Unhealthy drinking habits can also manifest in other ways, and there are multiple types of drinking habits to be aware of. Your loved one may be among the 15 million people navigating an alcohol use disorder, which is characterized by drinking more than you want to and for longer than you want to, despite wanting to cut down. Whatever their specific drinking patterns might be like, it can be incredibly challenging to watch a loved one struggle to manage their alcohol consumption. Seeking more information on how to support someone in recovery is an act of love for your family member, partner, or friend; and a way to care for yourself. 

First, let’s discuss why this can be so challenging.  

It’s important to remember that your loved one’s ability to stop drinking is not a reflection of their love for you or even of their desire to cut down. In response to excessive alcohol use over time, the brain forms associations that make it incredibly challenging to stop drinking. Your loved one’s brain may have become dependent on alcohol and rewired to believe they won’t survive without it. Alcohol changes the brain chemistry by affecting neurotransmitters, including dopamine, serotonin, GABA (γ-aminobutyric acid), and glutamate. As alcohol use increases over time, the brain has even more difficulty achieving a balanced state known as homeostasis. When alcohol wears off, the brain craves more alcohol and if it doesn’t get it, the body can experience withdrawal symptoms. A recovering person struggles with a subconscious desire to drink and may feel defenseless against their alcohol cravings. 

When observing this cycle from a distance, you may feel frustrated, let down, hurt, and afraid. You may feel discouraged, angry and have difficulty understanding why they just can’t stop or slow down their drinking. Your emotions are valid. Learning about alcohol use disorder can help you gain a deeper understanding of why making a change can be so difficult, alleviate any self-blame you are experiencing, and exhibit deeper empathy towards your loved one. Education is the first step. Then what? To illuminate your path towards collective healing, I’m going to answer frequently asked questions about how to support a loved one’s recovery. 

How involved should I be in my loved one’s recovery?

Your loved one is accountable for their own recovery. Recovery support can be very important during this process, but you are not responsible for their relationship with alcohol. Taking responsibility for one’s own alcohol use is a critical component of the recovery journey, and you may need to set boundaries to clarify that. A productive place to start is by learning about codependent relationships and making sure you are focusing your energy on your own needs. To support yourself while supporting someone in recovery, you can join forums for friends and family and seek family therapy to help you establish healthy boundaries. Monument also has a moderated support group for friends and family. By prioritizing your own needs, you’re also giving your loved one the room they need to grow. 

How do you strike a balance between empathy and tough love during a setback?

When your loved one drinks more than they had planned or wanted to, it’s okay to feel disappointed. They also may feel ashamed about losing control. Alcohol abuse numbs emotions, and a recovering person navigating alcohol use disorder may not be able to process their feelings in a constructive way. To find a productive path forward: 

1. Acknowledge the situation and confront your loved one by grounding yourself in facts.
2. Discuss what happened after they drank too much and what they would have liked to have happened instead.
3. Explain that you know that changing your relationship with alcohol is a journey and that it takes time.
4.  Acknowledge that your loved one is expected to do their part by taking an active role in their recovery.  

How can I help provide accountability without being overbearing?

Accountability is ultimately your loved one’s responsibility. However, they don’t have to practice accountability alone. They can connect in daily alcohol support groups, work with a therapist in alcohol therapy, and chat with other Monument community members.

While you aren’t expected to provide accountability, you can play a supporting role by helping your loved one establish clear and achievable goals. For many people struggling with alcohol use disorder, the thought of never drinking again is too overwhelming at the beginning of the recovery journey. Your loved one may choose to explore moderation to begin changing their relationship with alcohol, which can present its own challenges. 

Let’s revisit the facts: moderation is challenging for many because dopamine is released in the brain when drinking alcohol.  After one drink, the brain craves more dopamine. The continued release of dopamine with continued alcohol consumption makes it hard to stop at just a couple of drinks. During the early days of the recovery journey, you’ll likely see your loved one fight against these tendencies as they try to drink less frequently, drink smaller amounts, and wait as long as they can before they begin drinking. While it can be challenging for everyone involved, this is a time of growth. Your loved one will begin to prove to themselves that they have control over their drinking. During this period, there are many ways you can support their progress, including the following. 

Provide honest and productive feedback

Simply state facts about their drinking. You can say something like: “You had more to drink last night than you intended to. Your goal was to drink fewer than three drinks, and that was surpassed.” Offering your loved one an objective perspective on their drinking habits can help them refocus on their goals without guilting or shaming. You can also share how their drinking habits affect you personally. Try to use “I” statements, examples, and references to your loved one’s behavior, not their character. Explore these tips on how to talk to a loved one about their drinking for additional pointers. 

