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Neuro-Psychoanalysis, 2004, 6 (2) 165

Dreaming in Addiction:A Study on the Motivational Bases of Dreaming Processes

Claudio Colace (Civita Castellana)

Claudio Colace, Ph.D.: Public Sanitary Service, Service for Drug Addiction, ASL Viterbo, Civita Castellana, Italy.Correspondence to: Claudio Colace, via Luigi Volpicelli, 8, Cap. 00133 Roma, Italy (email: claudio65@infinito.it).

The study of dreams in drug-addicted subjects who typically show an abnormal desire to use drugs (i.e., drug craving) represents anew clinical contribution to the investigation of the role of motivations in dreaming processes. This paper reports two studies onthe 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 onlyin abstinent subjects and not in those who regularly use heroin. These results are largely compatible with the previous literature ondreaming in other forms of addiction. Drug dreams undoubtedly show that a clear specific motivational state (drug craving) isstrongly involved in the occurrence of dreams clearly related to it. The implications of these data for dream research and theory arediscussed.

However, this trend has changed in recent years.Several research fields have contributed to reconsider-ing the role of motivations in dreaming processes.

First, Solms’s neuropsychological studies (1997,2000) have shown that dreaming can be initiated by theforebrain mechanism, regardless of REM state. What ismost crucial in the generation of dreams is the meso-limbic–mesocortical dopaminergic system, the samesystem that the affective neurosciences have shown tobe involved in the instigation of goal-seeking behav-iors and appetitive interactions with the world (i.e.,the “seeking” or “wanting” system) (Berridge, 2001;Berridge & Robinson, 1998; Ikemoto & Panksepp,1999; Panksepp, 1998). Second, functional neuro-imaging studies have confirmed neuropsychologicalfindings by showing that dreaming processes involveseveral forebrain structures, including frontal and lim-bic brain areas (arousal, emotion, and motivation) (e.g.,Braun et al., 1997; Maquet et al., 1996; Nofzinger,Mintun, Wiseman, Kupfer, & Moore, 1997). Third, thenew neuro-psychoanalytic approach has proposed tostudy the neural correlates of psychoanalytic conceptsby focusing upon the changes in psychological func-tioning that occur following damage to different brainstructures (Kaplan-Solms & Solms, 2000).

In this context, a new clinical contribution to theresearch of motivations in dreaming is represented by

Background

For a long time, the study of the role of motivations indreaming processes has received very little attention indream research and theory. This trend is well repre-sented by the following events. In 1968, Bokert foundthat the frustration of biological drives clearly affectsREM dreaming processes, but his study did not receiveenough attention from the scientific community (i.e.,no one attempted to replicate his experiment). In 1977,McCarley and Hobson, based on detailed study ofsleep physiology, suggested that REM sleep anddreaming are due to an automatic and cyclical brain-stem neural mechanism and that therefore the underly-ing causal mechanism of dreaming is “motivationallyneutral” (p. 1219). In this view, the psychoanalyticmodel (Freud, 1900) and any perspective associatedtherewith of studying dreams from a motivationalviewpoint was hastily put aside. Later, in the 1980s,the psychological cognitive approach put great empha-sis on the description of dream-generation processes,by assuming that the issues of dream meaning anddream motivation could be temporarily omitted (e.g.,Foulkes, 1985). Antrobus’s (2001) words describe thissituation well: “an explicit model of how drive, mo-tives, or personal concerns act to produce the dreamhas never been described” (p. 2).

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166 Claudio Colace

the study of dreams in drug-addicted patients (e.g.,Colace, 1999, 2000a; Johnson, 2001). Several authorshave noticed that drug-addicted patients (addicted, forexample, to alcohol, cocaine, or heroin) frequentlyreport dreams the contents of which are related to theirabnormal urge to use the drug they are addicted to (i.e.,drug craving). These authors have investigated theusefulness of these dreams from the point of view ofthe treatment of addicted patients (e.g., Christo &Franey, 1996; Reid & Simeon, 2001; Yee, Perantie,Dhanani, & Brown, 2004).

Recently, some authors have also analyzed the im-plication of these drug dreams for dream researchand psychoanalysis (Colace, 2000a; Johnson, 2001;Shevrin, 2001). Colace (2000a) suggested that thestudy of dreaming in drug addiction may give a newmethodological opportunity to examine the role ofdrives in the dream-generation process, because in thissituation—as compared to normality—there is clearlyan abnormal motivational state (i.e., drug craving).Johnson (2001) noticed that the mesolimbic–meso-cortical dopaminergic system identified by Solms asessential for the motivational trigger of dreaming isexactly the one that, when exposed to addictive drugs,is responsible for drug craving and drug dreams.Shevrin (1997, 2001) suggested that drug addiction isan expression of drive in the psychoanalytic sense,which explains the persistence of drug dreams longafter addiction problems have been resolved.

My purpose in this article is to report new system-atic observations about dreaming in heroin-addictedsubjects and to reconsider the literature on dreaming inaddiction in order to underline the several implicationsthat this research field may have in the investigation ofthe role of drives and motivations in dream-generationprocesses.

Addiction

Before describing the study of dreaming in drug-ad-dicted subjects, focusing on a few points about addic-tion may be useful.

