This article has been medically reviewed by Dr Robert Lefever, a world-leading addictions specialist.
The reason that people most frequently use to drink alcohol is craving. The word “craving” means a strong desire. No doubt, this term is used widely, but everyone defines it differently. And for people who abuse alcohol, craving means an irresistible urge and desire, even a weak one, to drink alcohol.
Many people who drink alcohol and even those who try to abstain from alcohol experience cravings. Returning to heavy alcohol consumption after a period of moderate use or abstinence is common in drinkers. In addition to personal will, efforts and consistency, professional support and care matter a lot.
Traditional treatment approaches for alcohol dependence consider relapse as a treatment failure. These approaches have a dichotomous perspective for treatment. According to that dichotomous perspective, a person is either treated/abstains from alcohol or is relapsed. However, relapse is a transitional phase, and it is a process that unfolds with time.
If you are experiencing issues with alcohol dependence and feel unable to prevent yourself from falling prey to cravings, don’t worry. Call 0203 955 7700, and professional counsellors of help4addiction will devise a treatment plan suitable for you. Moreover, educating yourself about craving and different ways to fight it will help a great deal.
What Is Craving?
Addiction is a chronic and relapsing disorder associated with drug or alcohol consumption. The following three characteristics characterise it:
- A compulsion to drug or alcohol intake
- Not being able to control drug intake
- Experiencing a negative emotional state such as irritability, anxiety or dysphoria when one can’t get the drug.
In addition to this, you can conceptualise addiction as a three-stage cycle:
- binge/intoxication
- withdrawal/negative effect
- preoccupation/anticipation
When an individual cut down alcohol to a moderate amount or refrains from it for a while, the body tries to maintain its equilibrium or the previous state of functioning. As a result of these allostatic changes in the reward and stress system, withdrawal effects and preoccupation become worse over time. And the individual, in turn, feels the compulsion to seek and take alcohol.
Moreover, the concept of craving is central to addiction. But still, the clinicians and researchers have not developed a single definition of craving. Instead, they have tried to create numerous models of alcohol and other drug cravings.
Singleton and Gorelick (1998) have developed two general categories of craving models; conditioning and cognitive models. Conditioning models are based on the principle of classical conditioning. For example, consuming alcohol generates a significant physical, emotional, and psychological effect when an individual consumes alcohol. And the individual then craves for a drink to achieve the same effect again, also known as tolerance. This then turns into an addiction.
Conditioning Model
In terms of the addiction and craving model, some cues such as the sight of a beer bottle, bar, and social get-together become paired with alcohol consumption. These alcohol-related cues become conditioned stimuli and generate the same psychological and physiological effects as those individuals get with alcohol alone.
Moreover, two primary sources of reinforcement also play a role. These two sources are positive reinforcement and negative reinforcement. Primary reinforcement is the process in which a pleasant stimulus is added to increase the probability of a response. And in negative reinforcement, an aversive stimulus is removed to increase the likelihood of a response.
And suppose in response to these alcohol-related cues, the individual doesn’t immediately get alcohol. In that case, these physiological and psychological responses turn into cravings. These cravings urge the individual to drink alcohol either to experience the pleasant effect of alcohol or to remove/avoid adverse effects or withdrawal symptoms.
Cognitive Model
The cognitive model of cravings focuses on the explanation of craving in terms of cognitive processes. According to this model, your response to alcohol and alcohol-related cues depends on your expectations and beliefs. For instance, what do you expect to achieve by consuming alcohol, or to what extent you will gain pleasure from drinking? Similarly, your beliefs matter, i-e., are you able to resist the urge or cope with the desire to drink.
Neuroadaptive Model
Although both the models mentioned above have their significance, scientists believe that another feature of alcohol dependence is neuroadaptation. No doubt, long-term consumption of alcohol brings specific changes in the functioning of the mind and body. As the brain and the body are designed to maintain balance for the body’s normal functioning, many cells adapt to the continuous presence of alcohol. And hence, function accordingly.
This neuroadaptation, in turn, results in intolerance, or withdrawal, or reward memory. This reward memory is associated with some brain cells. It may be unconscious but enhances the attention of the individual to alcohol-related environmental cues.
What Are The Signs Of Alcohol Craving?
An individual experiences craving during early alcohol withdrawal. Moreover, you may also experience cravings during later recovery when you stop consuming alcohol. Brain mechanisms adapted to the consistent presence of alcohol result in many physiological and psychological symptoms. Although craving is just an urge or a desire, it is associated with many symptoms. Such symptoms include:
- Arousal of the autonomic system
- Cardiovascular hyperactivity
- Anxiety
- Sleep difficulties
- Concentration problems
- Lack of motivation
- Depression
- Sense of discomfort
- Others
In case you are experiencing any of these signs and loss of control, call 0203 955 7700. Help4addiction counsellors will help you in relapse prevention and recovery.
