Understanding Cravings: What’s Normal — and What Needs Treatment 

Cravings are one of the most misunderstood parts of addiction and recovery. For some people, cravings show up as fleeting thoughts that pass quickly. For others, they can feel urgent, intrusive, and overwhelming; strong enough to derail recovery even when someone desperately wants to stop using. 

Understanding what’s normal, what’s expected, and when cravings signal a need for treatment can help reduce shame, improve outcomes, and support earlier intervention. 

What Are Cravings, Really?

Cravings are the brain’s way of signaling a strong urge for something it believes the body needs. Under normal conditions—such as hunger or thirst—these cravings are essential for survival, helping us seek out food, water, and other necessities. 

However, with certain substance dependencies, the brain’s reward and motivation circuitry becomes dysregulated. This causes cravings to intensify dramatically, sometimes reaching levels hundreds or even a thousand of times stronger than natural survival-driven urges. These amplified cravings are driven by complex, interconnected neural pathways involving reward, reinforcement, memory, and avoidance of withdrawal. As a result, the brain begins prioritizing the substance as if it were essential for survival, even when it causes significant harm. 

According to Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorder is a chronic brain condition, not a failure of willpower. Repeated substance use alters how the brain processes pleasure, motivation, memory, and stress, making cravings a biological response, not a moral one.

The Centers for Disease Control and Prevention (CDC) reinforces this understanding, explaining that addiction weakens the brain’s ability to regulate impulse control and decision-making, while heightening sensitivity to substance-related cues.

“Cravings aren’t a sign that someone isn’t trying hard enough,” says Dr. Deana Kimes, Vice President of Medical Affairs at BrightView Health. “They’re a predictable response to changes in the brain caused by long-term substance use. Understanding that biology helps people move from shame to support.”

Why Cravings Happen

From a clinical standpoint, cravings develop because substances “train” the brain to associate use with relief, reward, or survival.

Over time:

• The brain releases less dopamine naturally
• Stress systems become overactive
• Substance-related cues become powerful triggers

This means that people, places, emotions, and even routines can activate cravings, often without conscious thought.

The CDC notes that these changes can persist long after substance use stops, which is why cravings may still appear during early or even long-term recovery.’

Dr. Kimes adds, “When someone experiences cravings weeks or months into recovery, it doesn’t mean treatment failed. It means the brain is still healing, and healing takes time.”

What’s Considered “Normal” in Recovery

Cravings can be part of the recovery process, especially early on.

Typical, expected cravings may:

• Be brief and situational
• Be triggered by stress, fatigue, or reminders of past use
• Pass with coping strategies or support
• Not lead to loss of control or return to use

SAMHSA recognizes that occasional cravings alone do not automatically indicate relapse or treatment failure.

When Cravings Signal a Bigger Problem

Cravings become concerning when they are persistent, intense, or disruptive, and especially when they interfere with safety or daily functioning.

According to SAMHSA’s diagnostic framework, cravings may indicate a substance use disorder when they are accompanied by:

• Repeated inability to cut down or stop
• Continued use despite harm
• Obsessive thinking about obtaining or using substances
• Return to use driven by urges rather than choice

Dr. Kimes adds,“If cravings consistently overpower someone’s ability to make safe decisions, especially after consequences, that’s not just a normal urge. That’s a clinical signal that treatment is needed.”

Why Untreated Cravings Increase Risk

Cravings are one of the strongest predictors of relapse. Without tools or treatment to address them, people are more likely to:

• Return to use during stress or transition
• Engage in risky behaviors
• Cycle in and out of care
• Experience overdose, especially after periods of abstinence

The CDC emphasizes that reduced tolerance following abstinence makes relapse particularly dangerous — even when someone returns to a previous dose.

How Treatment Helps Manage Cravings

Effective treatment doesn’t eliminate cravings overnight, it reduces their intensity, frequency, and power. Evidence-based approaches supported by SAMHSA and the CDC include:

Medication-Assisted Treatment (MAT)

Medications such as buprenorphine, methadone, and naltrexone help stabilize brain chemistry and reduce cravings — especially for opioid and alcohol use disorders.

Behavioral Therapies

Counseling helps people:

• Identify triggers
• Develop coping strategies
• Rebuild decision-making skills
• Address stress, trauma, and mental health conditions

Ongoing Support

Peer support, routine, and connection reinforce recovery while the brain continues to heal.

Dr. Kimes adds, “The goal of treatment isn’t to make cravings disappear instantly, it’s to give people control, stability, and the tools they need to respond safely when cravings show up.”

Why Early Intervention Matters

Recognizing when cravings shift from expected to dangerous allows people to get help sooner, often preventing relapse, overdose, or further harm.

Cravings are not a sign of weakness. They are a signal, and signals deserve a response.

Cover image provided by Adobe Stock.