According to DSM-IV (APA, 1994), addiction (orsubstance dependence) is a term used to denote acondition of drug use (e.g., heroin, alcohol, nicotine)defined by the inability to control it despite the healthproblems it creates. The main characteristics of addic-tion are: (a) compulsive drug-seeking behavior, (b)tolerance (more and more substance is needed to pro-duce an effect), and (c) withdrawal syndrome (clusterof symptoms follows the abrupt discontinuance of druguse).

Drug-addicted subjects show physical and psycho-logical dependence. The first term refers to physiologi-cal tolerance and to withdrawal syndrome, while thesecond refers to “drug craving”—that is, a very strongdesire to reexperience the effects of a psychoactivesubstance (Cami & Farre, 2003; Johnson, 2003;UNDCP & WHO, 1992).

Two research paradigms have been employed in theinvestigation of the neurobiological and neuroana-tomical substrate of drug addiction: animal behavioralmodels and functional neuroimaging studies in hu-mans.

Animal behavioral models (i.e., self-stimulation,self-administration, and conditioned place-preference)have shown that drugs have gratificational and motiva-tional properties. For example, laboratory animalsquickly learn to work (e.g., press a lever) for self-administered drugs generally abused in humans (e.g.,opiates, cocaine, alcohol) (Bozarth, 1987, 1990;Bozarth & Wise, 1981; Gessa, 1991; Pettit & Justice,1991; Weiss, Lorang, Bloom, & Koob, 1993; Welzl,Kuhn, & Huston, 1989). These gratificational effectsare mediated by the activation of mesolimbic–meso-cortical dopamine (DA) pathways that arise in themidbrain ventral tegumental area (VTA) and are pro-jected toward the nucleus accumbens (NAc) and pre-frontal cortex (Di Chiara, 1996; Di Chiara & Imperato,1988; Koob, 1992; Pulvirenti & Koob, 1990; Wise &Bozarth, 1987). In particular, the gratifying effects ofopiates and other drugs are parallel to the increase ofextracellular DA concentrations in the NAc, especiallyin the “shell” compartment (Di Chiara, 1996; Di Chiara& Imperato, 1988; Pontieri, Tanda, & Di Chiara, 1995;Pulvirenti & Koob, 1990). The DA increase startsduring the phase that precedes the drug use (i.e., appeti-tive phase) when conditioned-predicting stimuli un-leash drug craving (Di Chiara, 1995, 1996; Di Chiara,et al., 1999).

Recent findings obtained with functional neuroim-aging studies have confirmed the neurobiological sub-strate of addiction identified in animal experiments(e.g., Goldstein & Volkow, 2002; London, Ernst,Grant, Bonson & Weinstein, 2000; Sell et al., 1999).One approach in these studies involved the induction ofcraving by presentation of stimuli previously associ-ated with drug use. For example, cocaine-addictedpatients during exposure to cocaine-related videosexperienced craving (self-reports) and showed, viapositron emission tomography (PET), a limbic brainactivation (Childress et al., 1999; Grant et al., 1996).

The brain areas involved in drug addiction are thesame as those usually involved in the reinforcing ofprimary physiological stimuli (e.g., food) and other

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Dreaming in Addiction: A Study on the Motivational Bases of Dreaming Processes 167

activities that keep us alive (Blackburn, Pfaus, &Phillips, 1992; Fibiger & Phillips, 1987; Melis &Argiolas, 1995; Wise, 1989). We have seen that affec-tive neuroscience studies have recently described thesebrain areas (frontal and limbic structure, DA of ventraltegmental area) as a “seeking” or “wanting” system—that is, circuits that are involved in the instigation ofmotivated behaviors to satisfy biological needs (e.g.,Berridge, 2001; Panksepp, 1998).

Studies on dreaming in heroin addiction

Some clinical case reports (Colace, 2000a) have sug-gested that heroin-addicted patients during abstinencefrom the drug—a time when they usually experiencedrug-craving frustration (e.g., see Di Chiara, 1995)—dream about heroin. Conversely, they do not havethese dreams when they are using heroin regularly.

The following studies attempt (1) to establish moresystematically the presence of dreams about heroin inheroin-addicted patients who are abstaining from thedrug, (2) to test the observation that dreams aboutheroin occur more frequently in subjects who haveinterrupted the use of the drug (i.e., drug-craving frus-tration) than in those who have continued to use heroinregularly. The subjects were heroin-addicted patientswho received pharmacological and psychologicaltreatment in a public Center for Drug Addiction. Theheroin-addiction diagnosis was based on DSM-IV(APA, 1994) criteria.

Study I: Dreams about heroin during abstinence

MethodTwelve subjects who arrived consecutively at the

Center for Drug Addiction were interviewed one byone during psychological-support sessions. Each ofthem was systematically asked whether during previ-ous periods in which he or she had temporarily stoppedusing the drug (i.e., within a therapeutic community,because of unavailability of heroin, etc.) he or she haddreamed about heroin or not. Those who were able torecall their dreams were also asked to describe them,specifying if these dreams involved using heroin, seek-ing it, attempting to use it, refusing it, or other themesabout heroin.

