WORKBOOK

Managing Your Substance Use

Disorder
Third Edition

Dennis C. Daley
Antoine Douaihy

CHAPTER 8

Managing Cravings and Urges to Use

Substances
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This resource has been created by Psychology Tools and is based on

a chapter from Managing Your Substance Use Disorder (Third Edition)
published by Oxford University Press. © 2019 by Oxford University
Press, Inc.
 Managing Cravings and Urges
CHAPTER 8
to Use Substances

Goals

■ To learn strategies that will help you prevent or manage your

cravings

■ To begin tracking your cravings daily over the next few months

■ To identify the things that trigger your cravings in order to plan

coping strategies

Introduction

A craving, which can vary in intensity from mild to very strong, is a

longing for or a desire to use a substance. Your craving can be a desire for
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the euphoric high associated with using substances, or it can be a desire

to avoid or escape unpleasant moods or physical symptoms such as those
associated with withdrawal. An urge is your intention to use substances
once you have a craving. You can have a strong craving with very little
intention to use, or your intention to use can be quite high, making you
more vulnerable to relapse unless you use active coping strategies to help
you through your craving and urge.
Cravings can be overt, so that you are aware of them, or they can be co-
vert (hidden from your awareness) and show up in indirect ways such as
irritability. Cravings tend to be more frequent and stronger in the early
phases of recovery. Individuals addicted to heroin often report intense

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 Cravings

Triggers

External Thoughts COPING STRATEGIES

Environmental
ALCOHOL, TOBACCO, Cognitive
Feelings
OR DRUG CRAVINGS Behavioral
Internal Interpersonal
Behaviors Substitutions

SIGNS AND SYMPTOMS

(physiological and
psychological)

Intensity
(low-severe)

Figure 8.1
Craving triggers and intensities.

“drug hunger” that leads them back to using drugs again if they do not
find relief.
Cravings for substances are triggered by something external (people,
places, events, experiences, or objects) or internal (feelings, thoughts, or
memories). Your cravings not only vary in intensity from low to severe,
but also in how they show in your thoughts or how they make you feel
physically. When you experience a craving, your thoughts and feelings
determine how you cope with it. These connections are shown in Figure
8.1 and discussed in further detail in this chapter.
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It takes time adjust to not using substances, both physically and mentally.
It also takes time to figure out what triggers your cravings and to practice
ways of managing them. The strategies reviewed in this chapter should
help you prevent or manage your cravings.

Rating Your Cravings Daily

Learning to identify and label your cravings is the first step toward control-
ling them. You can call them whatever feels comfortable—​urge, craving,
desire, need to get high, and so forth. When you start your recovery, track

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 your cravings on a daily basis so that you can see how they change from
day to day. It also helps to be aware of how cravings and urges show in
physiological and behavioral symptoms. Anxiety, tension, sweaty palms,
racing heart, irritability, avoiding people, and lying to people are just a
few common ways in which your cravings may show up. Use Worksheet
8.1: Daily Craving Record, later in this chapter, to track your cravings
over the next few months. (Figure 8.2 shows an example of a completed
Daily Craving Record.) You may photocopy the form from this book
or download multiple copies from the Treatments ThatWork Web site at
http://​www.oup.com/​ttw/​us. Take a few minutes at the end of each day
and rate the average intensity of the cravings you had during the day
using a scale of 0 to 5: a rating of 0 indicates no cravings, 1 indicates low
craving intensity, 3 indicates moderate craving intensity, and 5 indicates
severe craving intensity. Because the first 90 days of recovery present the
highest risk of relapse, we recommend that you track your cravings so you
can see how the ratings change over time. If you abstain from substances,
the intensity of your cravings usually lessens as time goes on. However,
there may be days when you experience a temporary increase in your
cravings. For example, Sharon’s daily ratings were “severe” for the first 2–​3
weeks and “moderate” to “severe” during the next 2–​3 weeks. The inten-
sity of her cravings decreased during the second and third months. About
6 weeks into her abstinence, she experienced severe cravings for a day. As
with any increase in craving severity, the important issue is managing it
without using. Eventually, all cravings go away or lessen in severity.

