Craving: causes of substance use cravings

The use of psychoactive substances, if it is done more or less frequently, it ends up causing the body to generate tolerance to this substance. This means that in order to achieve the same effects as at the beginning, the administered dose, or space consumption so that the body gets used to working without her.

If the body stops consuming or continues with doses that no longer take effect, some type of syndrome of withdrawal that causes a variable level of discomfort and suffering, appearing an intense desire to consume the substance in question. It's about the craving.

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What is craving?

We understand how craving the feeling of imperious and urgent need to carry out 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, that is, it does not have to provoke an action that leads to consumption.

This wish is given in subjects who have or have had dependence 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.

The craving it can appear even in individuals who have stopped using. Generally, it can be present actively 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 the consumption. This without taking into account the existence of falls and relapses.

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Causes and contexts of appearance

The craving for drug use is usually associated with the need caused by abstinence from it, but that reason is only one of those that exist. Some of the main moments in which craving appears are the following.

1. Abstinence syndrome

Withdrawal from a substance to which the body and mind have become accustomed can be very hard.

If the withdrawal of consumption occurs abruptly, too fast or inadequate it is frequent that diverse symptoms of variable danger appear. Even if this occurs in a planned and correct way, the decrease in consumption or the non-increase in the face of Feeling the effects can cause discomfort, frustration, anxiety and even aggressiveness and under control when subject. And even if the subject does not try to disengage, the progressive increase in the tolerance of the body towards the drug causes the need for increasing consumption, generating discomfort by not to get it.

In all these circumstances, it is common for craving to appear, with the purpose of avoiding or reducing the discomfort associated with non-consumption.

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2. Stimulate conditioning

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

This causes that, in the long run, coming into contact with certain types of stimuli causes a elicitation of the consumption response, appearing the craving before said stimuli, people or situations.

3. Pleasure seeking / displeasure avoidance

Many drug users start using because it generates pleasant sensations or to escape from problems concrete. 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, dejection or simple boredom. Sometimes it also appears as a way of trying to enhance a rewarding experience, such as with sex or food.

Possible explanations for the craving for consumption

The causes of this phenomenon have been explored and studied by numerous authors and schools of thought. Some of the possible explanations offered are as follows.

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 consuming maintains altered different brain mechanisms such as the brain reward system and the transmission of hormones such as dopamine, serotonin, and endorphins.

When consumption ceases or is not produced 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 the need will not be as high.

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Explanation according to conditioning

Another explanation can be found in conditioning.

On the one hand we can observe typical components of the classical conditioning, which in this case would cause a link between consumption and elements of the environment, with which the presence of said elements will evoke consumption. Thus, a desire for repeat the experience before the stimulation linked to it.

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

The cognitive perspective of craving

A more cognitive view refers to craving is mediated by one's own self-efficacy beliefs and expectations, being a main element to explain the information processing.

One of the most popular cognitive-behavioral models in explaining craving is the double affect model, which indicates that the craving comes from a part of the aversive emotional state that causes the syndrome of abstinence or unpleasant events and on the other the positive emotional state generated by the consumption of 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 aversives of its absence.

Another possible explanation is found in the cognitive processing model, in which it is stipulated that in drug addicts the habit of consuming has been automated, requiring an effort not to consume. From this perspective, craving is a non-automatic process caused by the effort not to consume.

Craving in addiction treatment

Treat substance dependence it is a difficult and prolonged process in time, which can be influenced by very different factors such as the type of treatment applied, the experiences of the individual during the period of time in which it is carried out or the perceived social support.

In this process, abstinence it will cause deep suffering in the person under 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 falls (consuming on one occasion but without necessarily reinstating the habit) and relapse (in which the habit of consumption is recovered), with which it must be especially taken into account when establishing programs of treatment. It is because of that it is essential to develop relapse prevention programs during any treatment.

In order to prevent it, it is necessary in the first place inform and educate the patient in which the desire for consumption is normal and the fact that the 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 desire. to do so, in order to avoid them or learn to cope adaptively without resorting to consumption. Strengthen and empower the patientAs well as restoring your sense of control and giving you tools and strategies that help you manage stress and resist craving, is another useful strategy to apply.