Episode #125

Triggers and cravings are a huge key to what helps addiction develop. It makes sense then that recovery is going to need solid ways to manage triggers and cravings. Triggers aren’t something we control. They are developed when we pair reinforcement with a desired response. If we pair two things together for a long enough time then our brain will make a connection and remember it. This is what helps addiction along even when the reward system isn’t pushing the person to use. Today we’ll talk about the way addiction sets in and how cravings play an integral role.


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance use from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

 Welcome back to the All Things Substance Podcast. This is episode 125. Welcome back to the All Things Substance Podcast. This is episode 125. Today we’re gonna talk about understanding cravings and triggers.  The reason this came up for me was a conversation that I was having with someone about why people continue to use substances regardless of the negative outcomes.

So imagine that someone’s entire life just fell apart. They’ve lost their job, their spouse is filing for divorce. Their children no longer wanna talk to them. Their friends and extended family are disgusted and not answering texts and phone calls. Clearly it is the substance that caused all of these problems in the person’s life. Surely they won’t wanna keep using, right? 

Why would someone continue doing something that stole everything from them? Are they truly so in love with it that they can’t let it go? Is it truly so much fun that they won’t give it up? The truth of the matter is that most likely that person will continue using and no, it’s not fun.

Using substances to the level at which someone’s life is falling apart has not been fun for a really long time. It’s possible that there were moments where the person was still having fun or that they had enjoyable experiences. Using drugs and alcohol stops being fun long before they get to this.  It’s kind of a lot of work actually. 

You have to think about, do you have the money to get what you need? How will you get what you need? When will you be able to use it? Is there gonna be anyone around who’s going to get in the way? How will you handle the people that might be there? How will you handle the responsibilities that you might not be able to? How will you deal with it while you’re high or what about the aftermath? How will you manage that also? 

The cycle repeats itself over and over and over and over again. It stopped being enjoyable, so why don’t people stop? Why is it so hard? To let go of something so destructive that isn’t even fun. The easy answer of course is addiction. We know that addiction is powerful. 

There is a debate among lots of different folks about whether addiction is something that someone chooses or if it’s a medical condition, a brain disease. Lots of people who have been terribly wounded by the addict or alcoholic in their life have a really hard time with the idea that addiction isn’t something someone chose. They chose to use. Therefore, it’s their decision and their responsibility. 

The problem is that we know way too much about the brain and how it interacts with these substances for that kind of simple answer. No one chose to be addicted. Nobody sat around and decided, you know what I’m gonna be an addict, and that’s gonna be fucking awesome. I’m gonna get totally hooked on this thing and give up everything I’ve ever wanted in order to keep it. 

The person chose to use, they chose to drink or use drugs or gamble. They chose to do it. Knowing that there’s a risk, but not truly believing that the risk was that great. Even people who have genetic predisposition for addiction, they don’t necessarily all become addicts and alcoholics. It’s a risk factor, but it’s not fate. 

There’s some trait that we have as humans that makes us think it’s not gonna happen to me. I will be smarter. I have my eyes open, and I will not succumb to this thing that has gotten other people. I’m not totally sure of all the factors that go into why we think that. I just know that we do. 

It’s why we speed. It’s why we take chances for things. It’s why the odds don’t really mean much to us because we think that we have some kind of unique skill, knowledge, luck, you name it. That’s gonna change the outcome. When I’m out on the road, I have just as much of a risk of getting pulled over for speeding as anyone else. Yet  for some reason, I think it’s not gonna happen to me because I’m paying attention, because I’m gonna notice a cop before they see me, because I’m only going six miles over the speed limit rather than someone else’s 10 or 15 miles over the speed limit. Yet the risk is the same. 

In order to understand why somebody would keep using, knowing that addiction is a possibility, we need to talk about what’s happening in the brain and how that develops. So when we think about addiction, a lot of people think about the reward pathway. That the brain wants to get high and feel something good, and that’s what reinforces substance use. That is part of it, but it’s not the whole story. 

