Jun 23, 2020 | By Gillian Tietz, M.S.

Alcohol Cravings: Brain Differences in Alcoholics vs Social Drinkers

Alcoholism

Alcohol cravings are common when a problem drinker or alcoholic decides to quit drinking. The more we drink, the more our brains associate alcohol with reward and pleasure. Alcohol actually rewires the brain to want more alcohol. When we remove alcohol from our lives, we are still left with the associations that alcohol is essential for the weekend or it is required for celebrations. These associations can cause powerful cravings.

Classical Conditioning Leads to Alcohol Cravings

In the 1890’s, Russian psychologist Ivan Pavlov performed experiments on dogs to study their salivation response.  He had the dogs hooked up to a tube to collect their saliva, gave them food, and observed their response. What he began to notice was that the dogs began to salivate when the researchers opened the door. This led him to experiment with conditioning the dogs. He rang a bell and provided the dogs with food. Eventually, just the act of ringing the bell would cause the dogs to salivate, even if no food was provided. The dogs became conditioned to hear the bell and expect reward.

We have conditioned ourselves to believe alcohol is rewarding and pleasurable. Have you ever been at a bar after a stressful day of work, and just the act of ordering your drink brings huge relief? You haven’t even had a sip yet, but you already feel better. This is because we have conditioned ourselves to believe alcohol is relaxing. This conditioning leads to craving alcohol.

What’s Going On in The Brain?

A 2003 study looked at brain activation for alcoholics and social drinkers using MRI. They found that when presented with a cue, the alcoholics had significant activation where the social drinkers did not.

The areas of the brain that were activated were all part of the pleasure system. Specifically, the nucleus accumbens (controls motivation), cingulate (converting feelings into actions), and insula (involved in the search for food and drugs). These regions have been observed to be activated in other studies in response to alcohol, cocaine, opiates, and nicotine. Interestingly, social drinkers did not have much brain activation in response to alcohol cues.

Can Alcohol Cravings Go Away?

In the MRI image on on the left, alcoholic patients were instructed to think about their favorite alcoholic beverage. This 2017 study looked at alcohol cravings in response to treatment that involved aversion therapy, group therapy, and teaching patients strategies to handle cravings. Aversion therapy is learning to remember the negative aspects of alcohol use, instead of associating it with positives. As the patients underwent treatment, they saw a significant improvement in alcohol cravings.

“When someone tries to quit drinking alcohol, he may see others enjoying alcohol in those familiar circumstances, which activates his brain’s pleasure center and can lead him to fantasize about drinking again. That can cause a sober person to crave alcohol.”

Alcohol Cravings and Relapse

A 2004 study found that alcohol cravings and obsession led to relapse. Researchers looked at 103 patients in treatment for alcoholism, and found that alcohol cravings were a significant contributor to relapse. The OCDS is the Obsessive Compulsive Drinking Scale, and is a method of self-reporting.

“Relapse during the treatment phase occurred in 32 patients and more than half of them dropped out due to relapse. We have found that patients with increased cravings measured by the OCDS dropped out significantly more often during the treatment phase. As a consequence, patients with increased craving should be treated more intensively by using additional relapse prevention approaches which may help the patient to recognize cues that lead to drinking. Patients should develop strategies to cope with high-risk situations such as negative emotional states and interpersonal conflicts.”

How I Handle Alcohol Cravings

Because alcohol cravings can be a major contributor to relapse, it is important that we find ways to handle and overcome them in sobriety. I was a wine drinker. When I quit drinking I had alcohol cravings when I would see someone drinking wine, after work, on the weekends, and at certain places I used to drink. I have handled these cravings in two ways: exposure or avoidance. Also, I regularly see a therapist.

I proved to myself that I could still unwind after a stressful day at work without drinking, that made the craving less intense over time. Similarly, each time I had a fun sober weekend, I broke down the association that alcohol makes a weekend fun.

I avoid my old drinking haunts completely. There is no reason for me to go to bars that trigger me or remind me of bad times.

I highly recommend finding a therapist who specializes in alcohol abuse to learn to deal with alcohol cravings. Meetings (AA, smart recovery, etc) can also be very beneficial in recovery for support, but also to learn that you are not alone.

Conclusion

Alcohol cravings can be a powerful trigger for relapse. As we adjust to sober life, we can learn to overcome their triggers. The science shows that although our brains are rewired to crave alcohol, this can lessen with proper treatment.

Have you experienced alcohol cravings? How did you overcome them?