Anatomy of a craving

You know that feeling of an itch... In the geometric center of your back when you’re alone and cannot reach the originating spot but only spots above and below and the more you try, the more intense the itch becomes, the more unreachable it is, and the more prominent the discomfort. Rapidly, it’s all you can think about. The more you try not to think about it the more the uncomfortable sensation grows and grows and grows and soon you’re itching from the inside, a burning, flaming, crawling, creeping sensation that activates neurons one by one in slow painstaking methodical torture.

The sensation of Itch is driven by nerve cells in the skin, pruritoceptive neurons. These are unmyelinated C-fibers and they’re very responsive to histamine release.

Endorphins are released with the act of Scratch (serotonin), then the itch signal from the pruitoceptive neurons is re-set, and the cycle begins again, with more intensity.

I’ve been plagued periodically with the development of hives with black fly, red ant, or spider bites and while they are now short-lived, the misery is real. The hives that used to be total-body now isolate to the area around the bite which invariably is in an unreachable area. It’s only 20 minutes of misery, but it feels like 20 hours.

It occurs to me that this is not dissimilar to a craving. And, neurologically, it is worth reviewing the process that is activated under the surface when we’re in the throes of wanting alcohol, or sugar, or a gambling fix, because the mechanism is the same. And it all starts with dopamine.

Cravings are rooted first in the concept of reward, and the fundamental reward chemical is dopamine. It is released from the nucleus accumbens with our first exposure to something pleasurable, and thus begins the reinforcement cycle. Quickly, even the memory of the pleasurable activity can trigger release of dopamine. Of note, ingestion of an addictive substance such as alcohol triggers a hyper-release of dopamine, much more so than another pleasureable activity, and euphoria ensues, and thus we are forever chasing that initial “high.”

Cravings are also rooted in our emotional centers. Stress, for instance, triggers activation of the amygdala and this interacts with the reward center to intensify cravings. Chronic stress is lethal because of the imbalance that results in the reward center activation. Cravings are triggered by our memories and associations. We can open a cupboard and see a wine glass and instantaneously a craving is stimulated by a memory of the wine swirling in the glass, the smell, and so on. The glass is a cue, and our brain anticipates a reward.

Craving compromises our prefrontal cortex’s function, and that thinking and control center of our brains goes off-line. This results in compulsive seeking of the substance or behavior, even when we have knowledge that we are putting ourselves in harm’s way. Our brain loudly demands that which gave it intense pleasure previously, or alleviated discomfort, or both.

Surfing our way through and over the wave of a craving starts with awareness. Noticing that the body is experiencing the sensations of craving is the grounding step. All too frequently we skip over that awareness and immediately, and impulsively, reach for the substance or behavior to alleviate the discomfort. The awareness allows us to slow down, engage our prefrontal cortex, and notice what sensations we are feeling. If we give those sensations a name, a detailed description, that opens the door to distraction.

We can more easily avoid the compulsive behavior and more readily engage in a replacement activity that is also pleasureable. A walk outdoors is a ready antidote.

Finally, being in community with others is also key, and a difficult step in the earliest days of navigating cravings.

If you are struggling and want to know more about navigating your way to the other side of that wave, message me.

Jenie