Craving (8 page)

How Cravings Drive Self-Defeating Behaviors and the Tenacity of Cravings

“Crave for a thing, you will get it. Renounce the craving, the object will follow you by itself.”

— SWAMI SIVANANDA

If a craving were just an innocuous thought, you could simply wait for another thought to take its place, think about something else, or distract yourself, and it would pass like any other thought. Some cravings are mild or benign and do pass in just that way. However, most people who struggle with cravings wish that they were just thoughts.
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In fact, many of the patients I have treated have tricked themselves into believing just that. They assume that they can control them just like any other thought and attempt to focus their attention elsewhere. The problem is, when that doesn’t work, they try again. And again. One pop-culture definition of “insanity” is repeating the same behavior and expecting different results. I don’t really like that definition, because when the environment or context changes, the same behavior can lead to success where previously it failed. However, people will often repeat the same approach to managing cravings that haven’t worked for months or even years. I’ve seen many patients who died without ever being able to change their harmful and ineffective methods for managing their cravings, chronically laboring under the false assumption that “this time will be different.”

In the
previous chapter
, we learned why someone might repeatedly try the same ineffective solution regardless of the outcome. The brain has powerful mechanisms to drive behavior in a survival-like fashion, and many of these deep-brain-driven impulses and drives are not consistently overcome with the conscious, thinking part of the brain (although sometimes they are in the short term). But the question remains: how do these craving thoughts drive the painful, heartbreaking behaviors that lead to such distress and despair? In this chapter, we’ll learn about some of the ways that your brain leads you to draw false conclusions about yourself and your behavior. Specifically, we’ll review the various types of distorted conclusions your brain can lead you to and why it does so.

We’ll also explore why cravings are so sticky—why the sufferer often believes the craving will last forever unless the urge is satisfied. Of course, this belief is irrational. There is no such thing as a permanent craving; all cravings eventually go away, whether or not we act or
act out
on them. Patients often describe this feeling as if there were an open window, and on the other side is relief, joy, peace, and happiness. The window feels like it is closing, and one thought that sometimes arises is something like “If I don’t jump through this window right now, I’ll never get another chance. I need to do this right now.” So they succumb to their cravings yet again.

False Beliefs

The irrational behaviors that result from cravings can be justified in any number of ways. The ways that your cortex can rationalize acting in self-destructive ways is only limited by your own creativity. These erroneous beliefs are designed to protect your sense of self and the sense that you are in control. Here are some of the excuses I’ve heard:

• “It will be different this time.”
  
• “I don’t care, it’s worth it” or “I’ve changed my mind.”
  
• “I can always do differently next time.”
  
• “I’ve changed. I can handle this now.”
  
• “I deserve this.”
  
• “I only thought this was a problem, but really it isn’t. Lots of people do this without difficulty.”
  

Of course, this is just a sample of possible excuses; there are many more. Deep regions of the brain, inside what is called the subcortex, create the drive; and the cortex, or surface of the brain, furnishes the excuses. This is why you cannot reliably think your way out of cravings (which
can
work sometimes). The thinking, cortical brain can always develop one more plausible, believable, convincing excuse. Just as the worst thing that can happen to a gambling addict in Vegas is not to lose, but to win, the worst thing that can happen to people who suffer from cravings is to successfully think their way out of them. The rare occasions when this strategy works fuels years or even decades of attempts to re-create such success consistently, success that always seems to be forthcoming but never quite arrives.

Members of Alcoholics Anonymous figured this out years ago, when they wrote:

Once more: The alcoholic at certain times has no effective mental defense against the first drink. Except in few rare cases, neither he nor any other human being can provide such a defense. His defense must come from a Higher Power.
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This view is not particularly popular in academic circles. In fact, there has been a widening rift between academic and clinical addiction treatment, and much of the gap centers around this disagreement. What’s unfortunate is that the core of the argument results primarily from simple miscommunication about Twelve Step terminology. For example, AA members usually use the term “cravings” to describe what happens after they drink, rather than what happens before they drink. The experiences that lead up to their drinking they call mental obsession rather than craving. A close inspection reveals that much (but not all) of the disagreement is over form and terminology rather than substance. I have further explained this debate in the appendix.

There has been seemingly endless debate over the role of cognitive (that is, thinking) therapies such as cognitive-behavioral therapy in managing addictions. These therapies, which are extraordinarily effective for depression, anxiety, and many other psychiatric conditions, work by helping people see where their thinking has been distorted. It turns out that our brains naturally distort the way we evaluate situations, and these biases or distortions provide a significant evolutionary advantage. Basically, we have patterns of thought that enable us to draw conclusions quickly and with limited effort. These patterns also ensure that we focus on the important, central ideas in a problem and limit our focus on irrelevant, distracting noise. For example, if you were about to be attacked by a bear, it is not important for your brain to focus on details in your environment, such as what sort of trees are around you or whether you can hear the sound of birds or smell flowers. Your entire attention focuses on the bear. And if you are later asked details of your environment at the time of the incident, you may think you remember them accurately when, in reality, your brain may have simply filled in erroneous information. That is beneficial for the survival of our species, but not necessarily helpful for historians, who would prefer to have accurate details.

So these distortions help us to be efficient and, in some cases, even to survive. In many other situations, however, these distortions work against us. When that happens, we draw false conclusions from our experiences. This can lead to negative thoughts that drive very unpleasant emotions. Cognitive types of therapy can often help correct this. These highly effective therapies help people, in a guided way, to notice and adjust the way they view their circumstances and thus feel better.

