Atmospheres of craving: a relational understanding of the desire to use drugs

Abstract

Aims

Craving is commonly described as an ‘intense desire’ to use drugs. Due to its relevance for addiction theories and treatment, much effort has been put into understanding how and when craving occurs. An undisputed definition of craving is however still lacking. The aim of this article is to explore how craving is experienced and resisted after cessation of substance use.

Methods

This article analyses interviews with former addiction treatment clients. By analyzing the described event of craving, the study shows the complexities in such narratives.

Findings

We found that the interaction between temporal, relational and material forces move people toward or away from craving. Craving thus seemed to be both relational and located in-between forces.

Conclusions

We conclude that craving appeared in the studied narratives to emanate from different atmospheres, with a concurrent focus on settings rather than on substances. A relational understanding of craving can add to the typical, but limited, account of craving as an individual issue. It also avoids stigmatizing ideas that people who do not resist cravings simply fail to say no. We end by asking if craving is a relevant concept within the addiction field at all.

Keywords:

• craving
• relapse prevention
• relapse
• atmosphere
• user perspectives
• assemblage

Introduction

In a research project on the theory and practice of Swedish relapse prevention for substance use problems, we interviewed Sven, a man in his sixties, about his experiences of craving and relapse. He appreciated our trying to shed light on complex phenomena, but was also a bit skeptical:

There’s always this discussion about the genetics, and what is formed during childhood, and the combination of the two. […] That’s why one needs to keep doing research on it, but they won’t reach any conclusions because there are too many variables. Medical and psychological. That’s mad tricky.

Obviously, Sven pinpointed a central issue in addiction research; with so many variables, how is it possible to make sense of behaviors and experiences that seem both irrational and messy? After a first look at the interviews with former addiction treatment clients conducted for this research project, we had to agree with Sven; the relationship between craving and relapse appears to be difficult to grasp. Craving was described by participants in contradictory ways: as both slow and sudden, planned and spontaneous, totally overwhelming and totally absent, as well as being an effect of feeling both good and bad.

This difficulty in conclusively defining craving has been recognized before (e.g., Abrams, 2000; Sayette et al, 2000; Tiffany & Wray, 2012). Despite this, its relevance for addiction is emphasized by the vast literature covering the topic (see, Tiffany & Wray, 2012), as well as its inclusion in diagnostic systems such as ICD (WHO’s International Classification of Diseases) and DSM-5 (The American Psychiatric Association’s Disease and Statistical Manual of Mental disorders, version 5). Craving is commonly described as an ‘intense desire’ to use drugs (e.g., Volkow et al., 2010) stemming from the addicted brain (e.g., Wiers & Heinz, 2015; Wilson & Sayette, 2015). Much effort, primarily through quantitative laboratory studies, has been put into understanding how and when craving occurs (see e.g., Conklin & Tiffany, 2001; Niaura, 2000; Wang et al., 1999). A core conceptualization within this framework is that addiction is ‘a chronic, relapsing illness, characterized by compulsive drug seeking and use’ (Leshner, 1997, p. 45).

There is however a growing body of research questioning such medicalized descriptions. For example, critical research has attended to addiction as unstable and context-dependent (Fraser et al., 2014; Sedgwick, 1993), and implicates that drug use itself should be regarded ‘as a social issue, with all the messy overlapping complexity this entails, rather than, as is the case at present, a narrowly conceived health issue’ (Fraser, 2016, p. 13). Despite this, there is a lack of qualitative and sociological studies of how craving is experienced by people who use substances. Although limited, prior qualitative work has effectively nuanced the definition of craving. It has been shown that craving experiences vary across individuals (Merikle, 1999), that definitions should not explicitly rely on irresistibility (Bruehl et al., 2006), and that craving-provoking ‘triggers’ are situational, relational, and individual (Dennis, 2016), and do not fit within ‘the standard framework of volition/compulsion’ (Brookfield et al., 2022, p. 7). Following such work, this article delves into the messiness of craving (Law & Singleton, 2005). We will not try to force different craving descriptions into a ‘typical’ craving experience, and neither will we rule out contradictory meanings of the phenomenon. Instead, we investigate craving as process (Duff, 2016). We draw on interviews with people who claim to have recovered from ‘addiction’ or ‘drug abuse’ through treatment and our ambition is to explore how craving is experienced and resisted after cessation of substance use.

