Undergoing substance use disorder treatment can lead to intense cravings during periods of abstinence, significantly increasing vulnerability to relapse. However, researchers have now found that several emotional and social factors contribute to these cravings and relapse risk, including feelings of loneliness, self-esteem, and abstinence self-efficacy (the confidence in one's ability to maintain abstinence). [1] This provides valuable information for developing more targeted and effective therapeutic interventions for addiction recovery in the future. [1]
Why support & confidence matter in addiction recovery
Recent research has provided new insights into how social support and self-confidence influence addiction recovery outcomes. [1] This study collected data from 249 individuals using six validated questionnaires, examining the relationships between abstinence self-efficacy, loneliness, social perception, drug cravings, and self-esteem. [1]
The key finding from this study was that abstinence self-efficacy, loneliness, and social perception play a key role in predicting drug craving and self-esteem. [1] It found that increased loneliness and lack of confidence in one's ability to maintain abstinence significantly increased the risk of drug cravings, highlighting the importance of support and confidence for a successful addiction recovery. Loneliness and self-esteem were also found to be negatively associated, meaning the more lonely a person is, the lower their self-esteem is, and subsequently, their chance of experiencing drug cravings is higher.
This research suggests that interventions focused on increasing abstinence self-efficacy, social support, and reducing loneliness could help to reduce drug cravings and improve self-esteem, ultimately reducing the risk of relapse. [1] This is further reinforced by earlier studies linking good social support to reduced cravings and lower relapse rates. [2]
Understanding drug cravings: The psychological and neurobiological
Substance use disorder is a complex brain condition linked to many psychological and neurobiological factors. [3]
Psychological
Several psychological elements contribute to craving intensity. Early life stress exposure and social isolation increase the risk of substance use. [3] Ongoing feelings of stress, anxiety, or other negative emotions can further trigger cravings and increase relapse risk.
Additionally, chronic substance use creates learned associations with environmental cues, such as people, places, or times of day. So when these cues are experienced during a period of abstinence, like visiting locations where they used drugs, the cravings can become more intense.
Neurobiological
Substance use can alter brain chemistry, particularly within the reward system, which consists of the basal ganglia, extended amygdala, and prefrontal cortex. [4] These regions normally work together to process natural rewards and guide decision-making; however, substance use takes over this system by triggering massive dopamine releases, exceeding the amount that is naturally released.
Over time, repeated drug use dysregulates this reward pathway, causing the brain to decrease its sensitivity to dopamine, meaning individuals require increasing amounts of the substance to achieve the same pleasurable effects. Subsequently, activities the individual previously found rewarding no longer feel pleasurable, and persistent cravings are experienced as the brain tries to restore the dopamine balance through ongoing drug use.
Building abstinence self-efficacy: The confidence to stay sober
Abstinence self-efficacy is defined as the confidence in one's ability to maintain abstinence. [5] It’s vitally important in addiction recovery, as research has shown that without this self-confidence, the chance of drug cravings and relapse risk is higher. [1] Several things can help boost abstinence self-efficacy:
- Building a strong support network of sober family, friends, and professionals.
- Address underlying physical and mental health issues, as these can undermine confidence.
- Cognitive behavioural therapy helps challenge the individual’s negative beliefs about staying sober.
- Structured treatment plans with achievable short-term goals can help to build momentum for ongoing addiction treatment.
- Develop good coping strategies to help manage drug cravings.
Building a strong abstinence self-efficacy can be key in starting and maintaining abstinence, and should be addressed early in the treatment program.
Creating & strengthening social support networks
Having a strong support network is vital for a positive outcome in addiction treatment, but sometimes this can feel daunting to establish, especially during recovery. Start by identifying current relationships and categorizing them as supportive, neutral, or triggering for substance use. This identifies the support network’s strengths and weaknesses, highlighting the areas for improvement.
Participating in activities like fitness classes or hobbies helps to meet like-minded sober people who can enrich your support network. There are also lots of online groups that can provide 24/7 access, which can be beneficial to people who don’t want to be limited by time of day. These relationships can then be strengthened by regular social interaction and substance-free activities. Active listening, positive shared experiences, and swift conflict resolution can help strengthen relationships and provide a robust social support network.
Addressing common challenges
Recovering from addiction is challenging and isn’t always a smooth journey. Low abstinence self-efficacy and social isolation are two common challenges that have been discussed above. Below are some tips addressing the other common challenges during recovery.
Self-esteem
Low self-esteem is linked with low abstinence self-efficacy, and therefore with increased relapse risk. Self-esteem can be improved by setting achievable goals, focusing on positive achievements, and not dwelling on negatives. Social interaction with a strong support network can further improve self-esteem.
Drug cravings
It’s important to accept that cravings are normal during recovery and they will pass. Try engaging in hobbies, such as playing games, sports, and exercising, as a distraction and to boost natural endorphins in the brain.
Self-control
Distraction and regular exercise can help with self-control, alongside sticking to a consistent routine, mindfulness, and lifestyle changes to avoid activities and locations associated with substance use.
Mental and physical health concerns
These are often the root cause of substance use, and must be concurrently treated alongside addiction recovery to increase the chance of long-term success.
Final thoughts
This new research has highlighted the connections between support, self-confidence, and positive recovery outcomes. By prioritizing abstinence self-efficacy, meaningful connections, and self-belief in treatment programs, the root causes of cravings can be addressed, rather than just their symptoms. As this research continues to influence clinical practice, individuals struggling with addiction can look forward to a more comprehensive and well-rounded treatment plan.
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