There are lots of things that use the reward pathways in the brain that don’t lead to addiction. This means that addiction has to do something quite a bit more  than just rewarding us for seeking pleasure. 

There are actually five characteristics of addiction as defined by ASAM, the American Society of Addiction Medicine, those five areas.

The first is the inability to consistently abstain. The second is impairment in behavior control. The third characteristic is cravings. The fourth is the decreased ability to recognize problems, and the fifth is a dysfunctional emotional response. 

Looking at these five main components of addiction,  the first was the inability to consistently abstain, and by this we mean that the person cannot, on a consistent basis, keep themselves from doing the thing, whether it is using drugs or alcohol or gambling. Those are the three things we know that have been identified as actual addictions in the DSM. There are other things in the DSM that it’s suggested that they should be considered as addiction, but they are not listed as addictions. These are the three 

Another component that they have trouble with is the impairment in behavioral control. This has to do with their ability to control the behaviors around the substance or around the behavior of gambling. 

The way that this shakes out is that the person’s behaviors start bleeding out into other areas of their life. This is usually when other people start noticing things. This isn’t to say that there weren’t behaviors before that, but the person generally can keep it contained. They have figured out how to keep others from noticing that they pay their rent late all the time because they don’t have money.

Or that every Monday morning they end up showing up late because they’re trying to recover  from a hangover or some other consequence from the weekend. Eventually, as addiction sets in, the control over that behavior starts to lessen, and that’s what usually ends up with others noticing and commenting on some of these out of character behaviors. 

The third component they list is cravings. Cravings were never really recognized, not until recently as being a part of the addiction process, even though it is central to the addiction process. Cravings are something that we in general in society, don’t wanna admit to having. It sounds really depraved. It sounds out of control to have a craving. It sounds dark, and the truth is, we have cravings all the time. We just don’t think of ’em that way. 

We think of them as having a thought, having a desire to do something. I want to do something. I have an urge to do something. But even the word urge feels a little strong. And part of that is nobody wants to think that they’re being mastered by anything. We all want to believe that we have control over ourselves, our behaviors and our desires. 

The fourth component of addiction is the decreased ability to recognize problems. When somebody is using, say the person I mentioned earlier where they’ve lost everything to the outside, it looks really fucking bleak, and it looks like the person should absolutely have understood that this was coming. 

Yet. They will downplay the consequences. They’ll say, so-and-so’s just being dramatic. It’s not that bad. Everything’s gonna be fine. It’s gonna work. When the other folks who aren’t using, they’re looking at the same situation and they’re like, everything is on fire. Do you not see the fire? And they’re like, everything’s not on fire. It’s like a small little flame. I’ll get it put out. No big deal.

This is actually from a brain change. This isn’t something that they are just willfully stupid. There are literal changes that I’ll get into in just a few minutes that are happening in the brain that are contributing to this. And lastly, the dysfunctional emotional response.  This isn’t my favorite phrase because I feel. It’s using professional language to try to explain something that doesn’t make sense.

Because truly what it means is that somebody’s response to something is fucked up. As in, that’s not normal. That’s not typical. And this isn’t about being judgmental. This is about, um, what, why are you doing that? 

So let’s pretend that somebody keeps going near a flowering bush. ? The flowers are blooming and it is beautiful and bright, and there are bees all around it, and it’s very clear that there are bees. They’re not hiding. They are buzzing in and out of each of the flowers, and clearly they are super interested in this bush. And then someone comes along and they keep getting close to the bush.  And they keep trying to touch flowers even though there are bees there, and each time they’re doing this, they’re getting stung and it’s taking longer and longer for the bees to dissipate each time they walk away. Yet they keep going back. 

The response that they’re having  to this issue is not logical. it’s not functional. It doesn’t serve any purpose, and the person doesn’t seem to learn to stay away from that bush.  If that bush is important enough, that person will try all sorts of things to get to the bush rather than just deciding it’s not worth it.

