What does it mean to crave something? Despite the fact that the feeling of craving lies at the heart of the addiction experience, we know very little about how it works. As recently as 2005, Alan Marlatt and Katie Witkiewitz described craving as "possibly the most widely studied and the most poorly understood concept in the study of drug addiction" (p. 18).
Psychologists used to think the feeling of craving was purely biological. But Marlatt and his colleague, Damaris Rohsenow, for instance, reviewed a series of studies in which alcoholics who believed they were drinking alcohol—whether or not there was really any alcohol in their drinks—began to crave it; while alcoholics who drank alcohol, but who believed they were drinking nonalcoholic beverages, did not crave it.
So what is a craving? When someone with Obsessive-Compulsive Disorder feels she must scrub her hands a certain number of times, she does not experience that need as coming from within her, but from above her. The experience is more of a "should" than a "want." When someone with a substance abuse problem, however, feels the need to use her substance of choice, she experiences that as a "want," a want so intense, that even though she doesn't want all the bad consequences that she's learned are sure to follow, she feels enormous temptation to give in to her desire. When she says she wants to stop, what she really means is that she wants to want to stop.
What does it mean to want something?
Psychologist Robert Abelson suggests the following thought experiment. Imagine a chess-playing computer. It makes every effort to win, and usually does, even against grandmasters. Yet we would never describe it as wanting to win, because we can't think of any situations in which it would try not to win. A mob boss couldn't persuade it to throw a game by threatening to break its legs, for instance.
David Shapiro, in his classic 1981 book Autonomy and Rigid Character, suggested a possible pathway that connects motivation and action. It all starts with an urge. But that isn't the same thing as action. We all have urges we ignore all the time. Instead, that urge may generate an awareness of the various possibilities of action, leading to some form of conscious intention, which, then, might give rise to an action. When I was in college, there were many times I'd rather have hung out with friends than study for finals. But the urge to be with my friends was counterbalanced by my other desires-to get good grades, and get into graduate school, maybe even to feel a sense of accomplishment. I made the conscious choice to hunker down and study not because I didn't really want to see my friends, but because my competing desires won out. I experienced them all as desires or intentions, and felt like the agent of my own actions, even though I missed out on something I would have liked.
A craving, on the other hand, seems more like an unrecognized intention. Even though you want to go to the racetrack, you may not feel like the agent of that want. A cocaine abuser clearly makes many decisions to satisfy her craving: find a dealer, find money to pay him, make the transaction, get the cocaine ready for use, and then sniff or snort. But she doesn't feel like the agent of all those actions. She feels like their victim, impulsive and lacking in a sense of deliberation, feeling she can't help herself. But, as Shapiro suggests, people in this position "do not altogether regret what their impulses choose to do with them."
Some characteristics of craving are:
- Impulsivity and speed
- The interest tends to be immediate or in the short-range
- Feeling like you're lacking in deliberateness, even if you're busy trying to figure out the fastest way to satisfy your craving
- An impaired sense of integrating past, present and future; the craving seeks only satisfaction, and it seeks it NOW.
Without a sense of planning for the future, it's easy to easy how a craving might win out over trying to develop full-blooded desires. It's the existence of competing long-term interests that makes it worth our while to postpone gratification. Without those interests, what's the point of not indulging our urges? If I didn't care about my grades, or about graduate school, why wouldn't I blow off my exam and hang out with my friends?
TESTING THE THEORY
Since substance abusers have particular difficulty with uncontrollable cravings, I analyzed stories told by a group of cocaine abusers and compared them with stories told by non-abusers (Greenstein, 1994, 2011). All the subjects were given the same picture cards and asked to make up stories about the characters in the pictures.
The stories told by abusers tended to be faster, shorter, more abrupt, and tended to miss temporal elements, like beginnings, middles and ends. The substance abusers tended to tell their stories in a way that felt less intentional. For example, they were more likely to blame the card itself ("the card makes it look like...") or even the tester ("you want me to say...") for the content of their stores. Even the protagonists of their stories were less likely to act intentionally, more likely to act "without realizing it" or while "flipping out."
Abelson, R. (1988). Lawless mind. Philadelphia: Temple University Press.
Greenstein, M. (2011). I Don't Want to Want to: Intentionality and Craving in Addiction. In: C.Piers (Ed). Personality and Psychopathology:Critical Dialogues with David Shapiro. New York: Springer Press.
Greenstein, M. (1994). Intentionality and irresistible impulse in addiction. Unpublished doctoral dissertation, New School for Social Research
Marlatt, G.A. and Witkiewitz, K. (2005). Relapse Prevention for Alcohol and Drug Problems. In:G.A. Marlatt and D.M. Donovan (Eds.) Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York: Guildford Press
Marlatt, G.A. and Rohsenow, D.J. (1980). Cognitive processes in alcohol use:Expectancy and the balanced placebo design. In: N.K. Mello (Ed.) Advances in Substance Abuse, Volume 1. Greenwich: JAI Press.
Shapiro, D. (1981). Autonomy and Rigid Character. New York: Basic Books.