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Drug dreams as a signal of drug craving persistence in time

Authors:
  • ASL Viterbo, National Health Service, Italy

Abstract

Drug dreams, that is, dreams in which patients addicted to drugs typically use or make an attempt to use the drugs they are addicted to, are a well-documented clinical phenomenon in various forms of addiction. One clinical function of these dreams is their ability to signal the latent recrudescence of drug craving even long after the patients have resolved their addictive behaviours. The following case is an example of how drug dreams reveal the extraordinary persistence in time of drug craving and the patient's risk of potential relapse, even after as many as 10 years of living in a drug-free state.
Case Report
Heroin Addict Relat Clin Probl 20xx; xx(x): xx-xx
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Corresponding author: Claudio Colace, AUSL Viterbo, Via Francesco Petrarca, snc 01033 Civita Castellana (VT).
Home: Via Luigi Volpicelli, 00133, Roma, RM, Italy; E-mail: claudio.colace@yahoo.it
Drug dreams as a signal of drug craving persistence in time
Claudio Colace
U.O.C. Psychology, AUSL Viterbo 5, Civita Castellana, Italy
Summary
Drug dreams, that is, dreams in which patients addicted to drugs typically use or make an attempt to use the drugs they
are addicted to, are a well-documented clinical phenomenon in various forms of addiction. One clinical function of these
dreams is their ability to signal the latent recrudescence of drug craving even long after the patients have resolved their
addictive behaviours. The following case is an example of how drug dreams reveal the extraordinary persistence in time
of drug craving and the patient’s risk of potential relapse, even after as many as 10 years of living in a drug-free state.
Key Words: heroin; addiction; drug dream; drug craving
1. Introduction
Drug dreams, that is, dreams in which patients
currently or once addicted to drugs typically use or
make an attempt to use their drugs of choice, are a
well-documented clinical phenomenon in various
forms of addiction [2-8, 11-16, 18]. Several stud-
ies have shown that the collection and analysis of the
manifest content of these dreams offer a useful way
to understand the degree and evolution of “drug crav-
ing”, (i.e., “the desire for the previously experienced
effects of psychoactive substances”) [17] in drug-
addicted patients, as well as on their ability to cope
with it. In this perspective, drug dreams have been
considered a valuable clinical resource for the treat-
ment of drug-addicted patients [7, 9, 10]. One clinical
function of drug dreams is their ability to signal the
latent recrudescence of drug craving even long after
the patients have resolved their addictive behaviours.
The following case is an example of how drug dreams
reveal the extraordinary persistence over time of drug
craving.
2. Case Report
Mr. G., a 48-year-old man, had been using her-
oin frequently for 2 years when he was admitted to
a pharmacological (methadone) and psychological
support programme at the Centre for Drug Addiction,
with a diagnosis of drug dependence (heroin) [1]. The
patient also showed psychiatric comorbidity with a
diagnosis of major depression disorder, pharmaco-
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Heroin Addiction and Related Clinical Problems xx(x): xx-xx
logically treated with Seroquel (quetiapine fumarate).
Currently, the patient has no longer been using heroin
for about 10 years, is stabilized and is being treated
with methadone at 70 mg/day. When he solicited a
psychological consultation he reported being alarmed
because he had had the following drug dream (which
he had not had for a long time): “I met some friends
and went to take drugs, I snorted, but while I was still
doing it I woke up”. On awakening from this dream,
the patient’s rst thought was: “How can it be that I
still dream of heroin?”. The patient said that he ap-
parently did not have any conscious perception of his
craving for heroin, and had no intentional desire to
use it.
3. Discussion
This case report shows how drug dreams can
reveal the extraordinary persistence of drug craving
over time and the patient’s risk of potential relapse
even after 10 years of living in a drug-free state. The
appearance of drug dreams, which is the reason that
led the patient to seek psychological consultation,
offers an extraordinary opportunity to analyse the
patient’s current situation. Indeed, a psychological
investigation showed that this patient had recently
suffered a recrudescence of his major depression after
the self-reduction of his drug therapy with Seroquel
(quetiapine fumarate), as well as his daily dosage of
methadone. These pharmacological variations might
be at the basis of this recrudescence of drug craving.
If so, it would support the idea that a long-term main-
tenance treatment would be necessary for treating
heroin addicts, and that any reduction in daily dos-
ages of opioid agonists should be performed under
medical supervision, even when treating patients who
have been stabilized for years. Our case report shows
that drug dreams may be a precious tool for therapists
(i.e., counsellors, psychotherapists, psychologists,
psychiatrists, clinicians) in observing sudden varia-
tions in the degree of drug craving during the treat-
ment of addicted patients even in the long term. From
this point of view, therapists should always encourage
patients to pay attention to their drug dreams, because
through these they may develop a greater awareness
of their craving and of the dangers of relapse, as well
as of their potential for bringing a change into their
lives.
References
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C. Colace: Drug dreams as a signal of drug craving persistence in time
cocaine dependence. J Nerv Ment Dis. 192(3): 238-242.
Role of the funding source
No funds.
Conict of interest
The author reports no conicts of interest. The au-
thor alone is responsible for the content and writing of the
paper.
Received November 12, 2013 - Accepted January26, 2014
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Heroin Addiction and Related Clinical Problems xx(x): xx-xx
... It is associated with the incapacity to control the urgency or exclusiveness of this drive through one's intentions. In this light craving can be considered a new psychopathological concept and syndrome [3,7,10,13,22,26]. Although craving is a phenomenon of clinical significance, there is no consensus on its definition, on the clinical factors determining its onset and on its correct assessment. ...
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