Drug abuse, dreams, and nightmares

Abstract

Craving is a concept with good face validity and poor construct validity. The difficulties measuring craving includes that it varies by time, by environment, by the amount of stress, by one's state of mood, that it may be partially unconscious and that there is no clearly established concept of what exactly is being measured. Neural mechanisms of drug craving are reviewed. The ventral tegmentum is central to craving. It is connected to limbic and cortical structures that help the organism learn to find alcohol and drugs via the establishment of drug cues that intensify craving. The dream on mechanism and the subcortical pathways of addiction are identical (Solms, Behav Brain Sci 23:843-850, 2000). Specimen drinking/drug dreams are provided. A possible neural mechanism of transition from heavy drinking of alcohol to physical addiction is described and tied to the onset of drinking dreams. Therefore, drinking dreams would represent a biological marker of the transition from psychological to physical addiction. With more empirical work, it is possible that drug dreams would be established as the psychological readout of the switch mechanism to physical addiction and persistent craving for alcohol or drugs. Drug dreams might then represent the gold standard for craving research because they are a direct readout of midbrain function, and become the basis of construction of scales to capture the phenomenon of craving. Drinking and drug dreams represent a biological manifestation of addiction that can be used in psychotherapy to help the patient to be conscious of their persistent urge to relapse and to understand that their brain has been permanently captured by the addictive drug; whether they use or not. Nightmares are a subset of dreams defined by the presence of alarm on awakening. Nightmares are common in the addicted population because of an increased incidence of childhood abuse and posttraumatic stress disorder. Despite the wishes of some patients to avoid using nightmares in their psychotherapy, addressing the issues raised by the nightmare is essential as part of helping the patient remain abstinent.