Quality, Not Quantity, of Cravings Predicts Relapse

There is a large volume of research on addiction, and more specifically, the mechanisms that cause relapse in individuals undergoing drug addiction treatment. The majority of people who enter a rehabilitation program also begin substance addiction treatment while they undergo detoxification. However, nearly half of detox clients never finish their treatment and are likely to begin using again. Therefore, it is imperative to understand what causes relapse. Some evidence points to cravings as one of the leading factors affecting relapse. But attitudes toward cravings, intensity of cravings, and frequency of cravings have not been studied together with relation to drug addiction and relapse. Reshmi Marhe of the Institute of Psychology at Erasmus University Rotterdam in the Netherlands recently led a study that addressed these issues.

For the study, Marhe evaluated 68 participants who were receiving inpatient treatment for heroin dependency. The participants received a digital device that assessed their cognitions and attentional bias toward drugs at random times (RA) throughout the day over the course of one week. They were also instructed to report their feelings and appraisals when they felt tempted to use (TA). Marhe discovered that the participants exhibited three classes of relapse: early relapse, late relapse which occurred after the one week assessments, and no relapse. Those who relapsed, whether early or late, did not have more frequent temptations than those who did not relapse. However, they did experience stronger cravings and more implicit positive attitudes toward drug use when they were tempted. But when the relapsers were compared to non-relapsers, RAs were the same.

This finding suggests that it is not the number of cravings that affects relapse risk, but the intensity of the cravings and how they are received. The relapsers had more positive attitudes toward drug use and had more attentional bias toward drug use during the temptations than the non-relapsers. But when cravings were not present, the overall cognitive appraisals were the same for all the participants. Marhe believes that these results have considerable clinical implications and added, “The data suggest that attentional bias (and implicit attitudes) may be an appropriate cognitive target for intervention.”

Marhe, R., Waters, A. J., van de Wetering, B. J. M., and Franken, I. H. A. (2012). Implicit and explicit drug-related cognitions during detoxification treatment are associated with drug relapse: An ecological momentary assessment study. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030754

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  • derrick


    December 26th, 2012 at 10:35 AM

    Oh I know how it is with food craving.I feel addicted to food and yes,the cravings can vary in intensity.Some days I have cravings at odd times that I can handle well but on some other days I have to rush to fulfill the craving.Its weird but cravings can definitely have an intensity and that can make a difference in the addict’s response.

  • shannon t

    shannon t

    December 26th, 2012 at 10:56 AM

    You have to know that when you are battling some form of addiction that there are bound to be numerous cravings for the substance throughout the day. It is going to come and go like waves and I guess you get used to that. But the strength at which the cravings occur, now that is a whole different story. There could be times when you think about it in passing and it really doesn’t have that much of an impct on you. But you know that there will be other times when you can’t hardly resist because the strength of the craving is so strong and powerful that it literally could suck you right back into all of the previous bad behavior that you were a part of.

  • Tom Lewandowski

    Tom Lewandowski

    December 26th, 2012 at 2:27 PM

    Absolutely, the intensity of cravings definitely impacts relapse potential. And client’s attitudes impact how these cravings are received. It’s something we stress with our clients in early recovery. You might not be able to eliminate your cravings, but you CAN change your attitude about what those cravings mean.

  • miguel


    December 26th, 2012 at 6:37 PM

    tried hard to quit cigarettes for a few weeks last year but it didn’t work.but in may this year I was able to quit!it was surprising at first but then I realized the difference was in the intensity of cravings and my attitude.what was the difference between 2011 and 2012 was that in 2012 I was far more aware of the health consequences of smoking so that must have impacted my attitude.secondly,the cravings in 2012 was not as strong as those in 2011 because I had gradually reduced consumption so my dependency was low and also I used to keep talking myself out of a craving everytime.

  • JJ


    December 26th, 2012 at 11:15 PM

    I would’ve thought the number or quantity or cravings would matter more..atleast for me fighting off one big craving would be easier than multiple smaller cravings..eventually I would real down with more and more cravings..

  • mark


    December 27th, 2012 at 4:11 AM

    I know that the strength has to play a big part, but being innundated with these cravings day after day and hour after hour, no matter how strong they are that has to play havoc with your determination to succeed. It’s not like these are something positive to take something away from, these are feelings that can wear you totally down.

  • simon


    December 27th, 2012 at 10:59 AM

    “The relapsers had more positive attitudes toward drug use and had more attentional bias toward drug use during the temptations than the non-relapsers”. Wow, so this “study” demonstrates that people who decide to-and are motivated to-quit, have less relapses. How can I get a government grant to do “research” like this?