Results

All the subjects recalled having had several dreamsabout heroin. Most of them remembered dreaming

about drug-seeking behaviors and about attempts touse it. Others dreamed about using heroin. Only onepatient reported to have dreamed of seeing heroin butrefusing it (see Table 1, and Appendix).

Drug dreams appear in the early days of interruptionof the drug use but also during the first months ofabstinence. Three of these subjects had been takingmethadone (the opiate, the chemical substitute forheroin) when they had drug dreams (see Table 1).Several subjects reported spontaneously that duringthe periods in which they had used heroin regularly,they had never had this type of dream.

Study II: Dreams about heroinin abstinent and nonabstinent patients

Method

Thirteen subjects who arrived consecutively at theCenter for Drug Addiction were observed during thefirst 14 days of treatment. All subjects received phar-macological treatment with methadone.

Each of them was interviewed in two individualsessions with a psychologist. During the first session,on admission to treatment, the subjects were evaluatedfor the diagnosis of heroin addiction. In the secondsession, after an interval of 3–14 days, a structuredinterview on dreaming was administered (see Table 2).

Having completed the dream interview, the subjectswere asked to fill out a self-evaluation on their heroinuse (use/non-use) since admission to treatment (i.e.,dream interviews were blind compared to self-evalua-tions on drug use). Although self-evaluations of druguse are generally valid (Kleyn et al., as quoted inChristo & Franey, 1996; Reid & Simeon, 2001), thisstudy controlled the validity of these self-evaluationsby employing random urine tests collected from 70%of the subjects by nurses who had no knowledge aboutthe purpose of the study. Analyses were performedusing the Statistical Package for Social Science (SPSS)for Windows, Version 8.0.

Results

At the end of the observation period (Session 2), 7subjects stated that they had been able to stop usingdrugs during the prior period (“abstinent” patients),and 6 subjects stated that they had continued to useheroin (“regular” patients). These answers matched theresults of random urine tests. The characteristics of thetwo groups are shown in Table 3.

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In the “abstinent” group, 6 of the 7 subjects (86%)recalled at least one dream about heroin, whereas noneof the subjects in the “regular” group had had dreamsabout the drug. This difference was significant at the.005 level according to the Fisher Exact Test (seeTable 3). In particular, subjects in the “abstinent”group recalled 10 dreams about heroin, 6 of whichwere about drug use and 4 were about seeking andattempting to use heroin (see Appendix for type andexamples of dreams).

Discussion and survey of literature

Dreams about heroin occurred regularly in theseheroin-addicted patients. Our studies confirm the hy-pothesis that the dreams are the result of abstinence(drug-craving frustration), as addicted patients who

use heroin regularly do not report drug dreams. Thesedreams are not determined by the withdrawal syn-drome in itself (i.e., abrupt interruption of drug use), asseveral of these patients were treated with methadone,an opiate that blocked or reduced their withdrawalsymptoms. Indeed, we found drug dreams in the earlydays of interruption of drug use as well as during thefirst months of abstinence. Clinical experience hasshown that heroin-addicted patients may have a relapseprovoked by a drug-craving recrudescence after one ortwo years of being drug-free. Such drug-craving per-sistence can, from our studies, be surmised to be thereason why drug dreams too continue to appear for along time.

Drug dreams are also experienced by patients treatedwith methadone; therefore, we can presume that thispharmacological treatment alone does not mitigatetheir drug craving. After all, clinical observations show

Table 1Addicted Patients Who Recalled Dreams about Heroin during Periods of Abstinence

PharmacologicalAge treatment Typical themes of

Subject (years) Sex Reasons for abstinence during abstinence When dreams occurred dreams about heroin

#1 22 M therapeutic community none during first 3 days heroin-seeking behaviorof abstinence and attempt to use it

#2 30 M unavailability of heroin none after 1 day of abstinence using heroin#3 26 M individual attempt methadone, during first 15 days using heroin

to stop use 70 mg/day of abstinence#4 29 M therapeutic community none during first 3 months using heroin

of abstinence#5 32 M individual attempt none during first month heroin-seeking behavior

to stop use of abstinence and attempt to use it#6 27 F therapeutic community none during first 2 months heroin-seeking behavior

of abstinence and attempt to use it#7 27 M individual attempt none during first 3 days using heroin

to stop use of abstinence#8 42 M individual attempt methadone, during first 2 months heroin-seeking behavior

to stop use 20 mg/day of abstinence and attempt to use it#9 37 M admission to hospital methadone, during first week heroin-seeking behavior

(recovery) 80 mg/day of abstinence and attempt to use it#10 40 M unavailability of heroin none during first 3 days heroin-seeking behavior

of abstinence and attempt to use it#11 28 M individual attempt none during first 6 months seeing heroin and

to stop use of abstinence refusing it#12 22 F individual attempt none during first 2 months using heroin

to stop use of abstinence

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Dreaming in Addiction: A Study on the Motivational Bases of Dreaming Processes 169

Table 2Dream Interview

1. After being admitted to the treatment, have you had dreamsabout heroin?

2. (If yes) Were these dreams about using heroin or associatedwith heroin in general?

