Craving. What it really is and how to deal with it

[Paracelsus]

Definition
Craving - an intense, urgent, or abnormal desire or longing. In our case, we are talking about psychoactive substances. But this can include food, shopping, relationships, impressions, alcohol, junk food, gambling, etc. Thus, craving is a sharp, intense fixation on consuming of something.

It`s inclusion as one of the 11 diagnostic criteria for addiction in the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders) makes craving a key clinical construct for the assessment and treatment of substance use disorders and behavioral addiction.

I`m hope some information about this condition will help some of the readers to recognize it, not brush it off and resist it.

Mechanism

Usually, craving is triggered by some kind of... trigger - something that reminds of consumption. It starts small, the desire intensifies and reaches its highest point, and then weakens and passes. All of this is due to surges in hormones and / or neurotransmitters (look at pic above). The path: trigger-initiate craving-gain-peak-fall is the same and works for everyone. Craving, if not specially "accelerated", usually lasts from several tens of seconds to several minutes. It weakens only if it`s not "reinforced" through consumption.

The main problem is that most people, when faced with craving, make the decision to consume the substance before this state of mind naturally subsides. We discuss situations where addiction has not yet moved to a deeply pathological level and / or manifests itself physically.

The stand

For the sake of imagery, craving can be thought of as an arrogant homeless shabby cat - if you feed him, he will come, yell, destroy your house and demand more.

The only option is not to feed him, not to give him what he so much asks for. In the beginning, of course, he will arrange a show - an escalation of demands.

The impudent will loudly shout and demand demand demand. If you manage it, there a change of tactic will take place - the impudent role will become a sucker. Thoughts like this may appear in your head:
Just once,
A little you can,
This case is special,
You have not used for a long time, you are such a good fellow,
You proved that you can restrain yourself, let's note it!

It`s more difficult to resist this approach. Especially if you don’t try, don’t put effort into fighting the beast.

For this reason, in most cases, relapse of addiction occurs in the first three months. This is one of the key deadlines to keep in mind and focus on.

To reduce the risk of relapse, it is very important to follow simple rules for at least these 3 months, under which it will be more difficult for the beast to pester you:
1. Don't be hungry.
2. Don't be angry or annoyed.
3. Don't be lonely. Find those who will listen, support, and will not condemn.
4. Do not associate with people who use or may facilitate use. Avoid the same places, situations and conditions.

It`s also really helpful for a person struggling with craving to periodically ask themselve the following questions:
- How do I feed my "raccoon"?
- Am I feeding him through the eyes and ears (looking, listnening about substances)?
- Am I feeding him through the memories about "good old days"?
- Feeding by savoring?
- Feeding throw the hopes of future consumption?



News from the scientific community

The mucolytic drug N-acetylcysteine (ACC) may be considered as a drug to reduce craving in substance use disorders.

According to a meta-analysis and systematic review of randomized clinical trials (RCTs), N-acetylcysteine treatment was superior to placebo. N-acetylcysteine reduced cravings in cocaine, methamphetamine and tobacco addictions, as well as cannabis addiction. Link to article in clearnet: pubmed.ncbi.nlm.nih.gov/28898494/

N-acetylcysteine is a source of cystine, stimulates the uptake of glutamate and prevents subsequent overstimulation of postsynaptic mGluR5 receptors. Normalization of cystine - glutamate metabolism by N-acetylcysteine leads to a decrease in the release of synaptic glutamate through a negative feedback mechanism.

So, N-acetylcysteine promotes restoration of intracellular and extracellular glutamate concentration in the nucleus accumbens, which may be associated with decreased cravings and, therefore, reduce the likelihood of relapse of addiction.

In addition to this mechanism, N-acetylcysteine reduces inflammation and promotes neurogenesis, which also influences the correction of drug seeking behavior.

According to the reviewers, N-acetylcysteine is suitable for the experimental treatment of drug craving for the first.

But do not rejoice ahead of time. A recent well-designed study found that NAC was not more effective than placebo in combating methamphetamine addiction. Clearnet: pubmed.ncbi.nlm.nih.gov/34308314/

Also, NAC was unable to show decent results for early and end-of-treatment abstinence in adult cigarette smokers. Clearnet: pubmed.ncbi.nlm.nih.gov/34171822/

Nevertheless, NAC can be useful as part of a comprehensive approach to combating addiction and stabilizing functioning. More about the role of NAC and its efficiency discussed in this recent study. Clearnet: sci-hub.st/10.1007/s43440-021-00283-7



Knowing your enemy does not mean defeating him. But this knowledge will definitely give you an edge. Fighting with craving and addiction, even not in it`s most pathological form, requires willpower, perseverance, patience and a willingness to replace vaccinations, to change oneself. Only by equipping yourself with these qualities can you come to balance and control your life without clouding your already imperfect brain with the dope of neurotransmitters.



Thank you for your time.
I invite you to discuss the topic and broadcast your experience with craving.

 

[MuricanSpirit]

I can tell that I crave for cannabis, yeye I know most people say its not that addictive but still it is.

eg. I have a lot of shit to do and sometimes I rather just smoke one even if I fully understand and know that it will hinder me in my current task. So I call this addiction. I wouldnt stop to go to work for it and ofc there are lines I would never step over but still its the first thing I do in the morning and the last one before I go to sleep.

 

[diogenes]

While I fully appreciate the scientific research behind addictions, I also think that addiction and addictive behaviour differs from person to person. Some people are heavy drinkers then stop and they never become alcoholics. The soldiers in Vietnam were given opiates to manage the atrocities of the war, but then were not addicted when returned to their life back home (instead some of them had bad PTSD but that`s a different story). Personally I have smoked periodically in my life but then stopped all of a sudden without a moment of craving. I think there is an underlying psychological setup in certain people which makes them more vulnerable to addiction and less able to stop. This is exaclty why it is disgusting to criminalize drug use and penalize it instead of trying to heal the underlying problem. Someone is already tortured by depression, loss, trauma etc resorts to drugs to alleviate the pain and the goverments hunt him down and push him even deeper instead of offering help. This only deepens addiction by making the original problem worse.

 

[Paracelsus]

You are right that it is naive to blindly extrapolate research findings to each individual. We all have our own special genotype, history of childbirth, upbringing, life, stress and disease. All this together determines the personality and its ability to respond to external and internal challenges. These also include craving, as an internal response to the imbalance of neurochemical homeostasis induced by external substances/ And where one person can easily cope with the danger thanks to personal characteristics, the support of loved ones and a good metabolism, there another will go into a spiral of addiction.