Addictions & Cravings: A Nutrition and Natural-Health Reference
1. Definition and Overview
Contemporary models of addiction utilize a neurobiological framework for the onset, development, and maintenance of an addiction, defining it as a chronic and relapsing disorder marked by specific neuroadaptations that predispose an individual to pursue substances irrespective of potential consequences. These neuroadaptations occur across three distinct neurobiological stages: intoxication/binge, withdrawal/negative affect, and preoccupation/anticipation.
Addictions involve persistent, compulsive, and uncontrolled behaviors that are both maladaptive and destructive. Substance use disorders (SUDs) are chronic brain diseases characterized by transitions from recreational to compulsive drug use and aberrant drug craving that persists for months to years after abstinence is achieved.
Food cravings are defined as individual preferences influenced by hormones and psychological factors, which differ from appetite, as they are not necessarily related to hunger or nutritional needs. A central dilemma in daily living involves balancing one's internal goals — such as eating well to stay healthy or control weight — with the consequences of consuming food that is appetizing and immediately available. This conflict is particularly challenging with foods that are desired or craved; the interplay between cognition and reward is a fundamental component of the regulation of food intake in humans.
2. Body Systems Involved
2.1 The Mesolimbic Dopamine System
Addictive drugs are inherently rewarding. They hijack the brain's dopamine system to increase dopamine levels in the nucleus accumbens, a key focal point for reward neurocircuitry in the brain. While dopamine is critical for the rewarding effects of drugs, its role in substance use disorders is still evolving.
The reinforcing effects of drugs mostly depend on dopamine signaling in the nucleus accumbens, and chronic drug exposure triggers glutamatergic-mediated neuroadaptations in dopamine striato-thalamo-cortical pathways (predominantly in prefrontal cortical regions including orbitofrontal cortex and anterior cingulate cortex) and limbic pathways (amygdala and hippocampus) that, in vulnerable individuals, can result in addiction.
At the neurobiological level, food craving has been associated with increased activity of the mesocorticolimbic or reward system, a network chiefly involved in the motivation to pursue biological and non-biological rewards. The reward system comprises the main targets of the dopaminergic projections arising from the ventral tegmental area (VTA) and includes the ventral striatum, hippocampus, amygdala, and orbitofrontal cortex (OFC).
2.2 The Prefrontal Cortex and Impulse Control
Major neurobiological changes in substance abuse disorders common to human and animal studies include a compromised reward system, overactivated brain stress systems, and compromised orbitofrontal/prefrontal cortex function. Incentive salience 'wanting' depends highly on subcortical mesolimbic dopamine neurotransmission, whereas cognitive forms of wanting depend on cortical brain regions such as orbitofrontal cortex, prelimbic cortex, and insular cortex. The conclusion that there may be multiple kinds of psychological desire with different neural substrates has fascinating implications for disorders of desire, including the possibility of irrational desires in which individuals powerfully 'want' a reward that they cognitively do not want at all.
2.3 Conditioning, Cue Reactivity, and Incentive Salience
As the addiction cycle repeats, the firing patterns of dopamine cells transform from responding to novel rewards to anticipating reward-related stimuli. An individual progressively gets a more significant dopamine release from the people, places, and things than the actual substance, leading to motivational urges — a phenomenon called incentive salience.
The magnitude of this dopamine increase was associated with the extent of drug craving, suggesting that in addiction there is a switch from the drug itself initiating dopamine release to drug cues and stimuli initiating dopamine release.
2.4 The Stress and Extended Amygdala Systems
Changes in the extended amygdala result in negative emotional states that perpetuate drug taking as an attempt to temporarily alleviate them. The withdrawal/negative affect stage is defined by two primary neuroadaptations. One adaptation arises from within the reward system, where chronic exposure to a reward decreases dopaminergic tone in the nucleus accumbens (NAcc).
2.5 Neurotransmitters Beyond Dopamine
The genes impacting the neurobiological cycle of addiction regulate neurotransmitter expression and regulation in the reward pathway, typically involving dopamine, glutamate, GABA, and opioid peptides.