3. How many dreams about heroin have you had?4. Please describe the last dream you had about heroin.5. Please describe the emotions you felt during this dream and

what you felt on waking up(Questions 4 and 5 were repeated for all the dreams aboutheroin that the patient could recall)

Table 3Characteristics of Sample

“Abstinent” “Regular”patients (N = 7) patients (N = 6)

Age (years) range = 17–40 range 22–45(mean = 23.2) (mean = 29.1)

Sex M = 6, F = 1 M = 5, F = 1Days between mean = 7.8 days mean = 8.5 daysSessions 1 & 2Daily methadone range = 15–40 mg range = 15–45 mgdosageNumber of dreams 10 0*about heroin

* Fisher p = .005

that several patients continued to use heroin and otherdrugs while they were undergoing methadone treat-ment. Another possible explanation is that the dosageof methadone administered to these patients was toolow: some authors make a distinction between a low,antiwithdrawal dosage (30 mg/day) and a high, anti-craving dosage (80–120 mg/day) (e.g., Maremmani,Canoniero, & Zolesi, 1999). But we remain doubtfulabout this, since drug dreams were also experienced bytwo of our patients who were administered a metha-done dosage of 70–80 mg/day.

This study was not aimed at assessing the therapeu-tic and prognostic use of these dreams; however, we dohave some clinical impressions in this regard thatmatch with the literature (see below). We believe thatthese drug dreams may help these patients to cope withand control their drug craving and allow them to keepon abstaining from drug. At times we have also ob-served that those drug dreams that failed to satisfy drug

craving could precede a relapse (i.e., increase of crav-ing in the morning after the dream) (see Appendix).

The indications in this study require caution andfurther confirmation. They are impaired by the smallsize of the sample, which limits the generalizability ofthe results. Replicating these results by means of the“dream-diary reports” method (dream reports writtenupon awakening) is also recommended. But it shouldbe kept in mind that it may be hard to adopt moresystematic methodologies with this type of patient.They do not cooperate easily, and they often interrupttheir therapeutic programs abruptly.

I have been able to find only one study about dream-ing in heroin-addicted patients with which to comparethese results. Looney (1972) observed a group of 37subjects who participated in a drug-dependence pro-gram, and it was found that all of them had dreamsabout heroin. In several of these dreams, the subjectsdid not succeed in obtaining the drug. Unfortunately,the author does not specify whether or not these pa-tients were abstinent from heroin.

However, these results confirm the indicationsof previous case reports of heroin-addicted patients(Colace, 2000a), and, most importantly, they arelargely compatible with the previous literature ondreaming in other forms of addiction, as follows (seeTable 4):

1. Drug dreaming is a widespread phenomenon inseveral other forms of addiction and occurs fre-quently amonga. abstinent polydrug-addicted patients (heroin, co-

caine, alcohol, and benzodiazepine) (Christo &Franey, 1996; Johnson, 2001)

b. abstinent tobacco smokers (dreams about smok-ing) (Hajeck & Belcher, 1991; Persico, 1992;Sharpe, 1985)

c. abstinent alcoholic patients (dreams about drink-ing) (Alcoholics Anonymous study as quoted inChristo & Franey, 1996; Beaman, 2002; Choi,1973; Denzin, 1988; Fiss, 1980; Kibiria study asquoted in Peters, 2000; Mooney, Eisenberg, &Eisenberg study as quoted in Christo & Franey,1996; Peters, 2000)

d. abstinent amphetamine-addicted patients(dreams about amphetamine) (Beaman, 2002)

e. abstinent cocaine-addicted patients (dreamsabout cocaine) (Colace, 2004a; Reid & Simeon,2001; Yee et al., 2004).

2. Drug dreams occur more frequently among abstain-ing patients than in those who still use drugs (Choi,1973; Hajek & Belcher, 1991; Persico, 1992).

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Table 4Presence of Dreams about Drugs in Addicted Subjects during Abstinent Condition: Overview of Literature

Author(s) No. of subjects Drug used Methods

Choi (1973) 100 alcohol questionnaire data: presence/absenceof dreams about drinking

Alcoholics Anonymous study* unspecified alcohol anecdotal verbal report

Fiss (1980) 20 alcohol dream reports of five morning awakenings

Beaman (2002) unspecified alcohol, amphetamine daily questionnaire

Mooney et al. study* unspecified alcohol and drugs anecdotal observation

Denzin (1988) unspecified alcohol qualitative observation

Peters (2000) 14 alcohol 2-week dream journals

Hajek & Belcher (1991) 293 tobacco dream questionnaire

Persico (1992) 24 tobacco questionnaire data

Christo & Franey (1996) 101 polydrug users questionnaire: dreams on drugor drug use (yes/no)

Johnson (2001) 1 polydrug users clinical case report

Reid & Simeon (2001) 46 crack cocaine daily questionnaire

Colace (2004a) 1 cocaine clinical case report

Yee, Perantie, Dhanani, & Brown (2004) 37 cocaine dream questionnaire

* As cited in Christo & Franey (1996).

