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Ice Cream, Vodka, Sex and Online Poker

Why do cravings come in so many delicious flavors?

Whatever it is you crave, you can usually bet it’s not good for you. Of course, if you’re honestly craving raw vegetables, meditation, affirmations and altruism, maybe this post isn’t for you. But if you’re like most people, you will at some point crave something that really isn’t going to help you achieve your goals or even make you happy in the long run. Why are there so many types of cravings?

And it’s not just limited to craving substances... even behaviors can be addictive. The new version of the textbook that classifies psychiatric disorders, the DSM-V, is expected to classify behavioral addictions for the first time; compulsive gambling will now be called Gambling Addiction, and even Internet Addiction will be included in the “needs further study” category in the appendix. This will have an impact on drug counseling. Although sex addiction and sugar addiction are not yet included in the psychiatric textbook, clinical experience suggests that these may be just as addictive and just as destructive for some sufferers. The verdict is in, and any substance abuse counselor will agree…behaviors can be just as addictive as alcohol and drugs.

So if there are so many different types of cravings for substances and behaviors, what accounts for why some people crave alcohol and others crave pain pills? Why do some people crave carbohydrates or sugar and others video poker? The truth is, we are only just starting to learn the answer. Clearly genetics plays a powerful role. For example, studies of identical twins of alcoholic fathers who are adopted into different families show an increased risk of developing alcoholism even when raised in a non-alcoholic environment. Also, some twin studies show that cocaine and opiate use may be even more heritable (see here for a chart of heritability by drug type). The serotonin transporter gene has been implicated in disordered eating. Gambling addiction is more common in identical twins than in fraternal twins, suggesting a strong genetic role for this behavioral addiction as well. Even compulsive sexual behaviors such as infidelity and sexual promiscuity have been linked to a gene (DRD4) that controls a type of dopamine receptor.

However, its not all nature. Research shows that family environment and social factors play a role too, and, according to a study of nearly 1800 twins, the effect of these “nurture” factors is most pronounced during early adolescence and begins to wear off as we age. Environmental factors that may contribute include access to drugs, poor family bonding, and peer drug use (yes, it does matter!) Children and adolescents with sexually intrusive behavior are more likely to have been abused themselves. Early exposures to gambling and poor family cohesion significantly increase the risk of developing gambling addiction. Low self-esteem, being bullied and depression increase the risk of binge eating. To very broadly generalize, being exposed to addictive substances and behaviors in childhood, especially without adequate support, can clearly influence what and how strongly we crave. Trauma only worsens the picture and for people who suffer from severe trauma, simple drug counseling may not be enough.

The expression “there is no accounting for taste” is only partially true at best. Cravings are complex but they do have genetic and social factors that drive them. Although nature plays a strong role in what we crave, environmental effects are also implicated, which means that more focus on prevention at a public health level is sorely needed.

Copyright Omar Manejwala, M.D. 2013. To learn more about what causes cravings and how to tame them, check out Craving: Why We Can’t Seem to Get Enough (Hazelden Publishing 2013).

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