What Triggers Cravings?

When was the last time you had an overwhelming craving for an addictive substance? Do cravings drive you to use drugs? Would you consider yourself addicted to: alcohol, nicotine, cannabis, methamphetamine, heroin, cocaine, or a prescription drug?

If you are uncontrollably overindulging in any type of drug and want to stop, I hope this blog post inspires you to take action and get the monkey off your back. The latest research offers new methods to stop cravings and break patterns of substance abuse.

Why Are Americans So Addicted to Alcohol, Drugs, and Nicotine?

Americans are more addicted to substances than we've ever been. Binge drinking, heavy cannabis use, and heroin overdoses are at an all-time high across the country. Recently, I wrote a Psychology Today blog post, "The Psychological Damage of Alcohol Abuse Can Be Lethal," about one facet of this substance abuse epidemic.

The growing epidemic of heroin use is particularly alarming. The reason for the uptick in heroin use and subsequent overdoses has been linked to widespread addiction to painkillers such as OxyContin, Percocet, or Vicodin. Opioid users often switch to heroin when their prescription expires or the pills become too expensive to support their habit. Heroin may be cheap, but the cost of its malstrom is astronomical.

A recent report titled, The Toxicity of Recreational Drugs, by Robert Gable reported on the addictive potential of various substances. In the report Gable asked, and concluded, the following:

Of the people who sample a particular substance, what portion will become physiologically or psychologically dependent on the drug for some period of time? Heroin and methamphetamine are the most addictive by this measure. Cocaine, pentobarbital (a fast-acting sedative), nicotine, and alcohol are next, followed by marijuana and possibly caffeine.

A 2011 report by Catalina Lopez-Quintero and colleagues titled, "Probability and Predictors of Transition From First Use to Dependence on Nicotine, Alcohol, Cannabis, and Cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)," was published in the journal Drug and Alcohol Dependence. The researchers concluded:

In a large, nationally representative sample of US adults, the cumulative probability of transition to dependence was highest for nicotine users, followed by cocaine users, alcohol users and, lastly, cannabis users. The transition to cannabis or cocaine dependence occurred faster than the transition to nicotine or alcohol dependence. Furthermore, there were important variations in the probability of becoming dependent across the different racial-ethnic groups. Most predictors of transition were common across substances.

"Person-Specific Cues" Are the Strongest Triggers for Substance Abuse

A recent study on cravings found that “person-specific cues” which are unique to every individual have an acute effect on triggering cravings for an addictive substance. Person-specific cues include things such as spending time with friends who also use your substance of choice, revisiting a place linked to using the drug, or hearing a specific song.

The researchers found that person-specific cues have a longer and stronger effect on the duration of cravings than “substance-specific cues," which include things such as being in the presence of bottles, pipes, syringes, lighters or other paraphernalia used to do drugs.

The May 2015 study, “Craving and Substance Use among Patients with Alcohol, Tobacco, Cannabis or Heroin Addiction: a Comparison of Substance- and Person-Specific Cues,” was published in the journal Addiction.

The study included 132 outpatients who were in the early phase of seeking treatment for alcohol, tobacco, cannabis, or opiate addiction. The researchers used mobile technologies to monitor and question participants throughout the day about the degree of their cravings, any substance use, and their exposure to various cues.

The researchers concluded that person-specific cues create more intense cravings and persist longer than substance-specific cues. Craving intensity predicted the odds of a relapse. The researchers believe that mobile technologies could provide multiple opportunities for understanding and addressing person-specific risk factors and fine-tuning individually tailored drug intervention programs in the future.

“Motivational Interviewing” May Be the Most Effective Way to Quit Smoking

According to data provided by the World Health Organization, there are over 1000 million smokers worldwide. Tobacco use is strongly associated with premature death. Do you smoke? Do you want to kick the habit? If so, "Motivational Interviewing" is an effective method for overcoming nicotine addiction.

A recent study by an international team led by researchers from the University of Grenada found that motivational interviewing can help smokers view tobacco as something disagreeable which helps them quit the habit.

Motivational Interviewing is a psychological technique used to produce changes in behavior. This intervention method focuses on amplifying the negative discrepancies between current behavior and positive consequences of a targeted behavior.

The May 2015 study, “From Appetitive to Aversive: Motivational Interviewing Reverses the Modulation of the Startle Reflex by Tobacco Cues in Smokers not Ready to Quit," was published in the journal Behaviour Research and Therapy.