Craving as a treatment target

Relapse prevention (RP), which to a large extent pivots around craving, is an important part of addiction treatment globally (Donovan & Witkiewitz, 2012). It was originally developed from cognitive-behavioral therapy (CBT) and is described as a ‘self-control program’ (Marlatt & George, 1984). RP is delivered by most addiction treatment agencies in Sweden (Ekendahl & Karlsson, 2021a) and is recommended by the Swedish National Board of Health and Welfare’s guidelines for addiction treatment (Socialstyrelsen, 2019). Most participants in this study had in some way engaged in formally organized RP. Our previous research elucidates theoretical assumptions made about RP and craving in professional speech, written treatment manuals, and training materials (Ekendahl & Karlsson, 2022). Craving emerged in those studies as a complex entity, residing both inside and outside of people’s minds and bodies. Clients were, for example, asked to identify ‘high-risk situations’ (Marlatt & George, 1984) such as places, events, and people that can trigger cravings and learn how to ‘say no’ (Ekendahl & Karlsson, 2022). They were also encouraged to practice so-called ‘urge surfing’—exposing oneself to craving to learn that it will increase moderately over time, and then slowly fade away (see e.g., Ekendahl & Karlsson, 2022; Ortiz & Wirbing, 2017). Thus, RP offers a ‘possible experience’ (Duff, 2016, p. 61) of how craving works and can be dealt with.

Still, the conceptual framework of RP risks ignoring the role of dynamic social and economic forces and as such has limited explanatory value. It may thereby not only stigmatize individuals as responsible for their own precarious situations, but also fail to explain what happens in specific craving situations (see also, Theodoropoulou, 2020). Drawing on qualitative work on the relationality of triggers (Dennis, 2016) and recovery (Duff, 2016), we will ‘complicate’ the idea of craving and that risk-situations can be fully managed by the individual. As we will show, craving appears instead as organic and unpredictable. Inspired by the perspective of affective atmospheres, detailed below, we explore how cravings are molded by ‘embodied, social and political conditions’ (Duff, 2016, p. 62) and how they are entangled in this complex experience. We end the paper with a discussion on how useful the dominant ‘possible experiences’ of craving (i.e., generalized descriptions aimed at a larger population) are for understanding clients’ ‘real experiences’ (i.e., lived experience of individuals) (Duff, 2016).

Theoretical framework

Previous research on craving has largely focused on the individual. However, moves toward a sociomaterial approach, inspired by assemblage theory (DeLanda, 2006; Deleuze & Guattari, 1988), is apparent in much recent research on alcohol and other drugs (AOD) and related phenomena (e.g., Duff, 2014; Fraser, 2006; Fraser, Moore & Keane, 2014; Fraser & Valentine, 2008; Moore et al., 2017; Törrönen & Tigerstedt, 2018). One important conclusion is that in paying attention to the messy and complex practice of substance use, researchers can ‘push beyond the default dualism of volition/control and mind/body, to a language that treats as continuous those processes of drug use that involve subjective experience, bodily functions and environmental factors’ (Brookfield et al., 2022, p. 17). In this vein, we focus on the congregations, or assemblages, of social, affective, and material forces in which craving can appear.

Assemblage thinking can inform a more dynamic understanding of cravings as relations and associations between human actors (e.g., substance users, treatment staff, family members, fellow clients), non-human objects (e.g., substances, places), and symbolic components (e.g., memories, future expectancies, treatment regulations). Trying to understand stories such as Sven’s (quoted in introduction), pivoting around the messiness of craving, made it relevant to analyze craving situations as contingent formations and processes rather than as passive and static structures (DeLanda, 2006). Our analysis targets not the subject of substance use or its behaviors, but ‘an assemblage of forces that produces both the subject of drug use and the effects of this use’ (Duff, 2014, p. 636).

Duff (2014) stresses that in studying the event of consumption, focus is directed toward the ‘real experience’ of the person who use substances and the time and place of substance use, instead of relying upon well-known explanations referring to ‘society,’ ‘structure,’ and ‘power.’ Focusing on how the participants describe ‘the event of craving’ encourages an understanding of craving that goes beyond the individual. This theoretical approach has inspired our analysis of when craving advances or retreats. As we have interviewed participants in a ‘cold state’ (Loewenstein, 2005), reflecting on past and prospective accounts of craving and substance use, this makes it somewhat difficult to capture ‘real experiences’ in an unfiltered manner. Instead, the data concern how the participants interpret their ‘real experiences’ and what they pay attention to in their accounts.

