The consumption of psychoactive substances , if carried out more or less frequently, ends up causing the body to generate tolerance to this substance. This means that in order to achieve the same effects as at first, the dose administered must be gradually increased, or the consumption must be spaced out so that the body gets used to working without it.
If the organism stops consuming or is maintained with doses that no longer have any effect, some kind of withdrawal syndrome tends to appear, causing a variable level of discomfort and suffering, with an intense desire to consume the substance in question. It is the craving .
What is craving?
We understand as craving the feeling of urgent and imperative need to perform a certain activity, whose absence generates anxiety . In the case of drugs, it refers to the intense desire to obtain and consume the substance in question that generates it. This desire does not have to find a behavioural correlate, that is, it does not have to provoke an action that leads to consumption.
This desire occurs in subjects who have or have had a dependency on a certain substance , forming an important part in the maintenance of the addictive process. It can be activated by the presence of stimuli previously associated with the consumption of the substance, by stressful events and even by the absence of sufficient stimulation.
Craving can occur even in individuals who have stopped using . It can usually be actively present up to two years later, although it is usually much more intense in the period between the month and the first year after the end of consumption. This does not take into account the existence of falls and relapses.
Causes and contexts of appearance
The craving for drugs is usually associated with the need for abstinence from drugs , but this is only one of the reasons that exist. Some of the main moments in which craving appears are the following.
1. Withdrawal syndrome
Withdrawal from a substance to which the body and mind have become accustomed can be very hard.
If withdrawal of consumption occurs abruptly , too quickly or inappropriately, various symptoms of variable danger often appear.Even if it is done in a correct and gradual way, the decrease in consumption or the lack of increase in feeling the effects may cause discomfort, frustration, anxiety and even aggression and under control of the subject. And even if the subject does not try to unhitch, the progressive increase in the body’s tolerance to the drug causes the need for increased consumption, generating discomfort for not getting it.
In all these circumstances it is frequent that craving appears, with the purpose of avoiding or diminishing the discomfort associated with not consuming.
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2. Stimulating conditioning
Drug use often occurs in a particular context. Places, activities and even people are over time associated with the fact of consuming .
This means that in the long run, coming into contact with certain types of stimuli leads to an elicitation of the consumer response, with craving appearing in the face of such stimuli, persons or situations.
3. Pleasure seeking / avoidance of displeasure
Many drug users start to use because it gives them pleasant sensations or because they avoid specific problems . Even if there is no physiological need as in the case of abstinence, a strong desire to consume may appear in situations of vital suffering, despondency or simple boredom. Sometimes it also appears as a way of trying to enhance a gratifying experience, as with sex or food.
Possible explanations for the craving
The causes of this phenomenon have been explored and studied by numerous authors and schools of thought. Some of the possible explanations offered are the following.
On a neurobiological level, craving seems to be caused by the adaptation of the nervous system to the substance. The dependent subject who stops consuming maintains different cerebral mechanisms altered such as the cerebral reward system and the transmission of hormones such as dopamine, serotonin and endorphins .
When consumption stops or does not occur to a sufficient extent, the body is altered by the absence of family elements. This causes intense discomfort that is associated with the missing substance , with which the persistent desire to consume it appears. With the passage of time, if consumption does not occur, the brain returns to a normal state, so that the need will not be so high.
Explanation according to conditioning
Another explanation can be found in conditioning.
On the one hand we can observe typical components of classical conditioning, which in this case would cause a link between consumption and elements of the environment, so that the presence of these elements would evoke consumption. Thus, a desire is provoked to repeat the experience in the face of the stimulation linked to it .
On the other hand, from the operating conditioning it can be established that the positive consequences of consumption and its persistent experimentation act as a reinforcement of consumption itself while generating the expectation of continuously achieving the same reward and in the same intensity. In the absence of this, the response is generated to repeat consumption in order to achieve the same effects.
The cognitive perspective of craving
A more cognitive view refers that craving is mediated by the person’s own expectations and beliefs of self-efficacy , with information processing being a main element to explain it.
One of the most popular cognitive-behavioral models in the explanation of craving is the double affect model , which indicates that craving comes from the aversive emotional state that causes withdrawal or unpleasant events, and from the positive emotional state generated by the consumption of the substance. The events and stimuli of the environment generate the activation of the network of responses and cognitions that are linked to the appetitive effects of the drug and the aversions of its absence.
Another possible explanation can be found in the cognitive processing model , in which it is stipulated that in drug-dependent persons the habit of consumption has been automated, requiring the non-use of effort. From this perspective, craving is a non-automatic process caused by the effort of not consuming.
Cracking in the treatment of addictions
Treating substance dependence is a difficult and prolonged process , which may be influenced by very diverse factors such as the type of treatment applied, the individual’s experiences during the period of time in which it is carried out, or the social support perceived.
In this process, abstinence will cause deep suffering in the person in treatment , suffering that will generate in a very powerful way the desire or desire to consume again: craving.
Craving is one of the main causes of falling (consuming on one occasion but without necessarily reinstating the habit) and relapse (in which the consumption habit is recovered), which should be especially taken into account when establishing treatment programs. This is why it is essential to develop relapse prevention programmes during any treatment.
In order to prevent this, it is first necessary to inform and educate the patient that the desire for consumption is normal and that the fact that craving appears does not imply that consumption will occur.
It is also useful to take into account the type of stimuli that facilitate consumption or provoke the desire to consume, in order to avoid them or to learn to deal with them in an adaptive way without resorting to consumption. Strengthening and empowering the patient , as well as restoring their sense of control and giving them tools and strategies to manage stress and resist desire, is another useful strategy to apply.
- Iraurgi, J. and Corcuera, N. (2008). Craving: concept, measurement and therapy. Northern Mental Health, 32; 9-22. Basque Country.
- River, P. (1987). The motivation of drug use: a psycho-biological analysis of urges. The Nebraska Symposium on Motivation: alcohol use and abuse. Lincoln: University of Nebraska Press.
- Sánchez, E.; Molina, N.; del Olmo, R.; Tomás. V. and Morales, E. (2001). Craving and drug addiction. Addictive disorders, vol. 3; 4; 237-243.
- Tiffany, S. (1990). A cognitive model of drug urges and drug abuse behavior: role of automatic and non automatic processes. Psychol Rev, 84, 127-90.