Intensity of Cravings Impacts Relapse Risks in Opioid Addicts
In the context of substance use/abuse, craving is the term used to identify a compelling urge to consume more alcohol or more of a given drug or medication. Guidelines issued by the American Psychiatric Association list the presence of this compelling urge as one of 11 potential symptoms of substance use disorder (the overlapping category for diagnosable substance abuse and substance addiction). In a study published in March 2014 in The American Journal of Drug and Alcohol Abuse, researchers from three U.S. universities explored the role of craving intensity in rendering people receiving treatment for an opioid addiction more likely to relapse back into active opioid use.
People who repeatedly consume large amounts of alcohol or certain drugs or medications run very real risks for triggering long-term alterations in the part of the brain that registers and processes pleasurable sensations. These alterations serve as the basis for physical dependence, a situation in which the brain comes to treat the presence of a given substance as a prerequisite for its daily operation. They also contribute to the necessary conditions for substance addiction, a highly dysfunctional mental and physical state that seriously reduces affected individuals’ ability to do such things as maintain a stable lifestyle or meet ongoing personal and social obligations.
Prior to 2013, the American Psychiatric Association (APA) used separate lists of symptoms to account for the effects of substance addiction and non-addicted substance abuse. However, doctors and researchers are well aware that overlapping symptoms of these problems regularly appear at the same time, and scientific consensus no longer supports a split approach to diagnosing them. For this reason, the joint substance use disorder diagnosis has replaced the separate substance abuse and substance addiction diagnoses. As part of their reorganization, the APA also added craving to the list of symptoms used to identify substance use disorder.
People affected by cravings experience strong urges to use more of a given substance, especially when exposed to internal or external cues that are consciously or unconsciously linked to substance intake. Cravings don’t suddenly die off when a person enters substance recovery; in fact, they can often intensify considerably both during and after the inevitable process of detoxification and withdrawal. Addiction specialists know that cravings have the potential to derail any given person’s sobriety and trigger a relapse back into active substance use.
In the study published in The American Journal of Drug and Alcohol Abuse, researchers from Boston University, Brown University and UC San Diego assessed the impact of craving intensity on the relapse risks of 147 people receiving treatment for opioid dependence/addiction. They undertook their project, in part, because relatively few previous research efforts have focused on this particular aspect of opioid addiction recovery. All of the study participants were recipients of buprenorphine, an opioid-based medication commonly used to reduce the severity of opioid withdrawal symptoms. During the study, each participant completed two questionnaires—the Desires for Drug Questionnaire and a modified form of the Penn Alcohol-Craving Scale—designed to help gauge any given person’s level of craving for opioid substances.
The researchers found that the peak level of craving for opioid use occurred roughly two weeks after the study participants started taking buprenorphine. They concluded that, for each participant, the chances of relapsing back into opioid use increased by about 27 percent with every single-point increase on the seven-point range of the modified Penn Alcohol-Craving Scale. In addition, they concluded that the chances for relapse rose roughly 25 percent to 51 percent if scores went up on two of the four subareas of the Desires for Drug Questionnaire. The subareas in question measure the desire to use drugs and the active intention to use drugs.
Impact on Relapse Risks
All told, the authors of the study concluded that increased drug cravings during the opening phase of opioid addiction treatment have a “modest” but very real impact on the relapse risks of opioid addicts receiving buprenorphine. The craving levels registered during the study were reported by the participants, not objectively measured by the research team. Still, the study’s authors believe that such self-reports may play an important role in helping addiction specialists and other health professionals determine which program clients/patients have the highest chances of relapsing early on in the treatment process.