For hundreds of years, craving has been recognized as a central causal feature of addiction and relapse in overeating, gambling, and other addictions. But what causes craving, how one ends cravings, and where these mental processes occur in the brain have remained unclear. Until now.
A new study by Yale’s Kulkarni and colleagues, reported in Nature Mental Health, showed that craving directly influences, and even alters, a person’s thinking, reasoning, and decision-making. Craving remains strongly linked with continued use, despite consequences.
Studying individuals with alcohol and cannabis use, Yale investigators demonstrated that moment-to-moment fluctuations in craving markedly change how the brain adapts, learning from rewards and making choices. Craving dynamically rewires learning. Craving can “reshape” decision-making instead of simply reflecting it, thus reframing drug use and free will.
Conscious and Unconscious Cravings
Decades earlier, Miller and I demonstrated that relapse in alcohol or cocaine dependence can occur without consciously reported cravings. This finding challenged assumptions that craving must be consciously experienced to drive substance use. But addiction involves some processes outside awareness. Cravings exist in conscious and unconscious forms, each playing a different role.
Conscious craving refers to subjective desire—a powerful urge that’s known. This is the most familiar form of craving and most often addressed in treatment.
Conversely, unconscious craving reflects automatic, conditioned processes mediated by mesolimbic circuitry and dopaminergic systems. These processes correspond to “wanting,” a form of motivation triggered by cues and capable of driving behavior outside awareness. Human and animal studies show conditioned responses to cues may occur without awareness. Cravings don’t automatically disappear just because they’re unreported. In a 2015 study, we showed that craving can be easily provoked, and opioid relapsers demonstrated significantly greater cue-induced cravings and brain responses than non-relapsers.
This dual-process model reconciles conditioning by emphasizing automatic cue reactivity, rather than just conscious desire and expectation. Both embody key aspects of craving, but neither alone is sufficient.
Psychological techniques such as cognitive-behavioral therapy (CBT) and mindfulness address conscious craving by helping people restructure their thoughts. Both therapies focus on recognizing triggers, building coping skills, and accepting cravings as temporary urges. Admitting you still have a craving is a first step toward separating thoughts from behavior, often with help from Alcoholics Anonymous (AA), social support, spiritual focus, and “This too will pass” mental routines.
NYU Professor Marc Galanter’s research found that AA members who recited prayers after viewing drinking-related images reported less craving for alcohol after praying than after reading a newspaper. The reduced cravings in those who prayed corresponded to increased activity in brain regions accountable for attention and emotion, measured by MRI.
According to Galanter, “Our findings suggest that the experience of AA over the years had left these members having an innate ability to use the AA experience—prayer in this case―to minimize the effect of alcohol triggers in producing craving.”
AA helps members accept cravings as temporary, normal parts of recovery rather than fighting them, reducing anxiety. Contacting sponsors or peers provides immediate help, accountability, and distraction during cravings.
Other Cravings
Cravings for food and sugar, alcohol, cannabis, and cocaine all involve the brain’s reward system, but these cravings are not all equal. Cravings for food can be especially hard to “turn off” since they’re also driven by survival drive signals.
Cannabis and alcohol both affect decision-making through changing how the brain learns from rewards over time, which can cause someone to be more likely to keep choosing the substance, even if consequences are clear and cumulative.
Alcohol users become hypersensitive to positive prediction errors under the influence of craving and quickly conclude “That worked → do it again.”
Cocaine shows this even more strongly. Craving turns the knob up or down on how much each experience matters. Cocaine turns it way up → experiences feel very reinforcing and almost impossible to forget. The brain becomes highly sensitive to cues linked with cocaine use. These cues may be obvious (like being around people one used cocaine with) or subtle (music, locations, even moods associated with use). Bad learning pairs these triggers and drives automatic use and choice—even if the person doesn’t feel a strong (or any) conscious craving for cocaine.
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Cannabis, in this Kulkarni study, turns it down, so experiences don’t change your expectations as much. “Learning less from experience” creates a different pathway to problematic use. Blunted learning freezes behavior in place, as the brain fails to update when something is no longer rewarding or is causing harm. People may keep seeking substances, not because they think they need them, but because their brain has been trained to want them.
Across these examples, a key idea is that the brain’s “wanting” system warps risk-versus-benefit thinking.
Craving and a New Model of Addiction
In simple terms, craving acts like a weighting system. It tells your brain what matters most right now and pushes you toward those choices. After you act (use or don’t use), the outcome feeds back and reshapes future craving. This helps explain why relapse isn’t straightforward. People can relapse even with low conscious craving (because cues and habits are driving behavior), or stay abstinent despite strong urges.
Craving changes how the brain makes decisions and what it considers important. When craving is high, the brain pays more attention to drug or food-related cues, updating learning in a biased way.
New Way to Treat Addictions
If craving is embedded within decision-making, then effective treatments must do more than simply suppress a symptom—they reshape the underlying system. Craving doesn’t just push behavior—it changes how strongly the brain learns from each outcome. Reversing this process requires thousands of repetitions of new, healthy behaviors to “overwrite” old reflexive ones.
Chronic substance use shifts behavior from deliberate, goal-directed choices to automatic habits, and it can take years of treatment and abstinence to fully reverse this shift. Interventions, both medications and behavioral treatments, can help reverse these changes over time
Craving is not a subjective symptom, but it can be measured, modeled, and modified, making it a useful clinical target for treatment development. This may yield promising treatments, such as GATC-1021, for those suffering from opioid use disorder, as reported this week in Proceedings of the National Academy of Sciences by UC Irvine researcher Valeria Lallai. Medications (e.g., GLP-1s) can reduce the brain’s response to cues and improve self-control and the tendency to choose immediate rewards. Overall, treatment works, not by eliminating craving entirely, but by diminishing its power and influence and restoring the brain’s ability to choose healthier options.
Conclusion
Craving is a dynamic, multi-level process involving conscious experience, unconscious drives, and the brain’s decision-making system.
Craving doesn’t just reflect desire—it reshapes how decisions are made. It also biases the brain’s internal “calculator,” increasing perceived value of substances like alcohol, cannabis, cocaine, or highly processed foods, tilting the system so instant rewards feel disproportionately important at the expense of long-term outcomes.