Alcohol Craving

Clinical Utility of Craving Measurements
by National Institute of Health

(Page 5 of 5)

Most alcoholics report that cravings are a frequent and troublesome aspect of their addiction. Consequently, clinicians should monitor their patients' cravings. Assessment and discussion of craving may improve rapport between clinicians and patients, thereby increasing the relevance of therapeutic interactions. In everyday clinical practice, self-report instruments will likely continue to be the most frequently employed type of craving measure, because behavioral and psychophysiological measures, despite their theoretical relevance, clearly extend beyond the resource capacities of most treatment settings.

Incorporating craving measurements into routine clinical practice can produce several potential benefits. First, craving-related measures appear to provide a good index of a patient's overall level of alcohol dependence. Anton and Drobes reported that alcoholics scored increasingly higher on the OCDS as a function of the severity of their dependence and, consequently, level of treatment involvement. That is, OCDS scores increased in order from nonalcoholics, to non-treatment-seeking alcoholics (patients with a low level of dependence severity), to alcoholics receiving outpatient therapy, to alcoholics in inpatient treatment (patients with the greatest dependence severity).

Second, craving assessment can provide valuable information concerning a patient's capacity to recognize and monitor internal states that may be related to his or her drinking. If a patient can be taught to recognize his or her specific level of craving, then that person may be more likely to use learned coping strategies at the appropriate time or to return for additional treatment sessions as craving-inducing situations arise during recovery.

Third, clinicians may find it useful to assess craving in order to recommend appropriate treatment alternatives. For instance, studies have suggested that alcoholics who report higher levels of craving benefit the most from the medication naltrexone as an adjunct to psychosocial treatment components.

Finally, because craving measures have been shown to predict alcohol consumption during active treatment, regular monitoring of craving throughout treatment may aid clinicians and patients in decisions regarding treatment intensity and duration. For example, patients who continue to experience high levels of craving (either constantly or in certain situations) despite compliance with their current treatment may require continued support, more intensive treatment, or possibly changes in their environment (social network and activities).

The relationship between craving and drinking outcome is still somewhat controversial in the alcohol field. Some studies have demonstrated that selfreported craving can predict treatment outcome or relapse, whereas other studies report that acute craving often does not lead to alcohol consumption in either active or relapsing alcoholics. One explanation for this discrepancy may involve the types of measures used to assess craving. It is possible that global measures of craving are more strongly related with drinking behavior than are state-oriented measures, because global measures involve the cognitive integration of craving-related experiences over a longer time period. As a result, such measures may more reliably incorporate aspects of craving that cannot be obtained from state measures of craving. In particular, global measures may be better suited to assess the overall anguish and distress experienced by an alcoholic, which may be related to the likelihood of relapse. Conversely, stateoriented measures only give a snapshot of an alcoholic's immediate alcoholrelated struggle. Whether drinking occurs at the time of the assessment, however, likely depends on several other factors.

Nevertheless, a pattern of high scores on state-oriented measures of craving, while probably unrelated to drinking at a particular time, may show a similar positive relationship with eventual drinking as do more global measures. Although this hypothesis needs to be tested empirically, its tenet is that clinicians need to regularly administer both state-oriented and global measures of craving in order to estimate both current and general levels of alcoholrelated distress. Such an approach could help optimize clinical judgments regarding the probability of relapse and the most appropriate interventions to prevent relapse.

Summary

The past decade has witnessed the development and increased availability of psychometrically sound and theoretically relevant self-report measures of craving. The measures described in this article are better able to capture the dynamic and multidimensional nature of craving across and within individual patients over time compared with traditional single-item assessments. These measures also can be used in a wide range of research and clinical settings according to the needs of the administrator. Additional work is necessary, however, to further refine and validate these measures. In particular, the generalizability of the available measures to various types of drinking populations must be evaluated, because different subpopulations of alcoholics (treatment-seeking, non-treatment-seeking, abstinent, and adolescent alcoholics) may require new and unique craving instruments. The currently available measures can serve as useful guides in the development and validation of such instruments.

Technological advances are likely to improve the multidimensional measurement and understanding of craving in the coming years. For example, researchers have begun to apply neuroimaging techniques, such as functional magnetic resonance imaging (fMRI) and positron emission tomography, in studies of craving. These new tools will be critical for identifying the brain regions activated concurrent with alcohol craving, particularly when combined with other existing technologies for measuring craving. Improvements in existing cue-reactivity approaches also hold promise for advancing measurements of craving phenomena. For example, methodological advances within the general study of emotion and motivation could be adapted for alcohol-cue reactivity analyses in order to better elucidate the role of emotions in alcohol craving. Such investigations are particularly important in light of recent studies demonstrating a link between emotion, cue reactivity, and treatment outcome.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.