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We are working on our website today. Please excuse the mess. Sept 16, 2015.

Substance Use Blog Series: Triggers

War, Nuclear War, Red, Button, Finger, Press, TriggerThis week in the Substance Use Blog Series, we are discussing what triggers are as well as some coping mechanisms for dealing with them. But before that we want to acknowledge that changing one’s relationship with substances is a layered process. Our human neurobiology is complicated and there are also social, psychological, and spiritual components to why people use substances. Writing a post like this (that only focuses on triggers) can be misleading in its simplicity. Coping with triggers is only one approach to addressing substance use. This post is meant to supplement the other helpful activities you are engaging in. Thinking in terms of triggers and coping mechanisms may not be useful for you at this time, or even ever. Don’t worry, there are other paths to reach your goals. We specifically encourage you to find a good support network of people who understand addiction. It can be a great help to connect with people whom you feel understand you and whom enable you to speak about what is troubling you daily. In addition, supportive people can recognize our “blindspots” and signs we may be heading for trouble.

Another comment before we begin is that even thinking about triggers can induce difficult emotions and cravings. Please pay attention to what might be coming up for you as you read this information. If you begin to feel triggered while reading the post, take a break and do some self-care, reach out to someone, or distract yourself until the craving has subsided. If you are already familiar with what triggers are you want to skip to the second half, which is titled Coping with Triggers.

Triggers – What are they?

In psychology, a “trigger” is anything that sets off an unconscious chain-reaction throughout our brains, resulting in a specific emotional or behavioral response. For example, a feeling of itchiness can be Domino, Wood, Greyconsidered a trigger for us to reach out to scratch that itch. Or, if we have been bitten by a dog in the past, dogs might become a trigger for feelings of fear (including an increased heart rate and quickened breath). In the psychology of marketing, people research what advertisements and product-display-triggers will makes us more likely to purchase things.

The word ‘trigger’ can also be used as a verb to label the chain-reaction described above. For example, in the substance use services world, we talk about people, things, or experiences triggering cravings for a substance. There might be multiple steps between a trigger and a substance craving, for example the trigger might actually bring up a feeling and it is the feeling that triggers a craving.

Triggers occur because our brains are constantly forming short cuts. If we didn’t make these short cuts, we’d be processing all the information around us as though it was new all the time! This would leave us with hardly any time to plan, problem solve, or be creative. The brain uses memories to jump ahead to the conclusion it is expecting, based on previous experience.

Triggers can occur very quickly and bring up many strong feelings. The strength of a connection between a trigger and a craving will depend on many circumstances, including how often the trigger was associated with the response, the biology of our individual brains, our age when the memory link was formed in our brains, and if the trigger is connected to a traumatic even. Triggers associated with a traumatic event can be particularly strong because the part of our brains that takes in sensory information (from sight, touch, taste, smell, and hearing) may be triggered to activate our flight-fight-freeze response, before that same information has even reached the thinking/impulse-control part of our brain. This means that our bodies start taking actions to run away, fight back, or freeze before we’ve had a chance to really consider what’s going on.

The good news is that brains can be re-wired and new memory shortcuts can be formed. This happens when a trigger is followed by something unexpected or new or as a shortcut becomes unused and other shortcuts form. Triggers for substance cravings become significantly less powerful overtime. Here is a short video about our brain’s abilities to make new pathways. This ability is referred to as neuroplasticity.

Next, we’ll review some strategies on how to cope with triggers for cravings while we are building new memories. 

 

Coping with Triggers and Cravings

  1. Get to know your triggers well
  2. Avoid them when you can
  3. Practice talking yourself down using the ABC model
  4. Experiential Activities: Urge Surfing, Self Care, and Holding On

Here is a link to a worksheet about coping with triggers from therapistaid.com. You can print it out or use it as a framework to make your own worksheet at home. The following strategies can help you come up with answers for the worksheet.

 Let’s get started!

1. Get to know your triggers well

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To try and identify triggers in your own life, it might help to break them up into three different categories: external, internal, and relational (which are a combination of internal and external).

External triggers can be people, places, and things in the world (as opposed to feelings or thoughts in your mind). Consider, what are the places where you are likely to feel cravings? Often this is where we have used substances in the past. Are there any songs, movies, or smells that trigger cravings for you?