Keep it positive

Changing your relationship with alcohol is often a non-linear journey, and progress is more important (and more realistic!) than perfection. Encourage your loved one with uplifting social support. Try out using language like: “You can do this. Keep your focus on your goals. I believe in you.” Finding new ways to feel joy together can be a rewarding and powerful piece to the recovery process and can de-center alcohol from associations with satisfaction.

Remind them it’s a marathon, not a sprint

Let your loved one know that this journey can be a long one and that they will achieve their goals with time. Setbacks do not erase their progress or determine their future. Remind them of this. Ensure them that they can and will achieve their goals if they stay focused and continue to evaluate the challenging moments. Setbacks can be incredible teachers.

Have resources on hand

Remind your loved one that they do not have to do this alone. Support is available from a variety of resources, many at no cost. Monument offers moderated support groups and other expert resources. Alcohol use disorder is a complex medical condition, and there is absolutely no shame in using evidence-based tools like alcohol therapy sessions and medication to stop drinking to treat it. 

Okay, how else can I support them? 

In brief, you can help your loved one realize they have choices. Alcohol use disorder is often accompanied by anxiety and depression and can lead to feelings of helplessness. Alcohol is in itself a depressant, and your loved one may feel stuck in a cycle of using alcohol to cope with their uncomfortable feelings. Our brain’s chemical response to depression and anxiety can also contribute to the cycle.

The human brain tries to make sense of its surroundings by relating previous experiences with current life experiences. When we are depressed or anxious, life seems difficult, scary, and even overwhelming. Depression and anxiety decrease our ability to cope with challenges because our brain is trying to protect ourselves by reducing the choices we have to make. For example, when we are depressed, anxious, or overwhelmed, our brain gives us two options rather than the actual 5 or 6 choices we most likely have. This process can lead to diminished decision-making ability and difficulty focusing. The lack of perceived choices can leave us feeling helpless, hopeless, and stuck in unhealthy habits. Chemical changes in the brain may include a lack of dopamine, serotonin, and other neurotransmitters. To make a change, the negative feedback loop must be interrupted by a new way of thinking. To help them establish more self-efficacy, you can encourage your loved one to explore their options, consider other positive outcomes, and seek new support options from professional help like therapy sessions, online alcohol treatment and medication. If other options are not considered for your loved one’s recovery, then it’s likely the same behaviors will continue. 

What should I avoid doing? 

First, you should know that asking that question is in itself an act of compassion. Let’s reframe this question and put your loved one at the center: how can you support your loved one in avoiding triggers? Early in the recovery journey, it’s especially important to avoid people, places, and things that trigger alcohol use. More specific examples include removing alcohol from the house and avoiding the environment your loved one used to drink in, whether that be a certain restaurant, bar, or even a piece of furniture. Eventually, your loved one may no longer associate alcohol with these things, but it takes time and work. Creating a safe environment is a helpful way you can support your partner during early recovery.

In addition to avoiding triggers, supporting new healthy rituals is a great way to empower their progress. You might explore creating new celebratory rituals with alcohol alternatives, practicing mindfulness and breathing techniques, and engaging in other alcohol-free activities that bring you both joy. 

As I’ve mentioned throughout, by showing up here and supporting someone as they navigate the alcohol recovery timeline, you’ve already done something incredibly meaningful for your loved one. Seeking information and resources shows compassion and care. The journey to long term sobriety or alcohol moderation is not easy. While your loved one’s recovery is ultimately up to them, your social support can mean the world to them and can encourage them along their path. Remember to take care of yourself because you are deserving of love and support too.

Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.

Alcohol cravings are very common for people navigating sobriety or moderation and are nothing to be ashamed of. While cravings can feel especially overwhelming at the beginning of the alcohol recovery timeline, you can manage them with the proper tools, online alcohol treatment, and understanding. 

In addition to seeking insight into how to address cravings when they do arise, many of my patients often wonder, ‘why do I crave alcohol in the first place?’. 

The simplest answer is that an alcohol craving is a result of the chemical changes that take place in the brain due to excessive alcohol use over an extended period. However, biological, psychological, and social factors influence our relationship with alcohol, and there are often other factors at play. 

Understanding how cravings work and what tools are available to address them can help us retrain our brain, reframe our perspective, and enable healthier habits.  

How Drinking Alcohol Affects Dopamine In The Brain

What Is Dopamine?

First, let’s talk about dopamine. Dopamine is one of the primary neurotransmitters released when you receive pleasure from certain things and activities. It’s also known as the ‘feel-good hormone.’ 