Addictive drugs share with palatable food the property of increasing extracellular dopamine, preferentially in the nucleus accumbens shell rather than in the core. However, by acting directly on the brain, drugs bypass the adaptive mechanisms (habituation) that constrain the responsiveness of accumbens shell dopamine to food reward, abnormally facilitating Pavlovian incentive learning and promoting the acquisition of abnormal dopamine-releasing properties by drug-conditioned stimuli.
2.6 Homeostatic vs. Hedonic Eating Systems
Food consumption is to a great degree driven by the tastes of food, which stimulate brain reward circuits, and brain reward mechanisms are therefore important in the pathophysiology of abnormal eating. Visual food cues elicit strong brain responses in motivational/reward and cognitive control areas; these responses were not attenuated by hyperinsulinemia, suggesting that the overpowering external food signals in our environment might override internal homeostatic hormonal signaling, contributing to the current obesity epidemic.
3. Contributing and Associated Factors
3.1 Genetic and Heritability Factors
Not every individual who uses addictive substances will develop a dependence. From early twin studies and family linkage reports, the heritable component of SUD vulnerability is estimated at approximately 50%.
Substance use disorders share partially overlapping genetic foundations, with specific loci, heritability estimates, and causal pathways differing across substances, reflecting both shared vulnerability and substance-specific genetic influences on addiction susceptibility. Genetic studies suggest roles for the genes encoding the neurochemical elements involved in both the brain reward and stress systems in the vulnerability to addiction, and molecular studies have identified transduction and transcription factors that may mediate dependence-induced reward dysregulation.
3.2 Epigenetic Factors
Epigenetic phenomena represent a varied orchestra of transcriptional tuning mechanisms that, in response to environmental stimuli, create and maintain gene expression–mediated physiological outcomes. Epigenetic mechanisms therefore represent a convergent regulatory framework through which the plasticity required to achieve an addicted state can arise and then persist long after drug use has ended.
Emotional stressors and social adversities may cause an initial epigenetic response that alters reward-signaling pathways, predisposing one to a positive response to drug use. With chronic drug abuse and development of addiction, other epigenetic changes may occur that oppose the initial acute response.
Increasing evidence shows that environmental and lifestyle factors may influence epigenetic mechanisms, such as DNA methylation, histone acetylation, and microRNA expression. Several lifestyle factors have been identified that might modify epigenetic patterns, including diet, obesity, physical activity, tobacco smoking, alcohol consumption, environmental pollutants, psychological stress, and working night shifts.
3.3 Personality and Psychological Factors
Impulsivity, novelty-seeking, and stress responsiveness are heritable personality traits that interact to shape susceptibility to substance use. Environmental factors, early-life stress, and social influences interact with the gut microbiome to shape neurobiological and behavioral pathways that modulate addiction risk.
There is convincing evidence that early and adult stressful life events are risk factors for the development of addiction and serve as cues that trigger relapses. Nevertheless, the fact that not all individuals who face traumatic events develop addiction suggests the existence of individual and/or familial resilient factors that protect these mentally healthy individuals.
3.4 Nutritional Depletion Associated with Substance Use
Addiction, whether to alcohol, drugs, or other substances, often leads to poor dietary habits. Individuals struggling with addiction may neglect their nutritional needs, leading to deficiencies in essential vitamins and minerals. Alcohol is known to deplete the body of vital nutrients such as thiamine (vitamin B1), folate, and magnesium. Similarly, stimulants like cocaine or methamphetamine can suppress appetite, leading to malnutrition. These nutritional deficiencies can have a profound impact on physical and mental health, exacerbating symptoms of addiction and making recovery more challenging.
3.5 Blood Sugar Dysregulation
Serotonin (5-HT) modulates insulin action in the brain, having a direct effect on hypothalamic glucose homeostasis. 5-HT is also involved in the regulation of bias toward selection of immediate over delayed rewards, control of meal size, and sweet preference, as indexed by increased sweet calorie intake following depletion of the serotonin precursor tryptophan. Disrupted blood sugar regulation is therefore discussed in the literature as both a driver of and a consequence of certain craving patterns, particularly for carbohydrates and sugar.
