Cravings – The all consuming experience of wanting something

In my studies of addiction, the concept of cravings comes up often. Researchers talk of “wanting” versus “liking” of drugs and of the idea that cravings are a programmed response to environmental signals that have been connected to drug use through experience.

What are cravings?

I agree with these descriptions and the idea that cravings are strong memories that are linked to the effect of drugs on the brain’s neurochemistry. The immense neurotransmitter release that is often brought on by the ingestion of drugs is responsible both for the experience and the lasting effects on learning. When it comes down to it, memories are really the brain re-experiencing an event, so it makes sense that reliving a drug, sex, or other past-compulsive experience would cause a serious emotional reaction.

But aside from all the research, I know very well what cravings feel like. I know the intoxication you feel the moment that memory hits you and your entire body tingles with anticipation. It’s as if your whole being is crying out saying “This is what we’ve been waiting for. Give it to me!!!” I never know to expect it, but when they hit, there’s no questioning – I know that a craving has just taken over me. It’s no wonder that people go out over these things, especially early on in recovery.

How to deal with cravings

I’m now at the point where no matter how strong the craving, I’m not about to throw everything I’ve worked for out the window for another hit. But still, it’s just so damn tempting.

When you have a craving, recognize it for what it is. You might as well enjoy the rush, it’s like a freebie you don’t get to control. By being scared of the feeling, you induce more anxiety and shame that may lead you to act out. Instead, recognize your lack of control over the craving, let the experience happen, and go on with your life.

If the experience is overwhelming, make sure there’s someone you can talk to about it (a therapist, partner, parent, or 12 step sponsor). As time passes your cravings will become less and less frequent, though without specific treatment, their intensity will likely not go away.

Cravings are a part os the reality of addiction – knowing what to do with them is a key to success.

Drug use memories and relapse: Can medication provide addiction help?

About a year ago, while sitting in a lecture on learning and memory, the idea that certain drugs can affect the emotional responses to memory long after the memory itself has been formed came up. As someone interested in addiction research, the implication for treatment immediately came up in my head:

Could we reduce the effect of triggers by giving people a pill?

In one word – Yes! But, the answer is not, in fact, that simple. Even in the studies already done in PTSD patients, the memories have to be re-triggered and the drug given at exactly the right time to be effective. In fact, in humans, some of the best work has been done in PTSD patients immediately after the traumatic event.

Addiction help through relapse prevention

Still, a recent study in animals suggests that the theory is sound. By interfering with the activity of a neurotransmitter important in the formation of memories, researchers were able to stop animals trained to self-administer cocaine from doing so. The animals, which had been trained to push a lever for cocaine when a light went on, reduced, or even stopped responding after a single dose of a substance that blocked memory formation. Essentially, the researchers prevented the animals from relapse. Again, this only worked if the drug was given while the light (as in the drug-trigger) was presented at the same time.

More recent studies, using repeated doses of the drug propranolol, have been shown to have an even more promising effect. Check out my coverage of that research here.

Given the powerful role of triggers in relapse, this avenue of research has some promising possibilities for future treatment of drug addiction.

The brain addiction connection : Crystal meth, and our friend dopamine

We’ve talked about the general way in which neurons in the brain communicate with one another and then reviewed the ways in which cocaine messes some of the basic processes that the brain depends on.

It’s time to move on to another drug, and since the brain-addiction connection is similar for meth and cocaine, it seems the natural next step…

Methamphetamine (speed, ice, glass, crystal, meth)

Remember how we said that cocaine affects the way that dopamine is cleaned up after being released? Well, crystal meth also affects dopamine, but in a different way:

Instead of not allowing a molecule (DAT) to pull released dopamine back into the cell that released it, methamphetamine doesn’t allow the dopamine in a cell to be stored in the little packets that it’s supposed to be put away in. Like the DAT molecule, there’s another molecule that packages dopamine (and other neurotransmitters actually).

This molecule is called vesicular monoamine transporter (VMAT) because it puts a specific kind of neurotransmitter (called monoamines) into packets called vesicles.

You may be asking this right about now:

“If cocaine and crystal meth act in such similar way, why are their effects so different?”

That’s a very good question.

Even though these two ways of affecting dopamine seem very similar, they cause different changes in the levels of dopamine in the brain:

This flood is similar to the effect of crystal meth on the brain. By interrupting the way the brain packages dopamine, speed causes an unstoppable flood of this neurotransmitter.While cocaine doesn’t allow the neurons to take dopamine back up (reuptake), the brain has these small monitoring devices called autoreceptors. These receptors detect the levels of dopamine in the brain and adjust the output. When cocaine increases dopamine levels, these autoreceptors decrease the amount of dopamine being released.

The problem with crystal meth is that the dopamine can’t be packaged at all, which means that whether the autoreceptors tell the brain to turn down dopamine output, the fact that the dopamine won’t go into it’s packages means it just keep leaking out.

Imagine having a burst pipe and trying to stop the flood by turning down the faucet… not too helpful, right?!

So what you end up with is a long lasting flood of dopamine that the brain can’t do much about… You may have already figured it out, but this is one of the many reasons why crysal meth has become the new drug epidemic; it just does its job really really well!

Dopamine function in a non-drug-using, meth addict after quitting, and a meth addict after 1 year of staying cleanThe long lasting effects on the brain are similar to those of cocaine, but can be even more devestating. Meth is very neurotoxic meaning that at high levels, it can actually kill neurons by over exciting them. In fact, for both cocaine and methamphetamine, but especially for meth, it can take a very long time (a year or more) for dopamine function to look like anything close to a non-user’s brain (look for the decrease in red in the middle figure showing less overall activity in this area).

Check out this video about meth’s effects: