I recently came across a paper in Addiction Biology called “Recent updates on incubation of drug craving: a mini-review.” The studies summarized here show that drug craving increases progressively for weeks after we stop using. And by “we” I mean rats, mice, and humans, all experimental subjects in this review.
Since many of my readers are “in recovery” — and maybe I am too — this may not come as a big surprise. But rats? What’s the story here? And what does it tell us about how to help ourselves get through this difficult time?
Well, we’re all mammals and we share a lot of the same neural hardware — in particular the amygdala and the nucleus accumbens. I’ll remind you what those do in a minute, but for now let’s just call them the motivational engine of the brain. What I want to emphasize here is that, besides these similarities, humans have other problems that make rodent life look like easy street. We have this enormous cortex (linked to a hippocampus that fills it with zillions of explicit, linked memories), and so the cues that trigger craving often come from, and are magnified by, our own ruminations. That can be a real drag.
Most of the studies in this review involve rats. In a typical study, rats get themselves addicted to cocaine, meth, or heroin (with considerable help from humans), and then once they start taking it reliably, on their own, their supply is cut off. After the 
withdrawal period is over, they are given cues that are associated with the drug they were on. These are called “conditioned stimuli” in Pavlovian conditioning. And then the experimenters measure how much they crave the drug (based on how much they take it, or how much they hang out in the place where it gets delivered) in the days and weeks that follow. The craving goes up, not down, as time goes on. And then finally it peaks and diminishes several weeks later.
The first thing to note is that the craving is always “cue induced.” It is literally triggered by a sight or sound — a green light or a buzzer — that previously meant “Come and get it!”
The second thing to note is that the incubation period, the period of increasing craving, is longer than we might like, but it’s not forever. Typically 10 days to a few weeks for rats. For humans, undoubtedly longer (in one study, it peaked at 60 days abstinence for alcoholics; in another, it peaked at 3 months for meth users).
It’s very important to realize that craving in the absence of cues decreases much more quickly, often beginning almost immediately after quitting.
What’s going on in the rat’s brain that makes it vulnerable to cue-induced craving? The amygdala is the main culprit, and the nucleus accumbens (ventral striatum) is its partner in crime. The amygdala registers rapid emotional significance. If something 
is emotionally meaningful, whether the emotion is fear, anger, desire, or whatever, the amygdala will increase its firing. This is where the cue starts the process of emotional arousal and readiness. Then the nucleus accumbens takes over (stoked as it is by a tide of dopamine, thanks to the amgydala’s output). As you know from my writing, the nucleus accumbens is the part of the brain that produces an urge go after a goal: it narrows attention to the goal, gives you that feeling of “I really want it”, and then activates behaviours…like prancing to the part of the cage where the coke gets dispensed, if you’re a rat, or picking up the phone and calling your dealer, if you’re a human.
If you’re a rodent, that’s all it takes. Craving is the emotional response to something you have learned. You’ve learned that something felt really nice, and it might be available, and because your brain is efficient and determined, you’re going to go after it. I should mention that rats on a high sugar diet show very much the same response once they’re cut off. So we’re not just talking about drugs.
But what if you’re a human? — and I assume you are if you’ve read this far. Then you’ve got a whole other set of problems. The initial cue can be the hands on the clock, telling you it’s about that time. It can be a mental image, a rumbling in your gut, the ragged touch of rising depression. It can be a baggie, an email, a neon sign, a dream. So far, you’re just a very intelligent rat. Your amygdala just sent a surge of dopamine to your nucleus accumbens — you’re alert, wanting, wishing… But you’re also thinking, and that’s where things get much worse.
You’re thinking that the day feels so empty without it. What am I going to do with my time? Thinking that there’s really nothing that can fill that gap. Thinking maybe that you deserve it, or you deserve how shitty you’re going to feel tomorrow, or both. One thought leads to another leads to 
another, and these thoughts fill your head. The amygdala and accumbens both connect to many many parts of the cortex, and they literally unleash these thoughts, which then trigger other related thoughts through direct synaptic connections. That’s rumination.
The problem is that the habit you’ve developed isn’t just a learning and feeling habit — it’s a thinking habit. And until you start to become accustomed to living without that thing, those habits have little to replace them.
So, it would be ideal to avoid cues, but that’s just not entirely possible, since they can come from anywhere (including your own brain). In which case, you have to work on your thinking habits until the cue-trigger starts to lose its force (this can take weeks or months for humans) and until thought patterns readjust substantially.
But how do you work on those ingrained habits of thought? There are many ways. Two come to mind immediately:
- Shift your thinking as soon as you start to ruminate. Don’t even wait ten seconds. You can turn off cascades of thinking far more easily before they build momentum.
- Fill your days with other attractive, compelling activities. Provide your day with contour: a beginning, middle and end, so that the rumination habits don’t have so much traction.
But there’s one more highly valued strategy, and in this you’re no different from a rat. Get connected to others when you quit. Cue-induced craving is greatly reduced by “environmental enrichment” for rats and for humans. (Remember Rat Park?) From the journal:
In 2012, Thiel et al. (2012) demonstrated that environmental enrichment reduces incubation of cocaine craving. They first trained rats to self-administer cocaine for 15 days (3 hours/day) and then either housed rats individually or exposed them to an enriched environment (group housing, toys and running wheels, etc.) during the withdrawal period. They found that environmental enrichment reduced cue-induced cocaine seeking on both withdrawal days 1 and 21.
And one more thing: Be brave.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Marc,nicely done! reminds me of how it was for me 45 years ago and what its like today for my son ( 39 yrs old) as I drive him to detox today ……….again . He has been trying ( or not trying) for over 20 years to get clean. Mr Brownstone always wins!
He starts out positive and in not too long “ego fatigue ” takes over.
Jim Maguire
Hi Jim. I’m sorry to hear it. Really, I know it’s painful.
It’s true that ego fatigue plays a large part in this. We reflexively try to deal with cravings by suppressing them, and it just doesn’t work. Suppression increases ego fatigue. Better to notice cravings, allow them, but shift the direction of the thought process that follows. We can say: so what, I’m craving again! What else is new? We can laugh at them, sneer at them…there are many ways to keep going. We just have to dislodge the assumption that the cravings are going to build into some kind of volcanic eruption and carry us away screaming. It doesn’t have to go that way, as you and I know.