3.6 Gut Microbiome
Environmental factors, early-life stress, and social influences interact with the gut microbiome to shape neurobiological and behavioral pathways that modulate addiction risk. These interactions highlight the multifactorial nature of substance use disorders, in which epigenetic, microbial, and psychosocial mechanisms converge to influence susceptibility, progression, and maintenance of addictive behaviors.
4. Nutrients Studied in Relation to Addictions and Cravings
4.1 Amino Acids and Neurotransmitter Precursors
Amino acids are among the most researched nutritional compounds in the context of addictions and cravings, principally because they serve as biosynthetic precursors to the key neurotransmitters implicated in reward, mood, and craving regulation. The following represents what has been reported in the peer-reviewed literature.
L-Glutamine
Glutamine is a conditionally essential amino acid necessary for energy, nitrogen transport, gut integrity, and immune function, and it plays a role in chemical dependency. Excessive glutamate prevents the metabolism of glutamate to glutamine, decreasing serum levels of glutamine — a state described as "glutamine deficiency syndrome." Glutamate stimulates withdrawal and craving, but also leads to increased glutathione and high levels of homocysteine, both considered risk factors for drug craving and relapse.
Evidence note: The mechanistic rationale for glutamine's role is supported by basic science; controlled clinical trial data specifically on glutamine supplementation for craving reduction are limited and no large-scale RCTs are yet available.
N-Acetylcysteine (NAC)
N-acetylcysteine (NAC) appears promising as a treatment in patients with substance use disorder (SUD) as it helps rebalance glutamate levels in the central nervous system (CNS). Basal concentrations of glutamate are indeed reduced in SUD patients but increased during craving.
NAC acts as a precursor to glutathione (GSH), replenishing intracellular GSH pools depleted under conditions of oxidative stress. It modulates glutamatergic pathways through the system xc−, enhancing cystine–glutamate exchange and reducing extracellular glutamate levels.
Scientific evidence (meta-analyses of RCTs): A 2024 meta-analysis of 11 randomized controlled trials found that NAC reduced craving rating (SMD −0.61, p = 0.03), with no differences in subgroup analysis according to drug addiction type (alcohol, cocaine, poly-drugs, amphetamine, nicotine). The authors concluded that NAC appears to reduce craving rating in SUD patients, but that evidence is weak, and more studies are needed to confirm this finding.
A separate meta-analysis published in Addiction Biology (2024) reached a more conservative conclusion: NAC did not significantly outperform placebo in reducing symptoms of craving (SMD = 0.189, 95% CI = −0.015 to 0.393), with very high heterogeneity (99.26%), indicating that findings may have been influenced by study-level variation. Though prior meta-analyses generally support NAC's efficacy in reducing symptoms of craving, individual trials have found mixed results. Overall, the evidence base for NAC and craving is preliminary and inconsistent across reviews.
L-Tryptophan and 5-Hydroxytryptophan (5-HTP)
Tryptophan is the dietary precursor to serotonin. 5-HT is involved in the control of meal size, sweet preference, and the regulation of bias toward immediate versus delayed rewards, as indexed by increased sweet calorie intake following depletion of the serotonin precursor tryptophan. Low serotonin has been discussed in the context of carbohydrate cravings and depressive states that can accompany addiction cycles.
Evidence note: Clinical trials specifically examining tryptophan or 5-HTP supplementation for reduction of substance cravings are limited in scale, and existing evidence is primarily mechanistic or from small pilot studies. The use of 5-HTP in combination with serotonergic medications carries interaction risks that have been documented in the pharmacoepidemiological literature.
L-Tyrosine
Tyrosine is a precursor to dopamine, norepinephrine, and epinephrine. In the context of addiction, restoration of dopaminergic tone — reduced during the withdrawal phase — has been hypothesized to benefit from tyrosine repletion. One neuroadaptation of the withdrawal/negative affect stage arises from within the reward system, where chronic exposure to a reward decreases dopaminergic tone in the NAcc. Tyrosine supplementation in the context of addiction recovery is discussed in the clinical nutrition literature, but large, well-controlled human trials are lacking.
