Drug cravings are the powerful urges that repeatedly reinforce a continuing pattern of substance intake in people dealing with addiction. The presence of these urges can easily derail an attempt to maintain substance abstinence during the recovery process from cocaine addiction. In a study scheduled for publication in 2014 in the journal Addiction Biology, researchers from two U.S. universities investigated the impact that a personal history of child maltreatment has on the strength of the drug cravings experienced by adult men addicted to cocaine.
The presence of drug or substance cravings is one of the 11 symptoms recognized by the American Psychiatric Association as an indication of diagnosable substance use disorder (a condition that includes both substance addiction and impairing levels of substance abuse). These cravings arise after repeated exposure to excessive amounts of alcohol, drugs or mind-altering medications alters the brain’s basic chemical environment and triggers the onset of physical substance dependence. Essentially, a drug craving acts as a reminder from the brain that the needs of dependence must be met if the affected individual wants to avoid going through withdrawal. As a rule, drug cravings in an addicted or physically dependent person are reinforced by internal and external signals called drug cues. When exposed to such a cue, the affected individual typically experiences a significant uptick in his or her level of desire to consume more of the substance in question. Potential sources of drug cues include physical locations where substance use has occurred in the past, everyday stress or extraordinary stress, states of mind previously associated with substance use and interactions with substance-using peers or acquaintances.
Child maltreatment is the umbrella term commonly used to describe an action or absence of action that endangers the welfare or well-being of a minor child. Active forms of maltreatment include physical abuse (e.g., punching, choking, kicking or burning a child), sexual abuse (e.g., involving a child in an adult sexual act or exposing a child to an adult sexual act) and psychological abuse (e.g., threatening, belittling or taunting a child). Passive forms of child maltreatment include neglecting the material needs of a child, neglecting the emotional needs of a child, neglecting the educational needs of a child, neglecting the medical needs of a child, failing to provide protective oversight for a child and leaving a child in a setting where violence or other forms of abusive acts are likely to occur. Some adults purposefully commit acts of maltreatment, while others inadvertently do so. However, intent does not alter a perpetrator’s basic liability.
Impact on Cocaine Cravings
In the study scheduled for publication in Addiction Biology, researchers from the University of North Carolina at Chapel Hill and the University of Arkansas for Medical Sciences used an assessment of 38 men affected by cocaine addiction/dependence to investigate the impact that a history of child maltreatment has on the severity of drug cravings. Twenty of the participants enrolled in the study were exposed to some form of maltreatment during childhood, while the remaining 18 participants were not. The researchers used a combination of a written script and guided mental imagery to provoke heightened levels of stress and drug cravings in both groups of participants. They also used a real-time imaging procedure called fMRI (functional magnetic resonance imaging) to measure the changes in brain function brought about by stress and drug craving exposure. The researchers concluded that, when exposed to heightened stress, the men with a history of child maltreatment underwent distinct changes in brain function. In addition, these men experienced distinct brain function changes when their drug cravings were prompted and when they experienced significant amounts of anxiety. Crucially, some of the observed changes occurred in brain regions that normally provide control over reward anticipation and impulsive behavior. Overall, the researchers concluded that a history of child maltreatment is linked to two important things. First, an addicted cocaine user with such a history feels an increased level of anticipation when exposed to drug cues. In addition, an addicted user with a maltreatment history loses some of the ability to control drug-using behavior. The study’s authors believe their work supports previous research findings that demonstrate child maltreatment increases addiction risks in adult substance users. They also believe their work helps shed light on the underlying brain mechanisms responsible for this increased risk.