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Drug dreams as a signal of drug craving persistence in time

  • ASL Viterbo, National Health Service, Italy


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
Corresponding author: Claudio Colace, AUSL Viterbo, Via Francesco Petrarca, snc 01033 Civita Castellana (VT).
Home: Via Luigi Volpicelli, 00133, Roma, RM, Italy; E-mail:
Drug dreams as a signal of drug craving persistence in time
Claudio Colace
U.O.C. Psychology, AUSL Viterbo 5, Civita Castellana, Italy
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
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
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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
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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Introduction: No room is currently being allocated in the literature to correlations between patients’ craving for heroin and their actual addictive behaviours, due to the fact that research is focused instead on risk behaviours leading to infectious diseases and the risks being incurred through overdoses. Methods: An expert panel open to rehabilitated patients built an inventory to assess craving behaviours in heroin use disorder patients. We administered it to a sample of 114 ‘typical respondents’, with the aim of testing the value of the various items in the inventory in demonstrating their discriminative effect, their reliability, and the existence of behavioural clusters. We tested the sensitivity of our inventory (its preliminary construct validity) by comparing groups each of which could be expected to be prone to a different type of craving. Results: The inventory demonstrated good internal consistency (reliability) across the sample. This high level of internal consistency suggests that the items measure the craving construct. Preliminary split-test data showed acceptable agreement for the subset of items examined. Preliminary construct validity was established through significant association in the expected direction observed for the utilized variables in identifying the modalities of heroin use. Preliminary factor analysis suggests that this inventory is unidimensional. Conclusions: The inventory appears to qualify as a tool that may be able to evaluate craving in patients with heroin use disorder through their addictive behaviours.
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Abstract Drug dreams, i.e., dreams in which drug-addicted patients use or attempt to use drugs, are a well-documented clinical phenomenon in drug addiction. These dreams offer a useful way to understand the vicissitudes of drug craving in patients who are drug addicts as well as their ability to cope with it. Authors consider drug dreams as a valuable clinical tool in the treatment of drug addiction. Although pathological gambling disorder is a form of behavioral addiction that has several aspects in common with substance addiction, gambling dreams (i.e., dreams about gambling) are seldom described in scientific literature. This study aimed to provide the first systematic investigation on the presence of “gambling dreams” among abstinent pathological gamblers. A total of 10 individuals who arrived consecutively for outpatient treatment at the Centre for Drug Addiction were evaluated on the basis of South Oaks Gambling Scale. They also completed a questionnaire on gambling dreams. The results showed that most pathological gamblers report gambling dreams. These dreams can be considered in terms of frequency, content, and relationship with craving in the same way as drug dreams for drug addiction. Further studies might also shed light on the clinical utility of gambling dreams for treatment of pathological gamblers. Keywords: Gambling disorder, gambling dreams, drug dreams, drug craving, addiction. Main Points • This study shows for the first time the presence of gambling dreams, i.e. dreams about the craving to gamble, in a group of pathological gambler outpatients, offering some insight on the vicissitudes of the patients’ craving and their propensity to cope with it. • The gambling dreams reported here are absolutely comparable, also in terms of contents, with drug dreams in drug addictions. These dreams have the craving to gamble as their main theme, just as drug dreams focus on craving for drug. • These initial observations apparently support the hypothesis that gambling dreams can be considered, in terms of appearance / frequency, content, and relationship with craving, in the same way as drug dreams in other forms of addiction. • The same type of clinical and prognostic usefulness would seem to arise for gambling dreams, as it does for drug dreams in the treatment of drug-addicted patients.
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"Drug dreams", or the dreams in which drug-dependent patients use or attempt to use the drugs that they are addicted to, are a well-documented clinical phenomenon in various forms of drug addiction. Authors have highlighted their clinical, prognostic and therapeutic usefulness, since they provide information about the patients’ “drug craving”, their ability to cope with it, and their motivation to stay clean and sober. However, the study of drug dreams also reveals several implications and inspiration for general dream research and theory, especially with respect to the recent neuropsychology of dreaming, the emotional adaptive theories of dream, and the classical Freudian theory of dreams. This book is aimed at providing a systematic and comprehensive discussion on drug dreams by considering the various perspectives involved (such as therapy in drug addiction, the neurobiology of drug craving, affective neuroscience, dream research) and, ideally, at suggesting future clinical applications for therapists (counsellors, psychoytherapists, clinicians) in charge of treating drug-addicted patients, as well as providing input for dream researchers. The book draws from the author’s clinical and research experience on drug dreams among heroin-addicted patients, as well as from the scientific literature in this field. The book is composed of three parts: the phenomenology of drug dreams, their clinical and therapeutic aspects, and their implications for the dream research and theory.
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Attempting to treat patients who are actively using addictive drugs is unlikely to be helpful and is potentially harmful. Actively using patients should be referred for detoxification before treatment for insomnia is implemented. All drugs of abuse cause insomnia. Although insomnia is most severe during withdrawal, it may be a long-lasting complication of addiction. Cocaine has been shown to provoke “occult” insomnia: degraded sleep accompanied by deteriorated cognitive functioning without the sensation of lack of sleep. This is thought to be caused by a decreased drive for sleep. Insomnia during methadone maintenance is the rule. Because of methadone-provoked central sleep apnea and because of the common lethality of benzodiazepines added to methadone, benzodiazepines are contraindicated during methadone maintenance. Physicians should be sure to include non-medication approaches for insomnia such as sleep hygiene, and if available, acupuncture. If medications are indicated for insomnia, trazodone, low-dose mirtazapine, quetiapine, clonidine, and valproic acid are good choices. Drug dreams are probably provoked by the same mechanism as drug craving: up-regulation of the ventral tegmental dopaminergic seeking system. Attention to drug-seeking during dreams may facilitate recovery.