4.2 B Vitamins
Homocysteine (Hcy) is an intermediate in the transition of methionine to cysteine. Without adequate vitamin B6, vitamin B12, and folate to convert Hcy to cysteine, Hcy builds up in the blood and even the brain. Elevated homocysteine has been associated with neurotoxicity and is common among people with alcohol use disorders due to alcohol's known interference with B-vitamin metabolism.
Chronic alcohol use interferes with folate absorption and metabolism, which may increase the risk of anemia and certain cancers. B vitamins, including B6, B12, and folate, are important for neurotransmitter synthesis; deficiencies can worsen mood disorders, making their replenishment a focus during recovery.
Evidence note: Thiamine (B1) repletion is well-established in clinical medicine for prevention of Wernicke's encephalopathy in alcohol use disorder, representing one of the most evidence-based nutritional interventions in this field. Evidence for broader B-vitamin supplementation specifically reducing cravings in humans is largely observational and mechanistic.
4.3 Magnesium
Deficiencies in magnesium are common among individuals with addiction, particularly those recovering from alcohol dependence. Magnesium is a mineral that plays a role in over 300 biochemical reactions in the body, including those related to stress and relaxation. Deficiencies in magnesium are common among individuals with addiction, particularly those recovering from alcohol dependence.
Zinc and magnesium are often found to be deficient in alcoholics, affecting various bodily functions including enzyme activity and protein synthesis. Magnesium helps manage anxiety and improves sleep quality, playing a crucial role in emotional regulation.
Evidence note: The association between magnesium deficiency and alcohol use disorder is well-documented in the clinical literature. Direct evidence for magnesium supplementation reducing addiction cravings in controlled trials is limited; the mechanistic rationale is grounded in magnesium's roles in NMDA receptor regulation and stress-axis modulation.
4.4 Zinc
Zinc and magnesium, often found to be low in individuals with opioid use disorder, play vital roles in numerous bodily functions and may help reduce withdrawal symptoms when properly balanced. Low zinc levels are linked to increased depression and irritability, highlighting zinc's importance in maintaining emotional balance.
Evidence note: Zinc deficiency is documented in both alcohol and opioid use disorders. Clinical trials on zinc supplementation for craving reduction specifically are sparse; the association rests primarily on observational and mechanistic data.
4.5 Vitamin D
In a study of 260 inpatients treated for substance use disorders, approximately 89.3% had a vitamin D deficiency as defined by French recommendations (<30 ng/mL). Using univariate analyses, vitamin D deficiency was associated with increased craving intensity for both the primary substance and food at hospital discharge. However, multivariate regression analyses showed no significant associations between vitamin D or calcium levels and craving intensities, indicating the univariate finding may be confounded.
This study confirms the high prevalence of vitamin D deficiency among inpatients treated for SUDs. Although preliminary, the findings highlight the importance of assessing vitamin D levels in SUDs, and call for further research on its role in relapse vulnerability and the potential benefits of supplementation during drug withdrawal treatment.
4.6 Omega-3 Fatty Acids (n-3 PUFAs)
N-3 fatty acids accumulate in neuronal membranes through young adulthood, becoming particularly enriched in the prefrontal cortex (PFC) — the locus of cognitive control of behavior. The PFC undergoes a surge in development during adolescence, coinciding with a life stage when dietary quality and intake of N-3 fatty acids tend to be suboptimal. Such low intake may impact neurodevelopment and normative development of cognitive functions suggested to be protective for the risk of subsequent substance and alcohol use disorders.
Studies on tobacco dependence have shown that smokers have decreased levels of blood DHA, and clinical trials demonstrated that daily administration of fish oil capsules decreased the dependence and craving levels of smokers. Among cocaine-dependent individuals, studies have shown that low levels of fatty acids are related to relapse vulnerability and aggression.
Scientific evidence (systematic review): Preclinical studies demonstrated that n-3 PUFAs improved behavioral, inflammation, lipid metabolism, and hepatic parameters altered by alcohol. However, clinical trials yielded inconclusive evidence. Despite the paucity of clinical and preclinical studies, available evidence suggests that n-3 PUFAs may exert a protective influence on alcohol-related outcomes at both the behavioral and molecular levels. The overall evidence is promising but preliminary; adequately powered RCTs in human addiction populations are lacking.
