Urges, compulsions: how to manage them

First and foremost, know that you are not alone or weird. According to the WHO, in 2015 substance addiction concerned almost 30 million people in the world (0.6% of the adult population), with a global drug use of 250 million.

That is not counting all the other types of urges, also commonly known as cravings*, that you can get that are not drug-related: bingeing such as happens with bulimia nervosa, addictive behaviors (including self-harm and compulsions**) and what we often don't recognize as urges, and their hurtful aspect even less: reaction urges such as lashing out during an argument or turning to comfort food in frustrating situations (which can happen to people even if they don't have an eating disorder).

This article is not about recovering from addiction and won't discuss treatment options ; it's really about all kinds of hurtful urges and how to manage them. But urge-management skills are useful for everyone, including for petty or agressive day-to-day reactions, and I sure hope these ideas might also come in handy next time your addiction makes resisting an urge difficult.

Here's a good website, free of charge, entirely focused on addiction recovery that you may find useful ; if you'd prefer a good old hard copy, get their workbook. They have also published one for Friends and Family.

In the meantime, here we go with some (i)D's (got it? I'm so proud of this lame pun).

*Technically, cravings refer to the intensity of the wants ("I want it more than anything else in the world") and urges refer to the urgency of the wants ("I have to get it right this second") but for simplification purposes we'll use them interchangeably here.

**The urge to perform an irrational action (a particular behavior that is not actually linked to the situation it happens in, but is meant to relieve anxiety) is called a compulsion. You'll notice that it's a word found in OCD : Obsessive-Compulsive Disorder. Which is to show that urges are definitely a part of addiction as we generally understand it (addiction to the consumption of a certain substance), but they can also be a problem in someone's life without having anything to do with substance use: behaviors can be addictive too, either on their own (in gambling or self-harm for example) or as part of a disorder such as OCD.

• Displace: remove all substances or all objects used for the behavior from your environment, and replace your habit by another (healthy) one

• Decompress: remove as much stress as you can from your life and find what your triggers are

• Do be kind: when you get an urge, use positive reinforcement instead of punishment on yourself

• Distract yourself by doing something to keep your mind and hands busy: the urge will eventually pass in about 15 minutes, except if you're still exposed to a triggering situation

• De-catastrophize by telling yourself that you CAN survive this and remembering worse times in your life that you have indeed overcome

• Distance yourself from the positive outcomes of satisfying the urge by focusing on the negative consequences, and get some distance from yourself by imagining you're helping someone else get through this urge

• Discourse: encourage yourself out loud and verbalize your difficulties

Displacing is about literally displacing the things that partake in your use or behavior. The same principle is used in suicide prevention: the best way to keep someone from killing themselves is to take away potential tools. Here are a few examples:

• Constantly biting your nails? Cut them as short as you can.

• Hurting yourself with a lighter? Throw it away.

• Plucking hair on your body? Get rid of the tweezers and get a regular professional hair removal session. Or switch to waxing yourself (much less ingrown hairs than with a razor)

• Smoking? E-cigarettes and other alternatives work relatively well

But we also know that the gesture in the habit is as powerful as, or more powerful than, the object of the habit itself. Take smoking for instance: a lot of smokers report that giving up on nicotine and other chemicals is difficult but not impossible. The dauting aspect of quitting for them is the habit of putting something in their mouths, or of holding something between their fingers. You've probably heard a quitting-smoker, at some point in your life, say: "But I don't know what to do with my hands!" It's clearly a very big part of smoking and the same goes for a lot of addictive habits and behaviors. You'll need to find a replacement for that gesture.

• Cutting your arms? Keep a rubber band on your wrist at all times and snap it when you feel the urge to cut. It'll hurt but won't actually do damage

• Smoking? Use a fidget toy to keep your hands busy

• Feel like yelling at your partner? Choose a funny word with them in advance that you can scream when you feel angry, which will deflate the situation

• Feel like hitting someone? Hang a dartboard with an annoying face on your wall and have at it

• Want to stab yourself in the guts for being a bad person? Instead, write down what you want to do to yourself in detail. Later, when the urge has passed, be sure to practice self-care and to get rid of that text.