This approach revealed the importance of social and material contexts. Therefore, the notion of affective atmospheres (Anderson, 2009) pushed our analysis further as it provides a coherent theory for exploring the relation between spaces, objects, people, and time. ‘Atmosphere’ is a somewhat ‘slippery’ term, but usually refers to a sense, ambience, or particular quality of an environment (Bille et al., 2015, p. 31). In a more theoretical description, Duff (2016) concludes that atmospheres are ‘an ontology of the interstitial; an interval, space or disjuncture between matter and non-matter, between subject and object, nature and culture’ (p. 62).

Scholars have explored the affective and embodied dimensions of spaces such as public transport in the night time economy (Duff & Moore, 2015), drinking environments (Bøhling, 2015; Shaw, 2014), commuter traffic (Bissell, 2010), and urban spaces such as parks or cafés (Duff, 2016). These studies conclude that affective atmospheres evolve in a gathering of bodies, forces, spaces, practices, and technologies that ‘prime’ people into acting and feeling in certain ways (Bissell, 2010; Duff & Moore, 2015). According to Shaw (2014), ‘atmospheres are always geographical, controlling but confined to a particular place’ (p. 89)—meaning that through border-making practices the specific place is vital in creating an atmosphere that gather and collect forces which act on bodies in this environment. While not targeting any specific environment or place, we will draw on these studies to investigate how different dimensions act together in shaping craving experiences.

Material and methods

Sample

As part of this research project, we have interviewed both treatment staff (see e.g., Ekendahl & Karlsson, 2021a, 2021b, 2022) and service users (see e.g., Ekendahl, Karlsson, Månsson & Heimdahl Vepsä, 2022). The analysis presented here is based on 12 qualitative interviews with people with extensive substance use experiences. The participants were recruited via one municipal social service agency and one outpatient treatment center within the Stockholm area. Staff assisted in the recruitment by introducing the project to potential participants and enabling contact with the researchers. The sample is thus self-selected, and there is no representation of people who had no contact with either treatment or social services. The sample consists of eight men and four women, aged between approximately 20 to 70 years. The participants described themselves as being (or having been) addicted to alcohol (n = 6) or polydrug use (n = 6). The period of having had substance use problems varied from a few years to more than two decades. Most participants described themselves as sober at the time of the interview, and all had engaged in some form of relapse prevention program and/or attended self-help groups such as AA (Alcoholics Anonymous) or NA (Narcotics Anonymous).

Interviews

The interviews were carried out face-to-face (n = 9) or over the phone (n = 3) during October–December 2019. They lasted between approximately 25 to 70 min and were transcribed verbatim by assistants. The interviews were semi-structured and covered four main topics: background (e.g. ‘Can you describe what type of addiction you have had?’), descriptions of craving, triggers, and relapse experience (e.g. ‘How would you describe what is usually called craving?’), thoughts and emotions connected to such experiences (e.g. ‘If you could use a symbol, metaphor, or image to describe feelings of craving, what would that be?’), actions and coping strategies (e.g. ‘Can you describe changes you have made in your everyday life to manage/avoid craving?’).

Analysis

To get an overview of the material, the transcriptions were read several times, and an initial content-based coding was done in the software program Nvivo concentrating on instances where craving and relapse were mentioned. This resulted in 33 codes, including for example ‘craving as slow,’ ‘craving as a consequence of bad relationships,’ and ‘no craving.’

To tease out important forces that affected feelings of craving, the Nvivo codes were then scrutinized for descriptions of the situation and behavior of the participants and their surroundings. We attended to specificities such as human and non-human objects, memories, expectations, places, and how they intertwine (see also, Dennis, 2016; Duff, 2016; Dilkes-Frayne, 2014). This resulted in three main forces: time, relationships, and materiality. These forces are analytic constructs emanating from participants’ descriptions of craving and relapse.

