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practicing their program. By separating the locus of control, they achieve success and a reduction in their desire. We’ll explore these concepts further in chapters 7 and 10 .
    The Vicious Craving Cycle
    Thus far in this chapter we’ve seen how distortions and bias in thinking can lead to problems in how we handle cravings, resulting in more cravings because we cannot see clearly enough to address them. However, there is another force that drives cravings: cravings themselves. To see how this works, consider this example:
    Tom is driving home from a particularly hard day of work after successfully quitting smoking for four days. He begins to crave a cigarette again but manages to resist the craving. He notices that his gas tank is down to less than a quarter full. There is enough to get home, but he may not have time tomorrow morning to fill it, so he decides to stop at a gas station. When paying for his gas, he notices the cigarette display. He decides he is only going to have one cigarette, but of course they aren’t sold individually. So he purchases a pack with the intention of smoking one and then throwing the rest away. After purchasing the pack, he thinks to himself, “Throwing these away would be a waste of money. I’ll just give the rest to my coworker tomorrow who is a smoker.” By the time he goes to bed, however, he has smoked the entire pack.
    By now, you may be able to see some of the cognitive biases in his thoughts, and there are several. But another force is at play here: the craving itself led to a behavior (purchasing a pack of cigarettes and saving them) that was also a setup for further cravings. Most smokers who are attempting to quit will tell you that if there are any cigarettes hidden anywhere, the thought of those cigarettes can be downright overwhelming. The behaviors that result from acting out on cravings are themselves a setup for further cravings. (Tom’s case is also a great example of “attentional bias,” where the addict preferentially notices the cigarette display and turns his attention away from all the other displays and toward the cigarettes. Several researchers have suggested that there is a relationship between attentional bias and cue-related craving.)
    There are countless examples of this phenomenon. I usually tell my patients to delete the contact information from their cell phones of anyone whom they wouldn’t contact except to act out on their cravings. Now, if you think about the phone numbers stored in your cell phone, you probably haven’t memorized most of them. You rely on your cell phone to find and dial the number for you. But with cravings, these numbers have a funny way of getting into your memory, where it’s much harder to “delete” them. The result is even more cravings. The craving leads to a behavior (not just calling a co-conspirator, but focusing on and remembering the number) that ultimately leads to more cravings.
    Beyond these superficial examples of how cravings lead to behaviors that drive cravings is a deeper cycle, driven by the emotional consequences of acting out on cravings. This phenomenon was described in 1939 in the book Alcoholics Anonymous.
They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks—drinks which they see others taking with impunity. After they have succumbed to the desire again, as so many do, and the phenomenon of craving develops, they pass through the well-known stages of a spree, emerging remorseful, with a firm resolution not to drink again. This is repeated over and over, and unless this person can experience an entire psychic change there is very little hope of his recovery. 36
    The sense of remorse and shame that follows acting out addictive behaviors can be powerfully debilitating. No discussion about cravings is complete without addressing shame. As a psychiatrist, I unfortunately know of many cases where a