These five components of addiction are super important because it’s not just about the reward pathway. There are all these pieces that come into play when it comes to addiction. We are gonna focus on the middle one, cravings. In order to do that, we need to set the stage a little bit to talk about addiction from a scientific point of.

Well supported scientific evidence shows us that addiction to alcohol and drugs is a chronic brain disease that has potential for recurrence and recovery. Additionally, there is well-supported evidence that the addiction process involves a three stage cycle. 

Binge/intoxication. Second is withdrawal/negative effect, and the third is preoccupation and anticipation. In your mind’s eye, I want you to take these three stages and put them in a circle with arrows going between them. We start with binging or getting high. After that, there’s the come down stage withdrawal or some kind of negative effect. And once that’s over, then we have the preoccupation and anticipation leading to the next time they binge or get high, et cetera, et cetera.

As this cycle continues, there are things happening in the background that are making addiction possible. Remembering that addiction is a chronic brain disease. Science also shows us that there are disruptions in three main areas of the brain are important when it comes to the onset, development and maintenance of addiction. 

Those areas are the basal ganglia, the extended amygdala, and the prefrontal cortex.  These disruptions are what causes substance related cues to trigger substance seeking. I’m gonna say that. There are changes, disruptions, as they call them, that make addiction grow and set in.

One of the ways that happens is that it makes it so substance associated cues trigger substance seeking. So that a cue that wasn’t there before, like, let’s say the popping of a can of beer, that that very noise can become a cue, and that alone could trigger someone’s desire to seek a substance.

Think about how it is for your cat or your dog when they hear a can opening, a bag, opening a treat jar. That just the noise never used to mean anything yet hearing that noise makes them come running  and probably have salivary differences because they’re getting ready to chomp on something yummy.

We learned that with Pavlov’s dogs, of course, and found that we could cue those things; that something that wasn’t put together could be put together and cause this known reaction. Those changes in our brains happen in those three areas of the brain, the basal ganglia, the amygdala, and the prefrontal cortex.

The second type of change that happens is there’s reduced sensitivity to pleasure reward. That’s where that comes in, that the pleasure that the person gets from this activity is not as great as it used to be.  It starts to diminish the feeling, so the person has to do more in order to get the same effect. On the other side of that coin, it also heightens activation of the stress. 

So in the very first part we said that the brain changes to allow substance related cues to trigger drug-seeking behavior. So the brain is set up ready to take these cues and learn that this equals this, that being in this vehicle means I get to get high. That watching this movie reminds me of when I was able to do the thing, and now I wanna do the thing again too. That our brain is learning and connecting these cues and doing so more readily. 

Next, what the brain does is make it so the thing that used to feel good doesn’t feel quite as good as it used to, so they have to use. Additionally, it makes the person more sensitive to stress and therefore amps up their agitation.  So they’re not getting as great a feeling from the substance, and they feel more agitated than they normally do. It’s activating the stress system and if all of that wasn’t enough, the third thing is that it reduces the functioning of the brain’s executive control systems. 

Which is key to their ability to make decisions and regulate actions, emotions, and impulses. So we’ve got the cues set up so that they can trigger them, and the brain is quickly learning all the different cues that lead to the drug seeking behavior.

They’re not feeling as good as they do normally when they use the substance they’re feeling more agitated than they normally do too, because their body’s now more sensitive to stress,  which is going to raise the cravings. Now their executive functioning is being impacted and disrupted, and they need that in order to make decisions and regulate themselves.

These three things together are happening in those parts of the brain during that three stage cycle: the using, the after or the come down and the in between where they’re preoccupied and planning for the next time they’re gonna use. So in the background, the agitation is growing, they’re not feeling good. They’re unable to look at things as clearly as they used to. They’re also not judging consequences as clearly as they might. They’re starting to see things differently. 

When you’re really used to something happening, say noise. If you are a person who grew up in a house with a lot of family and a lot of kids, you’re used to noise. If you’re around somebody who grew up as an only child with introverted parents, that person is not going to be used to noise. So what that person thinks is noisy is gonna be super different. Then what the other person with a large family thought was noisy. 