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Main results

among alcoholics who had drinking dreams, 80% were abstinent for more than 3 months, whereas among alcoholics who did nothave such dreams, only 18% were abstinent for more than 3 months

dreams about drinking occur commonly in subjects with alcohol dependence who stop drinking

among abstinent alcoholics with high craving, more than 80% dreamed about drinking (defensive or conflictual themes), whereasonly 30% of alcoholics with low craving had dreams about drinking (e.g., drinking and feeling happy)

individuals (97.8%) in the first 30 days of abstinence from alcohol and amphetamine experienced at least one recovery-relateddream; the dominant dream themes were about “past problems when drinking/using drugs” and “me being with others who weredrinking/ using drugs”

dreams about drinking or using drugs are very common during the initial period after the admittance to a ward

dreams about drinking appear in subjects with alcohol dependence who stop drinking

compared to a matched control group, alcoholics with 3–9 months of total abstinence show statistical differences in dreamcontents. Dream contents in alcoholics include taking alcohol and drugs, sobriety, institutions, and help-seeking interactions

of abstinent smokers (1–4 weeks), 33% (97/293) reported at least 1 dream about smoking (subjects caught themselves smoking);conversely, 97% (94/97) did not have these dreams while still smoking; in addition, in subjects who had been abstinent for 1 year,63% recalled having dreams about smoking

smoking-related dreams (regarding themselves or other people smoking) were reported by 6 ex-smokers; 5 of these were stillabstinent after 6 months and represented 45% (5/11) of the sample who succeeded in remaining abstinent for 6 months; conversely,one of these subjects was in the group of people who relapsed

of 6-week-abstinent patients, 84 percent reported they had dreamed about drugs; drug dreams were more frequent duringabstinence condition than while patients used drugs; drug dreams frequently occurred (46% of patients) also during the 6-monthfollow-up

a drug-addicted patient during psychoanalytic treatment reported several dreams (58/240, 24%) that had evident contents involvingseeking or using drugs

41 (89.1%) patients reported drug (crack cocaine) dreams during the first month of abstinence; the majority of these dreams wereabout using the drug

a drug-addicted patient during the first month of treatment stopped the use of cocaine; in the same period she recalled severaldreams about use of the drug

altogether, 74% of participants experienced at least one drug dream during the study (duration 36 weeks); the content of thedreams frequently included drug use or refusing to use the drug; dreams of drug use tended to occur during the first few weeks ofstudy

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3. There is a clear evidence of a positive relationshipbetween drug craving and the occurrence of drugdreams (Choi, 1973; Christo & Franey, 1996; Fiss,1980).

4. At least one study has shown directly that drugdreams are not due to withdrawal syndrome in itselfbut are, rather, related to drug craving. Thus, Hajekand Belcher (1991) observed that smoke-relateddreams appear in abstinent tobacco-addicted pa-tients who received pharmacological treatment withnicotine chewing-gum to mitigate most withdrawalsymptoms. From this standpoint, the authors con-clude that these dreams appeared to be determinedprimarily by cognitive processes (i.e., drug craving)rather than directly by falling blood nicotine levels.

5. Drug dreams persisted after 6–12 months of absti-nence (Christo & Franey, 1996; Hajek & Belcher,1991; Reid & Simeon, 2001), and Johnson (2001)found the presence of drug dreams in polydrugabusers even after 4½ years of non-use. However,some studies have shown that drug dreams tend todecrease as abstinence continues (Christo &Franey, 1996; Hajek & Belcher, 1991; Reid &Simeon, 2001). For example, Reid and Simeon(2001) showed that after 6 months of abstinence,drug dreams were reported less frequently than inthe first month of abstinence (cocaine-addicted pa-tients).

6. Gratifying drug dreams (about using a drug) arepredictive of continued abstinence and are a goodprognostic sign (Choi, 1973; Hajeck & Belcher,1991; Persico, 1992).

7. Some studies have shown that drug dreams (gratify-ing and nongratifying) may sometimes provoke anincrease of drug craving in the postdream reality(Christo & Franey, 1996; Fiss, 1980; Mooney,Eisenberg, & Eisenberg study as cited in Christo &Franey, 1996; Reid & Simeon, 2001).

Implications for dream research and theory

Motivational states are importantly involvedin dreaming processes

Drug dreams show that a specific motivational state(drug craving) is strongly involved in the occurrence ofdreams that are clearly related to it.

We might now assume that this motivational statecauses dreams related to it (i.e., the drive instigatesdreams) or that it increases, in a correlational sense,

the dreams related to it (i.e., the drive increases theincidence and frequency of dreams). In both cases, itcan be asserted that in the case of drug dreams, there isa drive importantly involved in the generation pro-cesses of dreams.

This assertion is substantiated by the following con-vergent facts:

1. Drug dreams respond only to a specific motiva-tional state, rather than to a normal emotional dayresidue. Thus, not all patients who think aboutdrugs, seek drugs, and use drugs every day havethese dreams. They have drug dreams selectively ormostly when they are in an abstinent state and areexperiencing frustration from drug craving.

2. Drug-dream contents clearly report drug craving ina specific and meaningful way—that is, mostly asdrive gratification (or attempted gratification)—rather than in other nonspecific ways (i.e., genericpresence of drug); therefore, drug dreams are final-ized and motivated psychological acts (nonrandomprocesses).

3. Drug dreams are related to aspects of postdream-motivated behavior (drug-seeking behavior, druguse). Thus, patients who report gratifying drugdreams (about drug use) succeed in remaining absti-nent for longer periods than those who do not havedrug dreams (Choi, 1973; Hajeck & Belcher, 1991).From this point of view, drug dreams affect aprevious motivational state and modify it in post-dream reality.