Good luck to your son.
Jim,
Great news about your son ! ! ! !
Guy Lamunyon
SMART Recovery
Sedona, Arizona
Great post Marc! I’m so glad to find out why alcohol cravings seemed to increase for a time after I became abstinent. But sure enough, they went away!
Love your blog, as always!
Thanks, April. I’m glad this hit home.
I agree with your suggested human applications.
See Rat Park below:
======================================================
Rat Park was a study into drug addiction conducted in the late 1970s (and published in 1980) by Canadian psychologist Bruce K. Alexander and his colleagues at Simon Fraser University in British Columbia, Canada.
Alexander’s hypothesis was that drugs do not cause addiction, and that the apparent addiction to opiate drugs commonly observed in laboratory rats exposed to it is attributable to their living conditions, and not to any addictive property of the drug itself.[1] He told the Canadian Senate in 2001 that prior experiments in which laboratory rats were kept isolated in cramped metal cages, tethered to a self-injection apparatus, show only that “severely distressed animals, like severely distressed people, will relieve their distress pharmacologically if they can.”[2]
To test his hypothesis, Alexander built Rat Park, an 8.8 m2 (95 sq ft) housing colony, 200 times the floor area of a standard laboratory cage. There were 16–20 rats of both sexes in residence, an abundance of food, balls and wheels for play, and enough space for mating and raising litters.[3]:166 The results of the experiment appeared to support his hypothesis. Rats who had been forced to consume morphine hydrochloride for 57 consecutive days were brought to Rat Park and given a choice between plain tap water and water laced with morphine. For the most part, they chose the plain water. “Nothing that we tried,” Alexander wrote, “… produced anything that looked like addiction in rats that were housed in a reasonably normal environment.”[1] Control groups of rats isolated in small cages consumed much more morphine in this and several subsequent experiments.
The two major science journals, Science and Nature, rejected Alexander, Coambs, and Hadaway’s first paper, which appeared instead in Psychopharmacology, a respectable but much smaller journal in 1978. The paper’s publication initially attracted no response.[4] Within a few years, Simon Fraser University withdrew Rat Park’s funding.[5]
Thanks for this summary, Guy. Very helpful.
And also around that time during the Vietnam war, I guess Americans were so scared when these soldiers come back from war because of their opiate use. And that there were going to be so many heroin addicts in America, but when those soldiers came back home and they were with their family they automatically quit and without experiencing withdrawal symptoms, supposedly. I cannot remember where I read this but I can definitely believe it.
I was one of these guys:
Breaking Bad Habits: How Vietnam War Veterans Broke Their Heroin Addictions
By James Clear | Behavioral Psychology, Habits
It was 1971 and the Vietnam War was heading into its 16th year when two congressmen, Robert Steele from Connecticut and Morgan Murphy from Illinois, made a discovery that stunned the American public.
While visiting the troops in Vietnam, the two congressmen discovered that over 15 percent of US soldiers had developed an addiction to heroin. (Later research, which tested every American soldier in Vietnam for heroin addiction, would reveal that 40 percent of servicemen had tried heroin and nearly 20 percent were addicted.) The discovery shocked the American public and led to a flurry of activity in Washington, which included President Richard Nixon announcing the creation of a new office called The Special Action Office of Drug Abuse Prevention.
The office was created to promote prevention and rehabilitation of drug addictions and also to track and research the paths of addicted servicemen and women when they returned home. It was this last part, the tracking of returning soldiers, that led to some surprising insights.
Lee Robins, one of the researchers in charge of tracking the veterans, found that when the soldiers returned to the United States only 5 percent of them became re-addicted to heroin. In other words, 95 percent eliminated their addiction nearly overnight. [1]
This finding completely contradicted the patterns of normal addiction. The typical heroin cycle went something like this: an addicted user would enter a clinic and get clean, but once they returned home, the re-addiction rate was 90 percent or higher. Nearly every heroin addict relapsed. The Vietnam soldiers were displaying a pattern that was exactly the opposite.
What was going on here? And, perhaps more important, what can it teach us about changing our own behaviors, building better habits, and breaking bad ones?
How Addictions Get Shaped
Here is what happened in Vietnam: soldiers spent all day surrounded by a certain environment. They were inundated with the stress of war. They built friendships with fellow soldiers who were heroin users. The end result was that soldiers were surrounded by an environment that had multiple stimuli driving them toward heroin use. It’s not hard to imagine how living in a war zone with other heroin users could drive you to try it yourself.
Once each soldier returned to the United States, however, they found themselves in a completely different environment. Not only that, they found themselves in an environment devoid of the stimuli that triggered their heroin use in the first place. Without the stress, the fellow heroin users, and the environmental factors to trigger their addiction, many soldiers found it easier to quit.
Compare this situation to that of a typical drug user. The individual picks up a bad habit at home, goes to a clinic to get clean (i.e. somewhere devoid of all the external stimuli that drive their habit), then return to their old environment with all of their old triggers surrounding them, and somehow hope to quit their bad habit. It’s no wonder 90 percent of typical heroin users became re-addicted once they return home—they are surrounded by all of the things that caused them to get addicted in the first place.
Similar situations drive bad habits for all of us, from nail biting to smoking to drug use. Of course, none of this is to say that the change in drug use was purely due to environment changes. (It is likely there were a variety of factors at play. [2]) But the central idea is a solid one: the stimuli that surround you shape your behaviors day after day, often without you realizing it. Environment drives behavior.
WOW! oh my goodness, wow. This is absolutely fascinating. Thank you, and were you yourself a heroin addict? I have a neighbor that is a Vietnam veteran, and when I used to attend a methadone clinic I also had met a Vietnam veteran. He would talk about how they used to get pounds of heroin and send it to America, to themselves, something like that, does that make sense? I did not understand at that time. I’ve been meaning to check up on my neighbor because I haven’t seen him in a while and he used to be an alcoholic, quit , and hopefully still is sober but he is on so many psychiatric meds:( such a nice man but smokes a lot of weed and gambles. Since his dog passed away about 2 years ago I’ve heard that he just never gets out anymore:( I hope he didn’t die. I keep thinking that there is a huge chance that he might be dead.
