Addiction Recovery: What are Cravings?
Drug (and alcohol) cravings have just been added in the psychiatric bible, DSM-V, to diagnose addiction. The inclusion of “cravings” as a diagnostic criterion has created much debate in the addiction world. Many experts do not want it in there, but those in charge of the DSM-V obviously think it is a good idea to include cravings.
What’s the debate about?
If you looked at all the research in the field you would quickly conclude that we don’t actually know what drug cravings are. This may seem very peculiar because many recovering from addictions routinely talk about cravings. For many, it is one of their greatest fears of recovery: What will I do when I get a really severe craving? Can I stop myself from using?
In this blog, I’ll examine some of the more influential theories of cravings. It should help you understand why some researchers are upset with the DSM-V. More importantly, it will help you understand the meaning of cravings in your recovery. Perhaps, it can help you understand that you need not be controlled by your biology—unless, of course, you want it to.
Different Theories of Cravings
In the two hundred years that we have been examining drug cravings scientifically, much has been made of the link between cravings and drug use. Norman Kerr, who published his research in the late 19th century, was convinced that cravings were an integral part of drug use. This seems to be the thinking of modern researchers who rely on brain chemistry to explain cravings.
Many have been less sure about the link. Studies have shown many people relapse even though they had no severe cravings. Some studies have shown those with severe cravings can resist drug use, if they can stop to consider the consequences of drug use. Other studies see cravings as a kind of automatic response that leads to drug use—similar to Pavlov’s dogs salivating at the sound of a bell.
Still, others have shown that cravings seem to be on some continuum of intensity, with only the most severe cravings leading to drug use. Others have suggested the intensity of cravings, itself, does not lead to drug use. Rather, they argue there is a motivational factor leading to the drug. Some see the brain chemistry response to not having the drug as only the initiating factor in cravings. The memory system then takes over because the person has to make sense of this physical response, which he or she likely interprets as desiring the drug.
To complicate matters, some Spanish researchers studied those in a detoxification clinic and discovered that while some clients craved the drug, others did not. Those who craved the drug had much higher levels of depression and anxiety. Those who seemed to have anxiety as part of their personality also had cravings.
In summary, we don’t yet have any agreement on what cravings are or what they mean.
Biology of Cravings
Although there are several theories of cravings that are based on the effects of the drug on the brain. One of the most famous is the Incentive Sensitization Theory developed by neuropsychologists, Kent Berridge and Terry Robinson. The researchers were trying to understand why so many addicts in recovery relapse after treatment (they estimated about 60 % within 3 months and 75 % within 12 months). Berridge and Robinson suggested that drugs sensitize the part of the brain that we think is most impacted by drugs.
According to this theory, sensitization leads to an irresistible craving for the drug regardless of whether the person wants to use or not. The person feels a compulsion to use. Perhaps someone is in recovery and wants to stay away from the drug. Yet, he or she feels an irresistible urge, a compulsion, and uses anyway. It may be that the person does not even have a desire to use, but the craving forces drug use anyway.
A Psychological View
Many psychologists do not believe that biology tells the whole story. Alan Marlatt, the most famous researcher in relapse prevention, developed a technique called “urge surfing”. Based on mindfulness meditation, urge surfing asks the recovering person to simply accept the urge, rather than trying to resist it. If you have paid close attention to yourself, you will soon realize that your thoughts and feelings just come and go. Drug cravings are like that too; they come and they go.
The problem many people in recovery face is that they do not realize feelings and thoughts come and go. They desperately try to control the urge rather than just let it happen. This desire to control the urge—because they think it is unacceptable to feel this way—is the real problem. If they could just let the craving come, it would also just go away.
A Meaning-Centered Interpretation of Cravings
It may be that how a person makes sense of his or her cravings has a lot to do with how intense the cravings are. If a person thinks he or she cannot deal with a severe craving, they will likely use. On the other hand, if those in recovery believe that they can handle the cravings, then they will.
This idea is similar to Alan Marlatt’s work. He talked about ‘alcohol expectancies’. Alcoholics have certain expectations of what they will feel when they drink; they make sense of their intoxication in a certain way. The key is what they expect to happen, will happen. Similarly, many in recovery have expectations of what cravings will be like. A mentioned, some think cravings will hijack their brains and lead inevitably to drug use. Others do not believe this.
Viktor Frankl was a great believer of people rising above their biology and environment. Overcoming cravings meant recognizing that you, as a person, are bigger and more powerful than a drug craving. Cravings are nothing to be afraid of. They are what they are. If you think they are irresistible and you cannot handle them, then….
This blog is also available in a 4-part video series.