Briefly, drug dreams offer a clear example of non-random and motivation-based dreaming processes andcontents. Although they are only one possible type ofdreams, they represent evidence that motivationalstates are elements that should not be neglected in thestudy of dreaming processes. Besides, this is consistentwith the evidence coming from Solms’s clinico-ana-tomical studies (Solms, 2000) (see below) and fromfunctional neuroimaging research (e.g., Braun et al.,1997) that suggest the involvement of motivations indream-generation processes.

Drug dreams and current theoriesabout dreaming

The phenomenon of drug dreams leads to a reconsid-eration of the neurobiological point of view accordingto which the mechanism of dream activation is “moti-vationally neutral” (McCarley & Hobson, 1977, p.

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1219). Instead, we have observed that such dreams aremotivationally directed. Even updated versions of theneurobiological approach still maintain that dreams aremerely the by-product of the REM sleep state (fore-brain synthesis of random and chaotic PGO [ponto-geniculo-occipital] stimulation) or a state of mindsimilar to delirium caused by organic brain disease(Hobson, 1988, 1997; Hobson, Pace-Schott, & Stick-gold, 2000a). In this approach, although emotions areconsidered as playing a part in the construction ofdream plots, they have no role in the process of insti-gating dreams. Hobson and his group are interestedonly in a “formal analysis of dream emotion” (Hobson,2000, p. 951), which may relate to their general at-tempt to define the formal features of dreams (i.e.,frequency of emotions) (Merrit, Stickgold, Pace-Schott, Williams, & Hobson, 1994; Hobson, Pace-Schott, & Stickgold, 2000b).

Drug dreams are also not consistent with the “re-verse learning” theory of Crick and Mitchison (1983)or Seligman and Yellen’s neurocognitive model(1987), both inspired by the above-mentioned neuro-biological approach. As these papers stress the role ofrandom PGO activation, they both claim that dreamsare inherently meaningless. Although Seligman andYellen suggest that certain current concerns (includingwishes and biological motivations) may direct theemotional setting of dream plots, the concerns have norole in dream instigation.

All the models referred to above may be defined asnonmotivational approaches to dreaming and cannotpredict the incidence and the increase in frequency ofdrug dreams as result of drug-craving frustration.

The phenomenon of drug dreams is somehow com-patible with the emotional adaptive theory of dreamingin its different versions. Therefore, the viewpoint thatdreams may resolve emotionally disturbing events (i.e.,emotional adaptation) (Breger, 1967; Breger, Hunter,& Lane, 1971; Cartwright, 1991; Cartwright, Newell,& Mercer, 2001; Fiss, 1980; Lavie & Kaminer, 1991),that dreams contain a surge of emotions or “calm” theemotional storm (Hartmann, 1996; Kramer, 1993), andthat dreams reflect the dreamer’s current emotionalproblems (Domhoff, 1996; Hartmann, 1996, 1998)matches the observation that drug dreams have helpeddrug-addicted patients to handle drug-craving stimula-tion and remain abstinent (see above). However, ac-cording to adaptive theories, we should have noticeddrug dreams in all the people who have daily problemswith drugs (i.e., all addicted patients); instead, we onlyfound drug dreams in abstinent patients. Finally, wenote that adaptive theories of dreaming are aimed moreat explaining how dreams incorporate emotions—that

is, the emotional function of dreams—rather than atexplaining the underlying processes of their motiva-tional instigation.

The empirical vitality of the psychoanalytic model

Drug-addicted patients gratify, or attempt to gratify,their frustrated craving for drugs in their dreams. Fromthis perspective, several authors have explained thesedreams from a psychoanalytic point of view (i.e.,dreams as wish-fulfillment or as wish-fulfillment at-tempts) (Choi, 1973; Colace, 2000a; Denzin, 1988;Fiss, 1980; Peters, 2000).

Drugs dreams can have an important role for thepsychoanalytic model of dreaming as the dreams ofchildren or as infantile dreams in adults (e.g., seeColace, 1997, 1998, 2004b). In fact, drug dreams indifferent cases are a clear example of what Freud calls“infantile dreams”—that is, dreams that occur underthe influence of imperative needs or psychically domi-nant situations (Freud, 1900, 1901, 1915–17, 1925):

In any case, there is yet another class of dreams whichare undistorted and, like children’s dreams, can easilybe recognized as wish-fulfilments. These are thedreams which all through life are called up by impera-tive bodily needs—hunger, thirst, sexual need—that is,they are wish-fulfilments as reaction to internal so-matic stimuli. [Freud, 1915–17, p. 132]Under the influence of imperative needs, adults mayalso produce dreams of this infantile type. [Freud,1925, p. 46]

But there is another clue that I want to point out. Inspite of the assumption of the empirical uncon-trollability of the psychoanalytic hypothesis (Hobson,1988, 2000; Hobson, Pace-Schott, & Stickgold,2000b), drug dreams show exactly the contrary. Spe-cifically, psychoanalysis predicts that the frustration ofa biological or impellent drive increases, in a correla-tional sense, the frequency of dreams undisguisedlyrelated to it (i.e., drive-fulfillment, or attempts at drive-fulfillment):

On the other hand, dreams of an infantile type seem tooccur in adults with special frequency when they findthemselves in unusual external circumstances. [Freud,1900, p. 131, n. 1]

Therefore, studying the frequency of drug dreams afterdrug-craving frustration has an empirical probativerelevance for psychoanalytic theory and shows thatthis theory can actually be empirically tested.

