Let's Talk About Craving
- Brain imaging research is revealing that the signals, or cues, that may spark an addicted person's desire
to take drugs can be incredibly subtle or quick. Expanded knowledge about craving helps scientists
develop new medical treatments for addiction.
Cravings - powerful desires - are part of the human condition. Our brains are "hard-wired" to appreciate
and to pursue natural rewards such as food and sex because of their critical survival value.
Drugs used by addicted people activate the same circuits that motivate food and sexual behavior.
Signals, called cues, can be sights, sounds, smell or thoughts. Cues activate the brain's powerful "go!"
circuit creating cravings. The cravings for alcohol and other drugs can be even stronger than those for
food or sex.
Managing the cravings associated with food, sex and drugs is the responsibility of the brain's inhibitory
"stop!" circuitry. Research suggests that some people have better "stop!" systems or better "brakes," than
others. Individuals with weaker "brakes," may have much greater difficulty managing cravings, putting
them at increased risk for addiction, and/or for relapse. Exposure to some drugs may actually weaken the
brain's braking system.
Cravings may have their beginnings outside conscious awareness. Recent brain imaging research shows
that drug and sexual cues as brief as 33 milliseconds can activate the brain "go!" circuit even though the
person is not conscious of the cues.
In addition to cue-induced craving, desire can also be fueled by:
- a small sample of the drug/food/rewarding activity (the "salty peanut" effect: "just a little" often leads to
- the wish to avoid negative effects (such as drug withdrawal, or negative moods, etc.). Many people
with addictions have a co-occurring mood disorder (anxiety or depression). These moods can
themselves become triggers for food or drug craving, increasing the risk of relapse.
Hope Through Research
You can get help with managing craving, and there is much ongoing research aimed at the development
of more effective anti-craving interventions (for food, drugs, sex, gambling, etc.).
Both anti-craving medications and anti-craving behavioral strategies may be helpful to inhibit or "stop!"
drug craving. Many of these medications have been well-studied; others are in the early stages of testing.
New anti-craving interventions may be available in a location close to you. Research treatments are
usually available at no cost (as they are supported by research grants), and they may offer a new
treatment option that is not yet available in the community.
FIVE THINGS TO DO ABOUT CRAVING
When you have an episode of craving:
- 1. Try to view the craving in a matter-of-fact way. Having a craving does not mean that you are
unmotivated - or that you are doomed to relapse.
- 2. Learning about your craving triggers, and how to manage them, will be an important part of your
recovery in addiction.
- 3. Try anti-craving behavioral strategies, such as the 5-minute contract (making a contract with yourself
not to act on the desire for the next five minutes, and then engaging in a distracting activity in the
meantime.) Many urges are short-lived - you will find they are weaker if you can "surf through" the
first few minutes.
- 4. Call upon the guidance of a trained treatment professional may be needed for successfully
implementing any of a number of well-described behavioral techniques that can be helpful in
managing cravings. Treatment manuals detail these strategies.
- 5. Consider an anti-craving medication. Craving can erupt quickly and feel overwhelming, making it
difficult to put to use behavioral anti-craving strategies, even well-learned ones.
medication may give you a better chance to use the tools you have learned. Some FDA-approved
medications for alcohol and heroin addiction may have a beneficial effect on cue-triggered craving;
medications for cue-induced cigarette craving and cue-induced cocaine/methamphetamine craving
are the focus of many ongoing research studies. Several medications are already under study or in
the research phase which may work for more than one type of craving, offering "one-stop-shopping."
Anna Rose Childress, Ph.D., is a research associate professor in the Department of Psychiatry at the
University of Pennsylvania School of Medicine. She directs the Brain-Behavioral Vulnerabilities Division at
the Center for the Study of Addictions, where she has conducted federally-funded research projects for
more than two decades. Dr. Childress tests potential new medications with potential impact on both
substance and non-substance addictions. Her addiction research has focused on the motivation for drug
use/relapse, with an emphasis on understanding and treating the profound craving states elicited by
heroin, cocaine and nicotine drug cues. Her early work characterized the subjective and physiological
responses to drug cues, developing behavioral anticraving strategies.