Image for representation,
Credit: iStock Photo
Whilst in recovery, the primary challenge is the management of reactions to cues. Addiction, in any form, is usually maintained by a learned response known as cue reactivity. When presented or met with stimuli related to drugs, individuals with an addiction have a significant physiological and psychological reaction. These in turn evoke an urge to use and consequently a relapse during the process of abstinence. Thus, understanding cue reactivity and managing them effectively, can support the management of craving as it is an important antecedent of relapse.
Cues can be of different types; however, Drummond (2000) categorises them into four main types. Individuals in alcohol addiction recovery, for instance, may feel triggered by the mere sight of an advertisement about alcohol. Being at a social gathering or bar surrounded by people who are consuming alcohol, the sight of the drink in the glass, and the very environment can be a strong stimulus. These are visual cues. The smell of alcohol would be an olfactory cue and a sip of it would be a gustatory cue. There have been instances when reactions set in when an individual in a rehabilitation centre for alcohol addiction even uses alcohol-based hand sanitisers. Thus, any visual, olfactory or gustatory cue would be classed under exteroceptive cues.
Sometimes, individuals have a situational connection to initial drug use, which ultimately becomes a learned coping mechanism. A teenager, going through stressors in school might explore drug use which could elicit a temporary cognitive respite from stress. Thus, they may associate the temporary respite from stress with a positive reward gained from the drug use. Thus, any internal cue which may
either be a response to stress or a sway in mood, or a withdrawal-related state would make up the interoceptive cue.
Some individuals may have a specific time of the day when they smoke a cigarette. When quitting smoking, the time at which they habitually smoke may serve as a cue in itself. As the body is used to the dose of nicotine at the said hour, it starts throwing a reaction to the lack of it. This, coupled with the distance at which the cigarette is accessible forms a strong cue. A pack of cigarettes in their bag they still have and which they can readily access or one they can borrow from a colleague sitting right next to them and the time of the daily dose would make up temporal cues.
The last category is a cue relationship. Oftentimes, cues occur in conjunction and are interrelated to one another. They very rarely occur in isolation. Sometimes cues can occur together and they are referred to as cue clusters. When cues arrange themselves in an order where one leads to another, they are referred to as a chain. For instance, if an individual smokes at a certain spot outside work every day, standing there without smoking, yet seeing another colleague smoking, becomes a dual cue, thus forming a cue chain. A cue cascade is a process where one cue increases the possibility of encountering the other.
Establishing new habits and routines can be extremely useful in the management of cues. For instance, if you’re used to going outside your workplace during lunch for a smoke, trying to go and sit in the same spot without smoking might make it harder. Thus, a completely new routine can be established. If there is a gym on-site, you could start using the gym during lunch hour and avoid going to the regular smoking spot for a while.
When replacing an old habit with a new one, the first factor to consider is how doable it is as this directly impacts your consistency with it.
Consistency is the key to the sustenance of a new habit and it takes at least around 21 days to form a new habit.
Research indicates that it takes about three months to make this habit a way of life. And when a habit is repeated at least 66 times, it becomes a newly established habit. Thus, rather than chasing instant results, the goal must be to achieve consistency.
(The author is a multidisciplinary professional who works in the UK.)