Wanting to Craving: Understanding Compulsive Involvement with Drugs
Posted by dlende on November 6, 2008
By Daniel Lende
A long-time research project of mine has been to understand how adolescents get hooked on drugs. Querer más y más, as they say in Colombia, to want more and more. When people get addicted – whatever the substance may be – they often report urges, cravings, and obsessive thinking as a primary force in why they keep using or relapse. Knowing the consequences often doesn’t matter, especially in those moments when that desire feels hot as a knife.
The easiest analogy for me to help people understand this type of desire is to ask people to think about that one time they really craved something to eat. Yes, that time, when you just had to have it. Most people have experienced this one time or another. With substance abuse, craving like this often becomes an unpredictable constant, something that comes on in the morning or while walking by a favorite bar or seeing a friend who has that gleam in his eye and a crooked smile on his face.
So here is what I found in Colombia, reported in a 2005 Ethos article entitled Wanting and Drug Use: A Biocultural Approach to Addiction (click for the full paper: Lende Wanting pdf). The abstract goes:
The integration of neurobiology into ethnographic research represents one fruitful way of doing biocultural research. Based on animal research, incentive salience has been proposed as the proximate function of the mesolimbic dopamine system, the main brain system implicated in drug abuse (Robinson and Berridge 2001). The research presented here examines incentive salience as the mediator of the wanting and seeking seen in drug abuse. Based on field work with adolescents at a school and a drug treatment center in Bogotá, Colombia, this article addresses: 1) the development of a scale to measure the amount of incentive salience felt for drugs and drug use; 2) the results from a risk-factor survey that examined the role of incentive salience and other risk factors in addiction; and 3) the ethnographic results from in-depth interviews with Colombian adolescents examining dimensions of salience in the reported experiences of drug use. Incentive salience proved to be a significant predictor of addicted status in logistic regression analysis of data from 267 adolescents. Ethnographic results indicated that incentive salience applies both to drug seeking and drug use, and confirmed the importance of wanting, a sense of engagement, and shifts in attention as central dimensions of experiences related to drug use.
Several years later, I like to highlight several things about this research. First, different domains of subjective involvement can be linked to dopamine –wanting more and more, the sense of an urge or push to use (often not a conscious desire), and the heightened focus on places and actions and times that lead to using. The scale I developed showed good internal consistency, adding support that these three senses of compulsive involvement are linked. If you want to know more about the scale, I have done a separate post detailing the compulsive involvement scale in both Spanish and English versions.
Second, the original theory of incentive salience and addiction was developed by Terry Robinson and Kent Berridge at the University of Michigan. (Here’s a recent summary paper of theirs on incentive salience and addiction.) Incentive salience has generally focused on the desire to use drugs, on motivations to use, and separated those from the pleasure or high associated with actually using drugs. My ethnographic research clearly showed that hard-core drugs users often felt surges in desire while using, not just in deciding to go use or seeking out drugs. Querer más y más, to want more and more, often referred to what happened while using. This effect helps to explain the often extraordinary amounts of drugs that some addicts use. It is that rabid urge to continue, to have more, and not just tolerance to a drug, that helps drive the excess often associated with substance abuse.
Third, neuroscientists are plain wrong if they try to reduce craving or desire to the combination of the pharmacological drug action and brain circuits. This common approach does not answer what it is that hard-core users want – it assumes that sensitization and chemicals account for everything (or at least everything that counts). Put differently, why do addicts want drugs?
A disease model or a moral model of addiction cannot answer this question because they assume cause already – it’s a biological problem or a failure in willpower. That avoids addressing what people themselves can tell us about their use. Brain imaging in humans also doesn’t answer the “why” question – scans can show neural correlates associated with craving, but they cannot get at the content of our experiences and our thoughts.
Anthropology can! The question that I devised to help hard-core users explain to me why was rather simple. “Think of your experiences while using as an imaginary place. What sort of place would that be?” For an anthropologist, or anyone interested in subjective experience, this question had one all-important point – it gave me data; it helped my respondents articulate their experiences in words that I could then analyze. It may be not be quite as fancy or expensive as neuro-imaging, but it too let me peer inside someone else’s head.
I will also admit that the question thrilled me because I knew some hard-core neuroscientists and the way they thought about the brain and addiction. Wanting, that’s just dopamine, they argued. Most of them struggled significantly more with imaginary places.
But the best thing about the question was the answers. Kids who had never used did not understand this question at all. But teenagers who used frequently, they got this question immediately. I still remember one of the first boys, a recovering cocaine addict at a local school who was now a heavy smoker. I asked him the question first about smoking. He looked down at his hand and put his fingers together like he held a cigarette. “A world in there? No,” he said. “But cocaine, oh yeah.”
In the end, what I found was that both cultural symbols and an individual’s sense of self impact what users experience. One girl who smoked marijuana nearly every day explained what she sought from using: “estar en un video,” to be in a video, where attention was shifted away from how she felt in her traumatic yet culturally valued family environment. Sure, the dopamine helped produce that shift in attention, but the idiom of “a video” was something cultural. In the end that was what she really wanted, to feel those “so present sensations” from marijuana that put her in a video that seemed, for a moment, far from home.