How to deal with cravings in recovery: what to do in the next 15 minutes

What happens during a craving?

A craving is a strong want, and an urge is the push to act on it now; both are normal in recovery, and both pass with time (SMART Recovery, 2017).

Craving

"I want it badly."

Urge

"I have to do it now."

NIDA names stress, cues linked to past use (people, places, things and moods) and contact with the drug itself as the most common triggers for relapse (NIDA, 2020). Researchers describe an urge as a wave that rises, crests and falls away (Hendershot et al., 2011). If it is still strong after 10 to 15 minutes, you may still be near the cue, and moving away is the next step (SMART Recovery, 2017).

When cravings come with other changes that build over weeks, read about relapse warning signs.

What can you do in the first 15 minutes of a craving?

Use SMART Recovery's five moves, remembered as DEADS: delay, escape, accept, dispute, substitute (SMART Recovery, 2017).

Coping with urges and cravings is Point 2 of SMART Recovery's 4-Point Program (SMART Recovery, 2017). Each move below says what you do.

1. DelayPut the decision off and wait the urge out instead of acting on it. Still strong after 10 to 15 minutes? You may still be near the cue.
2. EscapeLeave the place, the people or the situation that set it off.
3. AcceptTell yourself the urge is uncomfortable and that it will pass.
4. DisputeQuestion what the craving is telling you. See how to talk back.
5. SubstituteDo something from a written list of activities you keep ready.

And call someone. A sponsor, a friend in recovery or a counselor: people you have lined up ahead of time, as part of a sober support network.

How do you ride out a craving with urge surfing?

Urge surfing means treating the urge like a wave: you stay with it and watch your thoughts and body sensations as it peaks and fades, instead of acting on it (Hendershot et al., 2011).

It comes from mindfulness-based relapse prevention, which treats urges and cravings as passing events that you do not have to act on (Hendershot et al., 2011). You can do it anywhere you can sit or stand still.

1. Notice it and name itSay to yourself, "This is an urge."
2. Find it in your bodyWhere do you feel it: chest, stomach, hands, throat?
3. Breathe and watchBreathe slowly and watch the thoughts and sensations without doing what they say.
4. Stay on the waveNotice it build, crest and start to fall.
5. Go on with your planWhen it eases, move to the next thing on your plan.

The wave and the watching come from urge surfing as Hendershot et al. (2011) describe it; the wording of the steps is this guide's.

How do you talk back to a craving?

Disputing means answering what the craving tells you with a counter statement you worked out ahead of time (SMART Recovery, 2017).

SMART Recovery teaches two tools for this, called ABC and DISARM. Write your own answers ahead of time, so they are ready when the thought shows up.

What are the limits of these coping methods?

DEADS and urge surfing are skills you use on your own in the moment; they do not replace treatment, and the research behind them has gaps (NIDA, 2020; Hendershot et al., 2011).

General information, not medical advice.

When are cravings a sign you need more support?

When cravings keep coming back, grow stronger, or end in using, talk to your treatment provider; after a return to use, NIDA advises talking to a doctor about resuming, changing or trying another treatment (NIDA, 2020).

For some substances, medications can help prevent cravings, so ask your provider whether one fits you (NIDA, 2020). If cravings come with other changes that build over weeks, read about the early signs of relapse.

For some drugs, using the amount you used to take after a time without using can cause an overdose, because the body is no longer used to it (NIDA, 2020). For a possible overdose, call 911.