Ania, maybe go check on him. From Gabor Mate to Johann Hari to Bruce Alexander: the solution to addiction is connection.
I did and he was sleeping:( and I quote what his brother in-law said to me when I asked is everything ok with him?. “Oh Yea! everything is fine! He’s just getting old you know?!”, No he is not he is barely 70 I thought to myself, while I am there with my German Shepard (and he LOVES dogs and wanted me to bring her around whenever I walk her, and ok it just hit me literally. Because he just lost his dog and then I got my German. I feel terrible. And what happens to us when we interact with dogs and animals? We feel just as great, maybe even better. I’m rambling, so sorry:)
Also I’m scared to ask, but Marc did you by any chance receive something from me? asking you if you could possibly answer some questions of mine for a research/thesis paper? all re: addiction and the biochemistry, neuroanatomy, ect. I’m sorry, I know people such as yourself are extremely busy people. it would mean so much:) I’m so sorry again. -Ania
I absolutely agree Marc with the solution being connection. I am an addiction counsellor and I work from an attachment perspective.
Insecure attachment in childhood results in changes in the architecture of the brain that lead to deficits in impulse control, other types of executive function, difficulties in emotional regulation,and low frustration tolerance – all fertile ground for addiction to take hold.
These issues also make it difficult to create secure fulfilling relationships throughout a person’s life adding to the emotional distress they already have to deal with, and limiting access to the emotional rewards and emotional regulating properties of true intimacy.
I believe treatment should focus on developing the skills that will make healthy connection possible.
Guy, thanks very much for printing this overview of the Vietnam vets phenomenon. It fits extremely well with today’s post. The two obvious factors facilitating abstinence were:
-the absence of cues — so indeed “cue-induced craving” did not get a foothold
-the shift to an “enriched” environment. Here we mean nothing specific to cues but rather a foundation of interpersonal support, connection, motivation to remain connected to others, and pleasurable activities to fill one’s time.
So it all fits.
The speed and ease of the vets’ withdrawal/abstinence still puzzles me a bit. It reminds me of the opposite phenomenon. When I was working in the rat labs as a psych student, my supervisor studied opiate addiction. She gave the rats their morphine every day at about 4 PM. But she found that they began having withdrawal symptoms starting at around 3:30, just before chow time. It was as if time itself was the cue, and the cue initiated not only psychological craving (to the extent that rats are psychological) but also bodily changes related to opiate loss. Flip this phenomenon around, and…maybe it’s possible that the radical change in environment when the vets got home, including the complete absence of familiar cues, induced a bodily as well as psychological recovery.
This is great, Marc. I love this post for a few reasons:
1. Thinking about the neurobiology of these craving curves across animals is so compelling.
2. The psychology and the idea of a “thinking habit” makes so much sense and the curve makes so much sense experientially.
BUT MOST IMPORTANTLY, I THINK:
3. it’s really REALLY helpful to give people a head’s up about what to expect when they’re trying to quit (whatever), otherwise they feel like they’re faling in those first few weeks (“I’m too weak”, “I’m not the kind of person who can quit”) when they’re actually getting CLOSER to the easier point. If you KNOW that it gets worse before it gets better, then you may be empowered more to hold on for a little while longer.
Marc, as always, I love the way you think and write. Thank you.
“Shift your thinking as soon as you start to ruminate. Don’t even wait ten seconds. You can turn off cascades of thinking far more easily before they build momentum.
Fill your days with other attractive, compelling activities. Provide your day with contour: a beginning, middle and end, so that the rumination habits don’t have so much traction”..
This summarizes my personal “recovery” from not only my struggles with alcohol, but also the underlying issues that ignited those struggles – all of the “dysfunction” that my brain and I accumulated throughout my life experiences. In my own experience, conventional treatment often becomes a barrier between an “addict” and his freedom by further conditioning thinking patterns to do the very things that guide someone toward chronic suffering or relapse. Hence, the tragically low success rates of recovery.
“Putting recovery first”, which is routinely promoted by treatment programs, can “gridlock” one’s brain so that it’s thinking is held captive by the grips of the “disease.” One’s freedom lies in the brain’s abilities to focus BEYOND alcohol and drugs. In some instances, I’m not convinced the brain recognizes a healthy difference between the focus on using drugs/alcohol and recovering from them. As long as the focus is on drugs/alcohol (recovery from or using) what the brain produces stays loyal to drugs and alcohol. Yet, this is really good news because it vividly shows the power of one’s thinking. I remember actually having conscious thoughts after I drank for a few days straight, “how did this happen to me?” As if it occurred without my input. Of course now I know that it was in fact a direct consequence of my input (obsessing about alcohol). Consequently, I know with certainty that I am actually quite gifted at manifesting what I focus on – as we all are.
When someone directs his brain to know addiction as a permanent disease that increases in strength over time, where he is plagued with a life-long struggle – and relapse and tragedy are lurking around every corner – then what is produced is a lifelong struggle, in various forms – whether he is abstinent or active. Whereas if someone directs his brain to know its own power to produce whatever it focuses on, then exciting opportunities are presented to produce results that exist outside of the struggle.
For me personally, there are countless things for me to focus on that fulfill me to the extent that it is difficult for me to imagine that I ever associated alcohol with pleasure. I see how I was “rewarded” for my brain’s focus, but it is near impossible for me to see that what I produced as “rewarding.” Once you know pleasure, in its truest form, all false forms of pleasure entirely lose their allure.
There’s been a lot of unnecessary suffering (and death) because of our misconceptions about addiction. I think that there are a slew of people out in the world who know that conventional perspectives of addiction are invalid and illogical. At least here in the states, our “treatment” makes things tragically worse for far more than it helps. I’m not sure if they even help anyone at all as much as that they just don’t manage to exacerbate the issues for 100% of addicts. Unfortunately, between the amplified voices of the treatment industry and the deceptive rantings of the media, promoting conventional treatment and raking in the profits is far more important than offering any genuine efforts toward the healing of those who suffer.
I hope that changes – and thanks Marc, for your efforts toward that goal.
