'Craving is generally considered a significant factor in opiate addiction that is associated with drug-dependence and in relapse to drug use after treatment'-ARC expert consensus (Pickens and Johanson, Drug and Alcohol Dependence 30: 127-131). There are however difficulties in defining craving and urges to use drugs and in associating craving with drug use and relapse. Tiffany [Psychological Review 97(2): 147-168] has reviewed a considerable number of studies that associated reports of craving with consumption measures of drugs and revealed only an overall modest correlation of 0.4. These findings call into question the general assumption that subjective cravings are invariably associated with drug use. Furthermore, it led to Tiffany's provocative argument that cravings are not necessary for drug use. We have addressed these issues by using a range of complementary techniques derived from research in related fields such as the cognitive psychology of anxiety and depression, physiological response measurements and positron emission tomography (PET) neuro-imaging. Initially we developed computerized assessments to probe cognitive dysfunction in addiction that related to biased processing of automatic thoughts and beliefs about craving and drug use in opiate-dependent subjects and alcoholics. Subsequently in an attempt to develop a reliable method of inducing craving we explored an imagery-based technique that relied on the memory of craving experiences. These experiments were conducted both in opiate addicts who had achieved abstinence and in those undergoing detoxification. Finally, we have begun a study to understand the neural mechanisms of craving using imagery-based procedures at the same time as performing PET studies of regional blood flow using the O15-labelled water technique.

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This study investigated the effects of treatment with acamprosate on craving for alcohol by using a contextual priming task with alcohol and neutral words and craving questionnaires (ACQ, OCDS) in alcohol-dependent patients who abstained from alcohol for 6 weeks. The acamprosate-treated group (n = 16) were given 666 mg t.d.s. with standard group-work aimed at abstinence. The unmedicated control group (n = 13) received only standard group therapy. The results showed that the acamprosate treated group was faster in their responses to craving-related stimuli and scored lower on craving questionnaires during week 6 compared with week 2. Our results suggest that acamprosate may play a role in reduction of craving for alcohol after 6 weeks of treatment.

This study investigated the processing of sentences describing craving and withdrawal in opiate-dependent individuals. Eighteen patients who attended a methadone maintenance clinic for obtaining methadone, 18 patients who were not treated with methadone, and 18 control family members performed on a computerized contextual priming task. The task was priming sentences (craving, withdrawal, or neutral) to words (addiction, neutral, or nonwords). The methadone group was slower to process all sentences compared with family members. They were also faster to process drug-related words following withdrawal-related sentences compared with neutral words following neutral sentences. Finally, they were slower to recognize neutral words following neutral sentences compared with the nonmethadone group. Results suggest that the processing of information describing withdrawal and craving for drugs plays an important role in opiate dependence.