Abstract
Treatment of withdrawal and postabstinence craving has yielded mixed results in eliminating drug and alcohol use, improving outcomes, and reducing relapse in those patients addicted to alcohol and drugs. To assess the role of “conscious desire” (or craving) for drugs/alcohol during abstinence and withdrawal in continued addictive drug and alcohol use, we analyzed data from 1626 patients voluntarily admitted to a primary rehabilitation center in Minnesota. Eighty-one percent and 71% of all patients completed surveys at 6 and 12 months following discharge. Forty-two percent were diagnosed as alcohol dependent (AD) alone, 28% as alcohol and drug dependent (ADD) other than cocaine, and 25% as cocaine dependent (CD). At 6 months following discharge, the CD group had the lowest abstinence rate for drugs, at 83%, compared to the AD group, at 99%, and for alcohol, at 76%, compared to the AD group, at 75%. The AD group had the best outcomes and the least slippage from 6 to 12 months for drugs and alcohol. In all groups craving was not a major self-reported cause of relapse. For the CD subgroup, impulsive action with no known cause was the most common reason for relapse, while the AD group cited depression. These data agree with other reports in the literature suggesting that relapse is not commonly related to conscious craving. Our experience suggests that craving is rarely the first reason given for relapse. Drug seeking and use are such highly ritualized, automatic behaviors that the addict may appear not to require the intervention of conscious thoughts or distinct craving states to use. Clearly, obese patients eat without hunger, so addicts may use without craving. Subtle chemical changes in the abstinent brain associated with addiction may support the continuation of drug use but may not be consciously recognized.