Richard
Hi Richard, It seems we agree on a lot of things. I like your statement that “One’s freedom lies in the brain’s abilities to focus BEYOND alcohol and drugs.” And a lot of people are waking up to this. See Matt’s comment below and many others on this blog.
(and try to keep comments a bit shorter, please….I have trouble reading through everything)
So glad to hear that your life is filled with real pleasures now.
I am just a state school kid, pretty new to sobriety but doing well (Many thanks to Marc for exchanging very helpful e-mail with a total stranger, me). I am not an expert. But, just wondering…
There seem to be medications that can reduce cravings. A quick scan of the literature suggests they are administered primarily to ease symptoms during acute withdrawal. The primary mechanism by which they reduce cravings during that period is probably… easing withdrawal. Duh, I get it, not an expert, but that seems pretty obvious. During withdrawal, for example, after not sleeping for a week my brain would develop a strong case of “F-this itis.” I need sleep, just a wee little dose. With the support meds on board, a person can feel almost human during withdrawal. But, I wonder, would a *better* schedule involve dosing early and then according to the timelines summarized in this review, something thereabout? Something akin to The Sinclair Method, but expanded to include meds other than Naltrexone against drugs other than alcohol? I’m not talking about the heavy hitters like benzodiazepines. I understand they can be helpful acutely and although they are as appealing to me as a massive herpes outbreak on my penis and face, I understand they can be highly addictive. But how about the weaker sauce; clonidine, guanfacine, acamprosate, topiramate, some of the depression meds… I’m sure there are more. But of course, that would involve medical care for the recovering addict for several months, which costs money and those checks aren’t easily written these days. For all I know, this is already happening, in which case I apologize; chalk this comment up as me mistaking the 12oz Red Bull for my usual 8.4.
Great post Marc, thank you.
Red Bull here again… to clarify, I’m not suggesting “drugs are the answer to the drug problem.” But I attended maaaany group meetings where the use of meds was sacrilege, that Jesus was the only medication necessary to stay sober. A whopping, hourly intracranial dose of highly potent, all healing God. Well, God and a high school dropout, truck driving, meth relapsing sponsor who had a real hard time spelling dopamine (dopamean). That was the cure for me, I was told, again, again, ad nauseum. Just saying that some major groups tend to throw the baby out with the bathwater, and I think a better approach may be to use every weapon in the arsenal. The cognitive skills Marc talks about for sure, perhaps mixed with a dash of Big Pharma (really though, most are generic now).
Gonna sign off before I start to embarrass myself any more.
Phillip :
tell them all to go to hell . This is from a A.A pamphlet (here)
http://www.aa.org/assets/en_US/p-11_aamembersMedDrug.pdf
“A.A. members and many of their physicians have described situations in which depressed patients have been told by A.A.s to throw away the pills, only to have depression return with all its difficulties, sometimes resulting in suicide. We have heard, too, from mem- bers with other conditions, including schizo- phrenia, bi-polar disorder, epilepsy and oth- ers requiring medication, that well-meaning A.A. friends discourage them from taking any prescribed medication. Unfortunately, by fol- lowing a layperson’s advice, the sufferers find that their conditions can return with all their previous intensity. On top of that, they feel guilty because they are convinced that “A.A. is against pills.”
It becomes clear that just as it is wrong to enable or support any alcoholic to become re- addicted to any drug, it’s equally wrong to deprive any alcoholic of medication, which can alleviate or control other disabling physical and/or emo- tional problems.”
Nice…. I abandoned those meetings in favor of one on one counseling and emersion in the recovery literature. But this is good to know.
This blog is fantastic, always solid conversations / replies.
Philip,
For me personally, once I actually made the decision to stop drinking, abstaining from alcohol was the easy part. The challenge came about from confronting the “dysfunction” that pre-existed my use of alcohol. I kept the bulk of my more personal struggles at bay by not only numbing them with alcohol, but also by distracting myself with alcohol – drinking it and recovering from it. It seemed like I was always doing one or the other, so I never allowed the deeper, more significant issues/feelings to surface. While alcohol may have at one time seemed like it introduced relief to hurtful feelings, uncomfortable self-perspectives, and negative thinking,etc., ultimately, alcohol managed to exacerbate the very pain that it once seemed to relieve.
The questions in your post asked nothing that would prompt me to respond to you the way I am. However, knowing that you too will be left with whatever deeper, more meaningful issues that pre-exist your drug use compelled me to point out an observation that I hope somehow contributes to your efforts to be the best you can be and live the life you deserve.
There is a discrepancy between how you see yourself and who you actually are. That, to varying extents, is of course true for all of us – so I’m not singling you out to “pick on you”, but I AM singling you out because there’s something about your post that so blatantly shows the parts of you that you don’t see and you inadvertently deny or dismiss. There’s a couple sentences in your post that prepares us to hear words from a young, uninformed, un-knowing “novice” at recovery and life – and then the rest of your post speaks of someone who is generously equipped with wisdom, insight, goodness, creativity, eloquence, sensitivity, awareness – and so much more. The fact that I see that in your words is not about me. It shows how highly concentrated those things are in you that they can be revealed to a stranger in a couple of brief paragraphs.
Often the deepest and most painful part of human struggle – “addiction” and otherwise – isn’t about the trauma that comes from, for example, some horrific childhood abuse or painful experience. It comes from not feeling free to see and live our our best qualities and true potential. So if I were you, (and I have been my own version of you) – I would incorporate into my recovery plan a strategy to recognize the good qualities in myself. I would interrupt my brain’s default mechanism to undermine those same qualities – by beating myself up for PAST behaviors. Shame, guilt, self-disgust, etc., are so easily perpetuated and intensified by our thinking and self-talk alone. So many people – sober and otherwise – literally barricade themselves from knowing themselves and creating a life that shows the world their absolute best qualities by investing deceptive energy and focus on things that happened or things that they did years and years ago – or even yesterday. That’s a true tragedy.
I don’t believe you will waste time on such things. In fact, that’s what made me jump in and comment to you – because you seem closer to NOT doing that, which is really encouraging and inspiring to see. Just in case you don’t see that, I think it is profoundly important for you to mull it over and if you agree with me – then put some energy into appreciating yourself for that. That will further protect you from getting tripped up by the past and sustain your ability to keep moving forward toward all the things that you deserve.
