Craving (17 page)

The Power of the Group

There are many examples of the power of the group in supporting you to change your behavior. Fitness experts long ago recognized the tremendous advantage of exercising in groups. Of course, they recognize that there are barriers to this—some people feel self-conscious working out in front of others and are scared they will look stupid, won’t be as fit as others in the group, or won’t be able to do what’s suggested and will make mistakes. Most group exercise instructors are aware of these barriers and work hard to make everyone feel welcome; often they’ll meet with you one-on-one to answer any questions, confirm that you can generally go at your own pace, and offer suggestions for alternate exercises if necessary. Why all the effort and emphasis on getting people to exercise in groups? Because groups work. Once barriers are overcome, the group can encourage and create enthusiasm, accountability, and a degree of energy that keeps you motivated. Usually such groups are on a fixed schedule, and this aids in creating
habits,
which are critical to long-term behavioral change. Just being on a shared journey can create a sense of connectedness that can keep you motivated, engaged, and enthusiastic.

The online social networking portal
Meetup.com
is another great example of the power of groups (and the tremendous role that social media can play in behavior change). This site was created in the wake of 9/11, as its founder recognized the incredible strength that results when people come together around a shared issue, idea, or struggle. Today,
Meetup.com
users can search for groups in their geographic location based on hobby, interest, shared struggle, career, or nearly anything you can think of. And, if you don’t find it there, you can create a group yourself and see who joins. I’ve worked with many people who used social media, including Meetup, Facebook, and even Twitter, to find like-minded people to connect with. Of course, the usual caveats of safety, security, and sensibility have to be observed whenever meeting anyone in person whom you “met” online. Most of these meetings should occur in public venues, and last names can be avoided. But I’ve been downright amazed at how people have achieved success by connecting with or forming groups, online and offline, to tackle their individual goals.

Employee assistance programs (EAPs), counselors and therapists, physicians and researchers, social scientists and religious leaders have all harnessed the power of groups to help their stakeholders. In fact, nearly every type of problematic behavior is best addressed by including group work somewhere in the program or plan. For example, a Cochrane analysis of over fifty trials showed that participation in groups approximately doubles the chance of successfully quitting smoking.
¹⁰²
(The Cochrane collaborative is
the
definitive, independent source for analyzing and digesting medical evidence.)

Groups can convene in a formal therapy setting (where a leader or therapist guides and directs the work) or in a nonprofessional context (such as self-help groups, mutual-help groups, support groups). Some groups may charge for attendance (for example, Weight Watchers) and others may encourage but not require paid membership (like the breastfeeding support group La Leche League). Some groups even discourage meetings (such as Rational Recovery, which encourages members
not
to attend groups but to purchase learning materials to stop drinking, such as a DVD set that costs over $400!). That’s one of several reasons why I usually don’t recommend that method, although it may work for some.

Groups can be immersive, such as in halfway houses or sober living environments. One specialized type of environment is called a therapeutic community (TC), where people who are struggling with a particular issue live together in a community, and those who are further along in recovery help those who are struggling. These communities gained popularity in England in the 1940s and 1950s, then migrated to the United States in the 1960s and had a particular focus on drug addicts. These and similar communities have helped many people achieve successful recovery from addiction to alcohol and drugs, and even other mental health issues in some cases. I should point out that the methods found in some therapeutic communities can often be rather harsh and, for some, rather shaming. I tend not to recommend the harsher therapeutic communities for anyone struggling with significant shame or for whom the methods may be counterproductive (for example, people with post-traumatic stress disorder). On the other hand, halfway houses, sober living environments, and other recovery-supportive living arrangements can often make the difference between success and failure, and tend to be more encouraging than punitive.

Alternatively, and much more commonly, groups meet on a regular basis (weekly, biweekly, and so on) in a public setting, but the members don’t typically live or work together. Twelve Step groups usually meet once or twice a week, but some meet more frequently.

There is much to learn from groups that have helped people to manage and then ultimately eliminate their cravings. The group that is perhaps the best known and most popular in this regard is Alcoholics Anonymous (AA). Since the founding of AA in the mid-1930s, many other Twelve Step fellowships have emerged, including Cocaine Anonymous, Gamblers Anonymous, Overeaters Anonymous, Al-Anon (for those affected by loved ones with alcoholism), and many more.

Research has demonstrated that the social connections AA members form are a powerful contributor to their ability to stay sober.
¹⁰³
In one study, 655 people seeking treatment for alcoholism were interviewed when they entered treatment and then again one year and three years later. Involvement in AA groups was a significant predictor of sobriety at ninety days, one year, and three years. In fact, increased AA participation between twelve and thirty-six months later significantly increased sobriety at three years. In a similar study, researchers found that when you control for the size of the person’s social network, AA contacts predicted abstinence better than non-AA contacts, although non-AA contacts were helpful for other important life outcomes. These results, taken together, tell us that groups in general are important, but that groups of people facing similar problems are particularly important when seeking freedom from cravings and addiction.

How exactly do the social connections developed by Twelve Step members affect their cravings? John Kelly and his colleagues at the Center for Addiction Medicine at Harvard’s Massachusetts General Hospital recently conducted research to answer this very question
¹⁰⁴
Kelly’s research focused on over 1,700 people who were enrolled in a randomized controlled study of alcoholism treatment. He and his team assessed these people as they entered treatment, and at three, nine, and fifteen months later, to determine the relationship between Alcoholics Anonymous attendance, social contacts, and sobriety. They concluded that many of the benefits of Alcoholics Anonymous were due to the power of AA attendance to reduce “pro-drinking social ties.” Simply put, going to AA helped these people reduce their social contact with and dependence on others who supported their drinking. The researchers also found, to a lesser extent, that the AA-mediated pro-abstinence ties were connected to sobriety as well. In other words, “sticking with the winners”—connecting to people who were able to achieve and maintain recovery from alcoholism—also contributed to a person’s abstinence.