• About to say or write things you might regret later? Write everything you want to tell the person on a piece of paper, your phone or whatever. You can also burn the piece of paper when you're done but in any case, be sure to get rid of the text: it won't help if someone finds it nor if you later come across it again ; at best it'll reignite your past anger. Then, when you feel calmer and more poised, actually answer the person

For physical self-harm: if writing down the way you want to hurt yourself doesn't work, try reverse-thinking: it's not great, but it has sometimes worked for me in the past. Here's how it goes:

You'll keep from hurting yourself because you know it's an (unhealthy) coping skill that will provide you with relief, and you don't want to give yourself relief right then because you don't deserve it.

Think: what is it that you want right now? To hurt yourself.

And what do you not deserve? To have what you want.

So what's the best way to achieve that? To do the exact contrary of what you want.

And what's that?

• Basic, women's-magazine-like snowflake self-care: taking a nice shower with a nice-smelling soap
• Doing some housechores (it'll both annoy you AND be a nice gesture for your partner who deserves it, or for yourself who don't deserve a nice place)
• Exercising (which you either like, meaning self-care, or hate, so it's another kind of punishment that will actually do your body some good) ; etc.

If you can't replace the gesture or substance with a healthy alternative, you might want to consider short-term therapy such as Ericksonian hypnosis (particularly efficient for addictions such as smoking).

Look, being under a lot of stress and pressure is not going to help. In fact, it might have been what led to your habit or addiction in the first place. A lot of addictive behaviors, including but not limited to self-harm, are about finding a way to evacuate anxiety and release feelings of stress.

Also, accepting those stress factors and triggers is a very, very big part of solving your problems, enjoying better relationships and freeing yourself from addictive substances or behaviors.

So you'll need to make changes in your daily life, however small or challenging they might seem, to ensure your brain gets some rest. That could entail:

• Not seeing people you're "supposed to" if they make you anxious or lead to you putting a lot of pressure on yourself: parents, parents-in-law, colleagues, neighbours... At some point, you're going to have to take care of yourself if you want to live a good life. Social expectations are often bullshit: feel free to surround yourself with kindness and empathy, and to cut out or limit toxic relationships (I'm not saying some people are toxic ; I'm saying your relationship with some people might be toxic. There's a difference). You don't owe people anything but basic respect if you haven't chosen to have them in your life in the first place.

• Getting more organized and getting in the habit of visualizing your week or day in advance with a calendar. Might seem basic, might seem useless... I have found that it lessens my anxiety, like, big time.
• I've started including other people as well:
• For example, asking my mother-in-law to tell me all the social events we were going to attend during the Christmas holidays we were spending at her place, so that I could write them down and be prepared. She kindly did so and didn't even make fun of me for always wanting to schedule stuff!
• You can also use a family or flatmate group calendar where everyone writes down at least their regular obligations (it helped much for our 5-people-shared-flat in my year of studies abroad)
• It can also help to schedule some downtime... and follow through. That's what we now automatically do with my husband when planning social events with friends or family: if possible, one weekend including an outing will be followed by one weekend including none. Same goes for evenings during the week, but we try to limit those as much as possible.
• It should prove useful in identifying triggering situations or moments (you might be more vulnerable in the morning right after waking up for instance, or in the evening after a long day at work)
• Using an online calendar such as Google's might help in ensuring you never lose it, or change purses and forget to transfer it (I see you nodding in understanding)

• Knowing your (stress or other) triggers and avoiding them -- if at all possible. Of course the idea here is not to slowly restrict the number of situations you can accept until you can't get out of the house anymore. But some of them might not be needed at all, or could be easily transformed:
• Do you find taking the metro difficult, scary or bad-mood-inducing? Switch to a bus, tramway or bike
• Is public transportation as a whole stressful for you? See if getting headphones (even a noise-cancelling one) instead of earphones helps: it has helped me tremendously, especially if I set a calming or cheerful playlist before leaving the house
• Do you get anxious about having lunch with colleagues you're not close to? Simply watch your favorite YouTuber's latest video, listend to a podcast or read that long article you've meant to for days now, and have lunch by yourself. It's not a shameful thing to do.
• Do you find you get angry more easily when running errands on a Saturday? Though it doesn't immediately appear so, it might be because the sheer number of people puts you on your guard. It's okay that it is a stress factor for you though not for other people. Shop for a shorter while two or three times during the week or buy your groceries from butchers, dairy stores and bakeries. You can also order online!