Inspired by Duff’s (2016) take on the theory of affective atmospheres, we then analyzed full individual interviews to understand how these temporal, relational, and material forces could be congregated or assembled. We put specific emphasis on the situation of craving and the material and relational aspects that were communicated as pivotal in it. The theoretical concept of atmosphere (Duff, 2016) is of particular importance in this analysis as it allowed for an examination of how social, material, and affective forces can add to current understanding of craving and relapse.

Ethics

Ethical standards for qualitative social science research have guided the project (Silverman, 2010). Upon recruitment for each interview, the participants were given both verbal and written information about the project (potential risks and benefits, voluntary participation with the possibility to withdraw at any time). Participants were guaranteed anonymity (also in relation to the staff that helped in recruitment), and in the results-section they have been anonymized through pseudonyms and omitting sensitive information. Any changes in quotes to secure that participants are not identifiable is indicated by the use of square brackets in the results section. All extracts were translated from Swedish to English by the authors, with the aim to keep the original wording as exact as possible. Ethical approval for the study was given by the Regional Ethical Review Board in Stockholm, Sweden (2018/1064-31/5).

Results

For clarity, the analysis below is structured in two steps: (1) a presentation of important forces related to descriptions of craving experiences in the material as a whole and (2) a presentation of two examples where these forces gather in different ways. The described forces (step 1) should be seen as ‘building blocks’ interacting with each other to create different atmospheres (step 2) that either move the participant toward or away from craving. The second step of the results section thus comes closer to ‘grasping each existent in its novelty’ (Deleuze, 1988, p. 20) and accounting for a real experience in its intention to incorporate a range of human and non-human forces.

Temporal forces

Several accounts were given of craving as illustrating the intersection of many temporalities into one moment. When asked to describe a typical craving situation Börje, a man in his fifties who had been on maintenance treatment for two years at the time of the interview but who had used a variety of substances on and off for about 30 years, says that it is a sudden experience that can ‘happen at any time.’ When the interviewer follows this up, however, it appears as if the feeling of craving can be traced back longer in time. In the quote below, Börje describes how the craving he feels today dates back to a particular festival he attended in the 1990s:

Börje: For example, walking towards the city center to do something and then meet some old buddies, they’re having a beer and smoking a joint. Like, the sun is shining. Well, the sense of community.

Interviewer: So, it can be stuff like the weather too?

Börje: Weather, oh yes, that has to do with it. And then like concerts you have been to with someone, that you remember.

Interviewer: Yes, that’s associated with you having…

Börje: Yes, associated. I mean like the whole [festival] time, that was so wonderful.

Interviewer: So, if you think of [festival], then that triggers a…?

Börje: Yes, you see something like it, something similar and ‘wow, yes, this happened here and here’ and you walk along [street X], by [building X], towards [square X], and like…

Interviewer: But what kind of similar things can that be?

Börje: There are different things. Sometimes there are market stalls along the walk, and then some particular stalls that are usually not there, and then there’s a Peruvian guy playing a panpipe, and all that, even if that in particular is not associated with the old…

Interviewer: OK, so one situation is associated with another one that in turn is associated with cannabis?

Börje: Yes, and then you just ‘yes, there, aha, fuck, that’s where I sat and listened’ and like ‘yeah, that was so cozy.’

What is first described as a sudden craving experience is then linked to a long chain of associations of enjoyable moments. Such a winding road toward the craving situation is qualitatively far from the quite isolated ‘high-risk situation’ depicted by RP (Marlatt & George, 1984). Rather than a straightforward description of a particular factor that triggers craving, a chain of unexpected associations related to old memories is emphasized. Present craving experiences are intertwined with the past; immediate triggers are traced back to previous experiences, feelings, and behaviors. Craving is in Börje’s narrative triggered ‘at any time,’ but not by an isolated and sudden catalyst (see also, Dennis, 2016). It is rather shaped by potentially triggering memories along with present encounters with places, people, and senses in a complicated process. The future also surfaces in Börje’s account, through the desire to maintain sobriety. In the quote below, he describes his thoughts about using heroin:

Well, it’s chaos. So, this is present when my craving becomes… I mean, when I think that ‘fuck, it would be nice to have some smack.’ Then it’s like, no, wait here, a week later then you’re fucked up.