Finally, while these dreams are not a direct test forthe general thesis that all dreams represent a wish-

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fulfillment or a wish-fulfillment attempt, they do havea certain probative relevance for this. In fact, if it wereshown that even in these “simplest cases” dreams arenot preferentially a wish-fulfillment or wish-fulfill-ment attempt, this would be contrary to the mainstreamthesis.

Support for the neuropsychological approach

Johnson (2001) has recently suggested that drugdreams are consistent with the neuropsychological ap-proach to dreaming (Solms, 1997, 2000). Johnson hasunderlined that the mesolimbic–mesocortical dopa-minergic circuits involved in drug craving are exactlythe ones to which Solms attributes a crucial role in thegeneration of dreams.

In Johnson’s neuropsychoanalytic hypothesis, themechanism of drug dreams is the following:

Initially the ventral tegmental pathway provokesdreams that may show a wish for food, water, orsex. . . . Exposure to addictive drugs upregulatesdopaminergic neurotransmission in the ventral teg-mentum. . . . This may be why patients in detoxifica-tion programs constantly describe drug dreams; theyare craving drugs because of upregulation of theirventral tegmental pathway, and they are dreamingintensely and frequently for the very same reason. Thatis, upregulation both stimulates increased dreamingand introduces a new drive, whose object is addictivedrugs. [Johnson, 2001, p. 91]

Drug dreams provide a theoretical exemplification ofSolms’s neuropsychological model and represent clini-cal support for it . Thus, Solms (2000) suggests that hisstudies and evidence from different research areas(e.g., on the effects of L-dopa and of haloperidol) showthat the activation of the dopaminergic system is the“dream-on mechanism” (p. 847). Drug dreams may beconsidered a specific case of this mechanism. In fact,we have seen that the intensification of a specificmotivational state (i.e., craving for drug), which ismediated by the activation of the dopaminergic system,is closely associated with the presence of dreams re-flecting such a motivational state (see Figure 1). On theother hand, Solms also underlined that dopaminergicactivation in drug-addicted patients who crave drugs isa real example of what he means about dopaminergicactivation in dreams. In fact, with reference to thesearea of the brain, Solms writes: “we know that that partof the brain becomes highly active when an addict isseeking out the substance that he or she is addicted to”(Solms, 1999, p. 2).

Methodological contributionsto the study of motivations in dreaming

1. Drug dreams as a new research paradigm

The study of dreams in drug-addicted patientsfavors the observation of the relationships between

Figure 1. Motivational states and dreaming processes: lines of evidence from the neuropsychological approach, dreaming in addiction, andbiological-drive-frustration paradigm

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intense motivational states and dreaming processes.There are two major issues here.

First, addicted patients show a quantitatively abnor-mal desire to use drugs (i.e., drug craving) that may beobserved “in nature” and is easily found in dreamcontents (i.e., without psychoanalytic interpretation).In the ordinary dreams of normal people, this possibil-ity is quite rare (i.e., ambiguity of motivation and ofdream content).

Second, our knowledge of drug-craving neurobiol-ogy allows us to develop hypotheses about the neuro-biological events that co-occur during drug dreams.For example, it is plausible to assume that the occur-rence of dreams about heroin is related to the activationof the mesolimbic–mesocortical dopamine system.

As a result, the study of dreaming in addicted pa-tients may represent a new and simple research para-digm for the psychological and neurobiological studyof the role of motivational states in dreaming processes(see Figure 1).

From this perspective, dreams are assumed to bepsychophysiological events with an underlying neuro-biological activity; that, however, does not explain itentirely. We need to develop deeper insight into thecomplex links between neurobiological facts and men-tal events (Mancia, 2000).

2. Revaluation of the biological-drive-frustrationresearch paradigm

An important research paradigm for the study ofmotivation in dreaming is represented by the studies ofthe effects of biological-drive frustration on dreamcontents (i.e., the “biological-drive-frustration para-digm”) (Colace, 2004b). For example, Bokert (1968)found that subjects deprived of food and fluids prior tosleep have thirst and food content in REM dreamsmore frequently than those in the control condition(subjects not deprived of food and fluids).

The study of dreaming in drug addiction supportsand strengthens, from a psychological and neurobio-logical point of view, the biological-drive-frustrationparadigm (see Figure 1). The following facts suggestthat drug dreams have much in common with dreamstriggered by biological-drive frustration.

First, drug dreams as biological-drive-relateddreams represent the gratification (or an attemptedgratification) of prior frustrated drives (e.g., Bokert,1968; Choi, 1973).

Second, drug dreams as biological-drive-relateddreams may contribute to reducing the intensity offrustrated drives in the postdream period. Patients whohave drug dreams show a better ability to deal with

drug-craving stimulation than those who do not havedrug dreams (Choi, 1973; Hajeck & Belcher, 1991).This finding matches Bokert’s experimental data.Bokert found that subjects who report gratifyingdreams (themes of drinking and/or eating) later re-duced their need in the postdream reality: they drankless and rated themselves as less thirsty than subjectsreporting nongratifying dreams (no themes of drinkingand/or eating).