Even though it had nothing at all to do with the question(s) you posed, I hope my feedback somehow contributes to you.
Richard
Your feedback was fantastic, very much appreciate it! 🙂
Hi Philip. I have nothing against drugs that reduce cravings/withdrawal — nothing whatsoever. They’ve been shown to be effective in study after study. And I’m referring to the heavy hitters like buprenorphine (Subutex or Suboxone) or methadone as well as naltrexone. The former give you opioids so you can go through physical withdrawal at a kinder pace…and actually feel very little discomfort. The latter (naltrexone) make opioid drugs ineffective….so you give up craving them. Of course if you can get by on clonidine or baclofen, all the better.
If drugs are part of your plan, then fine. Buprenorphine would be useful during withdrawal, obviously, and naltrexone during the “incubation” period I wrote about. Getting off naltrexone does not produce withdrawal, but of course it does remove one layer of protection from starting up again.
The issue of “maintenance” is different, but let’s talk about that another time.
Hi Marc!
Well-written post, and I like how you offer strategies to cope with craving. I thought I might chime in with a few additional comments, considering I used to do these studies for a living.
One issue I have with some of the “incubation of craving” studies is that they don’t typically have the animals repeatedly exposed to the cues during their “incubation” time. In contrast, we are usually having to deal with repeated exposure to the cues in a variety of contexts, giving us multiple opportunities to re-learn (or unlearn) craving responses in their presence. The rats don’t get these multiple learning opportunities, so the cue just means one thing and is powerful in one context. What does this mean for us? Perhaps the incubation effect doesn’t apply, or maybe it’s way more complex (likely)? Personally, I’m empowered by the possibility that I have many more opportunities to re-learn how to deal with triggering cues than the rat, and I’m not too terribly worried about their incubation effects :).
Fascinating comment, Liz. Yes, of course, you’d know a lot about this paradigm.
I think you’re right that limited cue presentation makes a big difference. I’d imagine, as you say, that our (human) multiple contexts make the recurrence of craving much more complex, mood dependent, situation specific, and so forth. I suppose this complexity can be a blessing or a curse, as I think you’re also saying. More chances to fall and more chance to learn how not to fall.
Thanks so much for your input.
Yeah Marc– were all just a bunch of rats looking for the park!! lol
We humans tho as you point out are both blessed and cursed by the cortex.
The good news is however that we also have choice ( hard to see sometimes but its there) and we can learn to make better ones with some time and work
I tell folks in meetings that the first 90 days are the hardest and glad to see the science back that up
Great post and thanks
Thanks, Bill. It’s true, I described the cortex as sort of a minefield. But it’s benefits are incalculable. Choice is a mysterious phenomenon, arising as it does from habit, random events, environmental cues, specific expectations, long-range goals….but all of these percolate in the dorsolateral prefrontal cortex….and out comes a decision. Rats don’t seem to work that way.
The thing that always frustrates me when we’re talking about the rat park experiment is that there’s been so little in the way of the obvious follow-up: running experiments in human park. I’m as keen as the next mammal on “group housing, toys, running wheels etc.” but I wish there was more knowledge of human-specific flourishing; for happiness, and emotional wellness, for eudaemonia generally. Not using, I mean white-knuckle abstinence enforced for it’s own sake, doesn’t seem so different to me than using. Pretty dismal, even cruel at times. Wouldn’t it be really different though, to think about how if we have a soul, we can learn how to feed and care for it?
John, Bulls-eye! Your suggestion that in addition to promoting the understanding of addiction – that we promote the ways to flourish as human beings – is precisely what is so tragically missing from every form of “treatment” that I am aware of. It’s no wonder why people give up so often. The disease notion of addiction not only implies that it is IMPOSSIBLE to recover, but disease theory or not – we are inundated with explanations of how rare and difficult it is and the focus always seems to be on the suffering and tragedies of addiction. We don’t often hear or read “addicts;” stories that emphasize the fulfillment, peace, authenticity, excitement, and the general qualities of life that are perfectly within our reach – separate and beyond addiction (and recovery). So much propaganda that “factually” states recovery is a lifelong struggle – so we never really make it out of recovery – which is a component of addiction. Therefore, we never make it out of addiction – according to convention. I’d throw in the towel too – and I DID many times until I stopped believing what I was told. I personally didn’t create true freedom from “addiction” until I set it ALL aside – drinking and recovery alike – and made it about living a full life that as you say, feeds and cares for my soul.
Addicts aren’t a “breed of their own”, as some believe. Setting aside the specific compulsions/details of what obstructs someone from it, the road to happiness and fulfillment is the same for all of humanity.
Great post. Thank you!
Richard, this is an important message that embodies much of what we, as a community, keep coming back to…a philosophy many of us share.
The main reason I don’t call addiction a disease is because it comes with the territory of isolated humans living with pain. It is a natural growth process when loving relationships are absent. It’s not extrinsic or unnatural.
John, that’s what I meant by enrichment of course. The chapters in Hari’s book about programs for addicts in Switzerland and Portugal describe the human equivalent of Rat Park in detail. Same to a large extent with his chapter on the Portland Hotel Society in Vancouver. I think we’ve got enough to go on here. It’s no big mystery.
That is good, Marc, that addicts are arising from the Portland Hotel and in Switzerland and Portugal, to flourish in human parks. Best news I heard all day, and not a moment too soon, with so many more people are in the thralls of Black Friday. Let us addicts show the way, right through the transferred addiction of recovery to what I reckon to be a great UNCOVERY (of a greater mystery: curative for what is not a disease and liberation of abundance beyond enrichment).
LOL
Richard, you wrote:
“We don’t often hear or read “addicts;” stories..”
It could be that when most people discover that the addiction no longer is an element in their lives,they do not feel compelled to tell their “addicts story”, because they no longer feel or see themselves as an addicts.
And “addict” even “ex-addict” is a troubling label too for many people.
It would be invaluable to hear replies to questions like:
“what happens to triggers”
and;
“if and when you experimented with your addiction, what did you find.”,
and questions of that nature, from people that are no longer in the harbors of a recovery environment or a human park.
