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April 2001

The Scientific Exegesis of Desire: Neuroimaging Crack Craving

Arch Gen Psychiatry. 2001;58(4):342-344. doi:10.1001/archpsyc.58.4.342

UNFORESEEN and near-instantaneous, extreme cravings for crack cocaine euphoria inevitably assail addicts attempting abstinence. Appearing during routine activities, even after weeks or months of abstinence, such cravings routinely provoke relapse.1 This craving expresses quintessential classic conditioning. It is evoked by common stimuli, such as money, that acquire extreme emotional power solely because of incessant temporal pairings of the stimuli with the reward of extreme crack-induced pleasure. Commonly termed cued, evoked, or, most often, conditioned craving, this phenomenon and its management warrants—by clear clinical consensus—a preeminent role in determining treatment outcome. Conditioned craving thus presents a powerful potential avenue for research advances. However, it has proven difficult to research, notwithstanding decades of vigilant efforts since its introduction to addiction by Wikler.2 Recently, the advent of functional neuroimaging has renewed hopes that breakthroughs in understanding and hence treating conditioned drug craving are now at hand, and almost a dozen neuroimaging reports on evoked craving have now appeared.