As you track your cravings and rate them daily, pay close attention to the
internal and external triggers that you associate with these cravings and
the coping strategies you use to avoid taking a substance. For example,
Sharon’s cravings have recently increased. Sharon has been able to figure
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out a connection between upset feelings in a relationship and an increase

in the severity of cravings. The next two sections will discuss the connec-
tion between your cravings, triggers, and coping strategies.

Identifying Triggers to Use Substances

Identifying the people, places, events, and situations that trigger your
cravings or urges helps you anticipate triggers, which can in turn help you
plan coping strategies.

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Figure 8.2
Example of a completed Worksheet 8.1: Daily Craving Record.

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 External triggers include people, places, events, situations, or objects
that directly or indirectly contribute to your desire to use substances.
Common “people” triggers include drinking buddies, drug dealers, part-
ners or roommates who use substances, or coworkers and friends who
smoke in front of you. Any place where you previously used substances
(e.g., home, office, bar, friend’s house, street corner, car) can trigger a de-
sire to use. Similarly, events or situations in which substances are being
used can be a trigger for you. These include but are not limited to parties;
holiday, religious, or personal celebrations; after-​work get-​togethers; or
business meetings. Even objects can trigger your cravings. These include
the sight or smell of alcohol, tobacco, or other drugs; the smell of a partic-
ular perfume or cologne; the sight of paraphernalia associated with using
(e.g., lighters, mirrors, pipes, papers, needles, alcohol mixers); and the
sight, smell, or experience of other objects associated with using. For ex-
ample, Ryan identified certain pieces of music as triggers for marijuana
use. Even when he had no desire to use, if he heard certain songs while
riding in the car, he would experience a craving for marijuana. Common
triggers for smokers are a cup of coffee and the end of a good dinner, as
these are often associated with using cigarettes.

Cravings and urges can also be triggered by internal factors such as feelings,
specific thoughts and memories, or physical sensations. Distressing feelings
such as anxiety, depression, or anger can also trigger desires to use. It takes
time and effort to learn to manage feelings. Negative emotional states are
the most common relapse risk factor. Therefore, learning skills to manage
your feelings will reduce your vulnerability to relapse. Chapter 10 of
this workbook includes strategies for managing your upsetting feelings.
Positive thoughts and memories of using can trigger cravings and urges
as well. Examples include, “I really don’t have a problem,” “I can handle
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a few,” “There’s nothing like a few drinks (cigarettes, joints, lines of co-
caine),” “I can’t stand living without getting high on drugs,” and “Sex is
so much better when I’m buzzed up.”
Sometimes, cravings will be random and may happen at any given day
or time. At other times, however, cravings may be more likely to happen
during specific days or times. For example, when Dana first quit drinking,
her cravings were like clockwork: as soon as the “cocktail” hour arrived,
her desire for a few drinks before dinner increased. When she ate out in a
nice restaurant, she associated having a few glasses of wine with enjoying
a good meal.

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 Although we classify triggers as internal and external for purposes of
discussion, they are often interrelated: an external trigger will lead to
increased thoughts of using.
Complete Worksheet 8.2: Substance Use Triggers, later in this chapter,
to help you identify triggers, the degree of threat each represents, and
strategies to help you cope with them. Helpful coping strategies are
summarized in the following section.

Strategies for Managing Cravings and Urges

When possible, choose a strategy that provides a substitute “payoff.” For

example, if you drank to relax and cope with stress, then you need an
alternative way to relax and reduce stress. If you smoked marijuana or
snorted cocaine to enhance sex, then you need to find ways to enjoy sex
without relying on drugs. If you smoked cigarettes to quell your anger,
then you need to find healthier ways of dealing with anger.
As you review the following coping strategies, place a checkmark next to
those you have successfully used in the past or can use in the future.

