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There are two types of addiction-related craving: one is physical, which is related to withdrawal; and the other is memory-based, consisting of a desire that persists long after withdrawal has been subdued.
A study funded by the Brazilian National Council on Research and Development and published in the August issue of Alcoholism: Clinical & Experimental Research compares craving between pathological gamblers and alcoholics, correlating craving with personality. Results indicate that gamblers and alcoholics have distinctive personality traits that affect their cravings. "Personality, and temperament in particular, is defined as the usual basic emotional reactions and preferences towards both external and internal stimuli," said Hermano Tavares, coordinator of the Impulse Control Disorder Unit at the University of São Paulo (USP) in Brazil, and corresponding author for the study. "Craving is also defined in terms of the desire to use a drug and previous memories of pleasure superimposed upon a negative emotional state. So, both concepts involve emotional regulation and motivation. "The idea of our study was to investigate if specific personality traits could influence the craving experience among alcoholics and pathological gamblers, making it stronger, hence rendering more vulnerability to addiction." Study subjects ( 49 pathological gamblers, 101 alcoholics ) were recruited from individuals seeking outpatient treatment at community agencies and a hospital-based treatment center in Calgary, Alberta between April 2001 and November 2002, as well as through local advertising. All participants were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders IV criteria, rated their cravings (for either alcohol or gambling), answered a semi-structured interview, and completed the Temperament and Character Inventory and Beck Scales for anxiety and depression. "Both alcohol and gambling craving were directly related to clinical symptoms of depression and anxiety, and inversely related to length of abstinence," said Tavares. "However, alcohol and gambling cravings did not share temperament roots, pointing to different roles of both on emotional regulation. In other words, our study suggests that people turn to either alcohol or gambling for different reasons." Tavares said that positive emotions and negative emotions are two separate, distinct and independent dimensions, possibly regulated by different brain systems. "We found that alcohol craving was based on the temperament factor responsible for negative emotions," he said. "This suggests that those individuals who are especially vulnerable to negative emotions are the ones who will miss alcohol the most when trying to abstain. Conversely, gambling craving correlated to the temperament factor responsible for positive emotions. "This suggests that those individuals who naturally lack positive emotions and require intense stimuli to experience elation are the ones who will miss gambling the most when trying to abstain." "Thus, gambling seems to be more of a stimulant and anti-depression measure," added Sheila Blume, former medical director of Addiction Programs at South Oaks Hospital in Amityville, New York. "For alcoholics, craving correlated more with anxiety and harm avoidance, which indicates that alcohol is more of an anti-anxiety measure. Of course, these are not exclusive. "Alcoholics also drink and crave alcohol while depressed, and gamblers may crave when anxious, but these are statistical differences that can be helpful in understanding patients and in treatment planning." Both Tavares and Blume dismissed the lay notions of "unhappiness" or "sadness" as factors in addiction. "Unhappiness is too vague a concept," said Tavares. "Clinically speaking, anxiety is regarded as a state of negative emotionality and heightened arousal, while depression is best described as high negative emotions and low positive emotions. "Heightened arousal and low positive emotions respectively differentiate anxiety from depression, and negative emotions are shared by both. Alcohol seems to provide a lessening of negative emotions and may be used as a 'tool' to deal with tensions and nervousness, that is, anxiety. "Gambling seems to act as a 'fix' for individuals who are by nature partially deprived of feelings such as joy and elation, and require stronger stimuli to achieve emotional equilibrium and counterbalance depression." "These findings are not dissimilar to the findings of others in the field with clinical populations," said Blume. "This is not the same as saying that all addicts have the same 'addictive personality' but there are some traits that tend to show up in alcoholics, drug addicts and pathological gamblers more strongly than in the general population. "What is novel about this study is their correlation of these traits as well as emotional states with craving. To my knowledge, this has not been done before with alcoholics and pathological gamblers." Tavares added that "it is important to say that not all individuals with similar personality profiles will develop alcohol or gambling problems, but they may be at greater risk if the environment does not provide the opportunity to learn how to adjust their nature. "Being impulsive, prone to negative emotions, or requiring greater stimulation to attain joy may require special attention as these people could be at risk for a wider variety of addictive behaviors. "Perhaps a combination of traits, rather than the identification of an isolated one, is a better strategy to re-start investigating the validity of the 'addictive personality structure,'" he said. Blume suggested that future research look at the neurological basis of craving, as well as the mechanisms of how it works on a basic level. "We need better physiological measurements of craving and better anti-craving strategies," she said. Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "A Comparison of Craving Between Pathological Gamblers and Alcoholics," were: Monica L. Zilberman of the Department of Psychiatry at the University of São Paulo; David C. Hodgins of the Department of Psychology at the University of Calgary; and Nady el-Guebaly of the Department of Psychiatry at the University of Calgary. The study was funded by the Brazilian National Council on Research and Development, and the Alberta Gaming Research Institute. Alcoholism: Clinical & Experimental Research - www.alcoholism-cer.com
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