Book Review

Crave: the hidden biology of addiction and cancer

by Raphael E Cuomo, Ph.D (R E Cuomo Publishing, 2025)

This superbly written book by a professor and biomedical scientist at the UC San Diego School of Medicine, who is also a much-published clinical researcher and Fellow of the Royal Society for Public Health, supports HG understandings about the nature of addiction and more effective ways to approach treatment and adds a highly valuable biological perspective. I have quoted copiously, as the language is lyrical and expressive.

Cuomo states at the outset that addiction is not confined to the brain.¹ “It is systemic. The same feedback loops that compel a person to repeat a behaviour also interact with immune function, inflammation, metabolic regulation, and gene expression. … A mild increase in cortisol. A transient rise in insulin. Slight suppression of natural killer cell activity. But these are not isolated events. They are signals that the body is being nudged out of balance. And when addictive behaviours accumulate, especially when they layer on top of each other, the body’s ability to return to equilibrium becomes impaired.”

He explains how every time we act on a craving we reinforce an unhealthy pattern whereby dopamine, a neurotransmitter designed to help us pursue food, shelter, and connection “now compels us to pursue novelty, escape, and control”. And the pattern goes beyond dopamine. “It involves surges of cortisol, suppression of certain immune functions, spikes in glucose, and temporary reductions in antioxidant activity. The human body is built to withstand these shifts occasionally. By its nature, addiction is not an exception: it’s a loop. And when these stressors become chronic, they create a biological terrain that welcomes cellular disorder.”

As he points out, addictions impair more than one organ, such as lungs or liver, or function, such as attention span: “The body does not compartmentalise addiction neatly into one location. It feels it everywhere. Even the brain, often seen as the origin of addiction, is altered by its own feedback. Repeated craving and indulgence reshape neural pathways. The prefrontal cortex, which governs planning, decision-making, and impulse control, becomes less active. The amygdala, which responds to stress and threat, becomes more reactive. The basal ganglia, which reinforce habits, become more entrenched in the addictive cycle. These neurological changes do not stay in the brain. They alter how the body prepares for reward and how it recovers from stress.” Fortunately, as he points out, the body can also adapt to new healthier patterns, but it takes time.

Cuomo even uses the same terminology that we use: “Craving does not occur in a vacuum. It often arises in response to an emotional need that has not been met. Loneliness, boredom, anxiety, sadness, frustration: each of these emotional states can serve as a cue. When the brain learns that a certain behaviour relieves that feeling, even temporarily, it begins to rely on that behaviour as a coping mechanism.” We need to ask better questions. “What do I turn to when I feel depleted? What am I avoiding when I reach for this thing? What does my body need right now that this habit is temporarily replacing? Sometimes the answer is sleep. Sometimes it is connection. Sometimes it is the absence of stimulation. The more we listen, the more we learn. And the more we learn, the more capable we become of creating a biology that does not need to compensate constantly for the damage of unchecked craving. … These alternative responses are not about denying pleasure. They are about creating flexibility. The more ways the brain learns to regulate, the less dependent it becomes on a single behaviour.”

He highlights the pitfalls of what we might consider lack of privacy (“Constant engagement limits opportunities for rest, daydreaming, and unstructured thought. These gaps serve important biological functions. The brain uses downtime to consolidate memories, regulate mood, and integrate experience. When input is continuous, that integration process is disrupted. What follows is a persistent sense of agitation, often without a clear cause or resolution”); and misdirected attention (“When attention is stable, the nervous system becomes more efficient. Signals flow in sequence. Hormonal rhythms synchronise. Cellular repair improves. When attention is fragmented, the body fragments too. It cannot maintain homeostasis under conditions of constant input. That loss of balance creates openings for disease processes to take hold and expand”).

Cuomo looks in detail at what it takes to recover – ie prioritising over time behaviours and experiences that are healthy for us, such as time in nature, proper rest and relaxation, eating slowly, deep breathing, etc. He stresses the role of positive expectation and belief for shaping biological change, and the need for consistency: “Biology does not demand a flawless regimen. It responds to signals that are consistent, grounded, and non-chaotic. When those signals are present, the systems that defend against cancer, inflammation, and chronic disease begin to recover.”

His bottom line is that culture must shift, too. He is highly critical of those that normalise and even celebrate lifestyles that lead to craving and addiction – for instance by glorifying overwork, promoting addictive unhealthy foods and generating overwhelming lifestyles: “The future of prevention will not come from asking people to do more. It will come from changing what they are surrounded by. It will come from designing systems that support their bodies instead of overwhelming them. It will come from choosing rhythm over rush, presence over performance, and clarity over compulsion.”

The book does not contain references, perhaps because it covers so much ground that it would have been hard to choose what to reference, and we can maybe accept, from the author’s impressive credentials, that his biology is correct. A short book that packs quite a punch, it is well worth reading and digesting.

Reviewed by Denise Winn (July 25)