  • L.Y


    December 27th, 2012 at 1:01 PM

    While more frequent cravings are easier to measure,the same is not the case with ‘stronger’ cravings.what may be strong for one person may not be for another.

    it is subjective and the mental toughness can play a role.so I think they need to see if quantity or quality matters in an individual’s context.

  • Zane


    December 28th, 2012 at 3:55 AM

    Thankfully I have never had this sort of addiction to any one thing that would cause me to feel that strongly about something or to want it that badly.

    I do sympathize with those who do, because it is almost scary to think of how much control this could come to have over your life if it is allowed to fester and grow.

  • l jones

    l jones

    December 28th, 2012 at 7:38 AM

    I just wonder if this has any transfer to eating disorders. I would be interested in reading a study that examines this. It could really help several of my patients.

  • Stich


    December 28th, 2012 at 7:41 AM

    Quitting a dependency on something is hard enough mentally, It’s ashame that we as humans also have to deal with the physical part. Withdrawal is no joke and it doesn’t matter if its pain killers or alcohol. i don’t know why it has to be so hard but it is. I hope anyone reading this who is facing trying to break an addiction can stay strong and know that you have support even from people you don’t know.

  • m.P


    December 28th, 2012 at 3:42 PM

    Does the situation and time of the day of cravings matter to addicts too?I don’t consider myself an addict but I do use a particular substance on a regular basis.While I am able to stave off the cravings of the high during the day and when I’m with friends,I just cannot help but give in mostly at night time or when I’m alone.How does all this play out in our mind?

  • Alberto


    December 28th, 2012 at 11:07 PM

    Never is it tougher to quit when you are in the same environment and do the same things. Getting away from everything related to the substance of addiction can help to a great extent. I have had friends who have battled alcohol addiction successfully and those that didn’t turn out too well. Difference is in the attitude.

    With regard to cravings, a strong craving can be overcome by a strong mind but not by a weak one.

  • Marguerite Jones

    Marguerite Jones

    December 29th, 2012 at 4:10 AM

    my thought would be that a craving is a craving
    for an addict
    no matter how small or how strong
    how frequent or infrequent
    this is always gonna present a problem
    it is a chance for them to either be strong or stay weak



    December 29th, 2012 at 2:16 PM

    It’s good that they r looking at the minute reasons that can cause a relapse in an addict. Now if they only stopped considering users as criminals but as victims and addicts instead,then we can really move forward with this.



    December 30th, 2012 at 7:24 AM

    If your conviction isn’t strong enough the craving will feel like too much and you will give in.Whereas a strong conviction will not allow for that to occur.It is in the way we think of it.Its is all in our mind.Its not the cravings that are stronger,it is our mind that is weaker!

  • steven j

    steven j

    December 30th, 2012 at 3:44 PM

    I was reading about this study and something stuck me – could it be that the participants who relapsed actually didn’t mean to sign up for rehab and deaddiction at all.I mean there are those that are persuaded to go to rehab and deaddiction,they are still not mentally ready to.Such people will definitely have more chances of dropping out and ‘relapsing’.

  • Margo


    December 31st, 2012 at 5:56 AM

    When I first read the tagline I was like, quality craving? Is there any such thing?

    I think that a better term to use would be severity or strength of the craving. And I do see that how strong something like this hits you the more power it could have over your will to succeed or inability to conquer it.

    It’s like if it is persistent but not very strong, then eh, maybe you can ignore it. But when it comes over you so strong and powerful it would be very hard to ignore and move on from it without subcumbing to it.

  • HILda


    December 31st, 2012 at 1:29 PM

    ANd what is quality of a craving dependent on?the mental strength of an addict.I just think the ones that report more intense cravings are actually the ones whose scores on mental toughness are low!

  • PW


    December 31st, 2012 at 10:31 PM

    Being addicted to a substance would mean that I am craving for it all the time.Now if I enter a de addiction program it means I have made up my mind to quit and stay sober.

    I don’t understand why people enter such programs and then relapse anyway,it can bring down the morale of the entire group!if you’re unsure about whether you really want to quit,think about it.there’s no reason to join a de addiction program just because.entering such a program does not guarantee de addiction, making up your mind does!

  • kerrie T

    kerrie T

    January 2nd, 2013 at 2:27 PM

    Is there even such a thing as quality of cravings? Because for me, alcohol addiction in the past was all about how often I had the cravings. they seemed to be equally strong at all times. Only they were much harder to control when I was alone.

    Its the things and events surrounding that can influence your decision. there is no such thing as quality of cravings…At least according to me.

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