Börje negotiates feelings of craving with rational arguments about what is to expect if he gives in to his craving (‘chaos,’ ‘fucked up’). Thoughts of what consequences a future of drug use might produce is present in the craving situation as it is deeply rooted in past experiences. Several participants describe that they have been taught in treatment to visualize what will happen later if they give in to craving. What they have learned about possible experiences of craving is incorporated into their subsequent real experiences (see, Deleuze, 1994, p. 68; Duff, 2016, p. 59). Hence, craving goes beyond the particular moment, and it is in this intersection of past experiences, present emotions, and future expectancies craving seems to take place.

Relational forces

One typical narrative in the material revolves around complex entanglements between social contexts and individual psychology, and how this leads up to craving. This is exemplified by Kristina who describes relapse as a process shaped by relational forces. Kristina is in her fifties and describes herself as addicted to alcohol, and that she has been sober for almost a year. She talks about craving as ‘situations’ and ‘thought patterns’ and not as a physical experience, and how a relapse can come about:

For me, personally, I can understand why I started drinking again. It was pretty obvious because I moved. I did everything you’re not supposed to do. A new relationship, we started living together, I moved from my apartment, became a bonus mum of two young teenagers, stopped going to AA-meetings. Stopped working with the twelve steps. So, the relapse started long before I was actually drinking. So, for me, it’s a very mental process. And then, glass in hand, is only a matter of time.

Although this quote is primarily focused on a relapse situation, it illustrates how this is sometimes entangled with craving in the interviews. For Kristina, the ‘situation’ described above is defined as craving. In retrospect, she sees her relapse/craving as a process of transformation: affected by the introduction of new relationships (e.g. ‘bonus mum’) and the interruption of old ones (‘stopped going to AA-meetings’). This craving experience thus hardly stems from a particular moment of high-risk.

The affective importance of other people is further emphasized as Kristina claims that, to avoid craving, she has ‘worked a lot’ with creating boundaries in her relationships, and thus to untangle herself from other people. Here, craving is intimately connected to people and relationships. Craving is not an individual experience stemming from the addicted body and brain but allows for a more ‘fluid and open notion of the body’ (Dennis, 2016, p. 131). Kristina’s narrative is obviously influenced by AA philosophy. She has learnt the importance of managing relations, and that otherwise it is just ‘a matter of time’ before she drinks again. Like other participants, she has incorporated the AA narrative into her real experience.

Material forces

Several participants said that they did not experience craving. They also compared their sobriety with people they had met in treatment who they viewed as having ‘real craving.’ This perceived absence of craving may be related to the idea that craving should be sudden and ‘physical.’ This is for example described by Hans, a man in his fifties who had been drinking heavily for 15 years but had been sober for a little over a year at the time of the interview. Despite his lack of craving, Hans says that he has relapsed a few times since starting treatment. It was not an uncontrollable urge that made him drink again, but rather ‘an idea that takes root a good while before.’ In the following narrative, Hans recounts his last relapse:

That it happened at that time was pure accident. Because at that time I had started with Antabus and I had no plan whatsoever to drink. Because I had heard enough stories that, well, you can even die if it gets really bad. I didn’t want that. But on that particular day I forgot to take my Antabus at [treatment service]. So, I spoke with one of the counselors and said ‘I can take that at home.’ Because I had a couple of pills from the addiction clinic that I was supposed to bring to [treatment service] and take there. So, I said ‘I will take it this weekend.’ And then, I was living with my [relative] because there had been [an accident] with my apartment. [Relative] went to the hospital that same day and then I realized—wait, I have not taken any Antabus, [relative] is in the hospital, well, now is a good time. But I know that I would have taken a relapse sooner or later. It could have gone six months or a year, but I knew then already that I would try at least one more time. Luckily, in retrospect, it happened pretty early on and it went to the barrel.

It is clear to Hans that he was just waiting for the right moment to drink again. In his narrative, drinking alcohol was the endpoint of a series of interlinked decisions and circumstances and it emerged as a result of multiple material forces: not taking his Antabus, the accident with his apartment, living with his relative who had liquer at home (expressed later on in the interview), and being home alone. Having an unsupervised space of his own becomes an opportunity for substance use—for Hans, the narrative of his last relapse comes together as ‘a perfect storm’ (see, Brookfield et al., 2022, p. 7). Lacking in this narrative is a particular moment of craving. Instead, Hans pays attention to his place in-between objects (Antabus, accident, alcohol) and spaces (apartment). The common idea of craving as suddenly triggered and as an uncontrollable urge might thus be what made some participants state that they do not experience it—in their descriptions relapse instead depended on decisions that build up through the entanglement of material forces. Such processes could, however, be described as more or less deliberate and rational.