So, part of the beneficial effects of groups on urges and cravings appears to be related to reducing contact with people who support addictive and craving-related behavior. An oft-heard adage in the addiction recovery community is “If you hang out in a barbershop long enough, pretty soon you’re gonna get a haircut” One of my patients was trying to lose weight but always stopped at a Dunkin’ Donuts on the way to work because he preferred their coffee over that of the other coffee joints. He thought he’d be immune to the sights and smells of the doughnuts. (You’ll learn more about that sense of immunity and what to do about it in the
next chapter
.) And for a while he was able to avoid buying a doughnut, but he eventually found himself unable to resist them. The coffee might not be as good, but had he stopped by the coffee shop next to the health club, where other fitness-minded people were getting their morning coffee, he might have had better luck. To the extent you can, finding and connecting with people who support your recovery-oriented behaviors will go a long way toward helping your recovery, as will reducing your social contact with those who support the addictive, self-destructive, or craving behaviors.

A word about persistence when it comes to groups: one potentially unfortunate fact about groups is that they are composed of people—ordinary human beings, with all their foibles, quirks, and defects. You may attend a Twelve Step group, support group, educational group, or even a professional therapy group where you simply don’t like or agree with what you hear. In some cases, what someone says in the group, or even says directly to you, may seem entirely wrong or even downright offensive. In my experience, it’s important not to quit or give up when this happens. If your problem is serious, I’d recommend attending at least a dozen different meetings before abandoning a particular type of group. If you include travel time, for most people, this would mean spending about twenty hours attempting a particular type of group option. I also recommend you spend the vast majority of your time listening rather than talking at meetings. If you find yourself objecting to what you hear, discuss it with those you meet there (after the meeting ends), but also with your friends or others whom you trust. In particular, a counselor or the rapist can help you evaluate ideas that you may have gathered at the group.

I’ve also observed time and again that those who are most successful look for similarities with others when they attend groups, rather than differences. Years ago I had a patient who did not feel like he was connecting well with people at his Overeaters Anonymous group, but his eating habits were destroying his life and relationships, and even threatening his occupation. “All of those people had problems their whole life…mine just started two years ago,” he claimed. It’s actually very common when people are facing serious behavior change for their brains to generate objections, some of which may seem trivial to an outside observer. After all, who really cares when the problem started? If you are about to lose your job and family as a result of your behavior, perhaps you’d better find a way to use the group, even if your experience is different. I advised this patient to attend several more times and instead look for the similarities and make a mental note (or even go home and jot it down) when he heard something he
did
relate to. I suggested he focus on how he
behaved
like the others, how he
thought
like the others, and how he
felt
like the others felt. That suggestion did the trick, and he is still in active recovery today. When you attend these groups, look for the similarities between yourself and others in your behaviors, thoughts, and feelings. Note them, focus on them, jot them down, and discuss them with people you trust. This will help you overcome objections and more effectively harness the power of the group. Remember, in most cases, you should do everything in your power to involve groups in your efforts to combat cravings.

Family

There is one very special type of group that often influences people with cravings more than any other: family. Most people who treat addictions and cravings in general recognize that the problems are rarely restricted to the person himself; others are always affected. Because of the nature of addiction, the person suffering from cravings may not be aware of how his behavior is affecting others, but almost universally, the scope of the effect from cravings and addiction is broader than it seems. As we mentioned earlier, for some addictions, genetics itself plays a role in the problematic behavior, perpetuating across generations. Similarly, some self-destructive tendencies can be passed on by generations of dysfunction in families. Many programs and systems have emerged to address the family effects of addiction and related behaviors. Perhaps the most well-known of these is Al-Anon Family Groups, a Twelve Step fellowship that helps friends and family of alcoholics find understanding, support, healing, and recovery.

Interventions to address self-destructive, craving-related behaviors are much less effective if they are targeted to the person alone; the benefits increase dramatically if social supports are included. In many (but not all) cases, this is the family. If the idea of involving your family in your problem is terrifying, don’t fret: you are not alone. For many who struggle with cravings of various kinds, family relationships can be uncomfortable, unhealthy, and in some cases even toxic. If you have family that is willing to help, often the most difficult barriers are the pride and ego that prevent you from simply asking for assistance. Perhaps you believe you have already put your family through enough. Maybe so, but wouldn’t success be the best gift you could give them? In other cases, family relationships are so toxic and unsafe that family members shouldn’t be involved, especially in early recovery. This is always true in cases involving active abuse (physical, mental, emotional, or sexual). If you aren’t sure when or whether to involve your family in your recovery journey, seek out a professional to help you sort it out. If you can do so safely, and in a manner that supports your recovery, involving others and leveraging the power of family may be your most powerful tool in addressing cravings.

How Support Networks Can Help

One technique for tapping into the strength of social supports, community, and family in addressing cravings is called community reinforcement and family training, or CRAFT. CRAFT is an evidence-based approach to engaging concerned significant others and social supports in helping a person achieve and maintain recovery. This method involves training family and other support people on how to communicate with their loved ones in ways that support and emphasize positive, constructive change. A recent meta-analysis of four randomized controlled trials of CRAFT demonstrated remarkable success in engaging people with addiction in treatment.
¹⁰⁵
And staying engaged is one of the strongest predictors we have of the successful treatment of addictive disorders. These trials and much of the published literature on family interventions heavily underscore the observation that family and social networks play a tremendous role in supporting (or hindering) people who seek to find freedom from cravings and self-destructive behaviors.