Certainly such techniques can play a helpful role in many cases, especially when problematic behaviors don’t rise to the level of addiction, and in some cases even when they do. But most folks with cravings, compulsive behaviors, or even addictions are not able to experience sustained relief with these methods. Although the techniques help, they often fail to complete the job.
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They need something more.
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It would seem logical that the brain cannot ultimately outthink itself, and yet so many people repeatedly try to do just this. The phenomenon is reminiscent of a quote from the 2001 David Mamet film
Heist
with Gene Hackman. In this film, Hackman plays aging gang leader Joe Moore, who pulls off some impressive heists, and here he is being asked how he developed the plan for a particularly complex heist. His explanation is ridiculous and exemplifies the type of absurd belief we are talking about—that the brain could ultimately think its own way completely out of addictive cravings:

D.A. Freccia: “You’re a pretty smart fella”

Joe Moore: “Ah, not that smart.”

D.A. Freccia: “If you’re not that smart, how’d you figure it out?”

Joe Moore: “I tried to imagine a fella smarter than myself. Then I tried to think, ‘What would he do?’”

Cravings and Cognitive Bias

“When faced with facts that contradict our beliefs, most of us get busy changing the facts.”

— JOHN KENNETH GALBRAITH

A sense of helplessness and loss of control is extraordinarily unacceptable to your brain. Your brain works very hard to avoid experiencing this sense. Feeling out of control and not being able to manage your own circumstances are terrifying experiences. To help avoid this extraordinarily unpleasant sensation, your mind creates the illusion of control, telling you, “I can handle this—this isn’t a problem.” Your brain also creates the illusion of insight and understanding.
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All of these powerful psychological processes are designed to protect your ego, your sense of self. They help keep us sane. These processes (some of which are called cognitive biases) also help to make our brains much more efficient. We know that these biases exist from decades of psychological research and experimentation on how people make decisions and form beliefs.

Your brain is designed to reduce how much you need to actively think and remember so that you can perform routine tasks with great efficiency, even at the expense of accuracy. This is important to understanding cravings, because many of your beliefs about cravings may be erroneous but were generated by your mind in its effort to create efficient shortcuts. A neuroscience research group called the RIKEN Brain Institute in Wako-shi, Japan, recently found neurological evidence to confirm this. Akitoshi Ogawa and his colleagues used the functional imaging technique fMRI to scan the brains of people who were using inferential reasoning to make logical conclusions; then they scanned their brains again when the subjects drew illogical conclusions that were the result of various types of cognitive biases.
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Ogawa found that the same brain regions were activated regardless of whether the person was using cognitive bias or not. There was also some activation of other areas in the brain, probably reflecting the need to access memory in order to complete the tasks. On the basis of this and previous studies, he notes that the human brain is designed to categorize rather than memorize, particularly when it comes to logic-related tasks. This is likely because the brain seeks to be efficient, and this process reduces the cognitive working memory load. Simply put, your brain likes shortcuts even though they sometimes lead to false conclusions; in general, such shortcuts help you become efficient in the things you need to do. Yet this process can lead to some false beliefs about cravings and addiction in people who are experiencing cravings.

Most of the people I’ve treated for addictions have believed at one time or another that they had some sort of deep insight or understanding of their self-destructive behaviors and as a result knew how to deal with them next time. Often I’ve advised these people that their plan for dealing with cravings, which is based on their new “insight,” is not likely to work. Usually, my advice falls on deaf ears. In many cases, their friends and loved ones are also telling them that their plan is foolhardy. Yet they persist. Why? Why can others see what they cannot? Why are they so convinced that their methods are going to succeed, and that their friends, loved ones, and even their doctor “simply don’t understand”?

This is where cognitive biases come in. As noted above, your brain uses these biases to create the illusion of control to protect your ego and to provide more efficient thinking. Sometimes, however, the natural tendency toward efficiency results in false reasoning, and this is directly related to the way your brain uses cognitive bias. Many such biases exist; we’ll go over some of the ones that are most active in people who crave.

Confirmation Bias

One such bias is called the confirmation bias. The confirmation bias leads you to naturally accept any evidence that supports your belief and to reject any evidence that goes against it. An absolutely fascinating aspect of this bias is that your susceptibility to it is genetically determined! The confirmation bias is a particularly tenacious bias, because you believe you are reviewing evidence, and you end up with a litany of data supporting your position. As an example, I once advised a patient completing addiction treatment that returning home to live was a very bad idea, as her husband was still drinking and using drugs. Also, she mostly drank at home and quite often with her husband. I thought that some time in a sober house might be helpful, so she could learn and practice a sober lifestyle in a safe environment before attempting a return home. She believed, however, that she had acquired powerful insight into her addiction that would keep her sane. Furthermore, she cited dozens of examples where she had been able to avoid drinking or using drugs around her husband. Of course, her friends and other patients pointed out that there had been hundreds, or even thousands, of times when she couldn’t avoid drinking around her husband. Nonetheless, she stubbornly held on to the times when she could and described the times when she did drink as conscious, intentional choices. She went home and was drinking again before nightfall. This same confirmation bias plays a role in helping the compulsive gambler go back to the casino to “reclaim the money they are holding for me” (that is, to recoup his losses).