Monday, March 31, 2008

Let's Talk About Craving: by Anna Rose Childress, Ph.D.

Let's Talk About Craving

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  • 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.

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When you have an episode of craving:

Avoiding Relapse

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In some ways, the hardest part of establishing and maintaining long-term recovery comes when the initial, intensive part of treatment has been completed.

To avoid relapse, most recovering people need to be in the warm embrace of loved ones - whether their close, biological family or the new "family" of other recovered people that they can turn to when they feel in danger of relapse.

One study identified the five factors that most often contribute to relapse:

  • inability to manage stress or negative emotional states
  • interpersonal conflicts with family or others
  • failing to stick to the recommendations of doctors and counselors
  • negative thinking
  • low motivation to change

These factors are not so different from the variables that affect relapse when dealing with other chronic disorders, such as diabetes:

  • failing to stick to diet, medications, or behavior change
  • poverty
  • poor support from family members
  • a co-occurring mental health disorder

Among other things, addicted people must learn how to avoid contact with the triggers that may set in motion their brain's demanding cry for drugs or alcohol. And when those triggers are unavoidable, people must develop the skills that will prevent the craving from taking over. Learning these skills must be a core element of any treatment program; maintaining them should be part of an aftercare program or long-term recovery plan.

"Aftercare is just that," says Don Perks, who helps fellow members of Steamfitters Local 635 in New York City. "It's a continuing care that you really need to be involved in if you're gonna wanna survive this. If you just leave 30 days' treatment and you don't go to meetings and you don't get involved with a sponsor and a group and a commitment, you're going back in no time at all. You can't resist the temptation."

"I cannot emphasize enough the role of the aftercare contract and the aftercare program," says Scott Basinger, who heads a confidential addiction assistance program for employees at Baylor College of Medicine in Houston. "It's been the key to success."

Joe Powell leads a recovery center in Dallas, where participants can gather for friendship, mutual aid, job training and other tangible assistance that can help recovery people get on their feet, start a new life and remain committed to their recovery plan. Although peer support is an essential part of the recovery center, the organization focuses on solution-oriented endeavors, and does not limit itself to the specific issues raised in the addiction-focused dialogue that comes in a 12-step program. Powell says that in this case, aftercare is "about the solution, not about the problem."

"Most people think we're replacing AA. We're not replacing 12-step," he says. "People in long-term recovery are in a different stage; they don't have the same needs. We put together a recovery commitment plan for clients - our goal is to get them to where they are preparing for a lifetime of recovery."

Services such as recovery centers, peer coaching and mentoring and educational and skill-training services play an important role in helping an addicted person rebuild a life, avoid relapse and sustain long-term recovery. A small federal program, the Recovery Community Services Program (RCSP), funds community- and faith-based programs that provide these services, linking individuals with housing, jobs, and/or education; and hosting alcohol- and other drug-free social activities. To learn about RCSP grant projects, visit


  • CASA 12-Steps Blog

  • CASA-12-Steps-Program Group
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