Sometimes even the thought of receiving pleasure from something will lead to the release of dopamine in the brain. Dopamine affects our reward system, memory, motivation, decision-making, and beyond. It can become deregulated with extended alcohol use. 

How Alcohol & Dopamine Interact

When you use alcohol to destress, decompress, relax, or reward ourselves, your brain forms associations. Your brain connects drinking alcohol with a feeling of relief and reward. As you continue to use alcohol in these moments, the association is strengthened in your brain’s pleasure center. 

If these associations become strong enough, even just the thought of having a drink can increase dopamine levels. Then, when you consume alcohol, even more dopamine is released. This ramping up of dopamine can lead to an acceleration of consumption, and what you might have thought would be one drink to ‘take the edge off’ becomes several. 

My patients frequently ask why they can’t stop after one drink like they had planned to, and the ramping of dopamine is often part of the explanation. Over time, the anticipation of alcohol becomes part of the drinking experience, and the brain adapts to “crave” alcohol in its pleasure center. This ultimately results in the urge to drink alcohol. This is also sometimes referred to as a “chemical romance” with alcohol. 

Why Alcohol Changes Brain Chemistry Over Time

When alcohol is consumed in increased amounts over an extended period brain chemistry continues to adapt in response. The brain moves beyond associating alcohol with pleasure or relaxation and begins to recognize alcohol consumption as required for basic functioning. 

The body craves alcohol not only to destress but to maintain a state of normalcy. This is a sign of alcohol dependency and a common indicator of an alcohol use disorder. A specific example of this is when people have to continue to drink more to avoid alcohol withdrawal symptoms. 

The body “depends” on alcohol to rid itself of withdrawal symptoms such as anxiety (or ‘hangxiety‘), heart palpitations, alcohol shakes, and increased heart rate. In extreme cases, people can have seizures when they try to abstain or decrease their alcohol intake. This is why it’s so important to work with a medical professional before quitting cold turkey or cutting back significantly.

If you believe you might be experiencing acute alcohol withdrawal, please contact your healthcare provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. If this is a medical emergency, call 911. If you’re looking to cut back on drinking, join Monument to connect with a physician about the safest path for you.

How Habits & Routines Play A Role In Cravings

While the changes to neurotransmitters explain cravings on a chemical level, habits and routines also influence cravings. These patterns include rituals like having a glass of alcohol in hand at 5:00 pm after work, or subconsciously buying alcohol every trip to the supermarket. 

These behaviors become automatic with time, and can often function as triggers when people try to cut back or abstain from alcohol. Noticing the routines that have become an alcohol cue is a helpful first step in creating a new habit, avoiding potential triggers, and preventing alcohol relapse. 

To learn more about how to build healthier habits and avoid triggers, you can read more about how to curb alcohol cravings when they do occur. 

How Treatment Works To Combat Cravings 

Even if you know the why and how of cravings, they can still be challenging to navigate. However, you have great behavioral and therapeutic tools at your disposal, and you are not alone in this journey. At Monument, you have a dedicated Care Team providing support, as well as therapists and physicians to empower your progress. 

One tool I discuss with many of my patients in the context of managing alcohol cravings is medication to stop drinking. Medications such as naltrexone affect dopamine receptors in the brain and block the effects of dopamine when drinking or anticipating alcohol. 

When drinking on naltrexone, it decreases the likelihood that dopamine levels will ramp up. Therefore, the brain’s association with alcohol and pleasure begins to weaken. This can be a very effective tool for many in managing cravings. 

However, long-standing habits and routines still play a large role in our brain’s associations, so there is no singular ‘fix’ for cravings. To build new habits and healthy responses to triggers, it’s often beneficial to engage in online alcohol therapy and participate in alcohol support groups to process emotions, develop coping mechanisms, and create long-lasting lifestyle changes. 

A specialized therapist can work with you to identify what habits trigger your desire to drink, manage thoughts about drinking, build drink refusal skills, and so much more. Why we drink is complex. 

The combination of medication, therapy, and community support is the gold standard in alcohol use disorder treatment because it takes a holistic approach, and empowers you to create sustainable behavioral change.   

What causes an “urge” to drink can be as simple as what alcohol means to a person at a single moment in time. The good news is, you can change what alcohol means to you, and there are tools that can help you do it. While combating intense alcohol cravings can be an uncomfortable and challenging experience, it is also a sign of growth towards a more balanced self. 

Naltrexone has the capacity to cause hepatocellular injury (liver injury) when given in excessive doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use for a patient with active liver disease must be carefully considered in light of its hepatotoxic effects. 

In treating alcohol dependence, adverse reactions include difficulty sleeping, anxiety, nervousness, abdominal pain/cramps, nausea and/or vomiting, low energy, joint and muscle pain, headache, dizziness, and somnolence. This is not a complete list of potential adverse events associated with naltrexone hydrochloride. Please see Full Prescribing Information for a complete list

If you’ve experienced alcohol cravings while navigating sobriety or moderation, guess what? You’re human. Alcohol cravings are a natural and even to-be-expected part of the alcohol recovery timeline, especially in the earlier days. My patients often ask me, “How do I stop alcohol cravings for good?” 

The reality is that the sobriety or moderation journey is often a non-linear one, and you may confront cravings at any point in your journey. However, the good news is, with the right support and online alcohol treatment, you can learn how to manage cravings, and ultimately reduce their frequency and intensity. Cravings are not a sign of weakness. You have agency, and with this resource, a wealth of craving management tools at your disposal. 

How to address alcohol cravings 101

Generally, a craving is defined as a subjective experience of wanting to use a drug. The experience is highly variable depending on numerous factors, including your mood, environment, where you are in the alcohol recovery timeline, and beyond. Cravings follow a period of abstinence from drinking alcohol, whether that’s a few hours or a few years. As a reminder, just because you experience a craving, it does not mean you’ve lost control or haven’t made meaningful progress. 

In fact, it’s an opportunity to exercise your control and show your progress. Cravings can last anywhere from a few seconds to even a few hours. It’s essential to keep in mind that cravings are temporary and that they will eventually go away.

It’s helpful to visualize cravings as the ebb and flow of the ocean waves. Sometimes the waves are big, and other times they are so small that you barely notice them. Riding out a craving can be like riding a wave. Check out some more information about ‘urge surfing’ to put this into practice.

While intense cravings can increase your risk of drinking, they do not have to lead to drinking. Through planning and practice, you can learn how to manage cravings more effectively. The management of cravings can be broken down into two parts: 

What you do before you start having cravings and what you do when you are having cravings.

Let’s dive in. 

Pre-cravings work: Decreasing the frequency and intensity of cravings

Engaging in your sobriety or moderation toolkit prior to having cravings is a really effective way to reduce the intensity of cravings. While craving management is useful, like treating any condition, prevention work can reduce future severity. Eliminating cravings altogether may not be realistic, but you can decrease the frequency and the intensity of cravings to be more manageable. The first tool for doing so? Understanding triggers. 

Although cravings often feel unpredictable, there are usually triggers that lead to them. Triggers are teachers, and play a key role in craving management. The next time you have a craving, take note of your mental and physical state.

• Where are you? 
• What time of the day is it? 
• How do you feel? 
• What are you doing?

As you continue to keep track of your cravings in a journal or document, you will begin to recognize patterns and be able to identify specific triggers. Triggers can be anything associated with drinking alcohol and can be categorized into internal and external triggers. 

Identify & address internal triggers

Common internal triggers include negative emotions (and sometimes even positive emotions), physical discomfort, boredom, and stress. Internal triggers can have a strong influence on your desire to drink. Frequent drivers of cravings are feelings of depression and anxiety. Those feelings are uncomfortable, and alcohol can provide immediate, short-lived relief. 

Your brain learns that behavior, and begins to crave alcohol whenever you are feeling depressed or anxious. However, drinking alcohol only masks these feelings and actually intensifies these negative emotions. It can be scary to identify depressive or anxious thoughts as a trigger, but it also provides a path towards healing. You can unlink depression and alcohol and anxiety and alcohol and treat both simultaneously.

If you are dependent on alcohol, it’s possible that you will experience alcohol withdrawal symptoms when you significantly cut down alcohol consumption or stop drinking. You should consult your physician before quitting alcohol cold turkey or cutting down. Severe withdrawal symptoms include delirium tremens and hallucinations, which can be dangerous or life-threatening without medical supervision. If you believe you are experiencing acute withdrawal symptoms, you should contact your provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. 

Identify & avoid external triggers

External triggers can include people, places, and things that you associate with alcohol. Our brain loves efficiency, and aims to make our behaviors more automatic by grouping things together. When you drink alcohol and artificially increase the dopamine levels in your brain, your brain tries to remember everything associated with that temporary pleasure to repeat the behavior. For example, you might come to associate certain activities, friends, and venues with drinking.

Typically it’s easier to control external triggers than internal triggers, and the most effective action to take is to avoid these external triggers as much as possible. If you have alcohol in your home, get rid of it or put it away in a place where it’s very inconvenient for you to reach. 