Why Does Relapse Occur?
Some mechanisms that lead to cravings may persist for weeks to months. And if the individual consumes very little alcohol or abstains from it, they would eventually change the brain mechanisms bringing them to the original state. And this original state resulted in a decrease in craving and enhanced overall being.
However, people can relapse to alcohol abuse even after many months of abstinence. Such people report intense urges or thoughts of drinking alcohol. This may result from recollections of memories, thoughts, and feelings over some time. This is a classical stimulus-response relationship. An environmental cue or changes in internal emotional states activate specific brain systems. This activation then leads to craving.
How To Treat Alcohol Craving and Prevent Relapse?
Marlatt and Gordon’s (1985) proposed a response prevention model based on social-cognitive psychology. The model incorporates the response prevention model and different cognitive and behavioural strategies that help an individual prevent or reduce the duration of relapse episodes.
According to the RP model, two types of factors contribute to or maintain a relapse episode. One category is immediate determinants, such as coping skills of an individual, high-risk situations, abstinence violation effects, and outcome expectancies. And the other category is called covert antecedents that includes lifestyle imbalances and cravings.
Based on the RP model, the treatment starts with assessing situations that cause relapse, especially the emotional and environmental characteristics. After the identification of these characteristics, the therapist analyses the response of the individual to these situations. Moreover, examining the lifestyle factors that expose the individual to these situations is essential.
After this assessment, the therapist devises strategies to enhance the cognitive and behavioural repertoire of the individual. These strategies help the individual cope with the situations and environmental and emotional cues and reduce the risk of relapse.
Different studies support the conditioning model of cravings concluding that many internal and external cues trigger a craving for alcohol just like Pavlo’s conditioned stimulus. Therefore, many treatments approach for alcoholism focus on intervening in this conditioning process and preventing relapse resulting from cravings.
In this regard, treatment strategies such as cognitive behavioural therapy help individuals cope with and manage cravings resulting from situations and cues. Similarly, joining social networks such as Alcoholics Anonymous distract the individual from craving. This is a highly effective program that also helps people enhance their resistance mechanisms.
Another treatment strategy is the use of medications, also known as anti-craving medications. The Food and Drug Administration (FDA) has approved three medicines for the treatment of alcohol dependence. These medications are acamprosate, naltrexone, and disulfiram. Of these medications acamprosate, and naltrexone are at the forefront and don’t cause tolerance, withdrawal symptoms, or any overt psychoactive effects on the CNS.
Conclusion
Alcohol cravings are the most frequently narrated cause of alcohol consumption after abstinence. Cravings can last from a few weeks to several months or even years. Suppose an individual doesn’t identify the cues that trigger cravings and know how to cope with these cravings. In that case, they can experience relapse. The treatment of alcohol dependence assesses the triggers, lifestyle, individual’s response to cravings, and cognitive and behavioural repertoire.
Contemplating addiction treatment can be challenging. If you are also looking for help and striving to live a healthy life again, please feel free to call us at 0203 955 7700. Consult with the counsellors of help4addiction and devise the appropriate treatment plan for yourself today.
Frequently Asked Questions
How Can I Resist Alcohol Craving?
distract yourself
avoid triggers
identify internal and external cues
keep track or make a drink diary
use anti-craving medications but with the prescription of a medical health specialist
keeping yourself busy, etc.
How long do alcohol cravings last?
Is it normal to crave alcohol?
What is the treatment of alcohol dependence?
Is alcohol dependence genetic?
Does relapse mean treatment failure?
How are cravings measured?
Until recently, a single item analogue scale was used to measure cravings. This scale required the drinker to rate the level of cravings. However, for precise measurement of cravings, many multi-item questionnaires have been developed. These scales include the Alcohol Craving Questionnaire-Now (ACQ-Now), the Penn Alcohol Craving Scale, the Obsessive-Compulsive Drinking Scale (OCDS), and the Alcohol Urge Questionnaire (AUQ).
Furthermore, scientists are developing procedures to measure cravings clinically and in laboratory settings.
Sources:
- What Is Craving?
- Brain Pathways to Recovery from Alcohol Dependence
- Relapse Prevention
- PAVLOV’S “BELLS” AND ALCOHOL CRAVING
- Neuroendocrine, Psychophysiological and Subjective Reactivity to an Alcohol Placebo in Male Alcoholic Patients
- Pharmacotherapy for Alcohol Dependence: Anticraving Medications for Relapse Prevention
- Anti craving medications for relapse prevention: a possible new class of psychoactive medications