OCD could explain repetitive but necessary behaviors that you don't understand yourself. Check in with yourself to see if you ever experience anxious and intrusive thoughts: weird or scary thoughts that make no sense, seem irrational or foreign.

If you have any kind of doubt, or if you are firmly convinced you don't have OCD but still can't explain those behaviors, secure an appointment with your GP or a therapist: there's zero reason you should let your life be less good than it could be.

That means being kinder to yourself and going for positive reinforcement instead of punishment. Stupid advice? Read on. Not precise enough? Here are some examples:

• I have personally found it (oddly) easier to not bite my nails when they are painted a color I like. I've tried painting them with a specifically-designed bad-tasting coat but it didn't work one bit. I was punishing myself by giving in to my urge and being physically punished for it, which only reinforced my belief that I was a bad person and I deserved the bad thing. Not helpful.

• Same thing for self-harm: not giving in to the urge of hurting myself physically and taking a nice, long shower in its place makes the urge go away much quicker than hurting myself again and again till I feel it's enough. And it's much more dangerous.

• Another example to show positive reinforcement works better: if I want to hurt myself or if I want to binge on a specific food, rewarding myself with a nice piece of clothing or a new video game for fighting off the urge will help me much more next time than punishing myself everytime I give in. That's because I can decide to endure punishments ; positive education is just so much more motivating (that's actually how psychopaths are dealt with in specialized clinics).

I'll explain more but here's the key message: whenever you feel an urge coming, do not just sit trying to fight it off, do something. Whatever it is. That'll make the whole thing much easier.

Urges generally last 15 minutes max. Plus, with time those very urges will become less and less frequent, and less and less intense. So the longer you hold on, the easier it will become.

Three things, before we move on to actual examples of activities:

• First, remember that we are talking about urges here so yes, those will pass -- but that doesn't mean your whole desire and need for the behavior or substance will disappear as well. You will still want it ; but it'll be much more manageable and shouldn't get in the way of your daily life like urges do.

• Second, the urge might not pass in the span of 15 minutes if you are still exposed to an environment or situation strongly associated with your behavior or substance consumption. Those are called triggers: if the urge doesn't pass, you'll need to break away from said triggers.

• Third, don't start. I've found it's much more difficult to break away once I have started giving in, simply because the ability to put realistic and feasible limits to oneself is one step further than simply refusing to do it at all.

To achieve distraction and wait the urge out, you'll need to be realistic and to show compassion and acceptance for yourself. It will be difficult, it will be painful sometimes even physically, it will take time you'd rather have spent on something else, it will disrupt your daily life, and you will most probably not succeed everytime. Wouldn't be called an addiction or addictive behavior otherwise. Yeah, you shouldn't have started doing drugs at all, yeah it's stupid to be plucking the hair on your head till you're half-bald, yeah you shouldn't feel this anxious when sharing a nice dinner with loved ones. But you know what? IT IS NOT HELPING.

So go on. Have a good cry. Be frustrated. Punch a pillow. Good.

Now let's focus on what is instead of what should be, coz that's how things get done and people better.