If you are conditioned to drink while watching TV from your favorite couch, rearrange them. The goal is to weaken the brain’s connection between the triggers and alcohol consumption. This process can include trial and error, and that’s part of the process. You can also join Monument’s online alcohol support groups to hear what’s worked for other members. 

During a craving: Tools for managing alcohol cravings

Even with your best efforts, both mild and intense alcohol cravings can still occur. It does not mean you did anything wrong or failed in any capacity. In fact, in the early phases of your recovery, you are expected to have cravings. Remember that cravings are temporary, and even if it doesn’t feel like it in a given moment, they will eventually pass. Identifying an alcohol craving early on presents more opportunity to manage it, and prevents escalation. Having the right tools at hand is the key to successfully managing cravings. Here are tips I share with my patients. 

Be mindful.

The very first step in managing an alcohol craving is recognizing it. Be curious about the experience. How strong is it? Do you feel it in your body? How does it feel? Where is it located? Be kind to the sensation of cravings—your perspective and attitude toward cravings influence how you manage them.  

Many people’s instinct is to feel bad when they have cravings. If you start creating negative associations with cravings, you will experience more negative emotions, which could further trigger you to drink. Understand that cravings are natural, and as described before, present an opportunity for you to put your skills into practice. 

Do not just rely on your willpower. 

One of the most common mistakes people make when managing cravings is relying too much on ‘willpower.’ Many psychologists define willpower as the ability to delay gratification, resisting short-term temptations in order to meet long-term goals. Using your willpower can be one of the tools in your toolkit, but it shouldn’t be the only one. 

Willpower is a finite resource that is often unpredictable and varies throughout the day. Additionally, relying on your willpower to resist cravings can take up a lot of effort and energy. When you’re tired at the end of your stressful day and have very little willpower left, you are in a very vulnerable situation, especially if you don’t have other strategies.

Remember the “Five Ds”

The “Five Ds”  are more popularly known in the management of nicotine cravings, but are just as helpful in managing alcohol cravings. 

• Delay: If you are working on moderating your drinking (instead of abstaining altogether), try extending the time between when you experience a craving and when you have a drink. If you wait long enough, your craving may just disappear, and you might not feel the need to drink. 
• Distract: Do something else. Keep yourself busy. Occupy your mind with a hobby, TV show, or meditation. If you’re able to, doing physical activity is a great way to distract yourself and release tension. Get up, and go outside. Take a walk. Lean on alcohol-free activities that bring you joy. 
• Drink water: You may be thirsty when you are craving alcohol. Drink plenty of water throughout the day to avoid thirst becoming your trigger. 
• Deep breathing: Take a deep breath in and exhale slowly and fully. Activate your parasympathetic system in order to relax.  
• Discuss: Reach out to other people who understand what you’re going through. Post in the Monument Community at any time or attend one of the many alcohol support groups. You are not alone in this. 

Medication to reduce cravings and therapy 

In addition to the behavioral tools like the 5 Ds, there are also other tools that can be extremely effective in craving management. One of those is medication to stop drinking. There are three FDA-approved medications to treat alcohol use disorder: naltrexone, acamprosate, and disulfiram. Two of these medications, naltrexone, and acamprosate, are shown to help with cravings. 

Naltrexone helps reduce cravings by blocking opioid receptors in the brain. You can read more about naltrexone benefits to learn more, and if you think medication could be right for you, you can work with a physician on the Monument platform to discuss your options. It’s important to remember that while medications like naltrexone are a great tool, there is no ‘miracle drug’ to completely stop cravings. 

Another great research-supported tool is online alcohol therapy. Working with a therapist to form new, healthier associations and coping mechanisms is an excellent option for anyone looking to change their relationship with alcohol. They can help you address internal and external triggers, practice mindfulness, build coping skills, and much more. 

Now what? The long-term craving timeline 

If you’ve put all of the above tools into practice, you might be wondering, ‘how long until I stop experiencing cravings?’ As with most stages of the alcohol recovery timeline, the answer is unique to you. That said, as you remove triggers and develop new coping techniques, you should experience fewer and less intense alcohol cravings. 

The cravings may be so mild that you don’t even recognize them as cravings. It’s also important to note that your brain never entirely forgets its positive associations with alcohol, especially when confronted with stress and negative feelings. For that reason, it’s important to keep your tools fresh in your mind, and continue to engage in your sobriety or moderation toolkit as long as it’s serving you. You are more powerful than your cravings, and have all the tools at your disposal.

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Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.