4.7 Chromium
Dietary chromium supplementation for the treatment of diabetes remains controversial. Based on chromium's potential to improve insulin, dopamine, and serotonin function, researchers have hypothesized that chromium has a greater glucoregulatory effect in individuals who have concurrent disturbances in dopamine and serotonin function — that is, complex patients with comorbid diabetes, depression, and binge eating.
Evidence note: The connection between chromium and carbohydrate or sugar cravings is largely mechanistic, related to chromium's role in insulin sensitivity. Evidence from RCTs specifically targeting craving reduction via chromium supplementation is limited and mixed. This area requires larger, better-controlled trials before conclusions can be drawn.
5. Herbs and Botanicals: Traditional Use and Scientific Evidence
5.1 Kudzu (Pueraria lobata)
Traditional use: Kudzu (Pueraria lobata) is one of the earliest medicinal plants used to treat alcohol abuse in traditional Chinese medicine for more than a millennium. Native to eastern Asia, kudzu possesses a long history of traditional usage as medicine in Asian countries, with roots as the main raw material for active substances including flavonoids (isoflavones), isoflavone glucosides, organic acids, saponins, starch, and D-mannitol.
Key bioactive constituents: Three compounds from the group of isoflavones deserve particular attention: daidzin (DAI), daidzein, and puerarin (PUE). Preparations of P. lobata and their main components have potential in alcohol intake reduction, as indicated in a number of studies over the past two decades.
Scientific evidence (systematic review and meta-analysis): A meta-analysis of three randomized controlled trials showed that compared with placebo, kudzu may reduce alcohol cravings (odds ratio 2.97, 95% CI 1.37 to 6.46; I² = 0%, moderate-certainty evidence). Seven RCTs met eligibility criteria in the systematic review; most were small and had an unclear risk of bias. Four RCTs favoured kudzu over placebo in reducing number of drinks, normalizing drinking behaviour, and increasing days of abstinence.
Antidipsotropic isoflavones isolated from radix puerariae — including puerarin, daidzin, and daidzein — suppressed ethanol intake in rodents and abolished the development of alcohol withdrawal symptoms in preclinical models.
Evidence strength: Moderate-certainty evidence (GRADE) for craving reduction from a limited number of predominantly small RCTs. Larger, better-powered trials are warranted before definitive conclusions can be made.
5.2 St. John's Wort (Hypericum perforatum)
Traditional use: St. John's Wort has a long history of use in European herbal traditions for mood-related conditions. Its use in the context of addiction recovery has been discussed in the research literature in relation to its serotonergic and dopaminergic effects, given the role of both neurotransmitters in craving and mood dysregulation.
Evidence note: The botanical has been listed among plants with scientific support for the treatment of addiction in academic reviews. However, it carries documented pharmacokinetic interactions, particularly as a potent inducer of cytochrome P450 enzymes, that may affect the metabolism of other medications used in addiction treatment. Interaction risks, including serotonin syndrome when combined with serotonergic drugs, have been documented in pharmacoepidemiological literature. Direct RCT evidence for reducing substance-specific cravings is limited.
5.3 Rhodiola rosea
Traditional use: Rhodiola rosea has been part of traditional healing systems in Asia since the time of Chinese emperors, who sent expeditions to Siberia to obtain it. The Vikings were also reported to have used the herb to enhance their endurance, physical, and mental strength.
Evidence note: Rhodiola has been studied primarily as an adaptogen and for stress modulation. Its relevance to craving research is indirect — operating through stress-axis modulation, which is a recognized contributor to relapse. Controlled evidence specifically for addiction craving reduction is not yet established in the peer-reviewed literature.
6. Dietary and Lifestyle Factors
6.1 Dietary Patterns and the Western Diet
The Western diet is characterized by the habitual consumption of ultra-processed food products, with an elevated intake of omega-6 fatty acids (which in excess can promote inflammation), simultaneous insufficiency in brain-essential omega-3 fats, excessive sugar and sodium, reduced micronutrient intake, and a high intake of refined carbohydrates. This dietary profile depletes several nutritional substrates relevant to neurotransmitter function and reward-system homeostasis.
