Let's Talk About Craving
Summary
- 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 much more!)
- 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.
An anti-craving 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.