Internal triggers are comprised of private experiences, like thoughts, feelings, memories, and/or physical sensations (such as pain or discomfort). Some examples of private experiences people sometimes find triggering include,man wearing red and black checked shirt jumping near bonfire the thought of missing out on a fun time, feeling energetic and wanting to party, a critical thought about oneself, and/or feeling angry, alone, or ashamed.

Relational triggers are made up of interpersonal experiences with others. They often have elements of both external and internal triggers. For example, some people are triggered after a conflict, being spoken down to, by the desire to appease others, or to alleviate peer-pressure. Do you notice any relational triggers in your life?

 

2. Avoid Triggers when you can

This point is fairly straight forward, but here are some examples of strategies to avoid experiencing a trigger:

  1. Avoid places where substances can be attained or where they are likely being used
  2. Build structure into your life so that you have less time to be bored and drift into thinking about the past.
  3. Plan an exit strategy when you are going someplace where you might be triggered. What could you say to excuse yourself if someone asks you why you are leaving?

Avoiding triggers is all well and good, but sometimes we are triggered unexpectedly, or we have to encounter a trigger that we know leads to substance cravings. The good news is that all cravings pass. For example, the average nicotine craving 15-20 minutes[1] and many sources say that strong cravings for substances generally rarely last for more than 30 minutes. 

 

3. Practice talking yourself down using the ABC model

Once you notice that you are experiencing a trigger, you can try one of the following coping strategies. Cognitive Behavioural Therapy offers a helpful technique called the ABC model. It is founded on the idea that triggers are often fueled by underlying beliefs and assumptions about situations that are not correct or somewhat exaggerated. By recognizing our assumptions, we can take away some of the trigger’s power.

The ABC model involves identifying the factors in the following steps. These can be done in your mind, out loud, or you may want to write them down in a journal.

A – Activating situation – recognize and name the Activating situation or trigger

B – Irrational Belief – consider whether your belief is rational or exaggerated

C – Consequences – ask yourself, what are the consequences of holding those beliefs? Do the unnecessarily contribute to cravings or feelings of anger, stress, or behaviour such as avoid supportive others.

D – Dispute the Irrational Beliefs – what is the evidence for this belief? Are you reading into things? Do these beliefs actually benefit your life?

E – Effective new thinking – come up with a new position on the problem

You can watch a video about the ABC-DE’s made by SMART Recovery at the bottom of this paragraph. There is more information SMART recovery and an example of the ABC’s here

4. Experiential Activities

Urge Surfing

Sometimes challenging our thoughts doesn’t seem to work. If you find the ABC’s not working for you, you might want to try a strategy that focuses on feelings and sensory experiences rather than your thoughts.  One popular technique is called Urge Surfing. People who have researched cravings have noticed that after a trigger, urges increase for a short time, peak, and eventually fall away – just like a wave. Urge Surfing involves slowing yourself down, paying attention to your breath as well as the urge, and reminding yourself that the urge will pass.   

Here is a longer write up about urge surfing and a 3 minute guided recording of an Urge Surfing practice. Practicing along with a recording when you don’t have an urge will help prepare you to deal with a craving in the moment. 

 

Self-Care

Another technique for coping with a trigger is to engage in some comforting self-care, as discussed in this earlier blog post. Resisting a craving is uncomfortable and can even be emotionally painful. Engaging in self-care is meant to honour and respect the work you are doing. Some examples are:

  • Resting
  • Spending time with positive people (calling your sponsor if you have one)
  • Drinking water or tea for relaxation/hydration
  • Eating a tasty snack
  • Exercising
  • Doing a self-compassion exercise
  • Having a bath or shower
  • Listening to music
  • Making Art

Holding On (to something)

Finally, carry something with you that reminds you of the reasons you are changing your relationship with substances. Something that is pocket sized and has a comforting feeling. Maybe a photo, a piece of jewelry, or a stone. When you are feeling triggered, take it in your hand and consider it as an object from all angles.

  • Consider how it looks.
  • Consider how it feels in your hands, against your face.
  • Consider how it smells.
  • Does it make any sounds if you touch it against something?
  • Finally, consider why you are making this change.

As you consider all these things breathe slowly. Eventually the craving will pass.

All these practices take practice and trying something out will be a learning experience, even if you find that it’s not working for you. You will eventually find the coping skills that work best for you. Continue to acknowledge the work you are doing. Rewiring our brains takes time.

[1] https://www.webmd.com/smoking-cessation/understanding-nicotine-withdrawal-symptoms#2 .

 

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