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Clinical and laboratory assessment of the subjective experience of drug craving

Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, United States.
Clinical psychology review (Impact Factor: 7.18). 07/2009; 29(6):519-34. DOI: 10.1016/j.cpr.2009.06.002
Source: PubMed

ABSTRACT Measures of subjective drug craving - often defined as the experience of an intense or compelling urge or desire - may be used to predict relapse, evaluate psychological and pharmacological treatments, and test theories of addiction and craving. This review summarizes both direct self-report questionnaires and indirect behavioral, physiological and reaction time measures designed to assess craving for alcohol, amphetamines, cocaine, heroin, marijuana, and tobacco. Multi-item questionnaires have typically been based on one of four underlying conceptualizations of addiction or craving (obsessive-compulsive, approach-avoidance, multi-dimensional, intensity-frequency-duration). Most multi-item self-report questionnaires have high internal consistency, correlate significantly with single-item craving ratings, and demonstrate several aspects of construct validity. Proposed indirect or proxy measures of craving include drug dreams, speed of drug consumption, willingness to work for drug access, selection of monetary rewards over drug access, psychophysiological reactivity, and attentional bias to drug cues. These proxy measures of craving are presumed to obviate self-report biases, to be less subject to conscious self-control, and to reflect craving which the person may not be able to articulate; however, there have been too few demonstrations of their validity and they have too many practical limitations to supplant self-report measures of craving at this time.

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    • "However, because craving is composed of various subjective experiences (e.g., urges, strong desire, intention to consume, anticipated loss of control), and because craving may be experienced simultaneously as both pleasurable and unpleasant, users of this drug may have difficulty summarizing their experience of craving using a single numeral (Rosenberg 2009; Tiffany 1992). Although multi-item questionnaires have been developed to assess urges and desire, intention to consume, and anticipated loss of control for other drugs of abuse (e.g., Kavanagh et al. 2013; Rosenberg 2009; Tiffany & Wray 2012), we could find no questionnaire to measure craving for MDMA/ecstasy. Therefore, using previously published craving questionnaires as a model, and based on subsequent pilot testing of 19 draft craving items, we developed an eight-item measure designed to assess one's experience of current craving for MDMA/ecstasy. "
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    ABSTRACT: This study evaluated the prevalence, intensity, and correlates of craving for MDMA/ecstasy among recreational users employing a new multi-item, self-report questionnaire reflecting experiences of desire, intention to use, and anticipated loss of control. Using a web-based data collection procedure, we recruited MDMA/ecstasy users to rate their agreement with eight craving statements immediately before and immediately following 90 seconds of exposure to either ecstasy-related or control stimuli. Participants (n = 240) then completed questionnaires to measure ecstasy refusal self-efficacy, passionate engagement in ecstasy use, substance use history, and demographic information. Fifty percent of participants indicated some level of agreement with at least two (out of eight) statements indicative of craving and 30% agreed at some level with six or more such statements. The questionnaire used to assess craving was internally consistent, unidimensional, and had excellent one-week test-retest reliability. Craving scores varied as a function of both cue exposure and frequency of ecstasy use, and were significantly associated with ecstasy-related attitudes. Recreational users of MDMA/ecstasy endorse some experiences indicative of craving for this drug, even though only a minority report intense craving following explicit cue exposure.
    Journal of psychoactive drugs 05/2014; 46(2):1-8. DOI:10.1080/02791072.2014.901586 · 1.10 Impact Factor
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    • "As in all subjective states, cravings are not directly observed but generally deduced from self-reports and behavioral observations (Toneatto, 1999). Nevertheless, there are difficulties in the assessment of craving with self-reports because the psychometric instruments available generally operationalize different conceptualizations of the nature of craving (Rosenberg, 2009; Kavanagh et al., 2013). Perhaps a combined measure of craving formed by various craving instruments could provide a more accurate picture of the subjective experience of craving and reduce the conceptual confusion of the phenomenon. "
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    ABSTRACT: The way in which genetic risk mediates the development of craving in alcohol dependence is still relatively unknown. The authors sought to clarify the extent to which alcohol craving could be predicted by a relevant polymorphism in the promoter region of the gene encoding the 5-HT transporter (5-HTTLPR). A sample of 101 alcohol-dependent patients admitted for alcohol treatment was recruited for the study. At admission, blood samples were taken for DNA extraction and alcohol craving information was collected with a composite measure. The 5-HTT polymorphism was genotyped. Alcohol dependent patients who were homozygous for the long allele (LL) self-reported higher scores of craving when compared to patients that were homozygous for the short allele (SS). However, the results were not statistically significant. Also, no significant associations were observed between the 5-HTTLPR genotype and other drinking variables. No 5-HTTLPR genotype effects were observed on alcohol craving experience in a sample of alcohol-dependent outpatients.
    04/2014; 218(1-2). DOI:10.1016/j.psychres.2014.04.026
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    • "Extensive behavioural and neurobiological data indicate many commonalities between food craving and drug craving (for a review see Pelchat, 2009). For instance, both lead to foraging and ingestion habits that persist and strengthen despite the threat of negative health and social consequences (Volkow & Wise, 2005) and, furthermore, cravings can predict both relapse to drug taking in abstinent substance users (Rosenberg, 2009) and weight regain after bariatric surgery in obese patients (Odom et al., 2010). The neurotransmitter systems implicated in food craving overlap substantively with those involved in drug craving; for example, exposure to both food and drug craving-provoking stimuli is associated with increased levels of reward circuitry dopaminergic activation in the brain (Blum, Liu, Shriner, & Gold, 2011). "
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    ABSTRACT: Obesity and eating disorders, such as bulimia nervosa (BN) and binge-eating disorder (BED), can be conceptualised as forms of addiction. Food cravings are thought to precipitate the compulsive overeating that is seen in these conditions. Transcranial direct current stimulation (tDCS) has been used to suppress food cravings, but there is insufficient evidence to support its application in clinical practice. Furthermore, the potential moderating role of impulsivity has not been considered. This study employed a randomised within-subjects crossover design to examine whether a 20-minute session of placebo-controlled bilateral tDCS to the dorsolateral prefrontal cortex (DLPFC) (anode right/cathode left) would transiently modify food cravings and temporal discounting (TD; a measure of choice impulsivity) in 17 healthy women with frequent food cravings. Whether the effects of tDCS on food cravings were moderated by individual differences in TD behaviour was also explored. Participants were exposed to real food and to a film of people eating, and food cravings and TD were assessed before and after active and sham stimulation. Craving for sweet but not savoury foods was reduced following real tDCS. In addition, participants who exhibited more reflective choice behaviour were more susceptible to the anti-craving effects of tDCS than those who displayed more impulsive choice behaviour. No differences were seen in TD or actual food consumption after real versus sham tDCS. These findings support the efficacy of tDCS interventions in temporarily lowering food cravings and identify the moderating role of intertemporal choice behaviour.
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