Third, drug dreams and biological-drive-relateddreams shared the same neurobiological substrate, asfollows.

• The mesolimbic–mesocortical DA system that me-diates drug craving is usually involved in the rein-forcing effect of biological drives (i.e., motivatedbehavior) (Blackburn, Pfaus, & Phillips, 1992;Fibiger & Phillips, 1987; Melis & Argiolas, 1995;Kelly & Berridge, 2002; Wise, 1989) (see Figure 1).

• There is an increase of DA in NAc during theappetitive (i.e., anticipatory) and consumptionphases in biologically motivated behaviors (eating,drinking, copulating), just as in drug craving(Bassareo & Di Chiara, 1999; Blackburn, Pfaus,& Phillips, 1992; Damsma, Plaus, Wenkstern,Phillips, & Fibiger, 1992; Di Chiara, 1995, 1996;Romo & Schultz, 1990).

• Addictive drugs are considered “reinforcers” in thesame way as are food and water (e.g., Falk, Dews, &Schuster, 1983; Nader & van der Kooy, 1994;Young & Herling, 1986).

3. Validity of the neuro-psychoanalyticperspective

The purpose of the neuro-psychoanalytic approachis to study the neural correlates of psychoanalyticconcepts by focusing attention on the changes in psy-chological functioning that occur following damage todifferent brain structures (Kaplan-Solms & Solms,2000). The studies on drug dreams represent an exam-ple of neuro-psychoanalytic investigation. As Johnson(2001) pointed out, drug dreams may be viewed as analteration of normal dreaming processes (drug dreamsdo not occur in normal people) caused by persistentchanges in neurological functions (brain alterationscaused by drug exposure).

Conclusions

In recent years, several clues from different researchareas have contributed to doubt being cast on a diehard

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assumption that is implicit in various current research-ers—that is, that “we can explain dreams withoutworrying about the dreamers’ motivational states.”

The study of dreaming in addiction leads to a closerobservation of how motivational states affect dream-ing. Further research is needed to study this relation-ship in deeper detail. However, probably the investiga-tion of dreams under the influence of clearly observableabnormal motivational states (such as drug craving, butalso the biological drives) could probably represent anew framework for the development of a new motiva-tion-based approach to dreaming.

Appendix:Types and examples of dreams about heroin

The dreams collected about heroin (Studies I and II)were generally of two types:

A. “Using heroin.”B. “Seeking and attempting to use heroin.”

Both dreams have a clearly nondistorted andnonambiguous content. Interpretation was not re-quired.

In dreams of Type A, the subjects sometimes pre-sented feelings of guilt or repentance after the use ofheroin during the dream and/or on awakening. Further-more, in these cases some of the subjects presentedfeelings of relief on awakening when they realized thatthey had not really made use of the drug. In fact, thesubjects may be strongly determined to remain absti-nent (i.e., to be controlled), so they struggle with theirdrug craving and may experience a strong conflict. Onthe other hand, other subjects had dreams whereclearly pleasant feelings were associated with the con-sumption of heroin, but without the subsequent feelingof guilt.

In dreams of Type B, the attempt to use heroin failedfor some reason—for example, because the subjectsmet the police or an acquaintance, or sometimes be-cause the dream was interrupted (awakening) beforethey could use the drug. Generally, on awakening thesesubjects felt anger on realizing that there had been noreal use of heroin and experienced an increase in theurge to use the drug (drug-craving increase).

Several authors (e.g., Araujo, Oliveira, Piccoloto,Magrinelli, & Szupszynski, 2004; Reid & Simeon,2001) have underlined the possible prognostic andtherapeutic uses of drug dreams in the recovery ofaddicted patients. I have analyzed these aspects of drugdreams elsewhere (Colace, 2000b, 2004c).

Examples of dreams

Use of heroin with subsequent feeling of guilt (n.1315). “The dream is composed of two scenes. Inthe first scene, I see a friend who proposes to go andget some heroin. Then I don’t remember what hashappened. In the second scene, I am playing footballand the coach approaches me and says somethinglike ’I know you use heroin.’ I didn’t recall anythingelse about the dream, but I was sure I had used thedrug in the dream. I had feelings of guilt andshame.”

Using drugs (n. 964). “I dreamed I was driving toRome with a friend of mine to get some heroin. Idon’t remember the details; however, I rememberthe scene when I sniffed the drug. The dream waspleasant, and there was no guilt or anxiety associ-ated with its use. While I was sniffing it, I remem-bered an intensely pleasant feeling, as if it were areal-life situation. On waking up in the morning, Ididn’t feel any particular emotion nor any feeling ofguilt.”

Seeking behavior and attempt to use the drug (n.1031). “I meet a friend, and I go get some heroin. Iprepare it, but when it is ready to take, I wake up.The feelings in this dream were the same as those Ihave when I am awake—that is, symptoms of absti-nence and desire to use heroin. When I woke up, Ifelt intensely disappointed because I had not beenable to take the drug. I still wanted heroin when Iwoke up, I had a strong urge to use it.”

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