Drug cravings are intense; recurring urges that frequently appear in addicts actively involved in drug use, as well as in former users recovering from the effects of active addiction. In active addicts, these cravings commonly trigger additional bouts of drug use; in recovering addicts, they can lower the resolve to avoid drug use and lead to the onset of a relapse. Many current treatment programs deal with cravings through use of several different psychotherapeutic methods known collectively as cognitive behavioral therapy, or CBT. In 2012, researchers at Peking University documented the effectiveness of a new technique called memory reconsolidation that uses a memory-altering technique to weaken recovering addicts’ ties to their cravings.
Drug Craving Basics
When people use various drugs, they alter the brain’s normal environment by changing the way in which its cells communicate. In some cases, addictive drugs achieve their effects by triggering an increase in important brain substances (neurotransmitters) that carry chemical signals between individual cells. In other cases, drugs themselves mimic neurotransmitters and directly change cellular function. If drug use occurs regularly for extended periods of time, the brain can come to expect these chemical alterations and rely on them for a modified form of everyday function. Addiction specialists refer to this reliance as drug dependence. In certain circumstances, dependence turns into addiction when a user develops an intense compulsion to seek out and use drugs; drug craving is a term used to describe this compulsion.
In part, drug cravings are ingrained memories of the act of taking drugs, as well as memories of the “desirable” effects that led to continued drug use in the first place. When addicts and recovering addicts experience cravings, they essentially relive these activities in their minds. In addition to the activities themselves, addicts and recovering addicts also relive a number of associated details, including the actions that commonly preceded drug use, the physical setting of drug use, and the social setting of drug use. Addicts and recovering addicts can also develop intense cravings when they encounter situations that mimic these details in some way.
Cognitive Behavioral Therapy
Cognitive behavioral therapy was originally developed to deal with the after effects of active alcoholism, as well as mental conditions such as anxiety and depression. Generally speaking, the therapy involves the use of a variety of techniques designed to alter and retrain an individual’s reactions to stressful situations. In the case of a recovering addict, drug cravings represent a prime source of reactive stress and, if left untreated or unaddressed, they can lead to a partial or complete relapse into drug-seeking and drug-using behaviors. Retraining methods used to counter cravings include visualization techniques, distraction techniques, and the act of talking through an ongoing craving with a trained psychotherapist.
Memory reconsolidation seeks to destabilize persistent memories by weakening their grasp on a person’s ongoing thought processes. According to the theory underlying this technique, the act of recalling any given memory temporarily destabilizes that memory and makes it susceptible to alteration. If that same memory is recalled again within a certain window of time, it begins to weaken and fade away.
The researchers at Peking University, whose findings were reported in the well-respected journal Nature, tested the theory of memory reconsolidation by exposing a group of recovering heroin addicts to a video presentation that featured images of people taking heroin, as well as images of heroin-related paraphernalia. Half of these addicts were then re-exposed to similar imagery 10 minutes later during a form of behavioral therapy known as an extinction session. The other half were re-exposed to drug-related imagery during an extinction session that took place six hours after the initial video presentation. The addicts in the first group, who were quickly re-exposed to their memories, experienced significant decreases in their drug cravings that lasted for as long as half a year. The addicts in the second group, who were not quickly re-exposed to their memories, experienced no significant changes in their craving levels.
Implications for Future Use
The participants in the Peking University study were confined to a hospital setting and never encountered social settings that could provoke their drug-related memories. For this reason, the researchers who conducted the study don’t know if memory reconsolidation is effective in an unsupervised, real-world setting. The researchers also don’t know if memory reconsolidation will work for people with addictions to alcohol or drugs other than heroin. However, when combined with existing programs of cognitive behavioral therapy, the technique may help doctors and addiction specialists develop tools for the long-term prevention of both drug and alcohol relapse. Further research is needed to determine the likelihood of this possibility.