Once you taste the coconut cream pie at The Camellia Grill in New Orleans, you will have dreams about it, and you will know what it is to crave something. Craving goes beyond wanting something. It is a nagging, persistent desire that seems to get worse the longer it remains unsatisfied.

Some would say that craving is an unnatural desire that is learned through repeated exposure to pleasant stimuli. Cravings turn a casual substance user into a substance abuser. Substance abuse reinforces craving until substance abuse becomes addiction.

With addiction, the cravings are 24/7 and can’t be ignored. The thing that used to satisfy the cravings is now the cause of the cravings in a vicious cycle that is difficult to escape:

Once you enter an addicted mode, your awareness, attitudes, and behavior contract to the habitual patterns of your addicted lifestyle.

Those words are from the new book, Building Recovery Resilience, by a team of addiction recovery specialists from Utah State University. They define “recovery resilience” as “an individual’s capacity to effectively apply coping and self-regulation skills in dealing with cravings, triggers, stress, and high-risk situations without reverting to substance use.” That is a very straightforward and useful definition.

They identify the ability to manage cravings as a primary objective of both the medications and the therapy that comprise the two tracks of modern addiction treatment. The “ability to manage cravings is a pivotal coping skill needed for sustained recovery from addiction,” the authors write.

The authors associate cravings with corresponding emotional states. From Alcoholics Anonymous (AA), they sum these up as “hungry, angry, anxious, lonely, tired, bored, and blue.” These are further condensed down to one emotional state in AA’s “Big Book”: “The root of alcoholism is self-centered fear.”

Building Recovery Resilience is a workbook that includes exercises for coping with cravings, triggers, and high-risk situations. A major goal of the authors is to get patients to think of themselves as being larger than an addict or a junkie or an alcoholic. Defining yourself as a person struggling with a disease rather than a person helpless to an addiction often buys the few moments of resilience necessary to ride out a craving.

For example, defining yourself as an addict or a junkie or an unrepairable person leads to “stinking thinking,” the authors say — a subject Pat Hartman has written about here on AddictionNews. Stinking thinking patterns include “denial, rationalization, blame, excessive self-pity, self-obsession, resentment, projection, over-personalization, and other types of defense mechanisms and/or cognitive distortions.”

Contrary to popular belief, cravings do not get stronger the longer you abstain — they get weaker. Even with powerful opioids such as fentanyl and heroin, after detox, the level of cravings recedes with time. There can still be urges, particularly related to environmental cues, but if they are resisted, they diminish in frequency and intensity over time.

In a rather philosophical article on the craving for drugs in a recent edition of the scientific journal, Mind & Language, author Hanna Pickard says that studies with rats prove addicts will choose other rewards besides drugs if they are available. “[T]here is strong evidence that drug use in human addiction is not habitual, but goal-directed,” Dr. Pickard says.

Dr. Pickard is the Bloomberg Distinguished Professor of Philosophy and Bioethics at Johns Hopkins University. The “choice of reward in both species [rats and humans] [is] influenced by factors such as relative reward size, cost, delay, and, of course, consequences,” says Dr. Pickard, before bringing home the significance for addiction treatment:

Arguably the most important illustration of this point, in relation to humans, comes from contingency management (CM) treatment. CM is a highly effective therapeutic modality which in effect structures a person’s environment to mirror forced-choice animal studies: Alternative rewards, such as small prizes, vouchers, money — or skills training and employment — are available on condition of abstinence.

Our old friend contingency management, of which we have written much here at AddictionNews. It works because even these small rewards can stimulate resilience, delaying relapse and teaching delay discounting. “[T]he treatment may work by explicitly engaging goal-directed deliberation,” writes Dr. Pickard, “thereby countering any habitual influence on goal selection.” Dr. Pickard concludes, “It is an outrage that [CM] is so rarely available to treat addiction.”

In summary, cravings are most intense during detox, but afterwards they decline proportionally with time, with exceptions for cue-induced spikes. Cravings are more frequent during negative emotional states; one way of resisting them is to finesse an elevated emotional state. Mindset is also very important, seeing oneself as larger than the addiction leads to a greater ability to surf a wave of cravings without indulgence.

Finally, contingency management works because it rebuilds the reward response mechanism through both small and large rewards for remaining abstinent. CM is currently the most reliable and inexpensive way to wean a person off hard drugs, which might be why the addiction treatment industry resists it.

Written by Steve O’Keefe. First published September 3, 2025.

Sources:

Building Recovery Resilience: Addiction Recovery and Relapse Prevention Workbook, Cambridge University Press, 2024.

“Craving among long-abstinent smokers: An Internet survey,” Nicotine and Tobacco Research, February 17, 2010.

“Craving for drugs,” Mind & Language, June 28, 2024.

Image courtesy of Stacy Spensley, used under Creative Commons license.