When we take that example, and we put it on chaotic drug related behavior. What somebody thought was shocking in the beginning of their use and swore up and down they’d never do, starts to become really commonplace later, and they’re not as shocked by it. 

So the idea of someone even using a needle to shoot drugs in the beginning seems like they would never, ever even know anybody who was. Later on, watching people shoot up themselves or doing it for someone else isn’t gonna seem like that big a deal because they’ve seen it a lot and they understand it and it’s fine. And that is part of what is happening in the brain.

We also know that these changes in the brain persist long after the substance use. Stop.  At this moment we don’t know how much the changes can be reversed or how long that would even take  if those changes could be reversed. 

Having these changes happen in adulthood is bad. A lot of times, and in fact most of the time, people’s addictions start before their brain is finished developing.

If our brain isn’t finished developing until our early to mid twenties, and you think about when people started using, it’s not true that everyone started using as an adolescent. However, the majority of the folks I’ve ever worked with that have an active addiction started when their brain was still developing, what a risky time for them to be doing these kinds of things.

I really simplified all the things that are going on. If you want to listen to more, there are some episodes back in six through 10 where I talk about addiction, the brain science, risk factors, protective factors in stages of use. So if you wanna hear more, those are very early podcasts  in the fall of 2020. You can do that over at betsy byler.com/podcast. 

All right, we have covered the groundwork for addiction. We know that this is a brain disease according to the American Society of Addiction Medicine, and it’s well documented in scientific research that has been rigorously done and rigorously reviewed.

We know that there are three main places in the brain that these changes are taking. We know that there are disruptions in functioning in three distinct areas during a three stage cycle. And the cycle is the thing that is kind of front and center as we talk about triggers and cravings.

Triggers and cravings  are things that were learned by the person.  that are active in the background. So let’s think about triggers, craving and use or action. Kind of like we do the cognitive triangle, that the trigger is the antecedent. It’s the thing that happens first. Next  as the trigger happens, the craving starts following the use or action. 

In order to intervene in addiction, cravings have to be managed. They are normal. They are to be expected, and even when the person isn’t aware of them, they will show up in dreams.

Using dreams are a fact of recovery especially in the early times. It feels like a betrayal of your brain that during the day you’re feeling good, didn’t have a lot of cravings, kept away from triggers, and then you go to sleep, and then in your sleep you’re using drugs or whatever the thing is that you’re using it.

You wake up and you have whatever feelings you have, relief that you got to use, horror that you used and now you screwed up your sobriety fear that you’re gonna get caught or whatever the case may be, or a combination of all of it. Everybody has a different response to using dreams depending on where they are in their recovery and how they’re feeling that day.

Using dreams become few and far between, thank God, but they are shocking when you first start having. even while we’re sleeping, our brain is moving through the cycle of use after effect preoccupation. Once that gets started, it doesn’t take very much to keep it moving.

So let’s talk about triggers.  because triggers are created in the brain. This is conditioning like Pavlov I’ve talked about. You pair two things together and eventually the original response is transferred to the other thing that previously didn’t have any meaning.

Remembering that one of the things addiction does in the brain is make these connections easier and makes the brain latch onto these connections faster.  When someone’s having triggers, It doesn’t take very long to develop them. 

So let’s talk about smoking cigarettes or vaping, for instance. Something that is common is that people want to smoke after they eat. Nobody comes into the world looking for a pack of smokes or their vape after they eat. It’s not a natural connection.

In the beginning when someone’s smoking, maybe they don’t have this connection, but when they’re smoking or vaping, they’re doing so usually around other people that also do it. If those people are vaping or smoking after they eat, the smell alone and the sight of someone doing it , is a trigger in and of itself, which can cause a craving that makes the person want to smoke also. So in a very short period of time that person’s trigger is now  the act of eating. They don’t even have to see someone else vaping or smoking after they eat. Just the act of eating alone can be enough. 