Environmental Coping Strategies

□ Reduce environmental cues by getting rid of the substances you are

trying to quit using. There is no need to keep cigarettes, alcohol, or
drugs in your house if you quit using.
□ Get rid of paraphernalia used to prepare or ingest drugs (e.g.,
lighters, ashtrays, needles, mirrors, papers).
□ In early recovery, when possible, avoid people, places, events, and
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things that you feel represent a high risk of relapse.

Cognitive Coping Strategies

□ Talk yourself through the craving.

□ Tell yourself that you are capable of coping with a craving no matter
how strong it is.
□ Remember that cravings always pass in time.
□ Buy yourself time by saying you’ll put off using for a few hours.
□ Remember the troubles caused by using alcohol or other drugs.

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 □ Ask for help and strength from a higher power.
□ Imagine the craving as a wave that you are surfing to safety. Rather
than fighting against the wave, you ride it to shore without getting
engulfed in it. “Ride out or surf ” the craving and it will eventually
leave you.
□ Delay your decision by telling yourself you’ll wait until later in the
day or tomorrow before you use. By that time, your desire may have
decreased in intensity or left completely.

Behavioral Coping Strategies

□ Distract yourself with an activity.

□ Do something physical, such as take a walk, jog, or work out, to
release tension.
□ Write in a journal or complete a daily craving record.
□ Read recovery literature for help and inspiration.

Interpersonal Coping Strategies

□ Talk to friends in recovery.

□ Talk to family or other supportive people.
□ Go to a recovery meeting and share your cravings.
□ Leave situations immediately if the pressure to use feels too strong to
resist.
□ Avoid interpersonal “set-​ups.” These are relationships or encounters
that influence you to use. This influence may be overt or direct,
or subtle and indirect. If, for example, you want to date someone
who uses alcohol and drugs or have a sexual encounter with
someone who is drinking or using drugs, you may not initially feel
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like using. Later, your desire to use may increase as the situation
unfolds and the person you are with invites you to use or uses in
front of you.

Substitute Coping Strategies

□ Smokers find it helpful to chew gum or eat mints or hard candy

when they feel like having a cigarette.
□ Substituting a soft drink or other nonalcoholic drink is helpful
during times or situations associated with alcohol use, such as
during the pre-​dinner cocktail hour or a wedding reception.

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 Homework

✎ Use Worksheet 8.1: Daily Craving Record, to track your cravings

over the next few months.
✎ Complete Worksheet 8.2: Substance Use Triggers, to help you
identify triggers, the degree of threat each trigger represents, and
strategies to help you cope with them.
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 Worksheet 8.1
Daily Craving Record

Ratings of Intensity of Cravings

Instructions: Each day, use the scale to rate the average intensity (0–​5) of your cravings to use
alcohol, tobacco, or other drugs.

0 _​__​_​_​_​_​_​_​_​ 1 _​__​_​_​_​_​_​_​_​ 2 _​_​_​_​_​_​_​_​_​_​ 3 _​__​_​_​_​_​ 4 _​__​_​_​_​_​_​_​_​ 5

None Low Moderate Severe

Month: _​__​__​__​__​__​__​__​__​__​__​

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Rating
Day 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Rating

Month: _​__​__​__​__​__​__​__​__​__​__​__​__​__​

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Rating
Day 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Rating
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Month: _​__​__​__​__​__​__​__​__​__​__​__​__​__​

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Rating
Day 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Rating

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 Worksheet 8.2
Substance Use Triggers

Instructions: List people, places, events, situations, objects, feelings, thoughts, memories, or times
of day that trigger your cravings or urges. Rate the level of threat presented by each trigger using
the scale below. Finally, list strategies for coping with each trigger that will help you avoid using.

0 _​_​_​_​_​_​_​_​_​_​ 1 _​_​_​_​_​_​_​_​_​_​ 2 _​_​_​_​___​_​_​_​ 3 _​_​_​_​_​_​_​_​_​_​ 4 _​_​_​_​___​_​_​_​ 5

No Threat Moderate Threat Severe Threat

Trigger (external or internal) Level of threat Coping strategies

(0–​5)
_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​ _​_​_​_​_​_​_​_​_​_​_​_​_​ _​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​_​
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