Moving toward craving: affective atmospheres of insecurity and loneliness

What has been described above are different forces that participants emphasized when talking about craving and relapse. Looking closer at the individual interviews, particular gatherings of such forces seemed to create atmospheres that impacted the participants’ experiences of craving. The following section will illustrate how the intersection of these forces can ‘come to work’ and move a person toward craving.

Craving is recurrently defined as both sudden and slow. The sudden experience often related to specific triggers (e.g., meeting a particular friend). The slower processes were more linked to feelings and situations with intense insecurity and loneliness. Such descriptions surfaced primarily when participants talked about relational entanglements and difficult memories. Craving was associated with one of the foundational codes in the material: ‘desire to escape.’ One participant in particular accounted for an assemblage of experiences that seemed to create atmospheres of insecurity and loneliness—Nora, a woman in her twenties who had been drug-free for some months at the time of the interview, but who had used a variety of substances since early adolescence.

In an extensive passage about craving Nora defines it as ‘unmanageable feelings and situations that I have a hard time to deal with and feel the need to escape from.’ She continues to describe how she previously experienced difficult situations:

I was very exposed to bullying when I was younger. I come from a lower middleclass family, and I grew up in a very nice area, I went to a very nice school where young people had a lot of money. They went out, they travelled, and it was mopeds and moped cars. I, for example, inherited most of my clothes from [relatives], and it wasn’t only that the clothes were inherited it was also that they were boys’ clothes. But for me that wasn’t a problem, I loved those clothes, but it made other people point it out very often. And then I had [physical markers]. So, it was very easy, I was an easy target for them to vent whatever they had to vent. And then at a very early age I was also sexually abused and that’s something I have been trying to escape from for a very long time. But I didn’t talk about it because I couldn’t see that it was something wrong, since I was so young that I didn’t understand it until now at an older age when grief has hit me. And it’s become unmanageable because I realized what had actually happened.

This passage indicates how Nora connects her ‘desire to escape’ with memories of being different and exposed. In her account, a myriad of different non-human (e.g., clothes, money, mopeds) and human (e.g., bullies, sexual abuser) objects gather. Nora interprets these objects as meaningful by connecting them to the particular area where she grew up (e.g., nice area, nice school): for example, wearing old boys’ clothes as a girl affected the way she claimed to experience social loneliness. Space thus becomes meaningful as it defines the borders of an affective atmosphere that, for Nora, is animated by vulnerability, social exclusion, and disconnectedness. Here, we see how different material, relational, and temporal forces come together to ‘prime’ (Bissell, 2010) Nora into a lonely disposition.

Although Nora had left this geographic place at the time of the interview, she describes how this atmosphere had lingered (see also, Bille et al., 2015). When Nora grew older, those experiences and memories made her crave ‘all types of drugs,’ anything to ‘escape unmanageable feelings.’ She continues:

It’s very difficult to explain but these feelings that come about, it’s when I’m really incapable of handling… I can’t talk about them because I don’t even know where to start. I feel craving the most when I for example feel grief, and the grief I feel, it becomes very overwhelming so I don’t really know who I should talk to, who I should call or how to express myself. Because I don’t have, I haven’t found a language to express it, which makes me shut off, because I feel more secure not feeling these feelings. So, you could say that it’s a safety loss when my cravings come about because my feelings are too strong.

Here, Nora claims to not know how to handle her feelings or who she should talk to—which makes her crave something to ‘shut off.’ Her narrative thus exemplifies how a mix of relational and social arrangements (e.g., school structures unable to counteract bullying, economic prerequisites), temporal tensions (e.g., anticipation and recollection), and affective conditions (e.g., insecurity, grief, and unsafety) gather in such a way that they move Nora toward craving. This atmosphere of insecurity and loneliness pivots around relational entanglements, memories, and psychology. Loneliness, is for Nora more psychological than physical since she is ‘basically out all the time, meeting people.’

