Worrying and substance use

Intrusive thoughts/rumination and relapse/cravings:

Physical and psychological dependence is common among people who use substances. Dependence describes the unpleasant symptoms you get when you try to avoid or cut down the use of a substance. This can lead to intrusive and intense thoughts about the substance, including a strong need to use again. 

These thoughts can also lead to rumination when people relapse, or use drugs again after choosing to stop. People can self-blame, regret, and worry about relapsing again in the future.

Thought suppression is a common strategy people use to try and control their unwanted thoughts. This is when someone actively tries to stop thinking about certain thoughts, like cravings for drugs or past relapses. It is important to recognize that this is not an effective strategy.

Try this exercise for yourself: for the next 30 seconds, try NOT to think of an elephant. Close your eyes and think of ANYTHING except an elephant.

Were you able to avoid thinking of the elephant?  

You probably immediately thought of an elephant or something related to an elephant, like the zoo or circus. 

 Thought suppression often results in more of the unwanted thoughts, not less. This means that attempting to suppress your thoughts about using substances may actually lead to increases in substance use. The harder you try to suppress your thoughts, the more frequent and intense your thoughts may become.

If avoidance is not a good strategy, what can we do about intrusive thoughts?

Mindfulness-based strategies can help you be aware of these unwanted thoughts, but not judge them. Here are some key principles of mindfulness:  

• A thought is just a thought and not reality.  
• A thought is only an “experience” in your mind. You can observe it without intervening or judging them for being negative. 
• A thought about doing something does not mean that you have to, or will do, that action. 

• E.g. If you are having intense thoughts about using substances you are trying to remain abstinent from, this does not mean you will relapse!

Mindfulness-based strategies are helpful to engage in when you are feeling cravings, as well as if you are stressed or distracted. The following activities will guide you through some examples.