Working with Substance Use Disorders: Overcoming Urges Using the 4 D’s

Underpinned by Cognitive-Behavioural Therapy (CBT), Relapse Prevention is widely recognised as an effective approach to helping individuals overcome Substance Use Disorders (and other problem behaviours). CBT techniques aim to manage the behaviours that pose a risk of relapse, empowering individuals to develop skills, insights and strategies to maintain sobriety, manage cravings and prevent relapse long-term. 

Whilst overcoming urges and cravings is often spoken about in the context of alcohol and/or drug use, it is important to recognise that unwanted behaviours can also include things like smoking, vaping, gambling and more recently, gaming. 

A simple and effective way to overcome urges on your own is by remembering The 4 D’s:

1. Delay – avoid situational triggers, particularly during the early phase of changing the unwanted behaviour. This won’t stop cravings from coming altogether however, when a craving does hit, you can delay the decision to engage in the unwanted behaviour for a minute at a time or longer if you can manage. During this time, say to yourself: "I will not act on this craving right away. I'll delay my decision to act on this craving for X minutes".
   
   🡪 Tip: setting timers on your smartphone or watch can be an effective tool to delay giving into urges. 

2. Distract – once the decision to use is delayed, try to distract yourself from thoughts about this behaviour. Generate some ideas for strategies to use as a distraction. Techniques might look something like:

   • Watching your favourite movie 

   • Going for a walk

   • Calling a support person

   • Listening to music

   • Guided meditation 

   • Playing your favourite instrument  

3. Decide – after the craving has passed, revisit all the reasons why you wanted to stop engaging in this behaviour in the first place. Decide then and there not to engage in this behaviour and congratulate yourself on not giving in to something that is, after all, only a thought or a feeling.

4. Decatastrophise with positive talk – by reminding yourself about the short- term nature of cravings (e.g. "this feeling will pass", "I can cope with this”), the urges themselves will be easier to deal with. Acknowledge that cravings are uncomfortable/ unpleasant but also that they will pass. 

Remind yourself:

• Urges are okay and are natural reactions to managing unwanted behaviours. 

• Discomfort is okay, I don’t have to change it.

• Urges are feelings and not “musts”. I can have these feelings and choose not to act on them.

• Urges are temporary and like any other feeling, they pass on their own. 

If you’re struggling with unwanted behaviours or need support with recovery, contact Sydney Psychology Group to book an appointment with one of our psychologists today. 

Written By: Deana Arbelaez (Clinical Psychology Registrar)