These are not questions a recovery program that wants more members would open to, but maybe a website that is NOT attached to an actual recovery approach could
consider listing questions like this for people to post to? 🙂
My Bad…here is the full sentence Richard wrote:
” We don’t often hear or read “addicts;” stories that emphasize the fulfillment, peace, authenticity, excitement, and the general qualities of life that are perfectly within our reach – separate and beyond addiction (and recovery).”
Hi Carlton
“What happens to triggers?” Good question. “Trigger” is a generic term for the vast number of motivators to engage the behavior. It takes a lot of work to recognize and inhibit them.
There are these unending, variable cues we have to engage the behavior– direct or indirect– and they have this generic, superordinate term that encompasses the lot of them. It is universal. Notice that there are equally numerous and diverse things that help us maintain our sobriety, yet there is no universal, generic term for them. No positive word. No antonym for “trigger” that carries the same weight, yet opposite meaning.
What’s that about? Isn’t that what we’re supposed to be focusing on in “recovery?” The positive things we do that help, not just the negative ones that cue us to use?
Endlessly inhibiting triggers fits the disease model of addiction, but some people do not feel it is a disease.
In hindsight, and for lack of medical terms, here is the best I can describe it:
Things that were not triggers before that addiction, became triggers during the addiction… and the became non-triggers again.
Marc described how the brain “prunes” itself, in the Podcast above, and that is the first logical description of what may have physically occurred, regarding triggers.
Again, if others could write versions of what they experienced, it could only increase the understanding of addiction, but could help people also seeking freedom from an addiction that may be reading this blog.
Hi Carlton. Indeed there is pruning involved. The same principle applies to the brain as to the rest of the body: Use it or lose it.
But that necessitates experiencing the trigger and then moving quickly out of range of the cognitive-behavioural cascade toward using. If you wrap triggers up in a box and avoid them entirely, they won’t lose their strength as fast as if you let them fire and then thumb your nose at them. That is literally breaking the connection…..previously high-traffic synapses become low-traffic synapses…and the result is pruning.
Not quite getting your tone here, John. Are you being cynical, hopeful, or both?
Yes, Marc, both. My tone is both hopeful and cynical, and too often I am. Ambivalent in the face of a paradox. Like, living in a state of informed bewilderment, like who isn’t in our network society?
My wish for us all is to instead experience equanimity. To have a view of addictions/recovery that is neither fearful nor indifferent, to pay just the right kind of attention to the right things, and to practice good habits supported by our best intentions.
Hopeless, but happy, here in Toronto.
What a great descriptor of our perennial state in this society: “informed bewilderment”!! When it could be informed wonderment…and openness and equanimity. Recovery doesn’t work without intention, and the intentional focus has to shift to care and compassion and what is important to us– that lays underdeveloped just outside the neighborhood of our negative addiction.
I think you’re right, John. It is no different than using, and I believe that in many ways it’s worse. Forcing someone to stop a behavior and “not do” and avoid something that has been a motivating coping mechanism doesn’t make sense, It’s punitive and encourages self-loathing and embitterment. We need to help.individuals learn a positive replacement that works for them…but nowadays that takes too much time and attention and compassion and nurturance. Things that are in short supply in our techno-network, need-it-now society. Stuffing “now appeal”, an adaptive trait, just makes it metastasize into disease, instead of using it to guide each other positively in the direction of our true nature.
“Incubation period? Seems more like an extinction burst in operant conditioning. But I’m not a psychologist so I’ll mind my own business.
The suggestions for urge rumination make sense. You need to distract yourself and do something different than use, or the things you did before you used.
Find something positive to fill the habit hole left by the addiction. We spend so much time in early recovery getting told what not to do, instead of finding things TO do. Even though it’s hard to be attracted to anything, find something engaging, and pleasureable, motivating– maybe something that fell away due to the addiction. Motivators that can help bring the dopamine system back into balance. There should be more emphasis in treatment on finding things that are motivating for the individual. Maybe getting people to laugh a little wouldn’t be a bad idea either.
I found another interesting rat experiment a while ago where they traumatized some rats, and then gave them chronic intermittent alcohol. They looked at the brains of both groups. The alcohol rats lacked something that down regulated something else in the mPFC that was implicated in inhibiting fear extinction. So people with PTSD may be exacerbating their own trauma related anxiety by drinking. Good to know.
For sure, Matt, we lose the capacity to downregulate anxiety through all kinds of mechanisms. Trauma does exactly that.
It’s interesting what you said about an “extinction burst” in instrumental conditioning. Makes a lot of sense, Mr. Nonpsychologist. I still wonder a lot whether operant (instrumental) conditioning is the best way to understand addictive impulses. We are “driven” toward the reward, by exposure to the stimulus, no doubt, and I guess this is classed as Pavlovian-to-instrumental transfer, a well-known phenomenon. But the “driven” part is not well explained by the standard Skinnerian model. Well, just a thought for now.
We clearly agree on all the rest.
I can’t speak to the psychology of operant conditioning, but the notion of the extinction burst really fits a lot of situations in quitting addiction, from the more instinctive (with “now appeal” trumping the fatigued ego) to the ones complicated by human emotion and cognition; the increase in frequency and intensity of urges when the substance or behavior is removed, or about to be removed; when someone reaches the last dose reduction in a tapering regimen; when people start going to meetings, therapy, other practices marshaled to stop the addictive behavior. I hear people say that upon leaving their first (voluntary) recovery meeting, a strong urge to use asserts itself almost immediately upon leaving the meeting. Aren’t these like mental and/or behavioral extinction bursts?
My post was a mess of over-caffeinated blathering. I guess what I meant was the instrumental conditioning triggers the behavior, and the interim processing can either dampen or redirect the urge, or amplify it, or dysregulate the whole process to an unruly mess. The fact that PTSD sufferers self-medicating with ethanol are actually making things worse is scary.
To put it simply, an extinction burst makes a lot of sense when craving skyrockets for a couple of days. But after that, it doesn’t. The curve of incubated craving goes UP — for 2-3 months after quitting — before dropping off. That’s way too long for an extinction burst.
