CRAVING: TYPES, MODELS AND TREATMENT - ARTE - 2025

The craving is a subjective experience that is a strong desire or urge to consume certain substance or to perform certain addictive behaviors. It refers to an irresistible urge, an obsessive thought or the search for relief from withdrawal symptoms.

Craving works as a motivational incentive to use the drug again, since positive effects are expected. It is considered as the main cause of relapse in addicted people, after episodes of abstinence from the substance. It seems to be the fundamental element by which addiction treatment is abandoned.

It seems that the first author to speak of craving was Wikler in 1948. He described it as an intense urge to consume opiates in the withdrawal phase. However, craving in the beginning was used more in the explanation of alcohol dependence.

In 1955, the World Health Organization indicated that craving was characterized by the following behaviors: relapse, drug abuse, loss of control, and excessive daily consumption. Craving, it was proposed, arose out of psychological and physical needs, as well as the need to interrupt abstinence.

However, it was not until the 1990s that this phenomenon was rigorously investigated. Recently, there is increasing interest in craving analysis. Various branches of psychology have tried to explain and take it into account for the research and treatment of addictions. Thus, there are models from cognitive psychology, behavioral psychology and neuroscience that try to explain its mechanism.

However, the exact operation of craving has not yet been clearly identified, since it involves a subjective experience that varies from person to person.

When and how does craving appear?

Craving can appear from a wide variety of addictions. For example: with tobacco, alcohol, caffeine; illegal drugs like cocaine, marijuana, ecstasy. In addition to other addictions such as addiction to gambling, shopping, food ("food craving") or sex, among many others.

It has been observed that craving or the desire to consume a substance increases when the person is in situations related to that consumption. For example, in a person addicted to alcohol, the craving can appear strongly when entering a bar.

Craving is a fundamental phase that addicts must accept and go through in order to overcome their addiction. Therefore, treatments focused on the abandonment of addictions are beginning to take into account craving.

Thus, it is important to detect, analyze, face and control the need to consume, since by managing these aspects, the craving will disappear, ensuring that the person does not suffer relapses.

Certain authors differentiate craving from impulse, indicating that the first consists of the desire to reach the psychological state produced by drugs (or addictive behaviors). While the impulse refers to the behavior of seeking or consuming the substance. Thus, the goal of the impulse would be to reduce the craving state.

Types of craving

Some authors affirm the existence of four different types of craving:

Response to withdrawal symptoms

This type of craving is what happens to people who use the drug very frequently. In these cases, the substance does not give them as much satisfaction as before, however, when they stop consuming it they feel great discomfort.

Therefore, craving appears as a need to feel good again and relieve withdrawal symptoms. For example, this is the type of craving that a person addicted to tobacco experiences when they smoke to reduce their anxiety.

Response to lack of pleasure

This kind of craving corresponds to patients who want to improve their mood quickly and intensely. It would be as a way to self-medicate when they feel sad, bored or are not able to face certain situations.

Conditioned response to addiction-related cues

Addicted people have learned to link previously neutral stimuli with the reward or reinforcement produced by use or addictive behavior. In this way, these separate stimuli could automatically cause craving.

Here we can place the example mentioned above of the person addicted to alcohol who tries to give up consumption. Simply looking at the bar from outside would make that person want to go in and consume alcohol. This is because they have linked the environment of a bar with the intake of alcohol.

Response to hedonic desires

This is the type of craving you experience when you want to increase a positive feeling. This happens because people have learned that certain behaviors give them great satisfaction if they accompany it with the drug.

For example, this can happen to people who have found positive effects from combining drugs and sex. Then, it can happen that when they are going to have a sexual relationship they feel craving to take the substance again at that moment.

On the other hand, there are authors who distinguish other types of craving according to the time of abstinence from the addictive substance:

Reinforced use

The desire would arise in the phase of drug use and disappear when abandoning it.

Interoceptive

This is the craving that appears one month after stopping the consumption or addictive behavior and appears due to physical symptoms or thoughts.

Covert

The desire or desire reappears about two months after leaving the substance. It is characterized by discomfort and a self-belief or self-delusion that the drug is no longer desired.

Conditioned on internal and external signals

This is maintained for up to two years after stopping consumption. Craving would be triggered by internal stimuli such as thoughts or feelings, and external stimuli, such as visual, olfactory or auditory signals from the environment that are reminiscent of the drug.

Causes: explanatory models

Various authors have tried to explain the phenomenon of craving from different perspectives. Currently, aspects of the different models are often combined to achieve a more exact explanation.

