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Craving isn’t merely an addiction symptom—it’s a core process driving behavior and relapse.

Craving reshapes decision-making by altering how the brain values rewards and risks and learns via experience.

Conscious and unconscious craving reshapes brain systems to drive use, addiction, and relapse.

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........

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