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Understanding the Four Cs of Addiction

Here’s a great discussion with Anna Lembke, the author of the excellent book Dopamine Nation giving a really good overview of how addictions work, as well as some suggestions for working with them.

Addiction is a complex issue, involving both physical and psychological components.

One effective way to assess if you’re suffering from addiction is through the model, referred to by Lembke, as as the ‘Four Cs’ of addiction: COMPULSION to use, Loss of CONTROL, Continued use despite CONSEQUENCES, and CRAVINGS.

These four dimensions are considered cornerstones in addiction psychology and can be applied to a wide range of addictive behaviours including substance abuse, gambling, and even behavioural addictions like overeating. Let’s delve deeper into each one:

1. Compulsion to Use

The first ‘C’ stands for ‘Compulsion to use’. This is characterized by an obsessive need to engage in the addictive behavior. It’s the constant thinking about the act and an overwhelming urge to perform it, regardless of the time or place. You may find yourself regularly and often involuntarily thinking about your next opportunity to engage in the activity or substance use. This compulsive behaviour can interfere with daily tasks, relationships, and overall quality of life.

2. Loss of Control

The second ‘C’ is ‘Loss of Control’. This means that once you start the addictive behavior, it becomes challenging to stop. You may consume more than you initially intended or spend more time engaging in the behaviour than you had planned. The hallmark of loss of control is the inability to stop, even when you want to. Your desire to engage in the addictive behavior overpowers your initial intention or your previous decisions to limit or stop.

3. Continued Use Despite Consequences

The third ‘C’, ‘Continued use despite consequences’, is a critical criterion for addiction. This means continuing the addictive behaviour even when it causes harm or has negative consequences in your life. These consequences can include declining physical health, damaged relationships, financial hardship, or even legal trouble. If you find yourself persisting with the behavior regardless of such consequences, it’s a significant sign of addiction.

4. Cravings

The fourth and final ‘C’ stands for ‘Cravings’. These are intense, often irresistible urges to engage in the addictive behaviour. Cravings can manifest physically, such as feeling a strong urge to consume a substance, or psychologically, such as constantly thinking about gambling. It’s crucial to note that cravings can be triggered by various stimuli associated with the addictive behavior and can be incredibly hard to resist, pushing you further into the cycle of addiction.


Here are three reflective questions for each ‘C’ that can facilitate a deeper understanding of these components with regard to your dependency or addiction, in order for us to start planning ways forward.

See if you can give yourself 20-30 minutes for the next four days, exploring each of these four C’s in turn by answering the questions given below for each category.

1. Compulsion to Use
* What triggers my compulsion to use. Are there ways in which I’ve been successful in other areas of my life in terms of avoid or manage triggers that push me towards doing things that I know I will regret? What strategies did I use there? Could these be applied in some way to my addiction.
* How would my daily routine need to change so as to help me not act upon the compulsion to use?
* What is primary coping mechanism I could like develop to combat the compulsion to use?

2. Loss of Control

* When do I feel the most control over my behaviour, and how can I leverage these moments to combat my addiction?
* What is one small aspect of my addiction that I feel I could regain control over right now?
* How does loss of control impact my self-esteem, and what steps would I need take to help restore this esteem and pride in my self?

3. Continued Use Despite Consequences

* How have the negative consequences of my addiction affected my relationships, career, health, or overall life, and what is one change I can make to reduce this impact?
* Are there any negative consequences that I haven’t fully acknowledged or addressed? How might I confront them?
* What can I do to remind myself of these consequences when I feel the urge to engage in addictive behaviour?

4. Cravings
* How do my cravings manifest physically and emotionally, and what strategies have I developed to deal with other cravings in my life, which could also be used to respond to these symptoms?
* When do I typically experience cravings? How can I proactively prepare for these moments knowing that they are going to come up?
* How can I alter my environment or routine to lessen the occurrence of cravings?

Each of these questions is aimed at prompting deep introspection, increasing self-awareness, and encouraging the creation of an action plan to address our addictions, dependencies, and “bad” habits.


Here are some strategies, many of them mentioned in Lembke’s book for dealing with these Four C’s of addiction. Let’s have a chat about which of these most interest you and you might like to try.

1. Compulsion to Use

  • Focusing: Regularly practicing different focusing/mindfulness/becoming-present strategies can help us become more aware of our compulsions and better manage them. A great app for doing this is The Act Companion.
  • Swapping “Good” Out For “Bad”: This involves drawing up a list of healthier activities like physical exercise, engaging hobbies, or time with loved ones (ideally, something meaningful and valued by us personally) to do instead of the compulsive activity.
  • Using Our Support Networks: Building/seeking relationships with supportive friends, family, and mentors who might understand our journey and be there to check up on us, ideally daily, when we are trying to change our relationship to our substance of choice.
  • Establish Regular Routines: Consistent daily routines, especially for those times of the day when we are most compelled to use, can provide structure and reduce the chance of giving into our compulsions.
  • Journalling: Documenting our thoughts and feelings can provide insight into the triggers of our compulsive behaviour.