The brain attaches all sorts of things as triggers. It could be a smell. It could be a sound. It could be a person. It could be a place, it could be a texture,  it could be the type of weather, it could be a certain car, it could be a movie, it could be seeing a certain color. 

There are so many things that can become triggers because our brain is always trying to make connections.  and remember that what’s in the background here is that there was a good feeling from the substance. And so the brain isn’t determined to ignore that. The brain is incentivized to find more of that thing. And so the brain is on the lookout to find ways to make that happen. 

If coming home from work is met with getting to have a drink, then coming home into the house itself becomes a trigger. Arriving at a destination can become a trigger simply because each time they come home, they have a drink, and the brain’s like, oh, we walked in here. We should have a drink.  And so perhaps they weren’t even out for very long. Maybe they just ran to the store. Maybe they were out doing yard work and they come in and they’re like, oh, I came in brain’s like, are we drinking right now? And that is the trigger.

Now a trigger  I can’t say always, but very often is going to lead to a craving. Cravings can be little, or they can be really big and really intense or anywhere in between. It kind of depends on what the trigger was, how often that trigger gets triggered, for lack of a better phrase, and a bunch of social emotional factors that determine how the craving is gonna hit the person.

Managing triggers is a giant part of recovery. It is also extremely important in the very beginning, in early recovery. When we talk about phases of recovery, which we’re gonna do in a couple weeks, we will be talking about how managing triggers is a very important task. 

The only thing that the person has control over is their own behavior they can’t stop triggers from happening. They can’t decide that they’re not gonna get triggered by this thing or that person. The only way to extinguish triggers is to remove the pairing so that the brain ultimately can forget. That takes time because our brains are good learners. They like patterns. They like having these things put together. 

One of the things that happens in early recovery is developing a list of triggers. What are the things that make people want to use? For everybody? It’s gonna be something different. If we take the example of smoking or vaping, it could be taking a car ride, it could be eating, it could be a stressful event, it could be driving by a gas station where they would normally buy something. It could be morning coffee, it could be letting the dog outside. 

Whatever the person paired with the behavior so often that the brain came to expect it.  When the brain expects the behavior,  it pushes a button, so to speak, that tells the brain and the body that they should expect this thing, and it causes a craving. 

I want you to imagine your favorite food. Truly. I really do want you to think about what your favorite food is, and if you need to stop till you decide. I encourage you, go ahead and do this little exercise with me. Got it. Okay. 

We all have a lot of favorite foods, I’m gonna pick one of mine that I don’t get to have very often, and that is Chicago style pizza. Now, to me, Chicago style pizza is only one thing and that is sauce on the top, very high sided crust that looks like cheesecake and comes from Giordano’s. Giordano’s. is the chain restaurant in Chicagoland that carries Chicago style pizza. 

There are a lot of places that do Chicago style pizza. There are also a lot of places who say they do Chicago style pizza and it’s a damn lie. But there are a few places that I will accept. Also do Chicago style pizza like Lou Malnati or Gino’s East. Those are places that do Chicago style pizza that I would say are close second and third. But to me, Giordano’s is the way to go. 

So Giordano’s isn’t something I get to have very often,  it’s not something that’s gonna get triggered a lot in my life, but I love it so much that sometimes I have dreams about Giordano’s. 

When I go to Giordano’s. I’m gonna pick up a pizza or I’m gonna sit down and it takes about 45 minutes to make a Chicago style pizza. And what I want is mushrooms. I don’t want any other shit inside my Chicago style pizza. I want cheese and mushrooms and that’s it. It takes 45 minutes. 

They cut it in either a six or an eight, either in six or eight pieces. When you cut through it, you have to make sure that you get all the way down because there’s cardboard and you wanna make sure it’s not sticking to the cardboard, and then you need to put it on your plate and you take one at a time because sweet Jesus, nobody’s eating a whole bunch at one time.