The three main models are the conditioning-based model, the cognitive model, and the neuroadaptative model.

Model based on conditioning

Theoretical models of conditioning are inspired by classical and operant conditioning from behavioral psychology. In general terms, it explains that the person associates consumption as a reward while he relates abstinence as a punishment that must be avoided.

In addition, this model also explains that the signals associated with the drug are repeatedly linked to the consumption of the substance. Thus, they become conditioned stimuli, which means that these signals by themselves provoke the desire to take the substance (craving).

There are different learning processes by which a given stimulus can be conditioned. By association of a neutral stimulus to the substance or addictive behavior or the association of a certain reinforcement or reward for consumption that causes the act of taking the drug to be repeated.

Within the craving conditioning models is the model based on the avoidance of the withdrawal syndrome.

When people experience withdrawal symptoms, they have negative feelings that they could alleviate with the use of the drug. This discomfort associated with abstinence ends up being linked to the environment in which the person is while suffering it.

For this reason, a connection is created between discomfort and the desire to use again, and the environment in which that person is. Then, in the future, when the addict finds himself in that environment again, he will experience craving again with the aim of reducing the possible withdrawal syndrome.

Other authors have developed models based on the search for positive effects related to consumption. This model defends that the positive symptoms experienced during drug use become a reward for continuing to use it.

The expectation that the reward will come when the drug is taken is what would activate the craving, as well as an emotional state aimed at finding the substance.

Cognitive models

Cognitive models differ from conditioning models in that they consider craving a complex state that comes from higher mental functions. These go beyond simple conditioning.

Thus, it encompasses various concepts such as drug memories, positive expectations of drug use, concentration problems, attention focused on certain stimuli, decision-making about drug use, or interpretations of one's own physiological reactions.

This approach involves the person's belief in their own ability to fight the desire to use again.

Neuroadaptive model

This model proposes to explain the phenomenon of craving through neuroanatomy and neurochemistry of the brain. His main research is carried out in animal models and neuroimaging techniques.

Thus, he argues that craving may be related to certain brain areas and certain neurotransmitters.

These models attempt to relate the characteristics of craving to certain neural systems, for example, many of the drugs appear to activate the nucleus of accumbens, which is considered the brain's reward center.

This structure connects to the amygdala, a key area in the limbic system. It influences emotions, stress regulation and conditioned learning. In addition, the nucleus of accumbens has connections with certain areas of the frontal cortex.

In this part of our brain, the information that comes from our senses, such as visual, auditory and olfactory stimuli, is integrated.

Specifically, in the dorsolateral prefrontal zone reward memories of drug use, as well as craving, are located. In this way, situations paired with substance use can be remembered with more attention, since the dorsolateral prefrontal cortex would be reactivated by the sensory information that comes from those situations.

On the other hand, the activity of the dorsolateral prefrontal cortex is regulated by another area called the orbitofrontal cortex. Thanks to this area, it is possible to reason and evaluate the risks and benefits of taking the drug. Thus, if the orbitfrontal cortex is injured or altered, it will cause the person to act impulsively.

Treatment of craving

The models described and the studies carried out on craving are mainly focused on developing better treatments to eliminate addiction. Specifically, to prevent relapses during recovery.

Therapy

Cognitive behavioral therapies equip patients with cognitive strategies to manage craving and the situations that cause it. That is, they strengthen the person to resist the desire to use again.

For example, in therapy, maladaptive beliefs that promote consumption are treated, distraction techniques, self-instructions, imagination technique, task programming, and methods are developed to reduce anxiety in a healthy way.

One of the methods used to control craving is the thought stopping method. It serves for the patient to prevent the chain of thoughts that produce the negative emotions of craving.

To do this, the person has to verbalize their thoughts related to the craving they want to eliminate. For example: "I'm going to feel bad if I don't take drugs." While the patient says the phrase, the therapist should interrupt by saying a word like "Stop!" or "Stop!"

This exercise will be repeated several times until the patient can do it automatically without the help of the therapist. In addition, an attempt is made to replace negative thinking with an incompatible or distracting one.

Drugs

On the other hand, drugs have been found that can reduce craving. Most recommended for alcohol dependence. However, this method is rarely used as its effectiveness has not been fully demonstrated. It seems to be better when combined with other therapies such as cognitive.

Some of the most widely used anticraving drugs are: disulfiram, acamprosate, and naltrexone. The latter appears to block the reinforcing effects of the drugs.

References

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