Cravings and Addiction: Understanding Those Powerful Urges

Introduction

Have you ever had a really strong desire for something, like a favorite food, perhaps a new gadget, or even just a moment of peace? For people struggling with addiction, those desires, called cravings, can be incredibly intense and hard to ignore. In fact, experts agree that these cravings are a major part of addiction and can even lead someone who's trying to quit back to using substances (Cless et al., 2023).

It turns out that these cravings aren't just in someone's head – they have deep roots in both our minds and our bodies. That's why the latest version of the official guide for diagnosing mental health conditions lists cravings as a key sign of addiction (American Psychiatric Association, 2020). To really understand addiction, we need to look at both the psychological and physical reasons why these cravings happen.

Have you ever had a really strong desire for something, like a favorite food, perhaps a new gadget, or even just a moment of peace? For people struggling with addiction, those desires, called cravings, can be incredibly intense and hard to ignore. In fact, experts agree that these cravings are a major part of addiction and can even lead someone who's trying to quit back to using substances (Cless et al., 2023).

It turns out that these cravings aren't just in someone's head – they have deep roots in both our minds and our bodies. That's why the latest version of the official guide for diagnosing mental health conditions lists cravings as a key sign of addiction (American Psychiatric Association, 2020). To really understand addiction, we need to look at both the psychological and physical reasons why these cravings happen.

It’s widely thought that cravings are intense urges to use drugs or alcohol because addiction changes the brain's chemistry. Often, the focus is on a brain chemical called dopamine (Cless et al., 2023; Pergolizzi et al., 2019). However, some experts believe this view of a purely neurological focus is too narrow and doesn't fully explain what's happening for everyone. They argue that we also need to consider the emotional and mental experiences that drive these cravings (Lavallee, 2020).

So, it seems that cravings in addiction involve both what's happening in the body and what's happening in the mind. How much each plays a role can vary from person to person. This means that the best way to help people struggling with addiction is to create personalized treatment plans that address their unique needs – both mental and physical. This approach helps counselors feel more equipped to support each individual on their recovery journey.

The Mental Side of Cravings

Thinking more about the mind, psychological cravings come from a desire to feel certain ways – maybe to feel numb, to escape problems, to find relief from stress, or to feel safe and accepted. When someone is really stressed or emotionally upset, it's natural to want to find some kind of comfort.

One idea, proposed by Khantzian back in 1985, suggests that people might use substances as a way to self-medicate when they're dealing with overwhelming emotional pain (Lavallee, 2020). Think of it like taking pain medicine for a broken leg – it might ease the pain for a bit, but it doesn't fix the real problem. Similarly, drugs might temporarily hide emotional distress, but they don't solve the underlying issues, often leading to more substance use and worsening health.

Cravings aren't just about emotions and stress, though. They can also be learned over time (Lavallee, 2020). People can develop strong connections between using substances and certain situations, people, or places. These triggers can then spark not just a desire for the substance itself but also a longing for the good feelings and rewards they associate with it. These thoughts can become so strong that they lead to constant thinking about the substance, which can then trigger a cycle of using it again and again because of the strong mental reward.

The Physical Side of Cravings

While the mental side of cravings is important, we also need to understand the physical changes that happen in the brain. Our brains are constantly changing and adapting, a process called neuroplasticity. When someone uses addictive substances regularly, it can actually change the brain's structure and how it works.

One key area affected is the brain's reward system, which uses a chemical called dopamine. Substances of abuse cause a surge of dopamine in this system (Tanabe et al., 2019). This reward system involves different parts of the brain that work together. With repeated substance use, things like certain people, places, or feelings can become linked in the brain to this reward system. So, when these triggers appear, they can set off strong cravings.

One key area affected is the brain's reward system, which uses a chemical called dopamine. Substances of abuse cause a surge of dopamine in this system (Tanabe et al., 2019). This reward system involves different parts of the brain that work together. With repeated substance use, things like certain people, places, or feelings can become linked in the brain to this reward system. So, when these triggers appear, they can set off strong cravings.

Brain scans show that long-term substance use can also lead to a loss of brain tissue in important areas (Tanabe et al., 2019). These areas are involved in things like processing rewards, making decisions, and managing emotions. When drug-related cues activate these areas strongly, it often means the cravings are more intense. Also, when someone tries to stop using, the withdrawal symptoms can make cravings even worse by further activating the brain's reward system. This shows how the physical effects of stress and substance use are connected. Over time, chronic drug use can also make the brain less responsive to normal rewards, making the substance seem even more appealing while other enjoyable things become less so (Tanabe et al., 2019). This might be because of problems with how dopamine is working in the brain.

How This Helps in Counseling

People struggling with addiction have complex cravings that are unique to them and can have both strong mental and physical components. To help them get better in a well-rounded way, it's important not to think of cravings as purely one or the other. Instead, we should see them as interconnected. One person might show more emotional signs of craving than physical ones, but that doesn't mean the physical side isn't there. It just means the treatment plan might focus more on the emotional aspects. By understanding this, a counselor can work on managing the physical cravings while also addressing the underlying psychological reasons for them.

Thinking about cravings in this dual way allows counselors to use different tools. For the mental side, they can use therapies like cognitive behavioral therapy (CBT). For the physical side, they can use medications like naltrexone, methadone, and buprenorphine, along with encouraging healthy lifestyle changes like exercise and a good diet, and incorporating mindfulness techniques. Going back to the broken leg idea, the goal is to heal the leg while also managing the pain. Counseling should be similar – working with the client and, when needed, involving doctors to provide the best overall care to support their recovery.

In Conclusion

The goal here isn't to say that everyone needs the exact same approach. Instead, it's important for counselors to consider both the potential mental and physical factors when creating a treatment plan. Each person has their own unique history and genetic makeup, which makes their cravings complex. By understanding both the psychological and physiological aspects that might be driving cravings, counselors can make informed decisions about the most effective way to help each client. More research is crucial, especially when working with people from marginalized groups. It's not right to assume that research done without proper representation applies to everyone. Prioritizing inclusive research will lead to better, fairer care for all clients.

References

American Psychiatric Association. (2020). Substance-related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425787.x16_Substance_Related_Disorders

Cless, M. M., Courchesne-Krak, N. S., Bhatt, K. V., Mittal, M. L., & Marienfeld, C. B. (2023). Craving among patients seeking treatment for substance use disorder. Discover Mental Health, 3(1), 23. https://doi.org/10.1007/s44192-023-00049-y​ 

Lavallee, Z. (2020). Addictive craving: There's more to wanting more. Philosophy, Psychiatry, & Psychology, 27(3), 227–238. https://doi.org/10.1353/ppp.2020.0028​

Pergolizzi, J. V., Raffa, R. B., Rosenblatt, M. H., & LeQuang, J. A. (2019). Craving and opioid use disorder: A scoping review. Drug and Alcohol Dependence, 205, 107639. https://doi.org/10.1016/j.drugalcdep.2019.107639

Tanabe, J., Regner, M., Sakai, J., Martinez, D., & Gowin, J. (2019). Neuroimaging reward, craving, learning, and cognitive control in substance use disorders: review and implications for treatment. The British journal of radiology, 92(1101), 20180942.