Before their motivation interviews, smokers responded to tobacco images as being agreeable in the same way they responded to pleasant images and photographs. After the intervention, however, their response to the same tobacco images was one of repulsion and disgust such as when viewing disagreeable images of a corpse or violence.

In a press release, the researchers concluded “Motivational Interviewing manages to change, at least temporarily, the emotional response that smokers present before stimuli associated to tobacco, from pleasant to unpleasant, which helps them overcome one of the main obstacles for quitting tobacco consumption, i.e. motivation for change."

The researchers concluded that Motivational Interviewing was the most effective type of intervention for smoking cessation when compared to other types of interventions.

Addiction Could Be a Pathology of Poor Decision-Making and Bad Choices

Philip K. Dick said famously, "Drug misuse is not a disease, it is a decision, like the decision to step in front of a moving car. You would call that not a disease but an error of judgement." The latest neuroscientific findings on drug misuse and addiction show that his sentiment might be right.

Is it time to rethink traditional interventions that treat drug addiction as a "disease"? Some neuroscientists believe the answer is "yes." Neuroscientists at McGill University are focusing on abnormalities in brain regions linked to poor decision-making and self-control as being central to cravings and subsequent addictive behavior.

Recently, researchers from the RIKEN Center for Molecular Imaging Science in Japan and the Montreal Neurological Institute of McGill University in Canada teamed up to study cravings and addiction using brain imaging.

Their research revealed, when someone craves a drug such as nicotine, various brain regions used for decision-making light up during functional Magnetic Resonance Imaging (fMRI). Abnormal brain circuitry between these decision-making regions could be the driving force for cravings and a relapse of drug use.

The 2013 study, "Dorsolateral Prefrontal and Orbitofrontal Cortex Interactions during Self-Control of Cigarette Craving," was published in the journal Proceedings of the National Academy of Sciences.

The research shows that cravings for a drug such as nicotine can be visualized in specific regions of the brain that are implicated in determining the value of actions, in planning the actions, and in overall motivation. This may explain why the aforementioned study found that “Motivational Interviews” are such an effective treatment for smoking cessation.

Previous studies have suggested that one of the reasons that addicted individuals stay hooked is that they place a greater value on immediate rewards of getting a fix than they do on the negative consequence or delayed rewards such as being healthier.

This research is all part of a burgeoning field called "neuroeconomics" which analyzes decision-making in humans by calculating the negative costs vs. the likely rewards of choices that individuals make regarding substance abuse. The researchers found that the neuroeconomic value of a drug to an addicted individual mirrors the degree of cravings seen in the brain regions of decision-making using fMRI.

The more someone craves a drug, the more decision-making regions light up. These imaging results can be used to predict future consumption. In a press release, co-author of the study, Alain Dagher, PhD, said:

Policy debates have often centered on whether addictive behavior is a choice or a brain disease. This research allows us to view addiction as a pathology of choice. Dysfunction in brain regions that assign value to possible options may lead to choosing harmful behaviors.

Conclusion: Making the Decision to Stop Using Is in the Locus of Your Control

Whether it's nicotine, alcohol, cocaine or heroin, the latest research suggests that person-specific cues create the most intense cravings. The neuroscience behind cravings suggest that addiction may be more about faulty decision-making brain systems than an actual "brain disease" based on addiction to a drug.

According to Dagher, "This research uncovers the brain circuitry responsible for self-control during reward-seeking choices. It is also consistent with the view that drug addiction is a pathology of decision making."

The latest studies on cravings help us better understand the neural basis of addiction. Hopefully, this cutting-edge research will help people squelch cravings and shake up the status quo regarding "recovery" and conventional rehab treatments or interventions for addiction.

If you'd like to read more on this topic, check out my Psychology Today blog posts,

• "The Psychological Damage of Alcohol Abuse Can Be Lethal"
• "Hyperactive Dopamine Response Linked to Alcoholism"
• "Does Long-Term Cannabis Use Stifle Motivation?"
• "Heavy Marijuana Use Alters Teenage Brain Structure"
• "Why Are Cannabis Users Susceptible to Memory Distortion?"
• "Mindfulness: The Power of "Thinking About Your Thinking""
• "Returning to an Unchanged Place Reveals How You Have Changed"
• "5 Neuroscience Based Ways to Clear Your Mind"

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