I can eat two pieces at a time. But more than that, like it’s a metric shit ton of cheese. And I can’t even explain to you how much, like I, I have no idea and I don’t care. It’s amazing. I don’t even like marinara sauce, uh, pretty much at all. But this shit is amazing.

So you get it on your plate and there’s definitely a cheese bowl. And so then I wanna turn the plate around and I like having the point of the pizza towards me. And I take and I cut a bite and you gotta cut it. And you gotta be really careful when you eat it cuz you can choke on cheese. I don’t know if you’ve ever choked on cheese, but you really fucking can’t.

There’s a mushroom at least in every bite. And it is A-MAZ-ING. It melts in your mouth and it’s so good and it’s even good if it’s reheated, but like fresh. Ugh, so amazing. As I’m telling you about this, I’m imagining what it looks like inside every Giordano’s I’ve been to. And I’m imagining the white plates that they use and I’m imagining the cheapest silverware that restaurants use and I can smell the pizza. 

And I know that when it’s fresh out of the oven, it’s not as set as it would be coming out of the fridge and into the microwave, and so, the end of the piece  it dips a little in the middle, and I can imagine what that feels like in my mouth  and I can promise you. that if there was a Giordano’s within reasonable distance, that is exactly what I would be doing right now is going to get it. 

Well, for me in northwest Wisconsin, there is not a Giordano’s near me, and so I have to wait until my sister comes in June and she will stop on her way through Chicago and bring me Giordano’s.

The reason I bring this  is that there are so many pieces about eating Gordano’s Pizza that are triggers for me. When I see the shakers of red pepper flakes and Parmesan, I think of them being on the table at Giordano’s. When I see red checkered tablecloths. That’s what I think of. When I hear Chicago I think of Chicago style pizza. 

I didn’t know that I even had Chicago style pizza until I was an adult. Yet the memory of it is so clear to me. Imagine that you’re doing something multiple times a month, a week, every day, multiple times a day. It does not take very long at all to put these triggers in there. 

I don’t know how many times I have eaten Giordano’s pizza, but it’s not uncountable. It’s not like I’ve eaten hundreds and hundreds of pizzas. I haven’t, but it’s enough that it’s in. That I’ve dreamt about it. Wanting you to look at your favorite foods is all about understanding triggers and craving. 

When we’re talking about addictive substances like drugs and alcohol and gambling as an addictive behavior, it doesn’t take much to put those things together. Once a trigger happens, remembering that the brain is looking for them and categorizing them and locking them in, then the craving hint.  and the craving is incredibly powerful.

 The craving is not just, oh, I want to. Every one of us has experienced cravings of some kind. A craving for ice cream, a craving for a cigarette, a craving for a drink, a craving for sex, a craving for a vacation, a craving to take a nap or Whatever the thing is, we’ve had a craving.

Think about the urge you have to check your phone, and if you don’t think you have these, I would encourage you to go to the app store, whatever phone you use, and download a phone tracker that shows you how many times a day you check your phone. Install that for one week. You will recognize the urges you have to check your phone. 

There are these moments in the day that we get used to checking our phone and we have no idea how many there are. But if you do this exercise, there are so many, I am not a person who checks my phone a ton. I might not check it for hours while I’m at work, but when I installed one of those trackers, I found that there were moments where I was like, oh I don’t want that to count, so I’m gonna leave my phone alone. 

It still ended up being like 50 to 75 times a fucking day. And it counts checking your phone as picking it up and turning the screen on. Not necessarily unlocking it, but checking the screen. And for me, that might be checking the clock, that might be looking at notifications, whatever it.

But that is an urge. Seeing my phone just looking at it is a trigger  to check it.  That’s not even a pleasurable thing. Like who fucking cares? But with drugs and alcohol, your body wants more. It wants more, and it’s gonna make it known. You may not have a rumbling in your stomach, like when you’re hungry, but the drive is real.

In the beginning when someone is trying not to use, remember that this is well trod territory where they have gone around  in this circle of using the after effect and the preoccupation. They have done this dance over and over and over and they have run grooves in their system. It doesn’t take much. A tiny little trigger Woo can push them through that. 