So let's not go with:

• Writing the century's novel
• Starting a business
• Recalling every mistake you've made this year and judging yourself for every single one of them

But rather with:

• Playing a game. I am suggesting this over reading a book or listening to music or a podcast, because a game requires you to be constantly active and to pay attention so that you react properly, which is exactly what we're aiming for here: focusing all of your attention on something else than your urge. In this sense, it might work better and more quickly than reading or listening from which you can easily get distracted.
• As Lana del Rey says, go play a video game
• Or just any game on your phone really
• If you have no game available whatsoever, cut off the Internet connection on your phone or computer, open a Google page and play the No-Internet-T-Rex game (never played it? Hit the space bar on your keyboard or the dinosaur directly on your screen)
• A board game with loved ones or colleagues (take a game break instead of a cigarette break!)
• A Rubik's cube (it's even better to get a small one that can fit in your pocket or your purse)
• Fidget-toy fidgeting if you have one. If you don't,   get one. And in the meantime, run your fingers on something hard SUCH AS YOUR KEYS. Ahem.
• Avoid drinking games though, obviously, lest it become an unhealthy coping method from which you'll have trouble breaking away

•      Reading,   watching or listening to something funny: it helps release the tension AND puts you in a good mood

• Eating something with a strong taste, such as bubble-gum -- and don't hesitate to blow bubbles! That takes concentration and careful calibration: a perfect mix of interesting and challenging... Taste (and smell) are very powerful senses that are harder to ignore (whereas you can just close your eyes or avert your gaze, put your hands on your ears...) so it'll help your body automatically take your focus off the urge. And it's easy to get in the habit of keeping bubble-gum in your purse or backpack for just such occasions

• Cooking is a good idea, too:
• You'll be engaging your senses of smell, touch and potentially taste
• It'll require your attention in terms of sight and sound (cutting vegetables, putting water to boil...)
• Cooking for someone else can bring great pleasure as it is a form of caring, and it can also bring about a moment of connection with your loved one(s) since you'll be sharing a meal and a conversation
• Cooking for yourself can trigger a nice expectation (a tasty meal) to replace your urge
• You'll be doing something considered "useful" by your brain, which will answer to the guilt you might feel from needing to "waste time" fighting this urge

• Exercising : in this case, running or walking might be a better option since they don't require any material, can be done no matter where you are, and also include a change of scenery which might come in handy removing you from the triggering situation

• Taking a really cold or hot shower (beware not to get burned or catch a cold, though): this is also about letting one or more of your senses take the lead, which can help you almost literally shake off the urge

• Counting in your head (it can also help to tap something with your finger at the same rhythm), for those moments when you can't engage in any obvious activity such as a game, blowing bubble-gum bubbles or listening to a podcast. Plus, it will help in trying everytime to beat your own record

• Talking to someone about it: either face-to-face, by phone, texting, joining a support group... whatever works for you

• Talking to someone about something else entirely: if you don't want to share what's going on, that's totally fine. Doesn't mean you can't engage in a conversation to distract you from your urge ; nobody has to know. Be sure to choose a topic you're interested in and someone you like, though ; let's not add wanting to escape a boring conversation to a compelling urge

• Writing about it for yourself (it's a part of what's called urge surfing):
• First describe what it physically feels like
• Then describe your whereabouts and what's going on around you right then and there
• Then describe what was happening up until the urge appeared
• Then write about what might have caused it (you don't have to know the answer, but thinking about the causes is a way of distracting your mind from the actual urge, without just completely ignoring it -- and it can also totally help you notice some patterns!)

• If you can't do any of the above-mentioned activities, acknowledging your current difficulties, your pain, your discomfort, etc. rather than trying to bluntly ignore them will help. Acknowledging without judging yourself for those difficulties (i.e, staying at the "this is how I feel" level and not yet going to the "I shouldn't feel this way or have this urge" level) is a good way to take away some of the urge's power, because you don't spend brain energy on trying not to FEEL the urge : your fight is only about not giving in to the urge, instead of being about not giving in to the urge AND suppressing that urge entirely. That's the second part of urge surfing.

Just sort of relax your mind and say yes, it does hurt, I know. Don't try and shut it out.

