Cravings can be defined as one of the most common and recurring features in the abstinence and recovery process of drug addiction. They can be triggered by different aspects related to an individual’s drug use, in the form of people, places, time, feelings, situations etc. The key to the management of cravings comes from a recovering addict’s ability to mindfully identify them and be prepared for their management through proactive learning of scientifically tested skill sets.
In this article, we will explore conditioning as a tool that can be applied to managing cravings in the long run.
What are Cravings?
Cravings in chemical addiction can be defined as a strong desire that arises as a result of exposure to elements that remind you of your addictive patterns, giving rise to unwelcome emotions that make you want to use your substance of choice. The elements causing these emotions can be anything from people, places, and times, to feelings and things. Cravings can manifest over a long period, from the time when your last dose wears off, to the acute stages of withdrawal, and the early to late stages of recovery.
Cravings have been a key pillar in addiction research for a long time, despite only being added recently in DSM-5 as a criteria for substance use disorder. Cravings can be defined as a desire or urge to use a mood-altering chemical. The concept of Cravings can be defined through behavioural and physiological aspects, which play an extensive role in identifying the complexity present in the idea of cravings in addiction as a disease.
What are the Causes Behind Cravings?
The use of addictive substances such as morphine, alcohol, and marijuana alter the abuser’s brain chemistry. During the prolonged use of the abuser’s drug of choice, the brain experiences persisting spikes in its level of dopamine, a neurotransmitter associated with pleasure. This leads to the inhibition of your body’s natural production of these hormones, causing your body to crave the drug of choice to reach the “Baseline” that it perceives to be normal.
Cravings are considered a common symptom among those in recovery. They do vary in quantitative measurements such as frequency and duration, and research suggests that addicts who have been addicted for a longer period will experience stronger cravings, as longer substance abuse will cause greater changes in your brain, affecting your cognitive and behavioural patterns in the long run.
How Long Do Cravings Last?
As mentioned above, the severity and duration of cravings are correlated with several factors such as how intense and how long-lasting the addiction was. With that being said, as per the literature, cravings and urges should be expected as a long-term feature of recovery. However, the craving does subside in intensity as an addict progresses on his journey of recovery.
Cravings are directly related to external and internal triggers such as time of day and your mood. Even though symptoms such as cravings can last for years on end, studies have proven that active participation in treatment relates to a significant fall in the craving level for patients in abstinence and early recovery.
Conditioning in Addiction
Mood-altering chemicals are initially used by patients for their euphoric effects. However, repeated drug use leads to a major association between these euphoric effects and environmental elements such as the location of the drug use and other auditory and visual stimuli. As such, these environmental “cues” become motivational factors that play a role in promoting continued drug use and can even cause the triggers that lead to cravings and eventual relapse.
Below, we will discuss what current research says about how we can apply behavioural therapy and conditioning to actively facilitate the extinction of beliefs that manifest in the form of cue-provoked cravings that lead to the eventual relapse of recovering addicts.
Classical Conditioning for Long-Term Craving Management
In Classical Conditioning, one of Ivan Pavlov’s experiments was set up in a way that a dog, being the test subject, was presented with two stimuli. One being the bell, and another being the food. The bell would be ringing first and the food would be presented second. This meant that the food was the unconditioned stimuli while the bell was the conditioned stimuli because the pattern of presentation meant that the bell would ring first, and the food would arrive second. The experiment created a paired association between the bell and the food. Meaning that the dog had been conditioned to expect food and salivate when the bell rang.
So how are the principles of classical conditioning linked to craving management? In Pavlov’s experiment, the bell served as a cue to the subject, telling it that the food was on its way. Similarly, triggers are external and internal cues that have a powerful effect on an addict’s mind leading to craving. For example, if a patient used to ingest pills in their car on their way back from work, both the car and the drug form a paired association. Hence, the car signals to the individual that the drugs are on their way, just as the bell signalled to Pavlov’s dogs that food is coming. Once the car has become a conditioned stimulus (a cue), the car itself can act as a trigger point that leads to a strong craving.
There are elements of Pavlov’s experiments on classical conditioning that can help fight triggers and cravings. The experiments show that once food stops being presented alongside the bell, the subject ends the affiliation between the conditioned and unconditioned stimuli. Meaning that eventually, when the bell rings, there is no more salivation from the subject. These principles can be applied in Cue Exposure Therapy for addicts to be able to fight their urges in the long run.
Cue Exposure Therapy
Cue Exposure Therapy relies on the principles of classical conditioning to treat cravings. The cues or triggers that are linked to addictive behaviours (i.e. place, time, weather, people, etc.) are the conditional stimuli that trigger a craving in the subject. With persistent exposure to these triggers, without there being any addictive behaviour involved, these cues slowly lose their power to induce craving among the subject, helping them better manage their drug addiction.
Since it is impossible for most people recovering from addiction to eliminate every trigger or cue linked to their addiction, it is important to reduce the power these cues have over the individual. Whilst these cues or triggers can lose power over time, being proactive and participating in therapies such as Cue Exposure Therapy can play a significant role in making craving management easier, reducing the risk of relapse.
Take for example an individual who frequents a mall where he ingests drugs in the public bathroom. This practice has led to him creating a paired association between the mall (Conditioned Stimuli) and Drugs (Unconditioned Stimuli). Over time, if it becomes necessary for this individual to go to the mall, he may need to find a coping structure beyond avoiding going to the mall. This is where Cue Exposure Therapy comes in. By going to the mall again and again and preventing the use of their preferred substance, their neural pathways stop associating going to the mall with the use of the drug, allowing for a reduction in the frequency of cravings related to the triggers. This is just one example of how exposure to conditioned stimuli can weaken/end the paired association between an environmental cue (External Trigger) and the use of a substance.
Conclusively, it is important to note that the research done on Conditioning, Classical Conditioning, Addiction, and Craving Management does not hint towards cravings caused by external triggers becoming extinct due to exposure to the Conditioned Stimuli for the addict. The literature does however show that the cravings caused by external triggers i.e. environmental cues can be reduced with the use of cue exposure therapy based on the principles of classical conditioning. Cue exposure therapy can play an especially important role in providing an alternative where avoidance of the triggers is not possible for the addict.