Content note: this post talks about cravings for cocaine and heroin. No details on use.
Sixteen years without cocaine or heroin, and yes, I still get them. Not often. Not like before. Before, the craving was the day. Everything else got arranged around it. Now it's more like a stranger who knocks once in a while, and I don't open the door, and after a bit he goes away.
So do drug cravings ever go away? For most people they fade a lot, but they don't fade in a straight line. In the first year, the craving you feel tends to drop steadily. But research on cocaine suggests the brain's pull toward drug cues can actually get stronger for a few months before it settles down. Years later, cravings tend to be rare and short, usually set off by stress or an old cue. For me, the honest version is: they mostly go away. Mostly.
Why do cravings sometimes get worse after you quit?
This part I didn't understand until I read the science, years later.
Researchers call it the "incubation of craving". In animal studies by a NIDA team, drug-seeking set off by cues got stronger over the first two months after the drug was taken away, stayed high for up to three months, and dropped after six (Lu, Grimm, Hope and Shaham, 2004).
In people, a study of adults addicted to cocaine looked at the brain's reaction to cocaine pictures at different points after stopping. That reaction was higher at one month and six months than in the first week, and lower by one year. Here's the strange bit: during that same time, people's own ratings of their craving went down steadily, from the first days all the way to a year (Parvaz, Moeller and Goldstein, JAMA Psychiatry, 2016).
So you can genuinely feel better while your brain is still quietly primed. The authors suggest the stretch between one and six months might be when people are most at risk of relapse and least aware of it.
I didn't know any of that. I just remember being blindsided by how hard some days hit after I'd thought the worst was over. If you're in that window right now, it's not you failing. It's a known thing. Lean on support harder, not less.
What do cravings feel like years later?
Different. Shorter. Less of an order and more of a memory with an itch attached.
Mine come from strange places. Stress, obviously. But good news too. Some success lands, and part of my brain reaches for the old way of celebrating, or the old way of wrecking things before they can go well. I've written about why I wreck things when they go well. It's the same muscle.
Smells, songs, a certain kind of night. Sometimes nothing I can name.
The difference now is that I recognise it for what it is. It peaks and it passes. I don't have to argue with it. I just have to not act on it for long enough.
What helps when a craving hits?
This isn't a treatment plan. If cravings are frequent or you're scared you'll use, talk to a doctor or a counsellor. There are treatments and, for opioids, medications that reduce cravings. That's a conversation for you and a professional, not for me. If you're early on with opioids, read getting through opioid withdrawal safely first.
What's worked for me, roughly:
- Say it out loud to someone. Sandra, my partner, knows to ask. Saying "I'm having one" takes about half its power away.
- Leave. The room, the party, the conversation. Nobody needs an explanation.
- Wait it out on purpose. Cravings rise and fall. Watching one fade a few times teaches your brain they do fade.
- Notice what set it off. Not to beat yourself up. To learn the pattern.
Peer groups help a lot of people with this, because everybody in the room knows what a craving is and nobody's shocked. Narcotics Anonymous and SMART Recovery both run free meetings, in person and online. SMART leans on practical, CBT-based tools for exactly this. I compared them in NA vs SMART Recovery.
One book helped me make sense of the brain side of all this. Anna Lembke's take on pleasure, pain and why everything feels like a drug now:
Dopamine Nation
Anna Lembke
My take. A Stanford addiction psychiatrist on why everything feels like a drug now. Phones included. Practical, not preachy.
Good to know. Simplifies the brain science.
Is a craving a sign you're going to relapse?
No. A craving is a craving. It's information, not a prophecy.
People in long recovery still get them. What matters is what you do next. Having a plan for that moment, before it arrives, is most of the game.
That said, if cravings suddenly get stronger or more frequent after years, pay attention. Something might be going on: stress, depression, a big life change, sleep falling apart. That's a good time to call your doctor, your counsellor or your group. And if you've been off opioids for a while, remember your tolerance is gone. I wrote about why relapse after years clean is so dangerous for that reason.