Lyra in The Subtle Knife by Philip Pullman

• On a more preventive aspect, you can choose to engage in a new hobby:
• You can decide that's what you'll do everytime an urge appears (like knitting for instance)
• Or you can include it as a regular in your agenda, leaving less time for the urge to take up (and it'll provide a nice, quick, almost automatic distraction if the urge appears during the time allotted to your hobby). In this case, be sure to still allow breaks, calm moments in your agenda, lest you find yourself under even more stress and in worse shape when fighting urges (see Decompress).

• Finally, sometimes you can also simply replace by something similar: if you feel like bingeing on a specific food, instead of going for the crackers eat a lot of carrots. It's not satisfying of course, but it's a way of at least switching to healthier alternatives if stopping altogether is not possible at the moment.

If you're in the midst of an urge, resisting, you're probably thinking "I just can't do this. It's unbearable. I've never suffered so much in my life". Well: keep in mind that your thoughts can precede your emotions, meaning that the more you say or think it's unbearable, the more it feels so. Try rather telling yourself that you actually have the power to do this, that you have indeed experienced worse moments in your life.

Remember the last time you were kicked in the nuts ; that incredibly painful period ; the day you gave birth ; that brutal food poisoning... Does this really compare? Is this truly unbearable?

And remember: they were mindblowingly painful but you survived those moments! You can do this as well, it is not that painful! That's de-catastrophizing your discourse about the pain caused by this urge. Like I said, your emotions and feelings will follow the same path of de-catastrophizing and it will become more bearable. Hang in there.

First, distance yourself from the positive effects you derive from the behavior or substance consumption.

When thinking about your urge, or the object of your urge be it a behavior or a substance, you necessarily think about everything good it would provide you with. That makes total sense. But now's the time to put on your metaphorical glasses and get a good view at the bigger picture: what negative consequences will arise if you act upon your urge? Why are you supposed to not give in, what are the real downsides there? Try to conjure up precise and powerful pictures of those negative consequences.

• It can be that you will feel physically awful afterwards, because you crash from the drug-induced high or because your stomach or skin will hurt.

• It can be that you will risk going to jail for possession and use of illegal drugs.

• It can be that you won't be in touch with reality to enjoy the company of your loved ones.

• It can be that your judgment will be impaired and you will drive with that substance in your system, risking the safety of innocent people.

• It can be that you will become violent towards people you love, say mean things you'll later regret, permanently hurting your relationship with them.

• It can be that you will hurt yourself more than intended. That you will bear the scars for the rest of your life. That your partner, children, or parents will feel guilty for not being able to stop you, everytime they see your scars.

It can be anything -- just think of what you don't want to lose to this urge.

Second, distance yourself from your own person, in order to think more clearly and feel things less intensely.

Imagine that you are with a loved one, but the roles are reversed and you're helping them fight the urge. What would you tell them? Which negative consequences would you remind them of? Would you believe that they can do it, that they can win the battle? Of course you would. So why not believe in you?

Or simply talk to yourself as if to another person: talk gently to the other you. Help the other you fight off the urge. Make the other you believe in their own power. Just like a friend would do for... well, you.

Often, saying things out loud:

• Reinforces their impact (use that to encourage yourself)

• Helps you gain a more objective understanding of them by viewing those thoughts as if they belonged to someone else and as such, better assessing their worth

• Lessens their grip on your mind. They can then take on a less serious, more drama-prone aspect because taking the secrecy out of them can also lessen the kind of shameful pleasure or relief you feel from the behavior or substance consumption, and thereby lessen the power it has over you: particularly useful for self-harm and suicidal urges. Personally, I find that "I want to spend the next hour plucking every last hair on my thighs instead of writing my book because I'm scared my husband will divorce me even though he told me 100 times he doesn't care", or "I want to kill myself because I am the worst person in the world", sounds much sillier out loud. And that helps me not act upon it.

This is it, I hope you have found something in there to help you, please know that you CAN indeed do this and remember that, as all bad things in life, it will pass. I have faith in you -- now you do the same.

If you have other ideas and strategies to combat urges, or you've noticed something you want to discuss, don't hesitate to write me an email at [email protected]! Take care.