While multiple genetic and environmental factors contribute to risk for and resilience to substance and alcohol use disorders, mounting evidence suggests that dietary patterns early in life may also modulate cognitive and behavioral factors thought to elevate substance use disorder risk, including impulsivity and reward sensitivity.
6.2 Protein and Amino Acid Adequacy
Nutrition, particularly as it is involved in supplying precursors for neurotransmitters — chemicals which facilitate activity within the central nervous system, such as tyrosine and tryptophan — contributes to addiction vulnerability and recovery. Amino acids are required to produce brain neurotransmitters and are found in both protein foods and carbohydrates.
6.3 Blood Sugar Stability and Carbohydrate Quality
Fluctuations in blood glucose levels have been associated with carbohydrate and sugar craving cycles. Tryptophan found in carbohydrate sources is better utilized by the brain than that in protein sources, producing more serotonin. Insulin production, which increases after eating carbohydrates, increases tryptophan absorption via the blood–brain barrier. This mechanism helps explain the common observation that carbohydrate consumption can temporarily alleviate certain mood-related cravings, potentially reinforcing a craving cycle.
6.4 Physical Activity
Socio-economic and environmental factors significantly influence health by driving epigenetic changes that alter genetic expression. Lifestyle elements such as diet, exercise, mindfulness, and environmental exposure play crucial roles in modulating these mechanisms. Physical exercise has been discussed in the literature as a behavioral intervention that can modulate reward-system neurobiology, though a detailed review of exercise RCTs in addiction falls outside the nutritional focus of this entry.
6.5 Mindfulness and Stress Reduction
Mindfulness has a substantial impact on mental health by playing a role in treating addictions, helping individuals stay present and aware of their current situation rather than diverting their attention to unhelpful or harmful distractions; it increases individuals' capacity to observe and experience strong emotions with greater objectivity, and helps mitigate consequences of traumatic stress experiences by strengthening resilience.
Mindfulness practices, particularly meditation, have been found to regulate DNA methylation, reducing stress and inflammation. Dietary interventions such as the Mediterranean and DASH diets enhanced health biomarkers and slowed epigenetic aging through favorable DNA methylation patterns.
6.6 Sleep
Disrupted sleep is associated with increased inflammatory mediators and varied regulation of genes associated with the circadian rhythm, as well as with the development of anxiety and depression. Certain genotypes have greater predisposition to developing depression when exposed to reduced sleep duration. Sleep disruption is a common feature of the withdrawal and post-acute withdrawal phases and is discussed in the literature as a factor that may amplify craving intensity and relapse vulnerability.
6.7 Stress and Adverse Life Events
SUDs involve vicious cycles of binges followed by occasional periods of abstinence with recurrent relapses despite treatment and adverse medical and psychosocial consequences. There is convincing evidence that early and adult stressful life events are risk factors for the development of addiction and serve as cues that trigger relapses.
7. Evidence Gaps and Research Limitations
The nutritional research in the field of addictions and cravings is characterized by important methodological limitations that should be clearly acknowledged:
- Neuroimaging studies of food reward have yielded widely divergent results when comparing individuals with obesity to normal-weight controls: some report heightened activation in reward-related brain regions, whereas others observe attenuated or negligible differences.
- Most research on nutrients and mental health in addiction contexts has been cross-sectional, indicating a need for longitudinal studies to establish more definitive causal relationships.
- Clinical trials on omega-3 PUFAs and alcohol-related outcomes have yielded inconclusive evidence.
- For NAC, evidence for craving reduction is considered weak, and more studies are needed to confirm findings.
- Most botanical studies in this area (including kudzu) involve small samples, short durations, and variable risk-of-bias ratings, limiting the generalizability of conclusions.
- No biological markers of substance abuse disorders currently exist, but there are many promising neurobiological features of substance abuse disorders that will eventually aid in the specific diagnoses of substance use, misuse, and dependence.
References
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