Craving: causes and symptoms of substance craving

This psychological phenomenon is one of the most important aspects of drug addiction.

The consumption of psychoactive substancesThe use of psychoactive substances, if carried out more or less frequently, eventually causes the body to generate tolerance to the substance. This means that in order to achieve the same effects as at the beginning, the dose administered must be gradually increased, or consumption must be spaced out so that the body gets used to working without it.

If the organism stops consuming or continues with doses that no longer have an 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 about the craving.

What is craving?

We understand as craving the sensation of urgent need to perform a certain activity, the absence of which 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 behavioral correlate, i.e. it does not have to provoke an action that leads to consumption.

This desire occurs in subjects who have or have had dependence on a certain substance, being an important part in the maintenance of the substance.It is 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 appear even in individuals who have stopped using the substance.. Generally it can be present in an active form up to two years later, although it is usually much more intense in the period between one month and the first year after the end of consumption. This without taking into account the existence of falls and relapses.

Causes and contexts of onset

Drug craving is usually associated with the need provoked by the abstinence of this oneHowever, this reason is only one of many. 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 occurs abruptly, too quickly or inappropriately, it is common.If withdrawal is abrupt, too fast or inadequate, various symptoms of varying degrees of danger often appear. Even if the drug is taken in a controlled and correct way, the decrease in consumption or the failure to increase in order to feel the effects can cause discomfort, frustration, anxiety and even aggressiveness and under control of the subject. And even if the subject does not try to unhook, the progressive increase in the body's tolerance towards the drug provokes the need for an ever greater consumption, generating discomfort if this is not achieved.

In all these circumstances, craving often appears, with the purpose of avoiding or reducing the discomfort associated with non-consumption.

2. Stimulant conditioning

Drug use usually occurs in a specific context. Places, activities and even people are eventually associated with the fact of consuming drugs..

This causes that in the long run, coming into contact with certain types of stimuli provokes an elicitation of the consumption response, with craving appearing in the face of these stimuli, people or situations.

3. Pleasure seeking/displeasure avoidance

Many drug users start using drugs because it generates pleasurable sensations or to escape from specific problems. 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 in the case of sex or food.

Possible explanations for 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.

Neuropsychological explanation

At the neurobiological level, craving seems to be caused by the adaptation of the nervous system to the substance. The dependent subject who stops using keeps altered different brain mechanisms such as the brain reward system and the transmission of hormones such as dopamine, serotonin and endorphins. the transmission of hormones such as dopamine, serotonin and endorphins..

When consumption ceases or does not occur in sufficient quantity, the organism is altered by the absence of familiar elements. This causes intense discomfort that is associated with the missing substance, resulting in a persistent craving for it.This leads to a persistent desire to consume it. With the passage of time, if consumption does not occur, the brain returns to a normal state, so 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 will evoke consumption. Thus, a desire to repeat the experience the experience in the face of the stimulation linked to it..

On the other hand, from operant conditioning it can be established that the positive consequences of consumption and its persistent experimentation act as reinforcement for the consumption itself, while generating the expectation of continually obtaining the same reward and at the same intensity. In its absence, the response of repeating the consumption in order to achieve the same effects is generated.

The cognitive perspective of craving

A more cognitive view of craving refers to the fact that craving is mediated by the person's own expectations and self-efficacy beliefs.A main element to explain it is information processing.

One of the most popular cognitive-behavioral models in the explanation of craving is the dual affect model. the dual affect modelwhich points out that craving comes on the one hand from the aversive emotional state that causes withdrawal syndrome or unpleasant events, and on the other hand 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 aversive effects of its absence.

Another possible explanation is found in the model of cognitive processingwhich stipulates that in drug-dependent persons the habit of consuming has become automated, requiring an effort not to consume. From this perspective, craving is a non-automatic process provoked by the effort of not consuming.

Craving in addiction treatment

Treating substance dependence is a difficult and lengthy process, which can be influenced by many different factorsIt can 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 perceived social support.

In this process, abstinence will cause profound suffering in the person undergoing treatmentThis suffering will generate in a very powerful way the desire or craving 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 must be especially taken into account when establishing treatment programs. This is why it is it is essential to develop relapse prevention programs. during any treatment.

In order to prevent it, it is necessary to first of all to inform and educate the patient that craving 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 craving, in order to avoid them or learn to deal with them in an adaptive way without resorting to consumption. Strengthening and empowering the patientAnother useful strategy to apply is to strengthen and empower the patient, restore his or her sense of control and give him or her tools and strategies to manage stress and resist craving.