Rather, I think our rising vulnerability to cues is mostly cognitive — some combination between appraised loss — i.e., missing it — and rumination tendencies that thrive on sadness, anger, and/or anxiety.
Hi Marc,
I very much appreciate your post. It’s always nice to hear from someone who doesn’t ascribe to the “disease” model. I believe that we are powerless over drugs and alcohol – seeing we are human and they are mind altering substances. I haven’t evolved spiritually enough to transcend the affect that drugs and alcohol have on me. However, we are NOT powerless over our thoughts and we “choose” whether or not we want to change the thoughts that don’t serve us. It’s a simple concept but not always so easy given our histories.
When I was sober a year I immersed myself in healing my childhood traumas. I was going to 12-Step meetings at the time for connection and new friends. Many people, from the meetings, told me I should be careful, I might want to drink. Fortunately, I listened to my own voice and dove into my past. Had I not, I probably wouldn’t be alive today. That was over 27 years ago and I really can’t remember ever having a craving once I was done with drinking. Having said that, the cravings for sweets didn’t go away. I do my best not to overindulge because I feel like crap when I do and it doesn’t go along with my self-love/self-care and healthy eating approach to
recovery. Needless to say, recovery is a lifelong process…
Thanks again for your insights
Barbara
Good to hear, Barbara. I think you mean powerless over the effects of drugs and alcohol but not over the thought processes that lead us there. Exactly so.
I often wonder why the notion of self-exploration, uncovering past trauma, is so at odds with some 12-step approaches. Yet it does not seem to counter the thrust of the movement. Well, good that you listened to yourself. Surely that’s the clearest path.
Profound realizations in ones life can occur before, during or after relapses.
Also, relapses can also be viewed as a persons effort to hold on to the relationship with an addiction, rather than something they are a victim of.
Although this study says drug craving increases progressively for weeks after a person stops using, it does not say how the individual felt about themselves and the addiction at the point in their lives when they were tested.
Although the addiction and recovery struggle can be inherently traumatic and life-threatening, the insights and wisdom experienced from the recovery process can be profoundly contribuitive and enriching to a person’s life-experience as a whole.
Yes, Carlton…great observation
We learn things about ourselves that people who have never gone through
addiction will ever know. Not a method for self-realization any sane person would recommend, but a profound learning experience nonetheless…
And lessons I know that I could not have learned any other way. Wouldn’t trade the journey for anything.
Great post Marc.
I share your post on my site.
https://www.facebook.com/addictionanddrugeducation/?ref=bookmarks
P.S I started on my second book.
You have been a great power of education, and have help me many times throughout my recovery..
Respect Richard Henry
Thank you, Richard. It’s good to hear from you, and your words encourage me to keep on writing and sharing. Good luck with your new book. Man, you have a lot of energy!
These are great observations and very good information for those who are seeking recovery from heroin or other addictive substances. It is good to note that as time passes, the intense cravings will diminish.
Yes, that’s a very important subtext here. Maybe not so sub. The cravings really do pass with time.
Brains learn by doing, and they learn new ways of thinking and feeling through new ways of doing.
The most interesting thing to me is that I experienced exactly what you talk about Marc, of course with no idea of what was happening in my brain or why. Learning about it now, even at my neophyte level, adds so much meaning and context to what I went through.
The urges to gamble when I stopped were incredible. I would literally be shaking, laying on the couch, trying not to go back. Exercise was my first big substitute activity.
One year later I walked through Vegas casinos with absolutely no problem and no urge to gamble at all.
So glad I found this amazing blog. Thank you.
Thank you too, Mark. It’s even more exciting to see real life following a scientific model than vice versa, at least for me. But the best part is the way the urge completely disappears after enough time. That happens to many other people as well, and it’s a testament to neuroplasticity on the one hand and human grit on the other.
This information on “Incubation of Craving” is so true. I am a recovering addict and have had to learn the hard way that sometimes it just does not get easier when you really think it should. At this point I’m quite certain that addiction is an ongoing battle to duel with every day, with some days being more trying than others and vice versa. Sometimes perceiving things in third person is helpful, this may sound a bit crazy but it sometimes works for me anyway.
I am so thankful for your articles and have found them very helpful and informative thus far. I find breaking every aspect of this addiction model up into logical terms and explaining them in a simple format works really well. To me it just makes more sense than praying, but that can be a good thing that seems to work for many people. So I look forward to your next article.
Thanks, Bella. It’s good to know that this kind of writing, applying scientific explanation to these powerful personal experiences, can really help people. I didn’t know this at the start of my writing, but now I don’t doubt it.
The thing about the prolonged “incubation” period is that it is entirely structured by cues. Craving goes down very quickly if the cues either don’t pop up, or if you can deal with them quickly and not let them grown into ruminations.
I think the third person perspective can be very powerful, because from there you can look at momentary cravings and wishes in the context of the larger picture of your life — probably past suffering but especially a different kind of future.
I agree with this man has written. I like clear, concise information which provides case backing to it. I struggle to this day with many issues and found the article to be self inspiring in terms of technique which may be applicable to my situation. Thank you very much for making the time to write it.
You’re welcome! I’m glad it is helpful.
Great post here. With evidence such as this would one say that abstinence is the only route? If dabbling now and then with drugs or alcohol wouldn’t one have to deal with these cravings constantly? Also, is there any way to prevent these cravings and using neuroplasisity to reshape your brain where it does not get cravings even after using for a while?
Thank you
I’ll have to refer you to the book for that, Michael, but in brief, neuroplasticity is the fundamental mechanism by which the brain reshapes itself out of addiction
As for dabbling, it generally reinforces synaptic connections between the cues and the addictive behaviours. Certainly not advised in the first few months. However, if the addictive urges really do let up, it is possible for some people to go back to occasional use, social drinking being the prime example. In this matter, you are your own experiment: be careful!
I don’t know why this stuff amazes me, but that answer is exactly what my therapist told me, in slightly more laymen’s terms. I had tricked myself into believing I was going to stop for a couple years, lay low dig out of the hole (crater) and then go be a casual gambler. He told me it could happen, like you described, but for me it would most likely be very risky.
The final message I needed to convince myself of was that I really could survive the rest of my life without it. It was the last wall to floor, but over time, I knew I would never go back.