2. Loss of Control

  • Setting Manageable Goals: It’s best to start by setting realistic, achievable goals that can help us regain a bit more control of our life, and then building on those.
  • Prioritizing Self-Care: Regular exercise, balanced nutrition, and sufficient sleep can help us maintain better control over our addictions, as well as establishing a counterfoil to activities that hurt or harm us.
  • Using our Tools: Like S.T.O.P, a very popular and oft-cited tool. Or indeed any other tool that works to create a pause between the urge and the loss of control that might follow on from it.
  • Adopting a Growth Mindset: Accepting that mistakes are a part of any change or recovery journey is crucial. Learning from them, rather than being discouraged by them.
  • Establish Personal Boundaries: We may need to do this within ourselves (the Inner Adult talking to the Inner Child) as well as with others to avoid situations that may trigger a loss of control.

3. Continued Use Despite Consequences

  • Prepare a Pros-Cons List: Listing the advantages and disadvantages of our substance use can help us understand its impact on our life.
  • Engage in Reality Testing: This technique involves challenging the thoughts and beliefs that lead us back to continued use despite negative consequences. It’s about separating our thoughts and feelings from the reality of the situation. Sticking with and reinforcing this “reality” as much as we can.
  • Establishing Accountability: Finding a trusted individual or group to hold us accountable to our healthy behaviours.
  • Educating Ourselves: Learning more about the potential risks and long-term effects of our habit.
  • Discovering Positive Activities: Finding and engaging in activities that bring joy and positivity to our lives.

4. Cravings

  • Practicing Delaying Gratification: When a craving arises, we can try to wait it out. This is even better if we use a distraction activity, or do some yoga or focusing on breath.
  • Engage in Distractions: Using activities that keep our minds engaged and help distract us from cravings.
  • Perform Breathing Exercises: Deep breathing exercises can help manage anxiety and reduce the intensity of cravings.
  • Practicing Positive Visualization: Envisioning a future where we are free from addiction, focusing on the benefits this will bring can be really helpful.
  • Ensuring Adequate Hydration and Nutrition: Regular hydration and balanced meals can help prevent cravings triggered by physical needs (such as the need for the sugar in alcohol when our blood sugar levels drop).

Remember, these are just starting points. Substance use disorders are complex and managing them often requires a personalized approach which further discussion in our sessions will allow us to do.


1. Addiction and Narrative:
Dr. Lembke emphasizes the role of storytelling and narratives in understanding addiction. Our brains are wired to seek pleasure and avoid pain, and addiction often arises from the pursuit of dopamine-driven rewards.

2. The Role of Dopamine in Addiction:
Dopamine, a neurotransmitter associated with pleasure and reward, plays a crucial role in addiction. Modern society, with its instant gratification culture, floods individuals with dopamine-triggering stimuli, increasing the risk of addiction.

3. Risk Factors for Addiction:
Various risk factors contribute to the development of addiction, including genetics, early life experiences, trauma, and social environment. Recognizing these factors can help individuals take preventive measures.

4. Anna’s Addiction to Romance Novels:
In a candid and amusing moment, Dr. Lembke shares her own struggle with addiction to romance novels, demonstrating that addiction can manifest in unexpected ways. This personal anecdote adds a relatable and human touch to the discussion.

5. Pain, Pleasure, and Addiction:
Dr. Lembke delves into the complex relationship between pain, pleasure, and addiction. Addressing the root causes of emotional pain and trauma is essential for overcoming addictive behaviors.

6. How to Tackle Addictions:
To combat addiction, Dr. Lembke recommends building resilience and finding healthier sources of pleasure and fulfillment. Engaging in activities that bring a sense of accomplishment, connecting with others, and developing coping mechanisms are essential strategies.

7. Medical Psychedelics and Addiction:
The conversation touches on the potential of medical psychedelics in treating addiction. While there’s hype surrounding these substances, more research is needed to understand their efficacy fully.

8. Honesty, Shame, and Recovery from Addiction:
Openness and honesty are crucial for those struggling with addiction. Overcoming shame associated with addiction is essential for embarking on the path to recovery and better mental health.

Take-home Points:

– Addiction arises from the pursuit of dopamine-driven rewards, and our modern society is filled with triggers that can lead to addictive behaviors.
– Recognizing risk factors and addressing emotional pain and trauma are crucial for tackling addiction.
– Developing resilience, finding healthy sources of pleasure, and fostering connections with others contribute to better mental health and a fulfilling life.
– Medical psychedelics show promise in addiction treatment, but more research is needed.
– Honesty and openness are vital for working with one’s own addictions.