Remember, this  hasn’t felt as good. So they’ve had to use more causing there to be more withdrawal.  The withdrawal is gonna be uncomfortable at the very least and super awful and shitty at the other end. And the person is now more sensitive to stress and agitation because of the substance use. They can’t judge danger as well as they used to, and they’re not able to see cause and effect and regulate things like they used to. It is a wonder that anyone gets clean. 

Triggers and cravings are one of the most important pieces of recovery and for us to understand when we have somebody that is in our office and wants to get rid of a behavior.

Knowing their motivation is important, knowing their stage of change is incredibly important. And if we don’t pay attention to triggers and cravings or urges or whatever people want to call it, the person won’t be able to get past that behavior. Sometimes cravings are mild, sometimes they’re like a nudge and the person realizes it and they’re like, no, stop.

I don’t wanna do that. And sometimes they’re like a tsunami and it feels like. The person’s gonna crawl out of their skin. Like everything on them is too tight and too loose and scratchy and feels weird and wrong. And their brain is racing and their heart is racing, and they just need it to stop, and their brain is telling them that this one thing will make it.

And even if that person is able to be like, no, it won’t help. I don’t want it. The brain’s like, it’s just this once you’ll be fine. It’s not a big deal. You were overreacting. Come on, we want this. It feels so good. And I don’t know about you, but I can talk myself into almost anything. 

For most folks, it’s the early years of recovery that are the hardest because they have to avoid all sorts of things that people wouldn’t think of. What we know though is that none of this is happening because they want it to. The brain got hijacked. The brain had these pieces in place to serve us, in order to keep us alive. That the drive to eat and the drive to have sex and the drive to sleep, were all there to make us survive.

Those same mechanisms get hijacked by substances and certain behaviors.  And these changes take place that make it all easier. It makes addiction set in faster and harder because those changes happen. Triggers and cravings are a huge deal. 

In the show notes on the website, I will put links to some articles and some studies about triggers and cravings so that you can read it if you’d like. Think about in your own life, what things you have urges to do  and which ones are the hardest for you to ignore. What triggers you to wanna do those behaviors, even though afterwards, you’re pretty sure you’re gonna regret it.

What’s the trigger? How do you remove the trigger? How do you break the pairing so that you can better follow through on your good intentions?

I hope that the information we talked about regarding these things has been helpful. This is the kind of information that I provide in far more depth  and with more relation to therapy in my program. Charting the Course. 

Charting the Course is a six week live taught program that is designed to help take the mystery out of navigating substance. Building confidence and competence for mental health therapists to be able to add substance use to their scope of practice.

This is not suggesting that everyone’s gonna advertise that they work with substance use or that they’re going to get some kind of special certification. It is meant to bridge the gap between our education that a lot of us didn’t have regarding substance use and practice. 

I believe we all see people who end up using substances and struggle with addiction. I believe that we can help them in-house. 

The registration for the summer cohort of Charting the Course  it’s gonna open in several weeks. If you wanna know when registration opens, you can head over to betsybyler.com/course and sign up to be on the waitlist.

There’s no commitment there. It is simply an interest list to let me know that you are looking at Charting the course. You can check out the frequently asked questions there for things like CEUs and finding out about cost. And if you have any questions, I always want you to contact me. It’s betsy betsy byler.com and I am happy to talk about this or anything else that I’ve brought up. 

Thank you so much for choosing to spend your time with me. Next week we’re gonna be talking about the stages of addiction . I hope you’ll join me for that podcast, and until then, have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.

Helpful Links


What Is the “Trigger” of Addiction? – PMC

How the brain gives rise to cravings: neuromarker sheds new light | YaleNews

5 Ways to Deal With Urges and Cravings – SMART Recovery

Drug Craving – an overview | ScienceDirect Topics

Why the pull of addictive cravings is so hard to resist | Aeon Essays


Neurobiology of addiction: a neurocircuitry analysis – PMC