Theories of drug craving, ancient and modern

Abstract

This paper reviews the principal theoretical models of drug craving and provides some directions for future research. The main models are classified broadly into three categories: (1) phenomenological models; based on clinical observation and description; these have been influential in classification systems of addictive disorders and in the development of pharmacological therapies; (2) conditioning models: based on conditioning theory; these have been influential in the development of cue exposure treatments; (3) cognitive theories; based on cognitive social learning theory: these have been influential in the development of cognitive therapies of addiction. It is concluded that no one specific theory provides a complete explanation of the phenomenon of craving. However, theories of craving grounded in general theories of human behaviour offer greatest promise, and generate more specific and testable research hypotheses. Theories that do not require craving to be present for relapse to occur have more empirical support than those that provide simplistic causal explanations. The cue-reactivity model shows promise in the exploration of the relationship between craving and relapse. However, further attention to the phenomenology of craving could help to advise the future measurement and study of drug craving, particularly in the context of research in which drugs are available to human subjects, with adequate ethical safeguards. There is a need for further study of the temporal dynamics of craving and consensus in the field on the most appropriate methods of measurement. Finally, new psychotherapies such as cue exposure and pharmacotherapies that aim to attenuate drinking behaviour, such as naltrexone and acamprosate, provide opportunities to improve understanding of the nature and significance of craving. However, the relatively uncritical assumption that craving is the underlying basis of addiction and represents the most appropriate target for treatment is challenged.

Craving in Intermittent and Daily Smokers During Ad Libitum Smoking

“…The findings are consistent with the notion that craving is not necessarily a unique feature of addiction and may simply represent an in-the-moment desire to smoke (or eat, drink, etc., Drummond, 2001;Orford, 2001) that can rise from processes other than dependence.…”

“…On the one hand, craving is often regarded as pathognomonic of dependence (DiFranza et al, 2011;Drummond, 2001;Robinson & Berridge, 2000), in which case, ITS should show little or no craving. On the other hand, there are indications from pilot data that ITS may be cued to smoke in particular situations, such as when drinking or socializing (Shiffman, Kirchner, Ferguson, & Scharf, 2009), and cues may drive acute craving Sayette & Tiffany, 2013;.…”

Effects of Expectancy and Abstinence on the Neural Response to Smoking Cues in Cigarette Smokers: an fMRI Study

“…There is no consensus on how to define or measure drug craving (Drummond, 2001). Self-report measures of craving are particularly prone to errors due to influence of the experimental context (ie subjects 'know' that the cues are supposed to make them crave), self-deception, variable interpretation of scales or questions, and differences in response style (Sayette et al, 2000), and may therefore not measure 'true craving'.…”

Compound Stimulus Presentation and the Norepinephrine Reuptake Inhibitor Atomoxetine Enhance Long-Term Extinction of Cocaine-Seeking Behavior

“…Reducing the impact of these cues is postulated to reduce relapse in at-risk populations (Hammersley, 1992;Drummond, 2001;Nic Dhonnchadha and Kantak, 2011), yet extinction therapy has not yet shown high efficacy (Bouton, 2002;O'Brien, 2008).…”