What do you Crave?

c. Omar Manejwala

We all crave something. Our society is based upon cravings and addictions. What will satisfy me NOW; What will get me though THIS.

I met Dr. Omar Manejwala at my local Starbucks just last week. He was working on his forthcoming book, when he asked me about the trivia tournament he had overheard me talking about to the baristas. Later, I asked him about the phone conversation I had overheard with his publisher.

Are you writing a book? I asked.

His book is called Craving:Why We Can’t Get Enough by Hazelden Publishing, due out in spring 2013.

I was really excited. Do you talk about the reptilian brain? I eagerly asked him.

Throughout our conversation, I found out that not only does he have extensive knowledge of the reptilian brain, he had worked at the same hospital I do. He now works in LA, and, yes, his clients have included celebrities; but he’s not divulging which ones.

I was intrigued with the concept of his book, so I asked him what had sparked his interest in addiction. He has been in psychiatric practice for nearly a decade. While he started out with no interest in treating addiction, he quickly became the rock star of addictionology.

People’s cravings can adversely affect their lives and people don’t know to do with that.

He said he quickly realized the need for a book on cravings. With all his experience, he was definitely up to the job.

He told me,

Cravings originate in the paleo-brain. Frequently they are somewhat outside of our control. Interplay between deep brain structures, neo- cortex, memory, thoughts, experience and context generates [our] cravings. They are determined both by deep urges that develop mentally and [through our] experiences.

Most people don’t seek treatment for their cravings, unless they are severe addictions, but when they have milder problems they won’t seek help.

I asked him what the number one secret to beating cravings was.

He listed a few for me:

the power of group, altruism, reframing situations, and forming new habits.

I asked him if he was somewhat jaded from all of his years doing this, if everything has become textbook, so to speak. I wanted to know if anything gets to him.

Anytime you are treating a devastating illness it can be tough. Often the family’s response is the hardest. Addiction is a family disease, the effects go on for years. Families are systems, they like homeostasis, if one member decides to get well, that can be a tremendous stress to the family.  Its also incredibly rewarding work.

If you have any system and you change one part of it, the rest of it is forced to change.

People don’t like change, even good change. So he spends a lot of his efforts on helping and supporting families. He says, unlike a job, where you can just leave if you don’t like the way things are going, you often can’t choose to leave a family. So people feel trapped.

He’s seen families of adolescents in eating disorder treatment. Whether or not they admit it, the parents feel responsible for child’s eating disorders. They feel shame, shock. Even if they can’t admit that they feel guilty, they often do.

He says that the teen might complain to their parent about the difficulty of the treatment. The parent feels guilty and pulls them out of rehab, and then, of course, nothing changes.

He doesn’t like the word dysfunctional. It takes a lot more than you would think it takes [to change]. It takes forgiveness, acceptance, accountability and people need to clean up their messes.

He talks about the importance of systems. Just because you stop doing what you’re craving doesn’t mean you are cured. Take care of the problem, change your environment.

I asked him if he ever felt discouraged when, despite his best efforts, he couldn’t help someone.

He said that you hope you are making a difference even if someone doesn’t meet their goals. Instead of thinking in terms of success and failure, think in terms of the journey.

c. 2012