Sober Synthesis

• Cortisol (stress hormone) has a diurnal pattern. Peak in morning, decreases throughout the day. Cortisol plays an important role in:
  • Regulating the body’s immune system, metabolism, inflammation
  • Reward, cognition, and emotional regulation, as well as restorative sleep.
• Alcohol and stimulant consumption increase the body’s production of cortisol, not only while the person is intoxicated, but also when withdrawing from the effects of intoxication and well after abstinence.
  • The raised cortisol baseline when not drinking results in feeling more stress and anxiety and subsequent craving.
  • Alcohol increases women’s cortisol levels more than men.
• High levels of sustained physical and/or mental stress release cortisol spikes.
  • Impairs prefrontal cortex functioning responsible for concentration, judgment, and planning (choice and willpower). Thus making cravings harder to resist. 

• “Cravings are ingrained memories of the act of taking alcohol/drugs as well as memories of the pleasurable effects.” 
• Animal research discovered that repeatedly drinking alcohol alongside particular cues can activate certain clusters of neurons to form a LONG-LASTING PHYSICAL MEMORY TRACE in the brain (medial prefrontal cortex). While memory is an experience stored in the brain, a memory trace is the physical neuronal cluster linked to a memory. “Cue-evoked reactivation of the memory trace is not something that can be simply stopped by ‘will-power.’ It may even occur unconsciously and still elicit strong feelings of craving.”
• Stages of re-occurrences (relapses)
  • Emotional-emergence of negative emotions
  • Mental-actively consider using again to relieve the discomfort experienced in the emotional stage.
  • Physical-drug and/or alcohol use

Tools

• Prevention
  • Avoid looking at your phone or watching news as the first activity in the morning to minimize early cortisol spikes.
  • Prioritize daily healthy habits: eating a vegetable rich diet; taking vitamins including fish oil, magnesium, vitamin D, vitamin B1 (in early recovery); taking prescribed medications; exercising including aerobic and weight bearing, light exposure (especially in the morning), connection, play, micro-sucs (small activities that you don’t want to do), mindfulness activities. These habits minimize HALT (Hungry, Angry, Lonely, Tired) and the subsequent stress response.

• Intervention (have a plan)
  • Engage in a distracting activity (walk, art, journal, knitting, music)
  • Engage in an active stress reduction activity (meditation, physiological sigh, panoramic vision).
  • Talk about the craving during group and/or with a support person
  • Ride out the urge – Works by fully experiencing the craving, taking control of it, and riding it out until it subsides. 
• Visualize past consequences and future consequences of using (play tape backward and forward) 
• Visualize future opportunities with abstinence (create new tape)
• Using self-talk – Recognizing the automatic thoughts that accompany cravings and countering them with empowering thoughts and self-talk 

Proposed questions for thought/sharing:

1. What changes have you made to improve how you recognize and work through cravings and how have those changes supported your recovery/wellness?

2. What are your challenges with recognizing and working through cravings? Any ideas for the future?

3. Have you been surprised by any cravings after sustained abstinence?