That is a splendid way to end this chapter….with a flourish rather than a gnashing of teeth. Survive and have fun! No cliff walking necessary.
For some, a deep feeling, or “sense-of-self” was also involved with the addiction besides just being a bad habit.
For instance, being a casual partaker with a previous addiction can be like a retired professional concert musicians playing “casual” Concerts. For some people once ou re-engage, you naturally are compelled do it with your full heart and soul, as you used to.
This of perspective also can help people re-trust themselves.
Its a natural thing to want to return to something with your full heart and soul, its not the “weakness of an addict”
Well said Carlton. Not only is my life so much more full without the addiction, but I am quite sure I could not go half way.
Better yet, I have no desire to even go down that road.
These are important and compelling questions.
Something this website, UNDERSTANDING ADDICTION is shedding light on, is that maintaining abstinence from a life-long disease may not be all there is to “recovery”.
Roughly 90% of the public are not maintaining abstinence, sobriety, or an addiction. and people that recover naturally may do not either…so “being free from maintaining something” may partially define “recovery”?
Here is one reply to your first question;
Actively abstaining from an addiction is invaluable, and many people feel addiction is a lifelong disease and that maintaining abstinence will keep the disease at bay.
But a percentage seem to innately feel addiction is something else, and maintaining an already natural state, ( i.e. sobriety). is not fully addressing or understanding what is occurring.
Again, this is something this website and some other addiction specialists are currently shedding light on.
So interesting, as soon as I began reading this article I automatically thought of “Rat Park”, I believe by Dr. Bruce Alexander at Simon Fraser University in British Columbia, Canada.
So, the cue’s that make us crave (and this is not easy) we have to replace them by positive behaviors that benefit us in life. WE have to create and not wait. We have to teach ourselves to not go after immediate rewards and we need to surround ourselves with the type of people that we can REALLY learn from; that will have a positive impact on our lives. I am speaking from personal experience. After doing so, whenever I see and think of drugs and booze I become SO sick to my stomach. Because now I have finally worked my butt off to actually get to the point of literally working for everything, if that makes sense? I work for not only an amazing MD but an amazing woman. I’m attending a great school with amazing teachers, I’m always trying to get out of my “comfort zone” and do and learn new things. The rewards have not been “right away”, because I prefer the better but later rewards, which are long term and automatic rewards that are short term. Short term because of the fact that we really are not learning, we are just going by memorization and conditioning, if that makes sense?
Marc, as much as I continue to agree with you that addiction is not a disease, I cant help but continue to wonder if you have maybe not gone deep enough biologically in your habit conclusions. I am trying to remain open to this so please don’t think I mean this in anyway disrespectful because I don’t. Protection for some (a1 dopamine allele) that might be missing for others, does this in anyway effect them in the real world in your view?
Marcus, I guess any allele affecting dopamine receptor density can alter vulnerability in combination with many other genetic and environmental factors. This doesn’t lead me to think in terms of disease, however. In fact many of the microfactors influencing personality and learning styles are genetic…but so what? So is propensity to excessive nose hair.
Yet my door is not shut. I’m still waiting for good arguments for the disease model, and I’m not hearing many of them. In fact, I can easily go more deeply into biological factors, like the issue of amygdala sensitization, which is a biological as well as psychological process that could provide the learning and “disease” camps some common ground.
So far, I don’t see these biological excursions as reason enough to take on the baggage of addiction = disease. But I’m open to discussion.
And don’t worry about being disrespectful, please! I love good debate.
Great article Marc, I’ve really enjoyed “Biology of Desire” and use it as a reference material in all of my trainings. This one piqued my interest because I always tell people “My amygdala is NOT my friend!” And this about sums it up. I have in my brain a little hunk of tissue that is wired to fire and consider everything around me as a threat. That parses into stress, anxiety, sleep disorder and craving to self-soothe in maladaptive means. I know the science supports this, but great to see one article put it in such a concise and engaging fashion. Hope all is well with you!
Hi China! I realized too late that we’d never made plans for a visit while I was in your land — just talked about it. I’m well, thanks. Finally slowing down after the book tour. Relaxing still feels like a new hobby I might be too old to master… but I’m starting to like it a lot.
I’m glad this post speaks to you, sums up the reactivity and sensitivity of the motivational system, and connects your experience with a sense of what’s going on in your brain. That’s what I wanted to do. I still experience all the things you mention, including craving, at times. The amygdala IS a friend, but it’s a dumb friend. It’s like having a cave-person as a friend. You’d be crazy to trust it to plan your day. But it’s good to have around for emergencies.
Anyway, glad too that you like the book and use it for your training sessions. Really glad!
Take care, maybe next time…
Very informative piece, Marc. Thanks.
What I’d like to hear is how this would apply to food and sex. One can expect
a craving for cocaine to abate, it seems. Perhaps to zero? Yet this wouldn’t
likely happen for food or sex. Is there data on this issue?
Notice the self diversion from cocaine to sunny beaches may work and can
be continued. But for food or sex, surely the diversion couldn’t continue to succeed.
Hi NN. I don’t know of any data on ongoing or rising craving after giving up food and sex. Wait a minute, you might give up sex, in a pinch, but food…?! You’re talking about abatement of a desire for something we fundamentally need…and it’s hard to guess exactly how that works. I imagine that the period of craving can go on much longer than with drugs you have to specialize in. The eating-disordered person I describe in my book took a long time to change the way she felt about food. It took a lot of work and a lot of pain. That’s not data, but it’s something.
Fascinating post on relapse and cues.
Want to share a tool that I have also found very powerful and helpful. I have been listening to and using Tony Robbins tapes for close to 20 years. I have used his tools of “pattern interrupts” to actually condition in powerful trigger responses to triggers that used to set me off on my own addictive patterns. It has taken a long time for some of these but they are getting far more consistent. This has helped me to stop drinking altogether as well as to stop a food trigger by giving up eating sweets in social situations altogether. I cannot explain the tools here but think they could be helpful with people dealing with triggers. I am planning to see Tony Robbins for a whole weekend in March in Florida and hope to learn more.
No easy answers but feel there is hope for us all.
Tim