When a person uses psychoactive substances more or less regularly, this habit eventually causes the body to develop tolerance to these substances. It is then that, to achieve the same effects as at the beginning, the user has to gradually increase the dose. Another option is to prolong use so that the body gets used to functioning without it. The problem comes when the person stops using or continues, but with doses that no longer have any effect. Withdrawal syndrome then appears, causing a feeling of discomfort and suffering that can vary. And with it, a strong desire to use the drug in question also appears. This sensation is called craving.
What is craving?
We can define craving as the urge or intense need to use a drug. If they do not do so, the individual experiences severe physical and/or mental distress. This sensation commonly appears in addictive disorders and can vary in intensity and significance. Craving is a very relevant factor that can lead the user to relapse into their addiction when experiencing the strong desire to try again a psychoactive substance they have previously tried. Relapses caused by craving can occur after long periods of abstinence or even during the treatment phase.
This sensation of urgency to use again appears soon after abstinence. It can remain for a long period of time, whereas withdrawal syndrome lasts for a more limited period. Craving changes throughout the day and is more intense during the early afternoon. By contrast, withdrawal syndrome usually appears between 24 and 48 hours and ends after three or four weeks. In addition, withdrawal syndrome is caused only by abstinence itself, whereas craving can be triggered by different factors such as drug-related cues, emotional states, and abstinence.
Contexts in which it appears
The urge to use a drug is usually associated with the need caused by abstinence from it, but there are other reasons. The main times when craving appears are as follows:
- Withdrawal syndrome. Abstinence from a substance that the body and mind have become accustomed to can be very hard. An important aspect during this period is how the withdrawal from use takes place. If it is too abrupt, rapid, or inadequate, it is common for different symptoms to appear that may be more or less dangerous. Even if withdrawal occurs in a regulated and correct way, a reduction in use can cause discomfort, frustration, anxiety, and even aggressiveness. In both situations, it is common for craving to appear with the aim of avoiding or reducing the discomfort associated with not using.
- Seeking pleasure. Even if there is no physiological need as in the case of abstinence, a strong desire to use can still appear in situations of life distress, dejection, or simple boredom. Sometimes, it also appears as a way to try to enhance a rewarding experience.
- Stimulus conditioning. Drug use usually occurs in a specific context (places, activities, people…). Over time, coming into contact with certain types of stimuli can trigger an elicitation of the use response, with craving appearing in the face of these stimuli, people, or situations.
Why does craving occur?
There are several reasons that attempt to explain craving, and different authors and schools of thought have tried to provide an answer to this phenomenon. Among the different explanations that exist, we find:
- Explanation according to conditioning. According to this theory, there is a link between use and elements of the environment, in which these elements encourage use. In this way, a desire to repeat the experience is triggered in response to the stimulation associated with it.
- Neuropsychological explanation. Another line of reasoning explains craving from a neurobiological point of view. In this sense, this sensation of urgency to use again would be caused by the nervous system’s adaptation to the substance. When the addict stops using, different brain mechanisms remain altered, such as the brain reward system and hormone transmission. When use stops or is not sufficient, the body is disrupted by the absence of familiar elements. An intense discomfort associated with the missing substance then occurs, and the desire to use it appears. Over time, if use does not occur, the brain returns to a normal state, and the need will be less intense.
- Cognitive models. A more cognitive theory states that craving is driven by the person’s expectations and self-efficacy beliefs. Information processing is a key element in explaining craving. There are several cognitive models, among which the dual-affect model stands out as one of the most popular. This model suggests that craving comes, on the one hand, from the aversive emotional state caused by withdrawal syndrome or unpleasant events and, on the other hand, from the positive emotional state generated by drug use. Another model is the cognitive processing model, which says that the habit of using has become automated in people with drug dependence, so not using becomes an effort. From this perspective, craving is a non-automatic process caused by the effort not to use.
With treatment, it is possible to find a way out
Overcoming craving and beating an addiction is possible, and treatment is the best option to achieve it. In general, the most effective method is cognitive behavioural therapy, which provides the patient with cognitive strategies to manage craving and the situations that trigger it. In short, they strengthen the person so that they resist the desire to use again. Over our years of experience helping people and families recover, at CCAdicciones we have managed to merge several types of treatment, creating a specific model. The model at our detox centre maintains a high recovery rate well above the average of other treatments, with 86% of patients recovered.