Nora’s narrative shows how this atmosphere of insecurity and loneliness appears to be of importance for her craving experiences, yet when asked to describe what situations she defines as ‘high-risk situations’ for craving and relapse, she mentions two very concrete situations: bumping into an old friend who lights up a joint and attending a birthday party where people drink alcohol. These situations should have been considered important by Nora, or she would not have mentioned them in the interview or in treatment (where she first defined them). They highlight that complex processes based on deep emotions (which is what Nora spends most of the interview talking about), and numerous intersections of affective conditions and dispositions, are probably not as easily targeted in treatments that look for logic craving situations to be ‘managed’ by the individual.

Moving away from craving: Affective atmospheres of predictability and belonging

In this section we illustrate how atmospheres can move people away from feelings of craving. Here, we will return to Sven, the man quoted in the introduction. Sven is in many respects different from Nora, he is older, was mainly using alcohol, and had been abstinent for five years at the time of the interview. He also places less emphasis than Nora on childhood trauma in his description of craving experiences.

Sven describes his cravings as both sudden (‘if I work, it is Friday […] then I sometimes felt craving’) and slow (‘no sudden craving […] it was decided days ago’), and to have found several strategies that can ‘knock out’ sudden craving and ‘counteract’ slow craving. He describes one of those strategies like this:

A change of routines. It’s not enough to remove routines related to abuse and addiction. […] I have to try to create myself in a different way. Put simply, a reprogramming. So, I have strict routines at home that I’m not comfortable breaking. For example, on Fridays, that’s ‘white night.’ To me, this means that I scrub everything in the bathroom. Thoroughly. Remove the lid and the toilet seat and everything. […] And then there are other routines at night. I will not go to bed without doing the dishes. Dishes have to be done and also clean the stove, the sink. […] Because I’ve noticed that the routines, to implant them in the brain, that’s an obstacle to coming up with good ideas like ‘no one will notice if I drink now.’

This extract illustrates how atmospheres of stability and predictability are cultivated and sustained in Sven’s routines. Something as seemingly mundane as cleaning or doing the dishes takes on great significance as a constituent feature of Sven’s recovery. In his apartment, during a specific time, he uses these border-making practices (Shaw, 2014) to create a secure and predictable ‘zone.’ Waking up hungover with an unclean bathroom nowadays gives him so much anxiety that craving is ‘nipped in the bud.’ His description of ‘white night’ thus yields an assemblage of objects (e.g., toilet, dishes, stove), spaces (e.g., a clean bathroom and kitchen) and time (e.g., Friday, night, time spent cleaning). This assemblage creates a boundary from where an atmosphere of predictability can emerge. As Sven claims to continue to ‘create’ himself anew, further practices can reinforce the atmosphere that moves him away from craving (see also, Shaw, 2014). His affective labor suggests that cleaning a toilet or using a washing machine (another example in his interview) can keep the real experience of craving at bay.

Another strategy in Sven’s narrative revolves around relationships. Just like he is working hard to create new routines, he is actively trying to find a new community:

I also go to AA-meetings at least four times a week. To hear the sharing. That’s what it’s all about, recognition and then start to understand yourself […] I’ve been thinking about this since I was a child: ‘Why is it like this?’ A good way to forget about problems is alcohol together with other people that are disturbed in similar ways as you are. And if you want to, at least you have a community there of people with similar experiences. […] And the most important tool is conversations with others at AA-meetings with similar experiences. The factor of recognition. I’m not better or worse, and we’re all heading somewhere and that gives me a sense of belonging. An identity I’ve been searching for all of my life. […] Also, these meetings, then I’m sober the day before, I’m sober the same day, and I’m sober the day after. There’s a tool for you. One meeting, one day—that gives me three days of sobriety.

Here, Sven indicates how important an atmosphere of belonging is—both in relation to drinking and ‘sobriety.’ In his active drinking days, he found belonging among his drinking buddies who were ‘disturbed in similar ways,’ and since becoming sober he has been searching for a different form of community—finally found among peers in AA. Sven mentions several aspects that are important to him in such situations. Ongoing and structured opportunities for social interaction (AA-meetings at least four times a weak) and novel encounters between people appears to animate and transmit belonging, support, identification, recognition, and interaction (relational forces). The ongoing and structured character of the meetings is also a defining practice, helping the atmosphere of stability and belonging to persist (Shaw, 2014; Theodoropoulou, 2020). This is thus the real experience of treatment for Sven; treatment meetings as sustaining a set of social encounters that enables affective and relational constituents of belonging and support. Sven’s example illustrates how ‘sociality and social engagement sustained particular atmospheres of recovery’ (Duff, 2016, pp. 66–67).