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Most of the research looking at addiction and the relationship with dreams has focused on newly abstinent alcoholics, or given no evidence of motivation to remain abstinent. This study compared the dreams of abstinent alcoholics in Stage II recovery from alcoholism with non-alcoholic controls. Nine female abstinent alcoholics 9 abstinent men, 11 non-alcoholic women and 9 non-alcoholic men kept dream diaries for 2 weeks. Waking personality, mood, and daily waking emotional experience were taken to ensure comparable waking personality and mood. A structured dream dairy was used to measure sleep behaviour, cognitions and self-appraisal, overall dream experience, and dream emotionality during a two week period. Results showed that male and female abstinent alcoholic’s dreams were more unpleasant, contained less self-esteem, and more unpleasant emotions than non-alcoholics. Within-group differences between waking and dreaming emotion were identified with all groups reporting significant increases in fear and anger during dreams. Based upon the emotional experience of dreams, we concluded that despite being more than one year away from active alcoholism, abstinent alcoholics dream reflected disturbed dreaming. The implications of these finding are discussed.
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Among 293 smokers abstinent for between 1 and 4 weeks, 33% reported having at least 1 dream about smoking. In most dreams, subjects caught themselves smoking and felt strong negative emotions, such as panic and guilt. Dreams about smoking were the result of tobacco withdrawal, as 97% of subjects did not have them while smoking, and their occurrence was significantly related to the duration of abstinence. They were rated as more vivid than the usual dreams and were as common as most major tobacco withdrawal symptoms. In subjects abstinent for 1 year, 63% recalled having dreams about smoking. They had on average 5 of them, and about a quarter occurred after the 6th month of abstinence. Having dreams about smoking was prospectively positively related to maintenance of abstinence. An explanation of this finding based on the association of smoking in dreams with aversive emotions is offered.
The study of dreams in drug-addicted subjects who typically show an abnormal desire to use drugs (i.e., drug craving) represents a new clinical contribution to the investigation of the role of motivations in dreaming processes. This paper reports two studies on the dreaming of heroin-addicted patients. These studies show that: (a) patients frequently dream about heroin (“using heroin” or “seeking and attempting to use heroin”) during abstinence (i.e., drug-craving frustration); and (b) dreams about heroin occur only in abstinent subjects and not in those who regularly use heroin. These results are largely compatible with the previous literature on dreaming in other forms of addiction. Drug dreams undoubtedly show that a clear specific motivational state (drug craving) is strongly involved in the occurrence of dreams clearly related to it. The implications of these data for dream research and theory are discussed.
This study aims to investigate sleep quality and the subjective dream experience in alcohol-dependent patients during withdrawal and abstinence compared with healthy controls. Thirty-seven patients with alcohol dependency and 35 healthy control subjects were asked to fill in several questionnaires and to give information about their subjective sleep and dream experiences. Twelve patients participated in a follow-up interview 4 weeks later. Sleep quality is impaired in alcohol-dependent patients during detoxication, and the subjective dream experience is more negatively toned compared with healthy controls. Both sleep quality and dream experience improves slightly after 4 weeks of abstinence. Patients with alcohol dependency during withdrawal and abstinence dream significantly more often about alcohol. However, none of the abstinent alcohol-dependent patients dreamed about alcohol during withdrawal. This study shows that the subjective sleep and dream quality is strongly impaired in patients with alcohol dependency. Differences in the dream experience between alcohol-dependent patients and healthy controls are in accordance with the continuity hypotheses of dreaming. The hypothesis of dreaming about alcohol as a compensatory effect, however, could not be confirmed.
The current study examined the dream content and dream meaning (discovery) via The Storytelling Method of Dream Interpretation (TSM) from the dreams of recovering alcoholics (N=29) compared to a matched sample of non-alcoholics (N=29). The study also examined the dreams and meaning of dreams in relation to waking day mood. Findings from the study revealed that the dreams of recovering alcoholics differ significantly from non-alcoholics and the dreams provide insight into the mood of recovering alcoholics. Discovery via TSM was found to be relevant, meaningful, and helpful in terms of waking life issues. Furthermore, regression analyses provide predictive evidence of discovery from the dream content for recovering alcoholics. Analyses comparing discovery categories revealed that the major discovery categories for recovering alcoholics include: sobriety, past events, emotions, and a positive future. It appears that TSM is a useful mode of therapy for gaining insight into recovery of alcohol addiction and waking day mood. Limitations, future research, and clinical applications are discussed.
This study tested the hypothesis that differences in both length of abstinence and demographic characteristics would be found between alcoholics who have dreams about drinking (DD group) and those who do not have such dreams (NDD group). The DD group was abstinent for longer periods of time; these parients were more often white, married, and taking disulfiram than were NDD patients. The author concluded that in outpatient treatment of alcoholics, dreaming about drinking is a good prognostic sign.
101 drug users were interviewed at baseline when 6-weeks abstinent. Eighty-four percent reported having drug-related dreams. More subjects reported drug dreams when abstinent than when using drugs. Ninety percent of subjects were followed-up at 6 months. Higher baseline measures of dream frequency were prospectively related to greater drug use. In the first 7 weeks of follow-up there was a rapid reduction in the number of reports, but half of the sample were still experiencing drug dreams in the sixth month. Drug dream frequency at follow-up was related to "craving" and lack of sleep.