This scale is a way to help a clinician and client speak the same language.
- One is totally fine. I’m not sure anyone really feels like a 1 for very long, if at all. There are no cravings present.
- Two is the smallest amount of ‘thoughts about a substance. This is compared to seeing a beer commercial with the attractive environment, entertaining and fun surrounded but beautiful people in their perfect event. It makes your mouth water and you think hey I would love a bottle… oh a pizza commercial I really want that hot steaming slice of cheesy goodness… oh the games back on. See what I did there, you think about it as long as it’s on the medium before you and gone when it isn’t.
- Three is a slight amount of distress – the physical equivalent of a headache. You have the tools to cope but you know that if it gets much worse, you may start to struggle. Usually lasts a few minutes but then it’s gone. No real coping skills needed for it to go away on its own.
- Four is just a really bloody bad day. Even though you’re coping with your cravings, you may not be able to hide them from others as easily anymore. At a 4, this is starting to impact on your normal daily living.
- At five, distress is starting to become more evident. You might find that it’s getting much harder for you to do the things you usually do, the way you usually do them. When I’m a 5, I start avoiding friends because I don’t want to deal with the hassle of socialization and the ways that affects my cravings. It’s time for early intervention and start looking for support.
- Six is getting pretty serious. I know it’s just over halfway, but remember that healthy, happy people are a 1.
- At seven, you’re reinforcing your distress because of the way you’re coping with it. This is where things like depression are really, really hard to manage without some kind of intervention. Socializing causes you distress, so you avoid it, and that just reinforces the entire pattern. Insomnia stresses you out, which releases stress hormones and makes it harder to sleep. You don’t have an appetite so you eat less, and that makes you less hungry. You need someone else to step in to help you. I know it often doesn’t feel as serious as this when you’re experiencing it, but to a healthy person, this is really concerning if it’s affecting multiple areas of your life. Healthy people don’t feel this way.
- Eight is serious distress. On the physical pain scale, you can’t function with the sort of pain you’re in here. It’s not much different with substance use disorders. You’re avoiding normal daily living tasks because they’re too hard. Your behavior and personality have changed in ways it’s impossible for those around you to ignore. You’ve run out of the ability to cope with things, and this is probably starting to come out in some ways that are pretty dangerous for you. Impulsive and compulsive behaviors. Make sure your support understands your distress.
- Nine is critical. Don’t be afraid to use your 9. Don’t wait until 10 to say ‘this is the worst I’ve ever felt’. Don’t wait until you can’t imagine things getting any worse. At a 9, all or most major daily life functions are seriously affected – sleep, appetite, hygiene, socialization, work/study, exercise, leisure. At a 9, someone is existing, not living.
- TEN is the worst you can imagine your distress to be. Cravings are constantly hitting. Your life is so affected you can’t think of anything else. At this point you are one step away from use and without serious intervention you are going to relapse soon.
This isn’t a definitive guide to cravings. You know yourself better than anyone else does. If you have a history of rapid decline, seek help earlier. If you know your history of therapy and full toolkit of coping skills means your ‘4’ is someone else’s ‘8’, communicate that to those involved in your care. The pain scale is only as good as we’re able to explain it to other people – whether that’s cravings, mental health, or physical level of distress.