Through Sven’s strategies we can see that it is in the intersection of what may seem as mundane and insignificant activities, practices, and experiences that move him away from craving. This is however in no way described as a quick fix. Sven claims to work hard to gather new and meaningful entanglements in his life that can ‘resonate together’ (Duff, 2016, p. 71).

Conclusions and implications

This study shows the complexities in descriptions about craving situations. Craving can be many different emotions, feelings, and situations. We find that it is in the interaction between temporal, relational, and material forces that people are moved toward craving. Craving thus seems to be both relational and interstitial; it exists in-between the gathering of different forces. These results are clearly at odds with how craving is depicted in relapse prevention, with its individual focus and instructions on ‘how to “say no”’ (Ekendahl & Karlsson, 2022). To conclude, craving appeared in the studied narratives to emanate from different atmospheres, with a concurrent focus on settings rather than on substances. Several participants claimed to feel the need to escape and shut off, which makes it relevant to ask what it is that they really crave - the substance or to feel better? Taking such considerations seriously, we might question the relevance of identifying concrete ‘high-risk situations’ connected to places and persons.

It should be noted that this study relates to the ‘cold state’ of craving (Loewenstein, 2005). Most participants had stopped using all or most substances at the time of the interview, and this makes it difficult to say something about what affects craving during ‘hot states.’ Also, all participants had engaged in different treatments which most likely influenced what they emphasized as relevant (Ekendahl et al., 2022). Despite this, craving appeared in the interviews as a complex series of associations, shaped by intersecting forces. This challenged how the concept is typically understood in the addiction field. For example, is craving really something personal when it seems to emerge in-between different spaces, objects, relations, memories, and future expectancies? And is the concept useful for those who had a hard time identifying craving, but still managed to find ways to keep sober?

We recognize that RP, and other CBT-based treatments, can be useful for dealing with straight-forward issues like identifying difficult situations (Marlatt & George, 1984). However, if we accept the messy and relational character of craving situations, this approach has its limitations (see, Theodoropoulou, 2020). If we instead treat high-risk situations as complex intersections of forces between volition and compulsion that are relational, where agency is distributed between a myriad of actors (Dennis, 2016), then the current treatment focus needs to be reconsidered. ‘Place-based’ strategies—like the one exemplified above (by Sven)—may be useful for creating atmospheres where recovery can begin to emerge. The same goes for making it possible to avoid certain relations while creating new and meaningful communities. Our results indicate that this is hard and complex work, consisting of several interacting aspects: for example, having an apartment outside of affectively charged areas, coming in contact with new communities, being given support to handle difficult memories, and creating new routines. This indicates that both structural welfare interventions, as well as more ‘finely grained […] habits, orientations and skills’ (Duff, 2016, p. 72) such as creating cleaning routines can be important in creating the real experience of becoming well and moving away from craving. It is also possible that benevolent atmospheres of predictability and belonging can be staged (see e.g., Bille et al., 2015; Duff, 2016). The AA community was mentioned by several participants, and it should be possible to stage similar affective and social atmospheres outside of treatment.

The results thus call for an approach less focused on teaching people how to ‘say no’ to substances. In accordance with Dennis’ (2016) study on triggers, promoting a relational understanding of craving can add to the typically limited description of craving, and at the same time reject stigmatizing ideas that individuals who do not resist cravings are individuals who fail to say no. Finally, if craving is both difficult to identify and rooted in a deeply personal gathering of forces, we question the relevance of the concept within addiction research. By taking seriously the impact of context, and the gathering of forces, we can hopefully ease the stigma attached to craving and relapse in the realm of substance use.

Acknowledgements

Thanks to the people who have been interviewed for this project. The authors would also like to thank the two anonymous reviewers and the members of SUG for their helpful and insightful comments on earlier drafts of this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work is funded by FORTE (Grant 2017-00290).